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Background: Total hip arthroplasty (THA) causes damage to hip joint mechanoceptors, which in turn leads to decrease in proprioception and increase in balance disorders. Few research has focused on balance training in patients with arthroplasty and none investigated the long-term effect of balance training using objective balance assessment methods in THA patients. The purpose of our study was to investigate the effects of balance training in patients with THA until 26 weeks postoperatively., Method: For this study 24 patients with hip osteoarthritis, who were candidates for THA were recruited. Of the patients with THA 16 completed the study protocol and the patients were randomized to 2 groups: conventional rehabilitation (CR, n = 8) or conventional rehabilitation plus balance training (CR + BT, n = 8). The CR group completed typical surgery-specific exercise programs, while the CR + BT group completed the CR plus balance exercises. The patients were evaluated by a hand-held dynamometer, single leg stance test (SLST), Tetrax balance system, Harris hip score, lower extremity function scale, 5 times sit to stand test and 50-foot timed walk test preoperatively and 8, 14 and 26 weeks postoperatively., Results: While the CR + BT group showed significant improvement for the right extremity eyes closed SLST score (p < 0.05), there was no significant difference for other assessment parameters between the CR and CR + BT groups (p > 0.05). There were significant improvements in both groups until 26 weeks following THA (p < 0.05)., Conclusion: The results of our study indicate that there were similar improvements in the balance and functional parameters in the CR and CR + BT groups. There was no additional benefit after 26 weeks of controlled balance exercises following THA., Competing Interests: Declarations. Conflict of interest: N. Elibol, B. Unver and V. Karatosun declare that they have no competing interests. All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Ethical approval was obtained from the Local Medical Ethics Committee of Dokuz Eylul University (approval number: 2012/22-01)., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: There is relatively little information on the long-term clinical results of patients aged < 50 years with a contemporary total hip arthroplasty (THA), although a high rate of revision is projected for this group. Therefore, the purpose of this study was to evaluate the long-term results (a minimum of 21 years) of a metaphyseal-engaging anatomic cementless total hip prosthesis in patients aged < 50 years at the time of their THA., Methods: This study included 360 patients (498 hips), specifically 212 men and 148 women. The mean age of the patients at the time of their THA was 45.8 ± 8.1 years. The predominant diagnosis was osteonecrosis (56%). Demographic data, the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the University of California, Los Angeles (UCLA) activity score were recorded. Radiographic evaluation and dual-energy X-ray absorptiometry (DEXA) scanning were used to evaluate implant fixation, bone remodelling, and osteolysis. The mean follow-up was 25.2 year (range 21-28 years)., Results: At the latest follow-up, the mean Harris hip, WOMAC, and UCLA activity scores were 93, 10, and 6.7 points, respectively. No patients had thigh pain. All hips had osseous integration of the acetabular and femoral components. No patient had grade 3 stress shielding. The 28-year survival rate was 98.2% (95% confidence interval [CI] 95-100%) for the acetabular components and 98.8% (95% CI 95-100%) for the femoral components. Overall, 90% of the patients were satisfied with the THA results., Conclusion: The results suggest that a metaphyseal-engaging anatomic cementless femoral stem with alumina-on-alumina ceramic articulation provide outstanding long-term fixation and substantial pain relief well into the 3rd decade after surgery. Furthermore, there was no alumina ceramic fracture or osteolysis. Moreover, approximately 90% of the patients were satisfied with the results of their THA., Competing Interests: Declarations Conflict of interest The authors declare that they have no conflict of interest. Consent for publication All authors have consent to publish. Informed consent Informed consent was obtained from all individual included in the study., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Purpose: Total knee arthroplasty (TKA) has consistently demonstrated lower patient satisfaction compared to total hip arthroplasty (THA). However, prior investigations failed to account for the patients' demographic characteristics. This study aimed to conduct a comparative analysis of patient-reported outcomes between TKA and THA while adjusting for patient background., Methods: A total of 326 primary TKAs and 259 THAs conducted at a single center were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores preoperatively and at 3 months, 1 year, and 2 years postoperatively. Notably, TKA patients exhibited advanced age and higher body mass index (BMI) than their THA counterparts. To mitigate the impact of these differences, we employed propensity score-matched data, adjusting for background characteristics such as age, gender, BMI, and diagnosis., Results: THA consistently demonstrated significantly superior WOMAC total, pain, and stiffness scores compared to TKA at 3 months, 1 year, and 2 years postoperatively. Nevertheless, no statistically significant disparity in WOMAC physical function scores was observed between the two groups at 3 months and 1 year postoperatively in the matched data (3 months, p = 0.131; 1 year, p = 0.269)., Conclusion: In contrast to earlier findings, our analysis of propensity score-matched data revealed no significant differences in WOMAC physical function scores between the TKA and THA groups at 3 months and 1 year postoperatively. The distinctive background factors observed in patients undergoing TKA and THA, notably advanced age and higher BMI, coupled with the delayed improvement timeline in TKA's WOMAC scores compared to that of THA, have the potential to impact patient-reported outcomes. Consequently, clinicians should be mindful of the potential impact of patient background on variations in patient-reported outcome measures following total joint arthroplasty., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Etiology of hip osteoarthritis (OA) and survival of hip arthroplasty in the young (below 40-years-old) remains poorly described. Furthermore, joint survivorship mid to long-term and PROMs according to the etiology are unclear. The study aims were to 1) identify the indications for arthroplasty in the below 40-years-old cohort; 2) define hip arthroplasty outcomes in the young and 3) test whether patients with sequelae of pediatrics hip disease have inferior outcome compared to other patients., Hypothesis: Our hypothesis was that hip arthroplasty is a viable option for managing hip disease in patients under 40, with excellent survival rates and outcomes., Material and Methods: This is an IRB approved, retrospective, consecutive, multi-surgeon, cohort study from a single academic center. Indication for hip arthroplasty of 346 patients (410 hips) below 40-years-old were studied; 239 underwent THA (58%) and 171 hip resurfacing (42%). Patient, surgical and implant factors were tested for association with implant survivorship and functional outcome for hip arthroplasty performed with a follow-up of more than two years. Pediatric hip sequelae patients were compared for survival and PROMs with the rest of the cohort., Results: The most common etiology of OA was FAI (47%), followed by pediatric hip sequelae (18%). The 10-year survivorship was 97.2% ± 1.2, mean OHS was 45.1 ± 6.3 and mean HHS was 93.4 ± 12.6. The pediatric hip sequelae subgroup demonstrated no differences in 10-year survivorship and better PROMs compared to rest (OHS: 46.6 ± 3.8; HHS: 96.0 ± 8.5)., Discussion: The most common aetiologies amongst the young with hip OA is FAI and pediatric hip sequelae. Hip arthroplasty in the young presents excellent 10-year survivorship and PROMs. Excellent survival and PROMs in the young with pediatric hip sequelae provide important information for decision-making in this challenging population., Level of Evidence: III; retrospective cohort study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: To quantify the effectiveness of prehabilitation prior to total knee and hip arthroplasty (TKA/THA) for osteoarthritis on postoperative outcomes assessed by self-report and performance-based measures., Methods: Embase, MEDLINE, CENTRAL, CINAHL and Scopus (inception-August 2022) were searched for randomized controlled trials. Self-report outcomes were function, health-related quality of life (HRQoL), and pain. Performance-based outcomes were strength, range of motion (ROM), balance, and functional mobility. The RoB 2.0 assessed risk of bias. Random-effects meta-analysis was performed up to 52 weeks after TKA/THA., Results: High risk of bias was found in 24 of 28 trials. Prehabilitation improved function (SMD = 0.50 [95%CI: 0.23, 0.77]), pain (SMD = 0.44 [95%CI: 0.17, 0.71]), HRQoL (SMD = 0.28 [95%CI: 0.12, 0.43]), strength (SMD = 0.72 [95%CI: 0.47, 0.98]), ROM (SMD = 0.31 [95%CI: 0.02, 0.59]), and functional mobility (SMD = 0.39 [95%CI: 0.05, 0.73]) post-TKA. No significant effect of prehabilitation on balance (SMD = 0.28 [95%CI: -0.11, 0.66]) post-TKA. All outcomes assessed had significant heterogeneity ( p  < 0.01). There were limited and contradictory trials ( n  = 2) for THA., Conclusion: High risk of bias and significant heterogeneity observed in our meta-analysis prevent conclusions regarding prehabilitation effectiveness on outcomes up to one year after TKA/THA.

Objective: This systematic review aimed to identify the existing patient-reported outcome measures (PROMs) used in hip or knee arthroplasty for adults with osteoarthritis and assess their content validity using the modified International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis (OA)., Methods: Four databases were systematically searched to identify disease or joint-specific PROMs evaluating function after hip or knee arthroplasty. Two reviewers independently evaluated the content of PROMs based on established ICF linking rules., Results: From 449 studies included in this review, 50 PROMs were identified. The mobility chapter of activities and participation was the most common component, followed by the sensory function and pain chapter of body function and structure. The most frequent ICF activity and participation categories were d451 going up and down stairs, d4701 using private motorized transportation, d4104 standing, and d4154 maintaining a standing position. However, 11 ICF categories of the modified OA core set were not captured in any PROMs. This ICF-based content analysis of PROMs revealed that included activity and participation categories vary widely, with little overlap among PROMs. The Knee Injury and Osteoarthritis Outcome Score and the Hip Disability and Osteoarthritis Outcome Score had the most coverage for activity and participation (36.7%)., Conclusion: Even though our search identified 50 specific PROMs, there remain gaps in content related to activity and participation coverage. By providing a content analysis of the PROMs used after hip or knee arthroplasty, this study may help clinicians select PROMs based on covered categories and relevant clinical objectives., (© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Objective: Hip osteoarthritis is a common cause of disability and surgery is often unavoidable. Patient satisfaction is high and functional ability improves after surgery. However, residual impairment and pain are common. Degenerative changes in tendons and muscles are probable causes. The aim of this study is to investigate gluteus medius (GMED) tendon degeneration in relation to muscle strength, physical function and walking distance before and one year after total hip replacement., Material and Methods: In total, 18 patients were examined pre- and post-operatively, of whom 15 were available in the final analysis. Muscle strength, physical function and walking distance were assessed. Tendon biopsies were assessed microscopically, and the total degeneration score (TDS) was calculated., Results: A correlation between the TDS and muscle strength was found for the hamstrings, GMED and quadriceps pre- or post-operatively. No correlations were found between the TDS and functional ability. Functional ability and muscle strength improved significantly after surgery., Conclusion: Our results indicate a correlation between tendon degeneration and the muscle strength of the hip and knee in patients with hip OA and one year after THR. To minimise post-operative residual discomfort, rehabilitation programs should probably be modified over time to match the pre- and post-operative needs. Further studies are needed.This study was registered at https://www.researchweb.org/is/vgr/project/279039 (in Swedish).

