Thresholds for operative eligibility based on body mass index (BMI) alone may restrict patient access to the benefits of arthroplasty. The purpose of this study was to evaluate the relationship between BMI and improvements in patient-reported outcome measures (PROMs), and to determine how many patients would have been denied improvements in PROMs if BMI cut-offs were to be implemented. A prospective cohort of 3,449 primary total hip arthroplasties (THAs) performed between 2015 and 2018 were analyzed. The following one-year PROMs were evaluated: hip injury and osteoarthritis outcome score (HOOS) pain, HOOS Physical Function Shortform (PS), University of California, Los Angeles (UCLA) activity, Veterans Rand-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (VR-12 MCS). Positive predictive values for failure to improve and the number of patients denied surgery in order to avoid a failed improvement were calculated for each PROM at different BMI cut-offs.Aims
Methods
The aim of this study was to determine the stability of a new
short femoral stem compared with a conventional femoral stem in
patients undergoing cementless total hip arthroplasty (THA), in
a prospective randomized controlled trial using radiostereometric
analysis (RSA). A total of 53 patients were randomized to receive cementless
THA with either a short femoral stem (MiniHip, 26 patients, mean
age: 52 years, nine male) or a conventional length femoral stem
(MetaFix, 23 patients, mean age: 53 years, 11 male). All patients
received the same cementless acetabular component. Two-year follow-up
was available on 38 patients. Stability was assessed through migration
and dynamically inducible micromotion. Radiographs for RSA were
taken postoperatively and at three, six, 12, 18, and 24 months.Aims
Patients and Methods
It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. Patients undergoing Birmingham Hip Resurfacing completed the Veteran’s Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups.Aims
Patients and Methods
We report the incidence of radiolucent lines (RLLs) using two
flanged acetabular components at total hip arthroplasty (THA) and
the effect of the Rim Cutter. We performed a retrospective review of 300 hips in 292 patients
who underwent primary cemented THA. A contemporary flanged acetabular
component was used with (group 1) and without (group 2) the use
of the Rim Cutter and the Rimfit acetabular component was used with
the Rim Cutter (group 3). RLLs and clinical outcomes were evaluated
immediately post-operatively and at five years post-operatively.Aims
Patients and Methods
The aim of this study was to report the implant survival and patient-reported outcome measures (PROMs) in a consecutive series of patients aged less than 50 years at the time of arthroplasty using the Birmingham Hip Resurfacing system (BHR), with a minimum follow-up of ten years. A total of 226 patients with osteoarthritis of the hip, who underwent BHR and presented to a single surgeon, were included in the study. Survival of the implant was confirmed by cross-checking with the Australian Orthopaedic Association National Joint Replacement Registry. Kaplan–Meier survival curves with 95% confidence intervals (CIs) were constructed. Pre- and postoperative PROMs were compared with Aims
Patients and Methods
To determine ten-year failure rates following 36 mm metal-on-metal
(MoM) Pinnacle total hip arthroplasty (THA), and identify predictors
of failure. We retrospectively assessed a single-centre cohort of 569 primary
36 mm MoM Pinnacle THAs (all Corail stems) followed up since 2012
according to Medicines and Healthcare Products Regulation Agency
recommendations. All-cause failure rates (all-cause revision, and
non-revised cross-sectional imaging failures) were calculated, with predictors
for failure identified using multivariable Cox regression.Aims
Patients and Methods
A possible solution for the management of proximal femoral bone
loss is a modular femoral endoprosthesis (EPR). Although the outcome
of EPRs in tumour surgery has been well described, the outcome of
their use in revision hip surgery has received less attention. The
