Patient-reported outcome and muscle-tendon pain after periacetabular osteotomy are related:1-year follow-up in 82 patients with hip dysplasia

Background and purpose — Larger prospective studies investigating periacetabular osteotomy (PAO) with patient-reported outcome measures developed for young patients are lacking. We investigated changes in patient-reported outcome (PRO), changes in muscle–tendon pain, and any associations between them from before to 1 year after PAO. Patients and methods — Outcome after PAO was investigated in 82 patients. PRO was investigated with the Copenhagen Hip and Groin Outcome Score (HAGOS). Muscle–tendon pain in the hip and groin region was identified with standardized clinical tests, and any associations between them were analyzed with multivariable linear regressions. Results — HAGOS subscales improved statistically significantly from before to 1 year after PAO with effect sizes ranging from medium to very large (0.66–1.37). Muscle–tendon pain in the hip and groin region showed a large decrease in prevalence from 74% (95% CI 64–83) before PAO to 35% (95% CI 25–47) 1 year after PAO. Statistically significant associations were observed between changes in HAGOS and change in the sum of muscle–tendon pain, ranging from –4.7 (95% CI –8.4 to –1.0) to –8.2 (95% CI –13 to –3.3) HAGOS points per extra painful entity across all subscales from before to 1 year after PAO. Interpretation — Patients with hip dysplasia experience medium to very large improvements in PRO 1 year after PAO, associated with decreased muscle–tendon pain. The understanding of hip dysplasia as solely a joint disease should be reconsidered since muscle–tendon pain seems to play an important role in relation to the outcome after PAO. Trial registration: ClinicalTrials.gov identifier: 20140401PAO

Ten-year comparison of two different techniques for femoral bone cavity preparation-broaching versus compaction in patients with cementless total hip arthroplasty:a randomized radiostereometric study of 30 total hip arthroplasties in 15 patients operated bilaterally

AIMS: Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. METHODS: A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. RESULTS: Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. CONCLUSION: Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042

No dislocations after primary hip arthroplasty with the dual mobility cup in displaced femoral neck fracture in patients with dementia. A one-year follow-up in 20 patients

Purpose: The aim of this study was to describe the dislocation rates, reoperation rates and mortality 30 day and one year following THA with AVANTAGE® dual mobility cup among dementia patients with an acute displaced intracapsular femoral neck fracture. Patients and methods: From 2010 to 2014 we identified 20 hip fracture patients with dementia, who have had total hip arthroplasty with the AVANTAGE® dual mobility cup. The primary outcome was dislocation. Secondary outcomes were revision surgery, 30 days and one year mortality, time to surgery and length of hospital stay. Results: Follow-up time was one year. None of the patients experienced dislocation or received revision surgery in the follow-up period. The 30-days mortality rate was 25% (confidence interval (CI) 95%; 4–46%) and the one year mortality was 45% (CI 95%; 21–69). Mean time to surgery was 27 h (CI 95%; 20–37 h) and mean length of hospital stay was 5.5 days (CI 95%; 4, 0–7, 6 days). Conclusion: THA with the dual-mobility cup seems favourable in the treatment of patients with a displaced femoral neck fracture and patients with dementia. Correct placement of the cup is pivotal and technically demanding. Not all orthopedic surgeons perform total hip arthroplasty while challenges regarding the logistics can be encountered since time to surgery is known to affect the mortality negatively

Isometric hip strength impairments in patients with hip dysplasia are improved but not normalized 1 year after periacetabular osteotomy: a cohort study of 82 patients

