Quality of life and functionality after total hip arthroplasty: a long-term follow-up study

<p>Abstract</p> <p>Background</p> <p>There is a lack of data on the long-term outcome of total hip arthroplasty procedures, as assessed by validated tools.</p> <p>Methods</p> <p>We conducted a follow-up study to evaluate the quality of life and functionality of 250 patients an average of 16 years (range: 11-23 years) after total hip arthroplasty using a validated assessment set including the SF-36 questionnaire, Harris Hip Score, WOMAC score, Functional Comorbidity Index, and a study specific questionnaire. Models of multiple stepwise linear and logistic regression analysis were constructed to evaluate the relationships between several explanatory variables and these functional outcomes.</p> <p>Results</p> <p>The SF-36 physical indexes of these patients compared negatively with the normative values but positively with the results obtained in untreated subjects with severe hip osteoarthritis. Similar results were detected for the Harris Hip Score and WOMAC score. There was a 96% rate of post-surgical satisfaction. Hip functionality and comorbidities were the most important determinants of physical measures on the SF-36.</p> <p>Conclusions</p> <p>Patients who had undergone total hip arthroplasty have impaired long-term self-reported physical quality of life and hip functionality but they still perform physically better than untreated patients with advanced hip osteoarthritis. However, the level of post-surgical satisfaction is high.</p

Early results of a conservative hip stem

Introduction: Different conservative stems are available for primary cementless total hip arthroplasty (THA). The aim of this preliminary study is to assess short-term results of the GTS femoral stem (Biomet) for THA. Patients and methods: For this retrospective study of prospectively collected data, 40 patients (28 males, 12 females) who received a THA with a GTS femoral stem from 2011 to 2013 were evaluated. The mean age at the time of surgery was 48.5 years (range 31-81). All patients were operated by one surgeon with a postero-lateral approach. Etiology: 30 osteoarthritis (19 primary, 6 post-traumatic, 5 post-dysplastic) and 10 AVN of the femoral head. A press-fit hemispheric titanium acetabular component was used in all cases. Tribology: 32 ceramic on polyethylene, 8 metal on polyethylene. The mean follow-up was 26.3 month (range 15-40 months). All patients were assessed preoperatively and at the last follow-up with two patient-oriented instruments, the Harris Hip score (HHS) and WOMAC questionnaires. As a part of routine care, radiographs were obtained preoperatively and at set intervals (One day postoperative, 6 months postoperatively, 1 year postoperatively, and annually thereafter) and evaluated for any radiolucencies or osteolysis in Gruen zones, heterotopic ossifications (Brooker scale), and stem subsidence. Results: The mean HHS increased from 44 points (range 17-61) before surgery to 91.3 points (range 82-99.7) at the last follow-up (P<0.001). The disability according to mean WOMAC Score decreased from 61.8 before surgery (range 32-100) to 9.2 (range 0-47) at the final follow-up (P<0.001). Thirty-eight patients (95%) were fully satisfied with their result. The radiographic analysis at the last follow-up showed non-significant radiolucencies (less than 1 mm of width) in 3 cases (2 Gruen zone 1 and 1 in Gruen zone 5). Heterotopic ossification was present in 1 hip (Brooker 1). No stem showed subsidence of more than 5 mm at the time of final follow-up. No implant-related complication was diagnosed in this series. No implant showed radiographic loosening or was revised for any reason. Conclusions: Short term subjective clinical outcomes and radiographic results of the GTS femoral stem are excellent and comparable with published data for contemporary cementless stems. The level of post-surgical satisfaction was high in this study group

HEMIARTHROPLASTY VERSUS TOTAL HIP ARTHROPLASTY FOR THE TREATMENT OF FEMORAL NECK FRACTURES. A PROSPECTIVE COMPARATIVE STUDY

