The design of a randomised controlled trial to evaluate the (cost-) effectiveness of the posterolateral versus the direct anterior approach for THA (POLADA - trial)

Background: Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures. Because of the increasing number of THAs, a growing demand for faster recovery and a greater emphasis on cost-effectiveness, minimally invasive THAs have been introduced in the last decades. The direct anterior approach is a minimally invasive, tissue-sparing approach in which intermuscular planes are used. Theoretically, this approach should result in a faster recovery of physical functioning and higher health-related quality of life. Methods/design: A randomised controlled trial will be performed. Patients will be randomly allocated to undergo THA by means of the anterior or posterolateral approach. Both the intervention and control group will consist of two subgroups: 1) patients with a good bone stock who will receive an uncemented femoral stem, and 2) patients with a poor bone stock who will receive a cemented femoral stem. Patients between 18 and 90 years with primary or secondary osteoarthritis will be included. Physical functioning and health-related quality of life will be assessed by means of questionnaires. Additionally, performance based tests will be performed to objectively assess the physical functioning. Cost-effectiveness will be assessed by obtaining data on medical costs in and outside the hospital and other nonmedical costs. Measurements will take place preoperatively, two and six weeks, three months and one year postoperatively. Discussion: There is some evidence that the anterior approach results in reduced tissue damage and faster recovery in the direct postoperative period, compared to the posterolateral approach. However, there is still a lack of well-designed studies that have confirmed the better outcomes and cost-effectiveness of the anterior approach. Therefore, the purpose of this study is to assess the physical functioning, health related quality of life and the cost-effectiveness of the anterior approach, compared to the conventional posterolateral approach

Long-term physical functioning and quality of life after pelvic ring injuries

BACKGROUND: Pelvic ring injuries are serious injuries, often associated with substantial morbidity and mortality rates. The long-term consequences of these injuries might affect the patients' personal life. Our aim was to assess the long-term effects of pelvic ring injuries on physical functioning and quality of life (QoL) using validated patient-reported outcome measures (PROMs) and comparing these results to normative data from the general population. PATIENTS AND METHODS: A retrospective cohort study was conducted on adults treated for pelvic ring injuries between 2007 and 2016. Demographics, fracture type, injury mechanism, treatment and complications were recorded. PROMs questionnaires concerning physical functioning (SMFA) and quality of life (EQ-5D) were used. Patients were divided according to their age (18-30, 31-64, 65 and older) and fracture type (Tile/AO type A, B or C). Differences in SMFA and EQ-5D scores of the operatively and non-operatively treated patients and between the study population and general population were analyzed. RESULTS: A total of 413 patients were identified of which 279 were eligible for follow-up. One-hundred and ninety-two (69%) patients responded with a mean follow-up of 4.4 years. Patients reported a median score of 13.9 on the SMFA function index, 16.7 on the bother index, 12.5 on the lower extremity, 18.8 on the activities of daily living and 23.4 on the emotion subscale. A median EQ-5D score of 0.8 was reported. There was no difference in physical functioning and QoL between operatively and non-operatively treated patients. Comparison of these results to normative data of the general population revealed a significant (P < 0.05) decrease in physical functioning and QoL in patients with all types of pelvic ring injuries. CONCLUSION: Long-term physical functioning and QoL in patients who had sustained a pelvic ring injury seems fair, although significantly decreased in comparison with their peers from the general population

E-bikers are more often seriously injured in bicycle accidents:results from the Groningen bicycle accident database

DoelAnalyseren van het soort letsel, de letselernst en de mortaliteit onder slachtoffers van een ongeval met een elektrische fiets vergeleken met een klassieke fiets.OpzetProspectief cohortonderzoek.MethodeSinds 2014 worden gegevens van patiënten die zijn behandeld na een fietsongeval op de SEH van het Universitair Medisch Centrum Groningen geregistreerd in een database. Wij analyseerden gegevens uit deze database over de ongevallen met een elektrische fiets (e-bike) of klassieke fiets die plaatsvonden bij volwassen patiënten in de periode juli 2014-mei 2016. Met ‘propensity score matching’ werden e-bikers gematcht met klassieke fietsers op basis van leeftijd, geslacht en aanwezigheid van comorbiditeit.ResultatenVan de 475 geïncludeerde slachtoffers bereden er 107 een e-bike. De gemiddelde leeftijd van e-bikers en klassieke fietsers was respectievelijk 65 en 39 jaar; e-bikers hadden vaker comorbiditeit. De e-bikers raakten significant ernstiger gewond dan klassieke fietsers, zij hadden ernstiger schedel-hersenletsel en ernstiger letsel van het gezicht, de bovenste en onderste extremiteit. Tevens werden e-bikers vaker en langer opgenomen in het ziekenhuis en vaker geopereerd. De mortaliteit was gelijk. Na propensity-scorematching bleek dat e-bikers 2 maal zo vaak meervoudig ernstig gewond waren geraakt, ernstiger schedel-hersenletsel hadden opgelopen en langer waren opgenomen als klassieke fietsers.ConclusieE-bikers raken bij een fietsongeval ernstiger en vaker meervoudig gewond en hebben ernstiger schedel-hersenletsel dan klassieke fietsers. Dit resulteert in een grotere zorgbehoefte. Preventieve maatregelen, zoals rijlessen en helmgebruik, moeten daarom gestimuleerd worden. Zorgverleners dienen extra bedacht te zijn op ernstigere letsels wanneer een patiënt een fietsongeval met een e-bike heeft gehad.OBJECTIVE: Analysing injury types, injury severity and mortality in victims of accidents with electric bicycles in comparison with conventional bicycles.DESIGN: Prospective cohort study.METHOD: Data of patients treated at the Accident &amp; Emergency Department of the University Medical Center Groningen after a bicycle accident are being entered in a database since 2014. We have analysed this database for accidents with electric bicycles (e-bikes) and conventional bicycles occurring among adult patients for the period of July 2014 to May 2016. 'Propensity score matching' was used to match e-bikers to conventional cyclists, based on age, gender and the presence of comorbidities.RESULTS: 107 of the 475 included victims were riding an e-bike. Average age of e-bikers and conventional cyclists was 65 years and 39 years respectively. Comorbidity was more common in e-bikers. E-bikers were injured significantly more severely than conventional cyclists. They had more severe injuries of the head and face, and upper and lower extremities. E-bikers were also admitted to the hospital more often, and for longer periods, and they underwent surgery more often. Mortality was the same. Propensity score matching revealed that e-bikers had multiple severe injuries (ISS &gt; 15) twice as often as conventional cyclists, that they had more severe head injuries and were admitted for longer periods than conventional cyclists.CONCLUSION: E-bikers who had a bicycle accident had more severe injuries, more frequently had multiple injuries and had more severe head injuries than conventional cyclists. This resulted in a greater need for care. Preventive measures such as riding lessons and helmet use should be encouraged. Care providers should pay extra attention to the possibility of severe injuries when a patient had a bicycle accident with an e-bike.</p

Pseudotumour incidence, cobalt levels and clinical outcome after large head metal-on-metal and conventional metal-on-polyethylene total hip arthroplasty MID-TERM RESULTS OF A RANDOMISED CONTROLLED TRIAL

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 (SD) 4) and 55 MoP (25 males, 30 females, mean age of 65 years, SD 5) were recruited after a mean follow-up of 50 months (36 to 64). 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 vs 7, odds ratio (OR) = 13.4, p = 5 microgram/L) were only associated with pseudotumours in women with a MoM THA. There was no difference in mean Oxford and Harris hip scores between patients with a pseudotumour and those without. 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