Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: A randomized controlled trial

The use of larger femoral heads has been proposed to reduce the risk of dislocation after total hip arthroplasty, but there is a lack of evidence to support this proposal. The aim of this multicenter randomized controlled trial was to determine whether the incidence of dislocation one year after total hip arthroplasty is significantly lower in association with the use of a 36-mm femoral head articulation as compared with a 28-mm articulation.Six hundred and forty-four middle-aged and elderly patients undergoing primary or revision arthroplasty were randomized intraoperatively to receive either a 36 or 28-mm metal femoral head on highly cross-linked polyethylene. Patients who were at high risk of dislocation (including those with dementia and neuromuscular disease) and those undergoing revision for the treatment of recurrent hip dislocation or infection were excluded. Patients were stratified according to other potential risk factors for dislocation, including diagnosis and age. Diagnosis of hip dislocation required confirmation by a physician and radiographic evidence of a dislocation.Overall, at one year of follow-up, hips with a 36-mm femoral head articulation had a significantly lower incidence of dislocation than did those with a 28-mm articulation (1.3% [four of 299] compared with 5.4% [seventeen of 316]; difference, 4.1% [95% confidence interval, 1.2% to 7.2%]) when controlling for the type of procedure (primary or revision) (p = 0.012). The incidence of dislocation following primary arthroplasty was also significantly lower for hips with a 36-mm femoral head articulation than for those with a 28-mm articulation (0.8% [two of 258] compared with 4.4% [twelve of 275]; difference, 3.6% [95% confidence interval, 0.9% to 6.8%]) (p = 0.024). The incidence of dislocation following revision arthroplasty was 4.9% (two of forty-one) for hips with a 36-mm articulation and 12.2% (five of forty-one) for hips with a 28-mm articulation; this difference was not significant with the relatively small sample size of the revision group (difference, 7.3% [95% confidence interval, -5.9% to 21.1%]) (p = 0.273).Compared with a 28-mm femoral head articulation, a larger 36-mm articulation resulted in a significantly decreased incidence of dislocation in the first year following primary total hip arthroplasty. However, before a 36-mm metal-on-highly cross-linked polyethylene articulation is widely recommended, the incidence of late dislocation, wear, periprosthetic osteolysis, and liner fracture should be established.Donald W. Howie, MBBS, FRACS, PhD, Oksana T. Holubowycz, PhD, MPH, Robert Middleton, MBBChir, MA, FRCS(Orth), and the Large Articulation Study Grou

An investigation into the reasons why BAC data for road accident casualties is missing from the South Australian traffic accident database

Report Series 93/1.O.T. Holubowycz, A.J. McLean & C.N. Kloedenhttp://catalogue.nla.gov.au/Record/125909

Self-reported drink-driving behaviour of injured male drivers and riders: a comparison between those with zero and high blood alcohol concentrations

O.T. Holubowycz, C.N. Kloeden & A.J. McLeanhttp://trove.nla.gov.au/work/1162781

Age, sex and blood alcohol concentration of killed and injured drivers, riders and passengers

Copyright © 1994 Published by Elsevier Science LtdThe relationships between type of road user, sex, age, and blood alcohol concentration (BAC) were examined among 1,389 adult vehicle occupants and motorcyclists fatally injured in crashes within South Australia from 1985 to 1992, inclusive, and among 1,573 adult vehicle occupants and motorcyclists admitted to a Level-1 trauma centre from August 1985 to July 1987. The relationships between BAC and both day of week of crash and the number of vehicles involved were determined among fatalities, whereas among admissions, duration of hospitalization and type of unit to which the casualty was admitted were also examined. BACs of .08 g/100 mL or higher were found in 38% of killed and 30% of injured drivers, 37% and 27% of passengers, and 35% and 22% of male motorcycle riders. Alcohol involvement was almost nonexistent among the elderly. The finding that the proportion of injured motorcyclists was similar to that of drivers is consistent with motorcyclists' increased risk of injury even in relatively minor crashes. Male motorcycle riders were found to be significantly younger than male drivers. They were also significantly less likely to have been drinking and, if they had been drinking, their mean BAC was significantly lower. The results are also consistent with the well-established observations that alcohol involvement is greater in single-vehicle crashes and in crashes occurring on weekends. Average duration of hospitalization was not found to differ between types of road user or between those with a BAC above and below .08 g/100 mL.Oksana T. Holubowycz, Craig N. Kloeden and A. Jack McLeanhttp://www.elsevier.com/wps/find/journaldescription.cws_home/336/description#descriptio