To clarify the relevance of physical activity (PA) with respect to a decrease in minimal joint space (MJS) of the nonoperative hip in female patients at 24 months post-contralateral total hip arthroplasty (THA). This prospective cohort study was conducted from six to 24 months post-THA. The subjects were 85 female patients with hip osteoarthritis (OA) who had undergone unilateral THA. The primary outcome was a change in MJS (ΔMJS). Daily step counts and moderate to vigorous physical activity were measured. To identify factors related to ΔMJS, a generalized linear model approach was used, with adjustment factors, Kellgren-Lawrence (KL) grade, PA, and interaction terms between PA and KL grade as explanatory variables. The interaction term between daily step count and KL grade was significant. The regression coefficient of the daily step count for ΔMJS was significant in the KL ≥ 1 group, but not in the KL = 0 group. A model with adjustment factors, an interaction term, and PA showed that the daily step count increased ΔMJS. PA was related to ΔMJS of the nonoperative hip in female patients with KL grade ≥1, but was not related to ΔMJS in patients without OA post-THA. Excessive daily step count may be a risk factor for a decrease in MJS of the nonoperative hip., (© 2024 Orthopaedic Research Society.)

Background: It is unclear if shelf acetabuloplasty provides adequate bone coverage when conversion total hip arthroplasty (THA) is required in patients with developmental dysplasia of the hip (DDH). We aimed to investigate the short-term results of conversion THA after shelf acetabuloplasty., Methods: Forty-six patients requiring conversion THAs after a prior shelf acetabuloplasty were matched to THAs for osteoarthritis secondary to Crowe I DDH in a 1:1 ratio. Surgical factors, clinical scores, cup placement, and bone coverage of the cup were evaluated., Results: The preoperative Japanese Orthopaedic Association (JOA) score and flexion range of motion (ROM) were lesser in the shelf group (JOA: 49.2 ± 22.4 vs. 60.1 ± 14.5, p < 0.01, flexion ROM: 69 ± 22.4 vs. 82.1 ± 17.5, p < 0.01). There were no significant differences in JOA (88.7 ± 8.7 vs. 92.1 ± 8.0,p = 0.053) and flexion ROM (93.5 ± 17.3° vs. 99.5 ± 8.0, p = 0.08) after the index THA.All cups in both groups were placed at the anatomical hip centre. The cup centre edge angle (cup CE) was significantly lower in the shelf group (21.3°vs. 28.4, p = 0.0011), and ratio of cup coverage over the cup was lower in the shelf group (77.0% vs. 86.9%, p < 0.0001). There was no significant difference in the number of cases where acetabular bone grafting was performed (87.0% vs. 80.4%, p = 0.46). The operative time tended to be longer in the shelf group (117 ± 30.3 min vs. 106.6 ± 25.3 min, p = 0.06), and there was no significant difference in intraoperative blood loss (294.3 ± 33.8 vs. 313.3 ± 25.9, p = 0.50)., Conclusion: Conversion THA after prior shelf acetabuloplasty provided encouraging short-term results with no major complications. Prior shelf acetabuloplasty did not complicate subsequent THA. Bone coverage of the acetabular component was inadequate in total hip arthroplasty, even with prior shelf acetabuloplasty., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Kyoto University Graduate School and Faculty of Medicine, Ethic Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by Kyoto University Graduate School and Faculty of Medicine, Ethic Committee. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background and Purpose:  As digital health services become increasingly important in osteoarthritis treatment, understanding patients' digital health literacy (eHL) is crucial, including those undergoing total hip and knee arthroplasty (THA/TKA). We primarily aimed to provide eHL norms in a representative group of Norwegian patients, and secondarily to examine the relationships between eHL and health-related quality of life (QoL)., Methods:  We invited 800 randomly selected THA/TKA patients from the Norwegian Arthroplasty Register to complete a paper-based questionnaire, which included sociodemographic variables. eHL was measured using the eHealth Literacy Questionnaire (eHLQ) with 7 domains: Using technology, Understand, Engage, Control, Motivation, Access, and Needs, scored from 1 (strongly disagree) to 4 (strongly agree). The EuroQol EQ-5D-5L measured health-related QoL. We used multivariable regression to examine relationships between eHL domains and health-related QoL controlling for sociodemographic variables., Results:  Respondents' (N = 383, 48%) mean age was 70 years (SD 9.0) and 246 (64%) were female. Mean eHLQ and the proportion of patients with low eHL (≤ 2.5) were Technology 2.7 (34%), Understanding 3.0 (14%), Engage 2.7 (28%), Control 3.2 (7.7%), Motivation 2.8 (35%), Access 2.8 (33%), and Needs 2.6 (46%). Low eHL correlated with older age and low education, but not with sex or type of surgery. Regression analyses showed that lower scores on the domains Technology, Engage, Control, Access, and Needs were associated with poorer QoL after adjusting for sociodemographic factors., Conclusion:  About one-third of THA/TKA patients have low eHL, and low eHL was associated with poor QoL.

Purpose: This study aimed to clarify the association between preoperative physical function and discharge destination after total hip arthroplasty (THA)., Methods: This retrospective study included patients who underwent primary unilateral THA for hip osteoarthritis. Preoperative physical function was assessed via maximal isometric muscle strength (hip abduction and knee extension) and comfortable walking speed. The patients were divided into two groups according to the discharge destination (home or transfer to other facilities). Multivariate logistic regression analysis was used to identify preoperative physical function associated with discharge destination., Results: Of the 174 patients, 120 were discharged directly to home, and 54 were transferred to other facilities. Those transferred to other facilities were significantly older, more likely to live alone, and had a longer operation time. In addition, they demonstrated lower hip abductor strength on both sides and lower knee extensor strength on the operative side. Multivariate logistic regression analysis revealed that hip abductor strength on both sides, not knee extensor strength, was independently associated with the discharge destination. The largest area under the receiver operating characteristic curve was 0.668 for the hip abductor strength of the contralateral side. The optimal cutoff point was revealed to be 0.035 kgf·m/kg and 0.031 kgf·m/kg for the operative and contralateral sides, respectively., Conclusions: Preoperative hip abductor strength, particularly on the contralateral side with a cutoff value of 0.031 kgf·m/kg, could be a predictor of discharge destination after unilateral THA. Our findings would be useful in planning rehabilitation programs., Competing Interests: Declarations Conflict of interest The authors declare no conflict of interest. Ethical approval This study was approved by the Institutional Review Board of Nagoya University Graduate School of Medicine (approval number 2020-0232). Consent to participate Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s).)

Introduction: For advanced osteoarthritis of the knee and hip, the most clinically effective treatment remains total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Success of these surgeries have traditionally been appraised by economic and volume-based measures. There has been a shift towards the use of patient reported outcome measures (PROMs) to quantify success and guide treatment. The present study provides analysis of three PROMS which have been validated for use in orthopaedic settings; the Oxford Knee Score (OKS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and the EuroQol-Visual Analogue Scale (EQ-VAS) - a non-disease specific measure of health. PROMs were completed pre-operatively, 6-weeks, and 1-year after elective TKA and THA undertaken in 2018 in a public teaching hospital in South Australia. Post-operative satisfaction/dissatisfaction was measured using a 5-point Likert scale and was collected at the same 6-week and 1-year points., Results: PROMs were collected from 285 eligible elective knee-arthroplasty, and 205 elective hip-arthroplasty patients. There was significant average improvement, greater than minimal clinical important differences between pre-operative and 1-year post-operative scores for all three PROMs tools. Inter-PROM correlation was strongest between FJS and OKS at 1-year post TKA (r s = 0.722), and between FJS and OHS in post-THA at the same interval (r s = 0.609). TKA patients with higher pre-surgical 10-year mortality were weakly associated with lower pre-operative OKS score (r s = 0.169). BMI was weakly negatively associated with pre-operative and 6-week post-operative EQ-VAS scores (r s = -0.291 and r s = -0.149 respectively). Post-TKA satisfaction was 77.2% at 1-year, and THA 88.5% at the same interval., Conclusion: This study provides an early insight from the use of the OKS, OHS, the EQ-VAS and the FJS as PROMs in primary TKA and THA at our centre. All PROMs demonstrate significant increase (improvement) at both 6-week and 1-year post-operative intervals, relative to pre-operative scores. The FJS demonstrated good sensitivity. Pre-existing co-morbidities do not appear to have any significant relation with post-operative PROMs collected in this study., Competing Interests: Declarations Ethical approval Ethics approval was provided by application to the Southern Adelaide Local Health Network (SALHN) Office for Research (reference number 329.17). Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Predicting the progression of hip osteoarthritis (OA) remains challenging, and no reliable predictive method has been established. This study aimed to develop an artificial intelligence (AI) model to predict hip OA progression via plain radiographs and patient data and to determine its accuracy., Methods: This retrospective study utilized anteroposterior pelvic radiographs of consecutive patients with hip OA who underwent primary unilateral total hip arthroplasty. Radiographs diagnosed with Kellgren-Lawrence (KL) grade 0-2 were extracted from 361 patients and 1697 images. This AI model was developed to predict whether OA would progress from KL grade 0-2 to KL grade ≥ 3 within n years (n = 3, 4, 5). A gradient-boosting decision tree approach was utilized according to feature extractions obtained by a convolutional neural network from radiographs and patient data (height, body weight, sex, age, and KL grade given by an orthopedic surgeon) with five-fold cross-validation. The model performance was assessed using accuracy, specificity, sensitivity, and the area under the receiver operating characteristic curve (AUC)., Results: The mean accuracy, specificity, sensitivity, and AUC of our prediction model were, respectively, 81.8%, 88.0%, 66.7%, and 0.836 for 3 years; 79.8%, 85.0%, 71.6%, and 0.836 for 4 years; and 78.5%, 80.4%, 76.9%, and 0.846 for 5 years., Conclusions: The proposed AI model performed adequately in predicting hip OA progression and may be clinically applicable with additional datasets and validation., (© 2024. The Author(s).)