aim of this study was to describe the outcome of using EPR for non-neoplastic
indications. A retrospective review of 79 patients who underwent 80 EPRs for
non-neoplastic indications was performed, including the rates of
complication and survival and the mean Oxford Hip Scores (OHS),
at a mean of five years post-operatively. The mean age at the time
of surgery was 69 years (28 to 93) and the mean number of previous operations
on the hip was 2.4 (0 to 17). The most common indications for EPR
implantation were periprosthetic joint infection (PJI) (n = 40),
periprosthetic fracture (n = 12) and failed osteosynthesis of a
proximal femoral fracture or complex trauma (n = 11).Objectives
Methods
The purpose of our study is to summarise the current scientific
findings regarding the impact of obesity on total hip arthroplasty
(THA); specifically the influence of obesity on the timing of THA,
incidence of complications, and effect on clinical and functional
outcomes. We performed a systematic review that was compliant with the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines to identify prospective studies from the PubMed/Medline,
Embase, and Cochrane Library databases that evaluated primary THA
in obese (body mass index (BMI) ≥ 30 kg/m2) patients.Aims
Materials and Methods
We compared the incidence of pseudotumours after
large head metal-on-metal (MoM) total hip arthroplasty (THA) with
that after conventional metal-on-polyethylene (MoP) THA and assessed
the predisposing factors to pseudotumour formation. From a previous randomised controlled trial which compared large
head (38 mm to 60 mm) cementless MoM THA with conventional head
(28 mm) cementless MoP THA, 93 patients (96 THAs: 41 MoM (21 males,
20 females, mean age of 64 years, standard deviation ( The incidence of pseudotumours, measured using a standardised
CT protocol was 22 (53.7%) after MoM THA and 12 (21.8%) after MoP
THA. Women with a MoM THA were more likely to develop a pseudotumour
than those with a MoP THA (15 Contrary to popular belief, pseudotumours occur frequently around
MoP THAs. Women with a MoM THA and an elevated cobalt level are
at greatest risk. In this study, pseudotumours had no effect on
the functional outcome after either large head MoM or conventional
MoP THA. Cite this article:
We investigated the changes seen on serial metal
artefact reduction magnetic resonance imaging scans (MARS-MRI) of
metal-on-metal total hip arthroplasties (MoM THAs). In total 155
THAs, in 35 male and 100 female patients (mean age 70.4 years, 42
to 91), underwent at least two MRI scans at a mean interval of 14.6
months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after
primary hip surgery. Scans were graded using a modification of the
Oxford classification. Progression of disease was defined as an
increase in grade or a minimum 10% increase in fluid lesion volume
at second scan. A total of 16 hips (30%) initially classified as
‘normal’ developed an abnormality on the second scan. Of those with
‘isolated trochanteric fluid’ 9 (47%) underwent disease progression,
as did 7 (58%) of ‘effusions’. A total of 54 (77%) of hips initially
classified as showing adverse reactions to metal debris (ARMD) progressed,
with higher rates of progression in higher grades. Disease progression
was associated with high blood cobalt levels or an irregular pseudocapsule
lining at the initial scan. There was no association with changes
in functional scores. Adverse reactions to metal debris in MoM THAs
may not be as benign as previous reports have suggested. Close radiological
follow-up is recommended, particularly in high-risk groups. Cite this article:
We carried out a further study of the long-term results of the
cemented Exeter femoral component in patients under the age of 40
with a mean follow-up of 13.6 years (10 to 20). We reviewed our original cohort of 104 cemented Exeter stems
in 78 consecutive patients with a mean age of 31 years (16 to 39).
Only one patient was lost to radiological follow-up.Aims
Patients and Methods
Cemented femoral stems with force closed fixation
designs have shown good clinical results despite high early subsidence.