Introduction: The treatment of femoral neck fractures may affect the postoperative functional outcome in the elderly. Objectives: This comparative prospective study was carried out to evaluate the outcome of total hip arthroplasty (THA) versus hemiarthroplasty for femoral neck fractures. Methods: We selected 80 patients (17 males and 63 females) who underwent hemiarthroplasty (40 cases; mean age 74,0 ± 5.5 years) or THA (40 cases; mean age 71,4 ± 6.5 years) for a femoral neck fracture at our Institutions between January 2011 and April 2012. These two therapeutic groups were carefully matched for their preoperative characteristics including age, gender, body mass index, ASA class, comorbidities (CIRS score), cognitive function (MMSE). Four- and twelve-month mortality, walking ability, and activities of daily living (ADL Index) were prospectively assessed in the two groups. Hip-related and general complications also were specifically noted. Models of multiple regression analysis were constructed to evaluate the effect of the surgical treatment (hemiarthroplasty or THA) on functional outcomes and mortality. Results: The mortality at 4 and 12 months was not significantly different in the two therapeutic groups. The walking ability at 4 months (P<0.05) and the ADL score at 4 months (P<0.01) and one year (P = 0.01) was superior in patients with THA as compared to those who underwent hemiarthroplasty. The pre-fracture functional level (P<0.001) and the use of THA versus hemiarthroplasty (P = 0.01) represented strong predictors of the four-month ambulatory activity and ADL Index. The use of THA versus hemiarthroplasty was not associated with a better one-year functional outcome. There was a higher risk of hip-related complications at four months in patients undergoing THA (P = 0.002). Conclusions: Despite more hip-related complications, THA can benefit patients with femoral neck fractures with higher four-month functional scores

Componenti acetabolari in tantalio nella protesizzazione primaria dell'anca. Studio prospettico

Gli autori riportano eccellenti risultati clinici e radiografici con l'utilizzo di componenti acetabolari con rivestimento esterno in tantalio poroso nell'artroprotesi primaria dell'anc

Ambulatory Ability and Personal Independence After Hemiarthroplasty and Total Arthroplasty for Intracapsular Hip Fracture: A Prospective Comparative Study

Background: Total hip arthroplasty (THA) has not only been associated with best functional outcomes but also with higher dislocation risk when compared with bipolar hemiarthroplasty (HA). The functionality and activities of daily living (ADL) of patients treated with THA or HA for intracapsular hip fracture (IHF) have been scarcely investigated in comparison with the preoperative status. Methods: Two comparable groups of 60 patients with an IHF who had undergone either THA or bipolar HA were created matching several preoperative characteristics. Matched variables included age, gender, body mass index, surgical delay, American Society of Anesthesiologists class, comorbidity, cognitive status, educational status, prefracture functional status, and radiographic fracture classification. Patients were prospectively followed up for 1 year using telephone interviews. Results: The ambulatory ability (5-item scale) and ADL Index significantly decreased in both the groups in comparison with the prefracture status at the 4-month and 1-year follow-up. The need for walking aids (5-item scale) at 4 months was significantly higher among patients who had undergone HA. Lower scores on the ADL Index were recorded among patients with HA in comparison with those with THA at 4 months and 1 year. No significant differences in ambulatory ability, complication rate, and mortality were detected between the 2 groups although HA and THA were associated with a tendency to a higher prevalence of general and local complications, respectively. Conclusion: THA provides better short-term results in terms of ADLs and allows early discontinuation in the use of walking aids as compared with bipolar HA in elderly cognitively intact patients with IHF

Functional outcome and mortality after surgery for hip fracture

INTRODUCTION Hip fractures are associated with significant disability and mortality. A multicenter prospective study is currently ongoing at our institutions to investigate the mortality and functionality of patients with hip fracture. This is the report on the first 200 patients. OBJECTIVES 1) To evaluate the functional outcome and mortality after hip fracture 2) To identify predictors of mortality, functionality, and personal autonomy on variable follow-up intervals in patients who sustained hip fracture. METHODS Two-hundred consecutive patients (142 females and 58 males; mean age = 78.6 ± 13 years) admitted to our hospitals for hip fracture were telephonically interviewed 4 months and 1 year after the treatment. Personal and medical data were collected on hospital admission and were compared to the follow-up data of all patients, using a validated examination set dealing with daily life activities (ADL scale), cognitive status (MMSE Scale), comorbidity (ASA and CIRS scales), and personal mobility. Mortality data was also recorded. Possible outcome predictors were checked with multivariate regression analysis. SPSS software was used for database and statistics. CONCLUSION This ongoing prospective study is aimed to evaluate mortality and functionality after hip fracture as well as to identify possible outcome predictors to be used to improve and personalise the surgical treatment. This first report shows that the preoperative functional status and comorbidities are major determinants of 4-month and one-year postoperative mortality and functional status of subjects who sustained a hip fractur