Background: The risk of falls causing periprosthetic fracture has become an issue with the increase in the number of patients undergoing long-term follow-up after total hip arthroplasty (THA) and the aging of patients. The Timed Up and Go test (TUG) is utilized to evaluate fall risk. This study investigated muscle volume around the hip joint based on computed tomography (CT), CT value, and muscle strength to investigate contributing factors to poor TUG 1 year post-THA., Methods: This study retrospectively investigated 124 patients with unilateral hip osteoarthritis who underwent THA and classified them based on TUG results at 1 year postoperatively into TUG of < 10 s (fast group [103 patients]) and ≥ 10 s (slow group [21 patients]). Body mass index, the volume and CT density of the psoas major and gluteus medius muscles on CT images, pre- and postoperative hip flexion muscle strength, and hip abductor muscle strength were compared in each group., Results: Age was significantly older and preoperative abductor (fast Group: 1.0 ± 0.3 and slow Group: 0.7 ± 0.3, P = 0.003) and flexion muscle strengths (0.9 ± 0.3 and 0.7 ± 0.3, respectively, P = 0.02) on the healthy side were significantly lower in the slow group. The gluteus medius muscle demonstrated significantly lower CT density in the slow group on both sides. Nominal logistic regression analysis revealed that age and preoperative healthy abductor muscle strength, which are poor factors for TUG 1 year post-THA, were significantly associated with TUG of ≥ 10 s at 1 year post-THA., Conclusions: The poor factors for TUG 1 year after THA were age and preoperative abductor muscle strength on the healthy side., (© 2024. The Author(s).)

Aims: The prevalence of obesity is increasing substantially around the world. Elevated BMI increases the risk of complications following total hip arthroplasty (THA). We sought to evaluate trends in BMI and complication rates of obese patients undergoing primary THA over the last 30 years., Methods: Through our institutional total joint registry, we identified 15,455 primary THAs performed for osteoarthritis from 1990 to 2019. Patients were categorized according to the World Health Organization (WHO) obesity classification and groups were trended over time. Cox proportional hazards regression analysis controlling for confounders was used to investigate the association between year of surgery and two-year risk of any reoperation, any revision, dislocation, periprosthetic joint infection (PJI), venous thromboembolism (VTE), and periprosthetic fracture. Regression was stratified by three separate groups: non-obese; WHO Class I and Class II (BMI 30 to 39 kg/m 2 ); and WHO Class III patients (BMI ≥ 40 kg/m 2 )., Results: There was a significant increase in the proportion of all obesity classes from 1990 to 2019, and the BMI values within each WHO class significantly increased over time. Risk of any reoperation did not change over time among non-obese or WHO Class I/II patients, but increased for WHO Class III patients (hazard ratio (HR) 1.04; p = 0.044). Risk of dislocation decreased over time for non-obese (HR 0.96; p < 0.001) and WHO Class I/II (HR 0.96; p = 0.002) patients, but did not change over time for WHO Class III (HR 0.94; p = 0.073) patients. Risks of any revision and PJI did not change over time for any group., Conclusion: The proportion of patients undergoing THA who are obese has increased dramatically at our institution between 1990 and 2019. Despite BMI values increasing within all WHO classes over time, two-year complication risks have remained stable or decreased in WHO Class I/II patients. However, continued efforts will be required to mitigate risks in the heaviest WHO Class III patients., Competing Interests: The authors received no financial or material support for the research, authorship, and/or publication of this article., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Introduction: Many patients who have undergone a periacetabular osteotomy (PAO) for developmental dysplasia of the hip (DDH) have had jobs preoperatively. Postoperative return to work and work productivity are important for livelihood security and the social economy. However, there is a lack of evidence on work productivity after PAOs. Therefore, this study investigated the return to work rates and influence of workload, clinical, and radiographic parameters on work productivity after a curved PAO., Materials and Methods: In this study, the data of 68 hip joints among 48 participants who underwent curved PAO for symptomatic DDH were analyzed. Correlations between postoperative work productivity and clinical, radiographic, and workload parameters were assessed. Work productivity was evaluated using the Work Productivity and Activity Impairment (WPAI) questionnaire. Clinical factors were assessed using the modified Harris Hip Scores (mHHS) and University of California, Los Angeles Activity scores. Preoperative and postoperative radiographic parameters were compared with postoperative work productivity. The workload was categorized using the Reichsausschuß für Arbeitszeitermittlung (REFA)-classification system., Results: Of the participants, 98% returned to work and 87.5% returned to their original jobs. Work productivity was significantly improved in all workload categories at the 1-year postoperative follow-up. Multivariate analysis demonstrated that preoperative Tönnis and REFA classification grades were significantly associated with the postoperative WPAI., Conclusion: Curved PAOs can improve postoperative work productivity and return to work rates. Preoperative progression of osteoarthritis and heavy workload affect postoperative work productivity., Competing Interests: Declarations. Ethical approval and consent to Participate: The study protocol was approved by our Institutional Review Board on September 8, 2011 (No 1219), and the study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Informed consent for participation in the study was obtained from all participants. Competing interests: The authors declare that they have no competing interests. Conflict of interest: All authors do not have any conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: To consider the inherent respondent burden of PROMs, the HOOS-12 as a shortform of the well-established HOOS questionnaire has been published. While the HOOS-12 has been validated in an initial study, further evaluation in other, non-English speaking cohorts is necessary. We therefore aimed to evaluate responsiveness, convergent construct validity, internal consistency, and floor and ceiling effects of the HOOS-12 in a cross-sectoral german cohort., Materials and Methods: European Quality of Life 5 Dimensions scores and HOOS data of patients undergoing total hip arthroplasty (THA) were used for the analyses. HOOS-12 scores were calculated from the full length HOOS. Statistical analysis was conducted, investigating internal consistency, floor and ceiling effects, convergent and discriminant validity, responsiveness, and known-group comparisons., Results: A ceiling effect was present for postoperative HOOS-12 score and its pain, function and QoL subscales. Internal consistency was high between baseline and all follow ups, inter-item correlation was high (Cronbach's alpha > 0.30) for HOOS-12 score and all subscales. Correlation of HOOS-12 pain with HOOS pain was high (r = 0.9). Correlation of HOOS-12 function with HOOS ADL and HOOS S/R was high (r = 0.89, r = 0.74). Correlation was moderate between HOOS-12 pain and HOOS-12 function with its respective EQ-5D score (r=-0.58, r=-0.59)., Conclusion: The HOOS-12 showed good convergent construct validity and is responsive to changes in pain, function, QoL and hip impact between preoperatively and 1 year postoperatively. A substantial ceiling effect for all subscales at 1 year postoperatively limits the ability to capture variance across particularly well performing patients., Trial Registration: The Trial is registered with the German Clinical Trials Register ( https://www.drks.de ; DRKS00013972; 23 March 23, 2018)., Competing Interests: Declarations. Ethic’s approval and consent to participate: The protocol was approved by the ethics committees of the participating federal states: Rhineland-Palatinate [837.533.17 (11367)], Baden-Wuerttemberg [B-F-2018-042], and Hesse [MC 84/2018]. The protocol is registered with the German Clinical Trials Register (DRKS00013972). Written informed consent was obtained from all patients before enrolment. The PROMISE trial was supported by a grant from the Federal Joint Committee (01NVF16015). Informed consent was obtained from all individual participants included in the study. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s).)