Background and purpose — In patients with hip dysplasia, knowledge of hip muscle strength after periacetabular osteotomy is lacking. We investigated isometric hip muscle strength in patients with hip dysplasia, before and 1 year after periacetabular osteotomy, and compared this with healthy volunteers. Furthermore, we investigated whether pre- to post-surgical changes in self-reported pain and sporting function were associated with changes in isometric hip muscle strength. Patients and methods — Isometric hip muscle strength was assessed twice in 82 patients (11 men) with a mean age of 30 (SD 9) years, before and 1 year after surgery, and once in 50 healthy volunteers. Isometric hip muscle strength was assessed with a hand-held dynamometer. Copenhagen Hip and Groin Outcome Score was used to measure self-reported outcome. Results — Despite 1-year improvements in isometric hip flexion (0.1 Nm/kg; 95% CI 0.06–0.2) and abduction (0.1 Nm/kg; CI 0.02–0.2), the patients’ muscle strength was 13–34% lower than the strength of the healthy volunteers both pre- and post-surgery (p < 0.01). Moreover, changes in self-reported pain were associated with changes in hip flexion (13 points per Nm/kg; CI 1–26) and abduction (14 points per Nm/kg; CI 3–25), while changes in self-reported sporting function were associated with changes in hip extension (9 points per Nm/kg; CI 1–18). Interpretation — Isometric hip muscle strength is impaired in symptomatic dysplastic hips measured before periacetabular osteotomy. 1 year after surgery, isometric hip flexion and abduction strength had improved but muscle strength did not reach that of healthy volunteers

The association between metal allergy, total hip arthroplasty, and revision

Background and purpose It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients in general with THA. Furthermore, we compared the prevalence of metal allergy in dermatitis patients with and without THA. Materials and methods The Danish Hip Arthroplasty Registry (DHAR) contained detailed information on 90,697 operations. The Gentofte patch-test database contained test results for patients suspected of having allergic contact dermatitis (n = 18,794). Cases (n = 356) were defined as patch-tested dermatitis patients who also had primary THA performed. Two age- and sex-matched controls (n = 712) from the patch-test database were sought for each case. Results The prevalence of revision was similar in cases (12%) and in patients from the DHAR (13%). The prevalence of metal allergy was similar in cases and controls. However, the prevalence of metal allergy was lower in cases who were patch-tested after operation (6%) than in those who were patch-tested before operation (16%) (OR = 2.9; 95% CI = 1–8). Interpretation We found that the risk of surgical revision was not increased in patients with metal allergies and that the risk of metal allergy was not increased in cases who were operated, in comparison to controls. Despite some important study limitations, our observations add to the evidence that the risk of complications in metal allergic patients seems limited

Does the physical activity profile change in patients with hip dysplasia from before to 1 year after periacetabular osteotomy?

Background and purpose — Knowledge of physical activity profiles among patients with hip dysplasia is lacking. We investigated whether patients with hip dysplasia change physical activity profile from before to 1 year after periacetabular osteotomy. Furthermore, we investigated associations between change in accelerometer-based physical activity and change in self-reported participation in preferred physical activities (PA). Patients and methods — Physical activity was objectively measured at very low to high intensity levels with accelerometer-based sensors. Subjectively, PA was recorded with Copenhagen Hip and Groin Outcome Score (HAGOS) in 77 patients. Associations between the 2 were analyzed with simple linear regression analyses. Results — Changes in accelerometer-based physical activity ranged from –2.2 to 4.0% points at all intensity levels from baseline to 1-year follow-up. These changes represent very small effect sizes (–0.16 to 0.14). In contrast, self-reported PA showed a statistically and clinically relevant increase of 22 (CI 14–29) HAGOS PA points 1 year post-surgery. Associations between change in accelerometer-based physical activity and change in self-reported PA were, however, not statistically significant and correspond to a percentage change in physical activity of only –0.87% to 0.65% for a change of 10 HAGOS PA points. Interpretation — Patients with hip dysplasia do not seem to change physical activity profile 1 year post-surgery if measured with objective accelerometer-based sensors. This is interesting as self-reported PA indicates that patients’ ability to participate in physical activity increases, suggesting that this increased self-reported participatory capacity is not manifested as increased objectively measured physical activity