A new triple-tapered stem in this category (C-stem AMT) was introduced
in 2005. This study compares this new stem with an established stem
of similar design (Exeter) in terms of migration (as measured using radiostereometric
analysis), peri-prosthetic bone remodelling (measured using dual
energy x-ray densitometry, DXA), Oxford Hip Score, and plain radiographs. A total of 70 patients (70 hips) with a mean age of 66 years
(53 to 78) were followed for two years. Owing to missing data of
miscellaneous reasons, the final analysis represents data from 51
(RSA) and 65 (DXA) patients. Both stems showed a typical pattern
of migration: Subsidence and retroversion that primarily occurred
during the first three months. C-stem AMT subsided less during the
first three months (p = 0.01), before stabilising at a subsidence rate
similar to the Exeter stem from years one to two. The rate of migration
into retroversion was slightly higher for C-stem AMT during the
second year (p = 0.03). Whilst there were slight differences in
movement patterns between the stems, the C-stem AMT exhibits good
early clinical outcomes and displays a pattern of migration and
bone remodelling that predicts good clinical performance. Cite this article:
The aim of this study was to evaluate the ten-year
clinical and functional outcome of hip resurfacing and to compare it
with that of cementless hip arthroplasty in patients under the age
of 55 years. Between 1999 and 2002, 80 patients were enrolled into the study:
24 were randomised (11 to hip resurfacing, 13 to total hip arthroplasty),
18 refused hip resurfacing and chose cementless total hip arthroplasty
with a 32 mm bearing, and 38 insisted on resurfacing. The mean follow-up
for all patients was 12.1 years (10 to 14). Patients were assessed clinically and radiologically at one year,
five years and ten years. Outcome measures included EuroQol EQ5D,
Oxford, Harris hip, University of California Los Angeles and University
College Hospital functional scores. No differences were seen between the two groups in the Oxford
or Harris hip scores or in the quality of life scores. Despite a
similar aspiration to activity pre-operatively, a higher proportion
of patients with a hip resurfacing were running and involved in
sport and heavy manual labour after ten years. We found significantly higher function scores in patients who
had undergone hip resurfacing than in those with a cementless hip
arthroplasty at ten years. This suggests a functional advantage
for hip resurfacing. There were no other attendant problems. Cite this article:
Controversy remains whether the contralateral
hip should be fixed in patients presenting with unilateral slipped capital
femoral epiphysis (SCFE). This retrospective study compares the
outcomes and cost of those patients who had prophylactic fixation
with those who did not. Between January 2000 and December 2010 a total of 50 patients
underwent unilateral fixation and 36 had prophylactic fixation of
the contralateral hip. There were 54 males and 32 females with a
mean age of 12.3 years (9 to 16). The rate of a subsequent slip
without prophylactic fixation was 46%. The risk of complications
was greater, the generic health measures (Short Form-12 physical
(p <
0.001) and mental (p = 0.004) summary scores) were worse.
Radiographic cam lesions in patients presenting with unilateral
SCFE were only seen in patients who did not have prophylactic fixation.
Furthermore, prophylactic fixation of the contralateral hip was
found to be a cost-effective procedure, with a cost per quality
adjusted life year gained of £1431 at the time of last follow-up. Prophylactic fixation of the contralateral hip is a cost-effective
operation that limits the morbidity from the complications of a
further slip, and the diminished functional outcome associated with
unilateral fixation. Cite this article:
High failure rates of metal-on-metal hip arthroplasty implants have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices. The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage. We aimed to identify validated surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty (THA). We conducted a systematic review of studies evaluating surrogate markers for predicting long-term outcome in primary THA. Long-term outcome was defined as revision rate of an implant at ten years according to National Institute of Health and Care Excellence guidelines. We conducted a search of Medline and Embase (OVID) databases. Separate search strategies were devised for the Cochrane database and Google Scholar. Each search was performed to include articles from the date of their inception to June 8, 2015.Objectives
Methods
The increased The proximal penetration of the femoral head five years post-operatively
was measured for 15 patients using radiostereometric analysis (RSA).Aims
Patients and Methods
Ceramic-on-metal (CoM) is a relatively new bearing
combination for total hip arthroplasty (THA) with few reported outcomes.