Introduction: Comparative studies evaluating the different material and surface finishing of acetabular components in total hip arthroplasty (THA) are lacking. Using a regional arthroplasty registry, the survival rates and the hazard ratios of different cups in THA performed for primary osteoarthritis were assessed, using endpoints: (1) every cup failure, (2) cup aseptic loosening, (3) periprosthetic infection., Materials and Methods: The inclusion criteria were: residing patients, THA for primary osteoarthritis, Delta-on-Delta bearings, head sizes 32 mm and 36 mm. Only the most implanted cementless cups were considered and were grouped according to material and surface finishing into three cohorts: 3D printed cups (I), ultraporous tantalum or titanium- coated cups (II), second-generation cups (III). 15,737 cups were included in the study: 9,862 cups (62.7%) in cohort I, 2,067 implants (13.1%) in cohort II, 3,808 implants (24.2%) in cohort III., Results: The three cohorts achieved comparable general 10-year survival rates (p = 0.62). In I and II cohorts, the survival rates of the cup types within cohorts were analogous (p = 0.86 and p = 0.31), but not in cohort III (p = 0.004). The hazard ratios for overall failure adjusted for age and sex were similar among the cohorts. Regarding cup aseptic loosening, the three cohorts had similar rates (p = 0.48) and similar adjusted hazard ratios. With periprosthetic hip infection as endpoint, the survival rates and the adjusted hazard ratios of the three cohorts were comparable (p = 0.68)., Conclusions: 3D printed cups provided similar 10-year outcomes compared to ultraporous cups and second-generation cups, with no additional risks of aseptic loosening and infection., Level of Evidence: IV (therapeutic study)., Take Home Message: - 3D printed cups provided similar 10-year outcomes compared to ultraporous cups and second-generation cups. - There is no additional risks of aseptic loosening and infection., Competing Interests: Declarations. Ethical review committee statement: Institutional board review was waived, as registry collects data as a standard practice and using data anonymization. Location statement: The study was performed at IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. Conflict of interest: The authors received no financial or material support for the research, authorship, and/or publication of this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: In a previous study we have shown that a cemented vitamin E-doped highly cross-linked polyethylene (VEPE) compared to a conventional polyethylene cup in total hip arthroplasty (THA) has a slightly higher proximal migration but significantly lower wear rates up to 2 years after surgery. In this follow-up study we investigated the same cohort at 6 years., Methods: This was a double-blinded, non-inferiority, randomised controlled trial on patients with osteoarthritis, with a mean age of 66 years. Patients were randomly assigned to receive either the conventional polyethylene cup or the VEPE cup in a 1:1 ratio. The primary endpoint was proximal implant migration of the cup measured with radiostereometric analysis (RSA). Secondary endpoints included wear rate of the cup and patient-reported outcome measurements (PROM)., Results: At the 6-year follow-up, 25 patients (11 controls, 14 VEPE) were available for RSA measurements, and we found no statistically significant difference in proximal migration between the VEPE and control groups. The wear rate was significantly lower in the VEPE group compared to controls, 0.03 mm/year and 0.07 mm/year, respectively with a mean difference 0.04 mm, (95% CI, 0.02-0.06 mm). There were no cup revisions and no difference in PROM between the groups., Conclusions: Based on our 6-year results, the VEPE group exhibited no statistical or clinically relevant difference compared to the control group, and the wear rate was significantly lower in the VEPE group. The use of a cemented vitamin E-doped highly cross-linked cup is a good option in total hip arthroplasty., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The growing adoption of robotic-assistance during total hip arthroplasty (THA) has provided novel means through which a patient's anatomy and dynamic spinopelvic relationship can be incorporated into surgical planning. However, the impact of enhanced technologies on intraoperative decision-making and changes to component positioning has not yet been described., Methods: A multicentre, prospective study included 105 patients (52% women) patients who underwent robotic-assisted THA with the integration of software that incorporates a patient's pelvic tilt (PT) and virtual range-of-motion (VROM) for impingement modeling. The primary outcome of the study was the percentage of patients who underwent changes to the preoperative plan for cup position after incorporating the data from the software., Results: Utilising the intraoperative VROM information, the preoperative plan for cup position was changed from the default (40° inclination and 20° anteversion) in 82/105 (78%) cases. When stratifying by spinopelvic mobility, 64% were considered normal (change ⩾ 10° and ⩽30°), 27% were stiff (change < 10°), and 9% were hypermobile (change > 30°). For all cohorts, the majority of cases (78%) deviated from the 40° inclination and 20° version target. When evaluating the proportion of cases within the Lewinnek and Callanan safe zones based on spinopelvic mobility, 19% of cases within the normal group were planned outside of both zones compared to 39% of stiff cases and 10% of hypermobile cases., Conclusions: Utilising the latest version of robotic-assisted THA software, the preoperative plan for cup position was changed in the vast majority (78%) of patients, causing substantial deviations from traditional, generic cup targets., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Objective and subjective outcomes in the direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty (THA) were assessed in this study, using the Oxford Hip Score (OHS) as primary outcome. Pain, 3 objective performance-based tests, surgical time, blood loss and length of stay were assessed as secondary outcomes., Methods: Patients with primary end-stage osteoarthritis were prospectively enrolled by shared decision making for the DAA (32 patients) or PA (26 patients). Baseline data were collected preoperatively and outcomes postoperatively at 2-, 6-, 9- and 12-month follow-up., Results: There is no significant difference (p  < 0.05) between the DAA and PA on primary outcome (OHS). There was a main effect of time which indicated an increase of OHS over time independent of group (p  < 0.01)., Conclusions: In the current study, no significant differences in postoperative functional outcome were found between DAA and PA in all follow-up moments., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Many patients suffer from osteoarthritis (OA) in multiple joints, possibly resulting in multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (C in ) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients., Methods: Primary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year C in (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression., Results: A total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year C in for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year C in for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small., Conclusions: The 10-year C in showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Plain radiographs remain the standard for diagnosing osteoarthritis (OA). Total hip arthroplasty (THA) is generally offered only for advanced OA by plain radiographs. Advanced imaging is used as an adjunct to assess OA severity in cases of progressive symptoms with less advanced OA by plain radiographs. The objective of this study was to compare outcomes following THA in patients who have advanced OA visualized by plain radiographs to patients who have less severe OA visualized by plain radiographs., Methods: From February 2016 to February 2020, 93 patients who had Kellgren-Lawrence (KL) grade 0 to 2 OA and underwent THA were identified. The median age was 65 years, and 55% were women. They were matched 1:3 to patients who underwent THA for KL 4 OA based on age, sex, body mass index, and Charlson Comorbidity Index. The primary outcome was achievement of the Hip Injury and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) minimum clinically important difference, substantial clinical benefit, and patient-acceptable symptom state at 1 year postoperatively., Results: There was no difference between the KL 0 to 2 and KL 4 cohorts in the achievement of HOOS JR minimum clinically important difference (86 versus 85.6%, P = .922), substantial clinical benefit (81.7 versus 80.2%, P = .751), or patient-acceptable symptom state (89.2 versus 85.6%, P = .374). The KL 0 to 2 cohort had a similar improvement in their 2-year HOOS JR (42.5 versus 38.6, P = .019)., Conclusions: In this series, there was no difference in outcomes following primary THA between patients who have severe OA on plain radiographs (KL 4) compared to those who have less severe OA (KL 0 to 2). In the setting of severe symptoms and the absence of advanced OA on radiographs, advanced imaging can be used to guide treatment and select patients who could benefit from THA., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic HRA in an international multicenter cohort., Methods: Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMs) in the form of the Forgotten Joint Score, Hip Disability and Osteoarthritis Outcome Score Jr., Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, and University of California, Los Angeles, Activity Score were collected preoperatively, and at 1 and 2 years postoperation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation., Results: The study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMs follow-up at 2 years. There was a significant improvement in Hip Disability and Osteoarthritis Outcome Score (P < .001) and Oxford Hip Score (P < .001) between the preoperative, 1-year, and 2-year outcomes. Patients had improved activity scores on the University of California, Los Angeles, Active Score (P < .001), with 45% reporting a return to high-impact activity at 2 years. At 1 and 2 years, the Forgotten Joint Score was not significantly different (P = .38). There was no migration, osteolysis, or loosening of any of the implants. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, 1 for unexplained pain at 3 months due to acetabular component malposition and 1 at 33.5 months for acetabular implant failure., Conclusions: The ceramic-on-ceramic resurfacing at 2 years postoperation demonstrates promising results with satisfactory outcomes in all recorded PROMs. Further long-term data are needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Understanding the gait pattern of patients eligible for total hip arthroplasty (THA) due to hip osteoarthritis (OA) offers valuable information for improving locomotive syndrome (LS). This study aims to measure the gait patterns of THA-eligible patients using an optical motion capture system and to analyze these patterns using principal component analysis (PCA). Additionally, this study examines the relationship between THA-induced gait patterns and LS., Methods: This before-after study included 237 patients who underwent unilateral primary THA due to hip OA. The primary outcome measures were spatiotemporal gait parameters. Secondary outcome measures included three LS risk tests: a stand-up test, a two-step test, a 25-question Geriatric Locomotive Function Scale (GLFS-25), and total clinical decision limits stages. PCA was performed using 16 spatiotemporal gait parameters collected before and three months after THA. Principal components (PC) were selected to achieve a cumulative contribution rate of 90% (0.9) or higher. Each summarized PC was compared using a paired t -test before and three months after THA. Furthermore, multiple regression analysis was conducted to determine how changes in each PC between before and three months after THA related to changes in the four LS evaluation items., Results: PCA identified three principal components (PC1, PC2, PC3) that accounted for a cumulative contribution rate of 0.910 using 16 spatiotemporal gait parameters. When comparing before and three months after THA for all three PCs, significant differences were observed in each PC ( p  < 0.001), with overall walking ability and stance phase being higher three months after THA than before THA, while the asymmetry of support time was lower three months after THA. The results of multiple regression analysis revealed that PC1, PC2, and PC3 were the most influential factors in total clinical decision limits stage. For each LS risk test, the factors related to the stand-up test were identified as PC1, PC2, and PC3, while the factors related to the two-step test were identified as PC1 and PC2. The factors related to the GLFS-25 were also identified as PC1 and PC2., Conclusions: The most important findings of this study indicate that the three PCs represent over 90% of the 16 spatiotemporal gait parameters, which are associated with total clinical decision limits stage and LS risk tests. The present results suggest that PC1 represents overall walking ability, PC2 represents the stance phase, and PC3 represents asymmetry of support time. Gait pattern characteristics, such as overall walking ability, stance phase, and asymmetry of support time, were clearly defined by these PCs. Regarding the relationship between PC and LS, all three PCs are related to total clinical decision limits stage. In addition, PC1 and PC2 related to all three LS risk tests, and PC3 related only to the stand-up test., Competing Interests: The authors declare there are no competing interests., (©2024 Miyazaki et al.)

Introduction: Symptomatic hip osteoarthritis (OA) causes significant morbidity and functional limitations. While corticosteroid injections (CSI) are commonly offered and administered for OA pain relief, it is unknown if they offer any clinically meaningful long-term benefit or reduce the overall need for surgical intervention., Methods: A cross-sectional retrospective cohort study was performed on primary hip osteoarthritis patients from a single academic tertiary-care center arthroplasty clinic from 2014 to 2019. Patients were divided into three groups. CSI + THA: hip CSI patients who underwent subsequent ipsilateral THA. CSI-noTHA: hip CSI who have not had ipsilateral THA to date. THA-noCSI: a control group of consecutive hip OA patients who underwent primary THA without prior CSI. Demographic variables, injection relief duration, and radiographic arthritis severity were recorded. Time from clinic presentation to injection and/or THA were compared., Results: 357 patients met inclusion criteria and underwent guided, arthroplasty provider-ordered CSI. Mean duration of relief was 6.7 weeks (SD 8.7). 244 injection patients (67.2%) subsequently underwent THA (CSI + THA). 150 of 390 patients have not undergone THA at mean of 25.5 months follow-up. Mean time from clinic presentation to THA was 8.6 months longer after CSI (16.3, SD 17.8) months in CSI patients compared to 7.7 (SD 10.6) months for patients without CSI (p < 0.001). Of 117 patients in the CSI-noTHA group at mean 25 months follow-up, only 43 (12% of all injection patients) had not had THA because they found injections effective. The remaining 74 (63%) of CSI-noTHA patients have been deemed medically unfit for surgery or are currently scheduled for THA., Discussion/conclusion: The results of this study suggest the utilization of intra-articular CSI as conservative treatment in an arthroplasty clinic does not prolong time to THA for a clinically important duration. The use of CSI should be reserved for diagnostic purposes and/or short-term pain relief in poor surgical candidates., Level of Evidence: III., (© 2024. The Author(s).)