Results of primary tantalum trabecular metal acetabular components

INTRODUCTION Tantalum trabecular metal (TTM) acetabular components may promote bone ingrowth and bone remodeling at the bone implant interface because of their optimal elastic modulus and three-dimensional structure that mimic cancellous bone. Frictional characteristics of this material may provide enhanced primary stability and warrant the use of these components even in cases of limited bone-implant contact. The aim of this prospective study was to assess clinical and radiographic results of primary TTM acetabular components at a mean 4-year follow-up. METHODS We assessed clinical and radiographic results of 210 primary cementless modular TTM acetabular cups implanted in 182 patients (107 males and 75 females) from 2002 to 2012 at the Departments of Orthopaedic Surgery of Federico II University of Naples and Magna Graecia University of Catanzaro. The mean age of patients was 61.3 ± 12.5 years (range 31-86). The diagnosis was primary osteoarthritis of the hip in 124 cases (59%), avascular necrosis of the femoral head in 33 (16 %), post-dysplastic hip arthritis in 21 (10 %), inflammatory arthritis in 14 (6 %), sequelae of Perthes disease in 7 (3.5 % ), sequelae of slipped capital femoral epiphysis in 4 (2%), and fracture or post-traumatic conditions in 7 (3.5 %). The mean follow-up was 49.2 ± 23 months (range 12-102). Harris Hip Score (HHS) was calculated preoperatively and at latest follow-up control. The level of pain, working ability, and satisfaction with the surgery were assessed using a visual analog scale. All patients underwent radiographic examination before surgery, immediately after surgery, and at latest follow-up. The inclination of the acetabular cup, the existence of any migration of the component, radiolucent lines and osteolytic lesions at the bone implant interface, zones of increased bone density, and heterotopic ossifications were assessed. RESULTS No patients had undergone revision. The patients' mean HHS at their latest follow-up visit (88.4 ± 8.4 points) was statistically significantly better than the preoperative mean score of 43.1 ± 15 points (p < 0.001). Pain level and the working ability recorded at latest follow-up showed an improvement with respect to preoperative values from 76/100 to 10 /100 (p < 0.001) and 45/100 to 80/100 (p < 0.001), respectively. The reported satisfaction was 89 /100. The average inclination of the acetabular component was 41.6 ± 8 degrees. No radiographic loosening or migration of these acetabular components was detected at latest follow-up. Radiolucent lines and osteolytic lesions at the bone implant interface were identified in 15 and 8 cases, respectively. However, all osteolytic lesions were already present on preoperative radiographs. Increased bone density around the cup was noted in 45 cases and heterotopic ossification in 24 cases, respectively. At the multivariate analysis, the most important negative predictors of HHS at latest follow-up were age (c = -0.3 , p < 0.001) and the inclination of the cup (c = -0.4 ; p < 0.001). CONCLUSION Primary TTM acetabular components provided satisfactory clinical and radiographic results at a mean 4-year follow-up. We observed no clinical or radiographic failures. Follow-up radiographs demonstrate effective new bone formation at the bone-implant interface

Factors predicting mobility and the change in activities of daily living after hip fracture: A 1-year prospective cohort study

Objectives: To assess the change in ambulatory ability, need for walking aids, and activities of daily living (ADL) after femoral neck, intertrochanteric, or subtrochanteric fractures and to examine the determinants of these functional outcomes. Design: A prospective observational cohort study. Setting: A multicenter study involving 1 university hospital and 2 community hospitals. Patients: A consecutive cohort of 552 patients (mean age, 78.3 years; range, 50-105) who underwent surgery for a hip fracture. Main Outcome Measures: Ambulatory ability, need for walking aids, and ADL index, 4 and 12 months after surgery. Results: At both 4 months and 1-year follow-up time points, there was a significant decrease in ambulatory ability and the ADL index score and also an increase in the need for walking aids in comparison with the prefracture status. Ambulatory ability, but not ADL, significantly recovered between the 4-month and 1-year follow-up. One year after fracture, the prefracture functional status was regained by 57% of the patients, but approximately 13% of the formerly ambulating patients were unable to walk. The prefracture status was the most important determinant of ambulatory ability, need for walking aids, and ADL. Comorbidities, a poor cognitive status, and non-weight-bearing status after surgery were also negative predictors. Neither the fracture pattern nor its specific surgical treatment was predictive of any functional outcomes. Conclusions: Regardless of the type of fracture or surgical treatment used, 57% of the patients do not regain their prefracture ambulatory ability. Recovery of ambulatory ability can occur until 1 year postoperatively. The prefracture status and cognitive level are the most important determinant of all functional outcomes

Qualità della vita ed autonomia personale in pazienti con frattura collo femore trattati con protesi

Le fratture mediali di collo femore sono gravate da elevata mortalità e morbidità postoperatorie. La funzionalità di soggetti 4 mesi ed 1 anno dopo l'intervento di protesi d'anca per frattura di femore è fortemente influenzata dalle condizioni funzionali preoperatorie, dalle comorbidità, dalle complicazioni e dal livello cognitivo dei pazienti