A total of 287 CoM THAs were carried out in 271 patients (mean age
55.6 years (20 to 77), 150 THAs in female patients, 137 in male)
under the care of a single surgeon between October 2007 and October
2009. With the issues surrounding metal-on-metal bearings the decision
was taken to review these patients between March and November 2011,
at a mean follow-up of 34 months (23 to 45) and to record pain,
outcome scores, radiological analysis and blood ion levels. The
mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268
hips (95%) had mild/very mild/no pain, the mean angle of inclination
of the acetabular component was 44.8o (28o to
63o), 82 stems (29%) had evidence of radiolucent lines
of >
1 mm in at least one Gruen zone and the median levels of cobalt
and chromium ions in the blood were 0.83 μg/L (0.24 μg/L to 27.56 μg/L)
and 0.78 μg/L (0.21 μg/L to 8.84 μg/L), respectively. The five-year
survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than
expected levels of metal ions in the blood, we would not recommend
the use of CoM THA without further long-term follow-up. We plan
to monitor all these patients regularly. Cite this article:
Patients from a randomised trial on resurfacing
hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24
to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty
(MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and
a matched control group of asymptomatic patients with a 32 mm ceramic-on-polyethylene
(CoP) THA (n = 33, 18 males; median age 63 years, 38 to 71) were
cross-sectionally screened with metal artefact reducing sequence-MRI
(MARS-MRI) for pseudotumour formation at a median of 55 months (23
to 72) post-operatively. MRIs were scored by consensus according
to three different classification systems for pseudotumour formation. Clinical scores were available for all patients and metal ion
levels for MoM bearing patients. Periprosthetic lesions with a median volume of 16 mL (1.5 to
35.9) were diagnosed in six patients in the RHA group (17%), one
in the MoM THA group (4%) and six in the CoP group (18%). The classification
systems revealed no clear differences between the groups. Solid
lesions (n = 3) were exclusively encountered in the RHA group. Two patients
in the RHA group and one in the MoM THA group underwent a revision
for pseudotumour formation. There was no statistically significant
relationship between clinical scoring, metal ion levels and periprosthetic
lesions in any of the groups. Periprosthetic fluid collections are seen on MARS-MRI after conventional
CoP THA and RHA and may reflect a soft-tissue collection or effusion. Currently available MRI classification systems seem to score
these collections as pseudotumours, causing an-overestimatation
of the incidence of pseudotumours. Cite this article:
We report the long-term survival and functional
outcome of the Birmingham Hip Resurfacing (BHR) in patients aged <
50 years at operation, and explore the factors affecting survival.
Between 1997 and 2006, a total of 447 BHRs were implanted in 393
patients (mean age 41.5 years (14.9 to 49.9)) by one designing surgeon.
The mean follow-up was 10.1 years (5.2 to 14.7), with no loss to
follow-up. In all, 16 hips (3.6%) in 15 patients were revised, giving
an overall cumulative survival of 96.3% (95% confidence interval
(CI) 93.7 to 98.3) at ten years and 94.1% (95% CI 84.9 to 97.3)
at 14 years. Using aseptic revision as the endpoint, the survival
for men with primary osteoarthritis (n = 195) was 100% (95% CI 100
to 100) at both ten years and 14 years, and in women with primary
osteoarthritis (n = 109) it was 96.1% (95% CI 90.1 to 99.9) at ten
years and 91.2% (95% CI 68.6 to 98.7) at 14 years. Female gender
(p = 0.047) and decreasing femoral head size (p = 0.044) were significantly
associated with an increased risk of revision. The median Oxford
hip score (OHS, modified as a percentage with 100% indicating worst
outcome) at last follow-up was 4.2% (46 of 48; interquartile range
(IQR) 0% to 24%) and the median University of California, Los Angeles
(UCLA) score was 6.0 (IQR 5 to 8). Men had significantly better
OHS (p = 0.02) and UCLA scores (p = 0.01) than women. The BHR provides
excellent survival and functional results in men into the second
decade, with good results achieved in appropriately selected women. Cite this article:
The primary aim of this independent prospective randomised trial
was to compare serum metal ion levels for ceramic-on-metal (CoM)
and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty
(THA). Our one-year results demonstrated elevation in metal ion
levels above baseline with no significant difference between the
CoM and MoM groups. This paper reviews the five-year data. The implants used in each patient differed only in respect to
the type of femoral head (ceramic or metal). At five-year follow-up
of the 83 enrolled patients, data from 67 (36 CoM, 31 MoM) was available
for comparison.Aims
Patients and Methods