Background: The commonly used ('legacy') PROMs evaluating outcomes of total hip arthroplasty (THA), have several limitations regarding their measurement properties and interpretation of scores. One innovation in PROMs is the use of Computerized Adaptive Testing (CAT). The Patient-Reported Outcomes Measurement Information System (PROMIS ® ) is a validated system of CATs. The aim of this study was to assess the measurement properties of PROMIS and legacy instruments in patients undergoing THA., Methodology: Patients in this multicenter study filled out a questionnaire twice, including Dutch-Flemish PROMIS v1.2 Physical Function (PROMIS-PF) and v1.1 Pain Interference (PROMIS-PI) CATs and short forms, PROMIS v1.0 Pain Intensity, and legacy PROMs (Hip disability and Osteoarthritis Outcome Score (HOOS), HOOS-Physical function Shortform (HOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), and two numeric rating scales measuring pain). The reliability, measurement precision (Standard Error of Measurement (SEM)), smallest detectable change (SDC), and burden of PROMIS instruments were presented head-to-head to legacy PROMs. Furthermore, construct validity was assessed., Results: 208 patients were included. All instruments had a sufficient test-retest reliability (range ICC: 0.83-0.96). The SEM of PROMIS CATs and short forms ranged from 1.8 to 2.2 T-score points, the SEM of legacy instruments 2.6-11.1. The SDC of PROMIS instruments ranged from 2.1 to 7.3 T-score points, the SDC of legacy instruments 7.2-30.9. The construct validity of PROMIS CAT and short forms were found sufficient, except for the PROMIS-PI short form. The burden of PROMIS CATs was smaller than PROMIS short forms (range 4.8-5.2 versus 8-20 items, respectively). The burden of legacy instruments measuring physical functioning ranged from 5 to 40 items., Conclusions: The PROMIS-PF is less burdensome, with high measurement precision, and almost no minimal or maximal scores, and an equal reliability compared to legacy instruments measuring physical functioning in patients undergoing THA. The PROMIS Pain Intensity 1a is comparable to the legacy pain instruments in terms of burden, reliability and SDC. Measuring the construct Pain Interference may not have additional value in this population because of its high correlation with instruments measuring physical functioning. The SDC values presented in this study can be used for individual patient monitoring., (© 2024. The Author(s).)

Osteopetrosis is a rare metabolic bone disease, characterized by dysfunction of osteoclasts, resulting in increased bone density and brittleness leading to pathological fractures and bone deformities. Hip and knee osteoarthritis (OA) are common long-term complications in patients with osteopetrosis. Joint arthroplasty surgery remains an effective and recommended treatment for these patients with an end-stage OA because it provides favorable outcomes. However, in osteopetrosis, joint arthroplasty surgery carries an increased risk of complications, and specific preoperative and perioperative considerations are required to deal with the technical challenges related to the disease. The aim of this article was to review some of the key aspects of osteopetrosis, provide technical recommendations, and answer clinically relevant questions related to hip and knee arthroplasty surgery., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background and Purpose:  Metabolic syndrome (MetS) affects more than 60% of the patients having a hip or knee arthroplasty due to osteoarthritis. As it is debated whether metabolic syndrome increases the risk of complications, we aimed to investigate the length of stay (LOS) and risk of readmission at 30 and 90 days after surgery, including causes of readmission., Methods:  We conducted a prospective cohort study of 2,901 patients undergoing hip and knee arthroplasty from May 2017 to November 2019. Physical examination, blood samples, and medical history from national registries determined the diagnosis of metabolic syndrome from the International Diabetes Federation definition. We used multivariate linear regression to investigate differences in LOS according to MetS, and binary regression to investigate the risk and causes of readmission within 30 and 90 days, including 95% confidence intervals (CI) and P values., Results:  Patients with MetS showed a slightly longer LOS (0.20 days, CI 0.10-0.29) and had an increased risk of readmission within 90 days (adjusted relative risk [RR] 1.2, CI 1.0-1.4; P = 0.02), but not within 30 days (adjusted RR 1.1, CI 0.9-1.4; P = 0.3) after surgery. Cardiovascular disease was the dominant cause of readmission., Conclusion: Although patients with MetS do not experience a clinically relevant longer LOS after hip and knee arthroplasty, they have an increased risk of 90-day readmission mainly due to cardiovascular complications, which should be considered when planning surgical care in this group of patients.

Background: The aim of this study was to analyze the influence of the positioning of the components of total hip arthroplasty (THA) evaluated by the acetabular anteversion (AA) and femoral anteversion (FA) angle on postoperative gait in patients with symptomatic hip osteoarthritis secondary to hip dysplasia undergoing THA., Methods: Between May 2023 and May 2024, patients with symptomatic hip osteoarthritis secondary to hip dysplasia (Crowe Type I and IV) who underwent THA were enrolled in the study. The AA angle and FA angle were measured by computer tomography (CT). Gait data were determined by using the Dynamic Right Gait & Posture analysis system. The relationship between FA, AA and gait data was analyzed by Pearson correlation test, subgroup Pearson correlation test, multiple linear regression., Results: A total of 40 patients (45hips) were included in the study. Compared with preoperative, the patient's postoperative foot progression angle, foot contact angle, plantarflexion velocity, swing foot speed, gait velocity, cadence, stride length were significantly improved. Preoperative FA is significantly different from postoperative FA (P < 0.05), while the difference between preoperative and postoperative AA is not significant. BMI, Crowe Type, AA were related to change of cadence. The less the postoperative AA of patients, and the more the cadence in the postoperative gait of patients., Conclusion: Our study showed that THA could improve the gait function of patients with symptomatic hip osteoarthritis secondary to hip dysplasia. Adjusting AA lower could obtain a much more postoperative cadence., (© 2024. The Author(s).)

Introduction: The Patient Activity Treatment Outcome Scale (PATOS) is a novel patient-reported outcome measure (PROM). This study explored patients' and orthopaedic surgeons' experiences with PATOS as part of a PROM battery. It aimed to investigate its influence on patient involvement and healthcare decisions about knee or hip osteoarthritis patients scheduled for knee/hip arthroplasty., Methods: A qualitative research design was adopted using semi-structured interviews with 19 patients and nine orthopaedic surgeons at a Danish orthopaedic surgery department. Thematic analysis was used to develop key themes from interview transcripts., Results: This study adds nuanced insights related to the use of PROMs in routine orthopaedic clinical practice. Home-based completion of PROMs prompted patients to reflect on their situations, priorities and goals regarding potential hip or knee arthroplasty, leading to better-prepared discussions with surgeons. The integration of PATOS with other PROMs made it challenging to discuss PATOS exclusively. Therefore, the results relate to the full PROM battery. The experiences of patients and surgeons were organised into four themes: 1) Patient involvement is key, 2) Questionnaire load, 3) Meaningful home-based completion and 4) PROMs were not used in the decision-making process., Conclusions: The questionnaire load and limited integration into healthcare decision processes raised concerns about the application of the PROM battery. The results emphasise the importance of refining the application of PROMs in orthopaedic practice from the perspectives of patients and surgeons alike., Funding: This work was supported by Innovation Fund Denmark [0172-01258B] TRIAL REGISTRATION. Not relevant., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Objective: Regaining hip and knee muscle strength is important after total hip arthroplasty (THA). However, it is unclear if muscles other than those of the operated hip also lose strength. This study aimed to identify deficits in hip and knee strength on the surgical and nonsurgical sides in female patients up to 12 months after THA., Methods: Participants were 91 female patients who had hip osteoarthritis and underwent unilateral THA. Forty-six community-dwelling women who were asymptomatic were selected as control participants. Patients with locomotor disorders or postsurgical complications were excluded. Maximal isometric strength of the hip flexors, extensors, and abductors and knee extensors and flexors on the surgical and nonsurgical sides were measured before THA and 3, 6, and 12 months thereafter., Results: Twelve months after THA, hip flexion, extension, and abduction strength on the surgical side were 84.6%, 83.5%, and 76.2%, respectively, of those in individuals who were asymptomatic; at the same time point, those on the nonsurgical side were 94.8%, 83.9%, and 79.4%, respectively. Knee extension strength on the surgical side was 89.3% of that in individuals who were asymptomatic. Compared to individuals who were asymptomatic, nearly all muscles showed significantly lower strength on both sides up to 6 months after THA., Conclusion: At 12 months after THA, hip and knee strength on both the surgical and nonsurgical sides did not recover to the level observed in individuals who were asymptomatic. In particular, hip abductor strength on the surgical and nonsurgical sides were 76% and 79%, respectively, of that in individuals who were asymptomatic., Impact: At 12 months after THA, hip and knee strength on the surgical and nonsurgical sides did not recover to the level observed in individuals who were asymptomatic, suggesting that the nonsurgical side may be inappropriate as a control to assess strength recovery on the surgical side., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To evaluate patients' functional outcomes after total hip arthroplasty through a direct lateral approach., Methods: The prospective, observational, descriptive study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from May 2019 to June 2020, and comprised patients aged 28-81 years having advanced osteoarthritis and avascular necrosis who underwent cementless total hip arthroplasty. The patients were followed up for 6 months. Outcome was assessed using the Harris hip score, Trendelenburg sign, post-operative hip dislocation, post-operative infection, and heterotopic ossifications. Data was analysed using Excel version 2019., Results: Of the 30 patients, 14(47%) were males and 16(53%) were females. The overall mean age was 49.8±15.28 years. The mean pre-operative Harris hip score was 43.166±8.27, while it was 83.566±3.83 post-operatively (p<0.001). There was 1(3.33%) case of heterotopic ossification, 3(10%) had Trendelenburg sign. There was no case of postoperative hip dislocation or infection., Conclusions: The lateral hip approach was found to be associated with good post-operative hip stability and good post-operative functional outcome with low post-operative risk of infection.