Usual drinking and drink-driving behaviour of injured male drivers and riders: a comparison between those with zero and high blood alcohol concentrations

O.T. Holubowycz, C.N. Kloeden & A.J. McLeanhttp://trove.nla.gov.au/work/2186509

Drinking behaviour and other characteristics of injured drivers and riders

NH & MRC Road Accident Research Unit report number 92/2.O.T. Holubowycz, A.J. McLean & C.N. Kloedenhttp://catalogue.nla.gov.au/Record/73731

The wear rate of highly cross-linked polyethylene in total hip replacement is not increased by large articulations: a randomized controlled trial

BACKGROUND: Larger articulations reduce the risk of dislocation following primary total hip arthroplasty, leading to increased use of these articulations. The wear rate of highly cross-linked polyethylene (XLPE) is low in standard-diameter articulations but remains unclear in larger articulations. The aim of this randomized controlled trial was to compare the mean wear rates of 36-mm and 28-mm metal-on-XLPE articulations between 1 and 3 years postoperatively. METHODS: Fifty-six elderly patients undergoing primary total hip arthroplasty were randomized intraoperatively to receive either a 36-mm or 28-mm metal-on-XLPE articulation. Factors that may affect wear were controlled by study design. Wear was measured using radiostereometric analysis. RESULTS: Mean annual proximal wear rates between 1 and 3 years were 0.00 and 0.01 mm/yr for the 36 and 28-mm articulation cohorts, respectively. No patient had a proximal wear rate of >0.1 mm/yr. Mean wear was very low in all directions, and the wear rate of 36-mm articulations was not significantly greater than that of 28-mm articulations on the basis of proximal, medial 2-dimensional, and 3-dimensional wear. CONCLUSIONS: The wear rate of a larger 36-mm metal-on-XLPE articulation between 1 and 3 years following primary total hip arthroplasty was low and no greater than that of a 28-mm articulation. However, before a 36-mm metal-on-XLPE articulation is widely recommended, particularly in young active patients, long-term wear rates and association between wear and periprosthetic osteolysis should be determined. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.Donald W. Howie, Oksana T. Holubowycz, and Stuart A. Callar

Usual drinking behaviour of injured male drivers and riders: a comparison between those with zero and high blood alcohol concentrations

O.T. Holubowycz, A.J. McLean & C.N. Kloedenhttp://trove.nla.gov.au/work/1162781

Blood alcohol concentrations of pedestrians

O.T. Holubowycz, A.J. McLean & C.N. Kloedenhttp://trove.nla.gov.au/work/1162781

Comparison of patient and doctor responses to a total hip arthroplasty clinical evaluation questionnaire

© 2002 The Journal of Bone and Joint SurgeryBackground: Surgeons traditionally undertake a prospective evaluation of patients undergoing total hip arthroplasty in order to determine outcomes. The validity of doctor-derived data is questionable because of the potential for interobserver error, reporting bias, and differences between the perceptions of doctors and patients. Also, the use of doctor-derived data necessitates the use of costly outpatient services. Consequently, there are likely to be benefits associated with the use of patient-derived clinical evaluation data. However, few studies have focused on whether data obtained from the patient and doctor differ. Methods: The agreement between patient and doctor responses on a sixteen-item total hip arthroplasty clinical evaluation questionnaire completed at more than 2900 clinical assessments was determined. Data from repeated assessments performed preoperatively and postoperatively enabled stratified analyses that were used to examine reasons for disagreement and factors influencing agreement. Agreement was measured with use of the kappa coefficient. Results: For twelve of the sixteen items, the patient responses had acceptable agreement with the doctor responses. Some important differences between patient-derived and doctor-derived data were found. If the patient had other joint or health problems, had a revision total hip arthroplasty, or reported mild or moderate pain, there was a greater chance of reduced agreement on the pain items. Younger patients demonstrated better agreement with doctors than older patients did. Conclusions: Patients’ perceptions of symptoms and outcomes after total hip arthroplasty are relatively similar to those of their doctor. There is minimum risk of misinterpreting outcomes data by replacing doctor-completed questionnaires with patient-completed questionnaires in uncomplicated total hip arthroplasty cases. For patients with comorbid joint problems or other health problems, and for those reporting substantial pain, direct physician involvement in the evaluation of pain is recommended. The selective use of patient-completed questionnaires has the potential to substantially reduce the costs of outcomes evaluation programs by minimizing doctor input. Pending revision of some of the items, the use of this patient-completed questionnaire is advocated.Margaret A. McGee, Donald W. Howie, Philip Ryan, John R. Moss, and Oksana T. Holubowyc