Aims: The influence of metabolic syndrome (MetS) on the outcome after hip and knee arthroplasty is debated. We aimed to investigate the change in patient-reported outcome measure (PROM) scores after hip and knee arthroplasty, comparing patients with and without MetS., Methods: From 1 May 2017 to 30 November 2019, a prospective cohort of 2,586 patients undergoing elective unilateral hip and knee arthroplasty was established in Denmark. Data from national registries and a local database were used to determine the presence of MetS. Patients' scores on Oxford Hip Score (OHS) or Oxford Knee Score (OKS), EuroQol five-dimension five-level questionnaire (EQ-5D-5L), University of California, Los Angeles (UCLA) Activity Scale, and Forgotten Joint Score (FJS) at baseline, three, 12, and 24 months after surgery were collected. Primary outcome was the difference between groups from baseline to 12 months in OHS and OKS. Secondary outcomes were scores of OHS and OKS at three and 24 months and EQ-5D-5L, UCLA Activity Scale, and FJS at three, 12, and 24 months after surgery. Generalized linear mixed model was applied, adjusting for age, sex, Charlson Comorbidity Index, and smoking to present marginal mean and associated 95% CIs., Results: A total of 62.3% (1,611/2,586) of the cohort met the criteria for MetS. Both groups showed similar increase in mean OHS (MetS group 22.5 (95% CI 21.8 to 23.1), non-MetS group 22.1 (21.3 to 22.8); p = 0.477) and mean OKS (MetS group 18.0 (17.4 to 18.6), non-MetS group 17.8 (17.0 to 18.7); p = 0.722) at 12 months' follow-up. Between groups, similar improvements were seen for OHS and OKS at three and 24 months postoperatively and for the mean EQ-5D-5L, EuroQol-visual analogue scale (EQ-VAS), UCLA Activity Scale, and FJS at every timepoint., Conclusion: Patients meeting the criteria for MetS obtain the same improvement in PROM scores as individuals without MetS up to 24 months after hip and knee arthroplasty. This is important for the clinician to take into account when assessing and advising patients with MetS., Competing Interests: None declared., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

This article addresses the challenges surrounding hip and knee osteoarthritis (OA) treatment in Jehovah's Witnesses (JWs), focusing on the complexities arising from their refusal of blood products and transfusions. Acknowledging the heightened risk of blood loss anemia during joint replacement surgery, this review explores documented strategies that enable safe elective joint arthroplasty in JW patients, emphasizing comparable initial diagnostic methods and non-operative treatments up until the pre-operative stage. Special considerations should be taken in the perioperative and intraoperative stage. Despite these challenges, safe arthroplasty is feasible with satisfactory outcomes through a combination of careful preoperative optimization, blood saving protocols, and cultural sensitivity., Competing Interests: Disclosure R. Schwarzkopf- AAOS: Board or committee member; American Association of Hip and Knee Surgeons: Board or committee member; Arthroplasty Today: Editorial or governing board; Gauss surgical: Stock or stock Options; Intelijoint: Paid consultant, Stock or stock Options; Journal of Arthroplasty: Editorial or governing board; PSI: Stock or stock Options; Smith & Nephew, United Kingdom: IP royalties, Paid consultant, Research support; Zimmer: Paid consultant. C.M. Lajam- AAOS: Board or committee member; American Association of Hip and Knee Surgeons: Board or committee member; Clinical Orthopaedics and Related Research: Editorial or governing board; Elsevier: Publishing royalties, financial or material support; FundamentalVR: Unpaid consultant; HJD Bulletin: Editorial or governing board; Journal of Arthroplasty: Editorial or governing board. C. Cardillo, B.C. Schaffler, K. Lehane, and A.A. Habibi have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to investigate the influence of sex on patients undergoing total hip arthroplasty (THA) for hip osteoarthritis (HOA), aiming to assess the clinical and functional outcomes using patient-reported outcome measures (PROMs)., Methods: A retrospective analysis of patients undergoing THA at Ospedale Galeazzi-Sant'Ambrogio between 2016 and 2022 was conducted. Inclusion criteria encompassed Kellgren-Lawrence grade III or IV HOA, with preoperative and 12-month postoperative PROMs. Enroled patients have been selected from a larger cohort without matching design for confounders. The analyses were performed using R software v4.0.3 (R Core Team) and data distributions were assessed using the Shapiro-Wilk normality test., Results: One hundred ninety patients (72 male and 118 female) who had both preoperative and postoperative PROMs have been analysed from our institutional prosthesis registry (Datareg). Baseline and 12-month post-THA PROMs showed significant improvements overall. VAS score dropped notably from baseline to 3 months postsurgery (7.1 ± 2.1 vs. 0.9 ± 1.7). Functional and mental PROMs, including Harris Hip Score-functional (HHS-F), Harris Hip Score-total (HHS-t), SF-12PS and SF-12MS, exhibited substantial improvements post-THA. Stratifying by sex, males had lower baseline VAS, higher HHS-F, SF-12MS and hip disability and osteoarthritis outcome score-physical function short form (HOOS-PS). At 12 months, males displayed significantly better VAS, HHS-F, SF-12PS and HOOS-PS scores. Complication rates were minimal (1.5%), with stable rates across genders, mostly involving dislocation and periprosthetic fractures. Implant survival at 12 months reached an impressive 99%., Conclusion: THA remains an effective treatment for severe HOA. However, females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. This difference could be attributed to physiological and psychosocial factors associated with sex, including hormonal changes, muscle mass decline and perception of pain. Longer follow-ups and prospective studies are necessary to validate these findings and facilitate personalised approaches in HOA treatment, emphasising the need for careful consideration of sex-related variables in clinical decision-making for THA patients., Level of Evidence: Level III., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Developmental dysplasia of the hip (DDH) is one of the principal causes of secondary hip osteoarthritis, giving rise to considerable pain, impaired mobility, and a reduced quality of life. The optimal approach to managing individuals who have Crowe type IV DDH remains controversial. This study aimed to review the existing literature on the application of total hip arthroplasty (THA) as a treatment modality for Crowe type IV DDH, assessing its efficacy in addressing this severe hip deformity., Methods: A comprehensive search across the PubMed, Scopus, and Web of Science databases identified relevant studies. Inclusion criteria encompassed investigations reporting outcomes of THA in Crowe type IV DDH patients. Data extraction and quality assessment were performed independently by 2 reviewers. Utilizing R software, the prevalence of THA complications was analyzed through proportion analysis, employing the inverse variance method., Results: In this systematic review, a total of 74 studies were included, comprising a collective sample size of 2,829 patients (3,356 hips) diagnosed with Crowe type IV DDH. The posterior or posterolateral approach was the most commonly utilized surgical approach, followed by the lateral Hardinge and direct lateral approaches. The majority of studies have employed subtrochanteric osteotomies. Notably, post-THA, leg length discrepancy decreased, Trendelenburg sign resolved, and back pain was reduced. Patient-reported outcome measures like the Harris Hip Score improved significantly. The pooled prevalence rates of major postoperative complications were also assessed, including dislocation (7.2%), revision (8.7%), intraoperative fractures (10.5%), loosening (5.7%), nerve paralysis (5.6%), deep vein thrombosis (3.6%), infection (3.8%), heterotopic ossification grade 2 and above (6.1%), and a complicated patient rate of 11.0%., Conclusions: Synthesizing diverse study data, an overview of THAs performance emerges, demonstrating significant enhancements in function, pain reduction, quality of life, and the correction of substantial leg length discrepancy. While THA has shown positive outcomes, instances of complications have been reported. The decision to undergo THA should involve a collaborative assessment between the surgeon and the patient, considering potential benefits and complications., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Total hip arthroplasty (THA) is the gold standard in the treatment of advanced hip osteoarthritis. However, hip resurfacing (HR) arthroplasty may present a viable alternative. The aim of this study was to compare complications, implant survivorship, and functional outcomes between HR and THA, to assess HR as a valid and safe alternative to THA., Methods: Inclusion criteria were randomized clinical trials (RCTs) published in English, comparing clinical outcomes and complications between HR and THA. A systematic review of the literature was performed on PubMed, Scopus and Cochrane Library, following the PRISMA 2020 statement, from January 1, 2015 to November 30, 2023. A meta-analysis was performed by Review Manager (RevMan) software version 5.4 to compare the rates of revisions, dislocations, infection, aseptic loosening and pseudotumor, and the clinical outcomes between the two groups. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the risk of bias., Results: A total of 8 RCT were included, involving 844 patients (387 hips for HR group and 469 hips for THA group). The mean follow-up was 7.72 years. There were no statistically significant differences between the two groups for UCLA and WOMAC score, revision rate, infection, aseptic loosening and pseudotumor (all p > 0.05), while the dislocation rate was significantly lower in the HR group (p = 0.04)., Conclusions: HR is a safe and effective alternative to THA. However, several factors are involved to reduce the complication rate and achieve high implant survival., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Background: Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA., Hypothesis: An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements., Materials and Methods: Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification)., Results: Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8±1.6 (0 to 5.67), 0.9±0.7 (0 to 2.67), and 0.4±0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with p-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC=0.628-0.955). High-grade osteoarthritis did not impact image sizing in any modality (r=0.08-0.22, all p>0.05)., Discussion: CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements., Level of Evidence: III; retrospective comparative diagnostic study., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: The impact of bone deformities, previous surgeries, and the surgical technique in total hip arthroplasty (THA) for congenital dislocation of the hip (CDH) at a long-term has not been clearly defined yet. In this single-centre observational study we sought to assess patients undergoing THA due to osteoarthritis secondary to severe CDH with low or high dislocation ten- to 20-years after surgery. To determine this purpose, we assessed: (1) THA-related complications and reoperations; (2) the clinical outcome, patients' satisfaction and radiological results; and (3) the possible risk factors for reoperation with particular attention to the surgical technique and the influence of prior surgeries., Hypothesis: We hypothesized that an anatomical reconstruction of the hip would decrease the reoperations rates in patients undergoing THA with severe CDH., Methods: Seventy-five patients (85 hips) operated between 1999 and 2012 at our large tertiary hospital were analyzed. Fifty-six hips were diagnosed as low dislocation (group 1) and 29 hips as high dislocation (group 2). The existence of prior surgeries was frequent: group 1, pelvic osteotomies 6 hips, femoral osteotomies 7, tectoplasty (shelf) 6, resection arthroplasty 1 and lowering of the greater trochanter 1; group 2 included pelvic osteotomies 10 hips, femoral osteotomies 10, and a femoral lengthening 2. The number of additional procedures during THA was: group 1 (19/56 [34%]), acetabular roof bone autograft 8 hips, acetabular medial wall autograft 2, hardware removal 6, extended femoral osteotomy 2, and a femoral shortening 1; group 2 (20/29 [69%]), acetabular bone autograft 12 hips, medial autograft 1, hardware removal 1, extended femoral osteotomy 2, and a femoral shortening 4 hips. The clinical and the radiological analysis were compared in both groups for a minimum follow-up of ten years. Cox regression models were used to detect risk factors for reoperation., Results: Nine patients (13.8%) required reoperation for the following reasons: cup loosening (5 hips), periprosthetic femoral fracture (3) and stem loosening (1); seven had prior surgeries. The 12-year survival rate for reoperation for any reason was 96.3% (95% confidence interval [CI] 91.2-100) in group 1 and 75.7% (95% CI, 65.8-90.8) in group 2 (p=0.003). Patients with high dislocation (p=0.02, hazard ratio [HR]: 6.25, 95% CI, 1.26-30.9) and those with an acetabular component inclination placed out of the target zone between 35° and 50° (p=0.03, HR: 4.27, 95% CI, 1.13-16.1) had a higher risk of reoperation., Discussion: An optimal placement of the acetabular component decreased the reoperation rates in patients undergoing THA for severe CDH. Hips with high dislocation and the existence of prior surgery can affect THA implantation., Level of Evidence: III; retrospective; comparative., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Research has suggested that glucagon-like peptide-1 receptor agonists (GLP-1-RAs) may have therapeutic effects on osteoarthritis of the hip and knee, in addition to managing diabetes and obesity. However, there is a lack of understanding regarding the association between GLP-1-RA use and the diagnosis of osteoarthritis (OA) of the hip and knee., Methods: A collaborative network analytics platform was queried for obese diabetic (n = 1,094,198), obese nondiabetic (n = 916,235), and nonobese diabetic (n = 157,305) patients who had an index visit between 2015 and 2017. Patients who had pre-existing hip and/or knee OA were excluded. A 1:1 propensity score matching was used to balance GLP-1-RA use in stratified cohorts for age, sex, race, body mass index, and hemoglobin A1c. The primary outcomes were rates of progression to hip OA, knee OA, major joint injections, total hip arthroplasty, and total knee arthroplasty. Cox proportional hazards models determined hazard ratios (HRs) between cohorts prescribed and not prescribed GLP-1-RAs., Results: All patients had a five-year follow-up. Rates of progression to hip and knee OA were higher among the GLP-1-RA users in both obese diabetic (hip HR: 1.63, 95% confidence interval [CI]: 1.46 to 1.82; knee HR: 1.52, CI: 1.41 to 1.64) and nonobese diabetic (hip HR: 1.78, CI: 1.50 to 2.10; knee HR: 1.58, CI: 1.39 to 1.80) cohorts. These diabetic cohorts received higher rates of major joint injections, though there was no difference in rates of total hip arthroplasty or total knee arthroplasty. No differences in five-year outcomes were seen when comparing obese, nondiabetic patients who were prescribed GLP-1-RAs with obese, nondiabetic patients not exposed to GLP-1-RAs., Conclusions: This five-year analysis found a greater risk of progression to hip and knee OA among obese and non-obese diabetic GLP-1-RA users. Further studies should explore GLP-1-RA effects upon glucose management, weight loss, and lower extremity arthritis development., Level of Evidence: III, retrospective cohort study., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Total hip arthroplasty (THA) is a common procedure that requires consideration of preexisting comorbidities. Factor V Leiden (FVL), an inherited thrombophilia, is one such condition that predisposes patients to venous thromboembolism (VTE, deep vein thrombosis, and pulmonary embolism). The present study aimed to characterize the risks associated with FVL patients undergoing THA and evaluate the effect of VTE chemoprophylactic agents on these risks., Methods: A total of 544,022 adult patients who underwent primary THA for osteoarthritis indications between 2010 and October 2021 were identified in an administrative claims database. Of these, FVL was identified in 1,138 (0.21%). Patients who had and did not have FVL were matched at a 1:4 ratio (1,131 with FVL and 4,519 without FVL) based on age, sex, and Elixhauser comorbidity index. Univariable and multivariable analyses were assessed for 90-day complications. Implant survival at 5 years was assessed and compared with log-rank tests. The relative use of different chemoprophylactic agents, including aspirin, warfarin, heparin, or direct oral anticoagulant (DOAC), was assessed. Bleeding events and VTE were compared for those prescribed either aspirin or warfarin, heparin, or DOAC. A Bonferroni correction was applied., Results: On multivariable analysis, FVL patients were found to have increased odds of 90-day deep vein thrombosis (odds ratio (OR) = 9.20), pulmonary embolism (OR = 6.89), and aggregated severe and all adverse events (OR = 4.74 and 1.98, respectively), but not elevated risk of other perioperative adverse events or 5-year reoperations. More potent chemoprophylactic agents (warfarin, heparin, DOAC) reduced, but did not completely eliminate, the increased VTE risks (without increasing bleeding events)., Conclusions: This study quantified the significantly elevated VTE risk associated with FVL patients undergoing THA. The lack of difference in other specific adverse events and 5-year reoperations is reassuring. Clearly, chemoprophylactic agents are important in this population and may need further attention., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Total joint arthroplasty (TJA) is one of the most common surgeries performed in the United States and is a durable and effective option in managing osteoarthritis of the hip and knee. Recent research regarding the procedure has focused on preoperative optimization and weight loss in particular. Obesity has been shown in prior studies to increase risks associated with TJA, and, as a result, debate has focused on whether a body mass index (BMI) cutoff is a prudent tool for preoperative optimization. This article discusses the ethical dilemma of instituting a BMI cutoff and reviews current literature regarding the topic., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The purpose of the study was to gain insight into how clinically relevant improvement in patient-reported outcome measure scores after total hip arthroplasty (THA) and total knee arthroplasty (TKA) may be underestimated or overestimated, we compared patient-reported outcome measure respondents and nonrespondents on their adverse event rates and assessed whether adverse event occurrence was associated with clinically relevant patient-reported outcome measure improvement from those without adverse events., Methods: All primary THAs and TKAs performed in 19 Dutch hospitals between January 2017 and December 2019 were included. The hip disability and osteoarthritis outcome score-physical function short form (HOOS-PS) and knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS) were used to assess the physical function after THA and TKA, respectively. Adverse events included 1-year revision, 30-day readmission, 30-day complications, and long (ie, >75th percentile) length of stay. A clinically relevant improvement was defined as at least a 10-point decrease in HOOS-PS and 9 points in KOOS-PS scores. Associations between adverse events and clinically relevant HOOS-PS and KOOS-PS improvement were assessed using binary logistic regression models adjusted for patient characteristics and clustering of patients within hospitals., Results: There were 20,338 THA and 18,082 TKA procedures included. Adverse events occurred more frequently in HOOS-PS and KOOS-PS nonrespondents than in respondents. The THA patients experiencing revision, complications, or long length of stay were less likely to experience clinically relevant HOOS-PS improvements (odds ratios of 0.11 [0.06 to 0.20], 0.44 [0.30 to 0.63], and 0.66 [0.50 to 0.88], respectively). The TKA patients experiencing revision or long length of stay were less likely to experience clinically relevant KOOS-PS improvements (odds ratios of 0.26 [0.12 to 0.55] and 0.63 [0.50 to 0.80], respectively)., Conclusions: Clinically relevant HOOS-PS and KOOS-PS improvements are likely overestimated, as nonrespondents had higher adverse event rates which were associated with lower likelihood to achieve clinically relevant HOOS-PS and KOOS-PS improvements., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Total hip arthroplasty (THA) is an effective surgical treatment for severe osteoarthritis of the hip. While THA is considered a reliable and safe procedure, outcome data on patients who have Ehlers-Danlos syndrome (EDS) is limited. The purpose of this study was to compare rates of postoperative complications after primary THA in patients who have EDS against matched controls., Methods: A large national database was searched to identify patients who underwent THA between 2009 and 2020. Patients younger than 18 years, those who have a history of prior THA, and those undergoing THA for a hip fracture were excluded from analysis. Propensity score matching was utilized to match patients who had EDS with patients who did not have EDS at a 1:4 ratio. Rates of medical and surgical complications at 90 days and 2 years were queried and compared between the cohorts using multivariable logistic regression. We identified 118 patients who had EDS and underwent primary THA, who were then matched with 418 controls., Results: At 90 days, the EDS cohort had greater rates of dislocation (8.5 versus 3.8%, P = 0.038). At 2 years, the EDS cohort had greater odds of dislocation (OR [odds ratio] 2.47, P = 0.018), aseptic loosening (OR 6.91, P = 0.002), and aseptic revision (OR 2.66, P = 0.02)., Conclusions: Patients who have EDS possess significantly higher odds of complications after THA compared to matched controls, including dislocation, aseptic loosening, and aseptic revision. Careful surgical planning in these patients should be made to prevent dislocation and potentially minimize the risk of other prosthesis-related complications leading to revision., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Obesity is a risk factor for end-stage hip osteoarthritis. While total hip arthroplasty (THA) is commonly performed to reduce pain and improve function associated with osteoarthritis, obesity has been associated with an increased risk of complications after THA. Although bariatric surgery may also be utilized to reduce weight, the impact of bariatric surgery on THA outcomes remains inadequately understood., Methods: This retrospective cohort analysis utilized multicenter electronic medical record data ranging from 2003 to 2023. Patients who have obesity who underwent THA were stratified based on prior bariatric surgery. The final bariatric cohort comprised 451 patients after propensity score matching. Complication rates and revision risks were compared between cohorts at 6, 24, and 72 months. Additional analysis stratified patients by interval between bariatric surgery and THA., Results: At 6-month follow-up, the bariatric cohort had significantly lower risks of surgical site infection, wound dehiscence, and deep vein thrombosis (DVT). At 24 months, the bariatric cohort had a lower risk of DVT. At 72-month follow-up, the bariatric cohort had reduced rates of revision, mortality, cardiac morbidity, and Clavien-Dindo grade IV complications., Conclusions: Obese patients who underwent bariatric surgery prior to THA experienced reduced medical complications at all time points and reduced rates of revision at 72 months relative to a matched cohort who did not undergo bariatric surgery., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The effect of biological sex on the outcomes of total hip arthroplasty (THA) remains unclear. Accounting for biological sex in research is crucial for reproducibility and accuracy. Average combined data may mask sex-related variation and obscure clinically relevant differences in outcomes. The aim of this study is to investigate hospital and patient-reported outcome measures (PROMs) after THA by biological sex to elucidate differences and ultimately provide more equitable care., Methods: We performed a retrospective review of patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographics, operative variables, hospital outcomes, and PROMs were compared between men and women patients. The PROMs included preoperative, 6-weeks, 6-months, and 1-year Single Assessment Numeric Evaluation, Visual Analog Scale, Hip Disability and Osteoarthritis Outcome Score Joint Replacement, University of California, Los Angeles, and Patient-Reported Outcomes Measurement Information System mental and physical scores, as well as satisfaction scores., Results: A total of 6,418 patients were included (55% women). Women were older (P < .001), had a lower body mass index (P < .001), and were more likely to have public insurance (P < .001). Fewer women were discharged to home or self-care (P < .001). Women had higher rates of cementation (P < .001) and fracture within 90 days (P < .001), and these associations remained significant with adjusted multivariable analyses. Women had significantly higher pain and lower functional scores preoperatively; postoperatively, most PROMs were equivalent., Conclusions: Important differences were observed in several areas. Demographic parameters differed, and a variable effect of biological sex was observed on surgical and hospital outcomes. Women had an increased incidence of cemented femoral components (indicated for osteoporotic bone) and postoperative fractures. Women's PROMs demonstrated globally lower functional scores and higher pain preoperatively. Differences attributed to sex should continue to be investigated and accounted for in risk-stratification models. Future studies are needed to elucidate the underlying causes of observed biological sex differences and are essential for equitable arthroplasty care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Depression is associated with inferior outcomes following hip or knee arthroplasty, though it remains unclear if this relationship is modifiable. This study examined the association between pharmacologic treatment of depression and patient-reported outcomes., Methods: This retrospective cohort study of 1,651 total hip arthroplasty (THA) and 1,792 total knee arthroplasty (TKA) procedures between October 2012 and June 2019 used institutional registry data linked to nationwide pharmaceutical claims. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score, with pain and function subscales assessed as secondary outcomes. The TKA and THA patients were analyzed separately via mixed-effect linear regression to compare patients who had depression treated with antidepressants (TKA, n = 210; THA, n = 150) to those who had untreated depression (TKA, n = 43; THA; n = 50), and those who did not have depression (TKA, n = 1,539; THA, n = 1,451)., Results: Among patients who had depression, not receiving preoperative antidepressant therapy was associated with smaller improvements in WOMAC global scores (TKA, adjusted mean difference [MD]: -13.1 points, 95% CI [confidence interval]: -21.4 to -4.8; THA, MD: -8.5 points, 95% CI: -15.7 to -1.2) at 2 years after surgery, but not at 1 year (TKA, MD: -5.4 points, 95% CI: -12.9 to 2.1; THA, MD: -6.3 points, 95% CI: -12.9 to 0.3). Those who did not have depression had similar improvements in WOMAC global scores to those who had treated depression at both one (TKA, MD: 0.8 points, 95% CI: -2.7 to 4.4; THA, MD: 1.8 points, 95% CI: -1.8 to 5.4) and 2 years (TKA, MD: -1.1 points, 95% CI: -4.9 to 2.7; THA, MD: -1.6 points, 95% CI: -5.6 to 2.3). The findings were consistent with secondary outcomes., Conclusions: Among patients who have depression, antidepressant therapy before TKA or THA is associated with improved outcomes. Additional studies are needed to establish the impact of interventions to address untreated depression before surgery., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Evidence of geographical variation in total hip replacement (THR) and deviations from treatment guidelines persists. In this exploratory study, we aim to gain an in-depth understanding of patients' healthcare trajectories by identifying and visualising medication use patterns in coxarthrosis patients before surgery. We examine their association with patient characteristics and THR, and compare them with recommendations on mild analgesics, opioid prescription and exhaustion of conservative therapy., Methods: In this exploratory study, we apply State Sequence Analysis (SSA) on German health insurance data (2012-2015). We analyse a cohort of coxarthrosis patients, half of whom underwent THR after a 1 year observation period and half of whom did not undergo surgery until at least 1 year after the observation period. Hierarchical states are defined based on prescriptions. We construct sequences, calculate sequence similarity using optimal matching and identify medication use patterns via clustering. Patterns are visualised, descriptive statistics are presented and logistic regression is employed to investigate the association of medication patterns with subsequent THR., Results: Seven distinct medication use patterns are identified, correlating strongly with patient characteristics and subsequent THR. Two patterns leading to THR demonstrate exhaustion of pharmacological therapy. Opioid use is concentrated in two small patterns with low odds for THR. The most frequent pattern lacks significant pharmacological therapy., Conclusions: This SSA uncovers heterogeneity in medication use patterns before surgery in coxarthrosis patients. Cautious opioid handling and adherence to a stepped prescription approach are observed, but many patients display low medication therapy usage and lack evidence of exhausting conservative options before surgery., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Spinopelvic stiffness (primarily in the sagittal plane) has been identified as a factor associated with inferior patient-reported outcomes (PROs) and increased dislocation risk after THA. Incorporating preoperative spinopelvic characteristics into surgical planning has been suggested to determine a patient-specific cup orientation that minimizes dislocation risk. Sagittal plane radiographic analysis of static postures indicates that patients exhibit a degree of normalization in their spinopelvic characteristics after THA. It is not yet known whether normalization is also evident during dynamic movement patterns, nor whether it occurs in the coronal and axial planes as well., Questions/purposes: (1) Does motion capture analysis of sagittal spinopelvic motion provide evidence of normalization after THA? (2) Do changes in coronal and axial plane motion accompany those in the sagittal plane?, Methods: Between April 2019 and February 2020, 25 patients agreed to undergo motion capture movement analysis before THA for the treatment of hip osteoarthritis (OA). Of those, 20 underwent the same assessment between 8 and 31 months after THA. Five patients were excluded because of revision surgery (n = 1), contralateral hip OA (n = 1), and technical issues with a force plate during post-THA assessment (n = 3), leaving a cohort total of 15 (median age [IQR] 65 years [10]; seven male and eight female patients). A convenience sample of nine asymptomatic volunteers, who were free of hip and spinal pathology, was also assessed (median age 51 years [34]; four male and five female patients). Although the patients in the control group were younger than those in the patient group, this set a high bar for our threshold of spinopelvic normalization, reducing the possibility of false positive results. Three-dimensional motion capture was performed to measure spinal, pelvic, and hip motion while participants completed three tasks: seated bend and reach, seated trunk rotation, and gait on a level surface. ROM during each task was assessed and compared between pre- and post-THA conditions and between patients and controls. Statistical parametric mapping (SPM) was used to assess the timing of differences in motion during gait, and spatiotemporal gait parameters were also measured., Results: After THA, patients demonstrated improvements in sagittal spinal (median [IQR] 32° [18°] versus 41° [14°]; difference of medians 9°; p = 0.004), pelvis (25° [21°] versus 30° [8°]; difference of medians 5°; p = 0.02), and hip ROM (21° [18°] versus 27° [10°]; difference of medians 6°; p = 0.02) during seated bend and reach as well in sagittal hip ROM during gait (30° [11°] versus 44° [7°]; difference of medians 14°; p < 0.001) compared with their pre-THA results, and they showed a high degree of normalization overall. These sagittal plane changes were accompanied by post-THA increases in coronal hip ROM (12° [9°] versus 18° [8°]; difference of medians 6°; p = 0.01) during seated trunk rotation, by both coronal (6° [4°] versus 9° [3°]; difference of medians 3°; p = 0.01) and axial (10° [8°] versus 16° [7°]; difference of medians 6°; p = 0.003) spinal ROM, as well as coronal (8° [3°] versus 13° [4°]; difference of medians 5°; p < 0.001) and axial hip ROM (21° [11°] versus 34° [24°]; difference of medians 13°; p = 0.01) during gait compared with before THA. The SPM analysis showed these improvements occurred during the late swing and early stance phases of gait., Conclusion: When restricted preoperatively, spinopelvic characteristics during daily tasks show normalization after THA, concurring with previous radiographic findings in the sagittal plane. Thus, spinopelvic characteristics change dynamically, and incorporating them into surgical planning would require predictive models on post-THA improvements to be of use., Level of Evidence: Level II, prognostic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)