scholarly journals Patient-reported Outcome Measures of Revision Total Hip Arthroplasty for Prosthetic Joint Infection is not Inferior to Aseptic Revision Total Hip Arthroplasty

2020 ◽  
Vol 14 (3) ◽  
pp. 73-81
Author(s):  
Lim JBT ◽  
Pang HN ◽  
Tay KJD ◽  
Chia SL ◽  
Yeo SJ ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Prosthetic Joint ◽  
Patient Reported ◽  
Aseptic Revision

Do patient-reported outcome measures improve after aseptic revision total hip arthroplasty?

2021 ◽  
pp. 112070002110363
Author(s):  
◽  
Ahmed Siddiqi ◽  
Jared Warren ◽  
Hiba K Anis ◽  
Wael K Barsoum ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Global Health ◽  
Outcome Measures ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Revision Total Hip Arthroplasty ◽  
Component Score ◽  
Patient Reported ◽  
Aseptic Revision

Background: The purpose of this study was to determine patient-reported outcome measures (PROMs) changes in: (1) pain, function and global health; and (2) predictors of PROMs in patients undergoing aseptic revision total hip arthroplasty (rTHA) using a multilevel model with patients nested within surgeon. Methods: A prospective cohort of 216 patients with baseline and 1-year PROMs who underwent aseptic rTHA between January 2016 and December 2017 were analysed. The most common indication for rTHA was aseptic loosening, instability, and implant failure. The PROMs included in this study were HOOS Pain and HOOS Physical Function Short-form (PS), Veterans RAND-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (MCS). Multivariable linear regression models were constructed for predicting 1-year PROMs. Results: Mean 1-year PROMs improvement for aseptic revisions were 30.4 points for HOOS Pain and 22.1 points for HOOS PS. Predictors of better pain relief were patients with higher baseline pain scores. Predictors of better 1-year function were patients with higher baseline function and patients with a posterolateral hip surgical approach during revision. Although VR-12 PCS scores had an overall improvement, nearly 50% of patients saw no improvement or had worse physical component scores. Only 30.7% of patients reported improvements in VR-12 MCS. Conclusions: Overall, patients undergoing aseptic rTHA improved in pain and function PROMs at 1 year. Although global health assessment improved overall, nearly half of aseptic rTHA patients reported no change in physical/mental health status. The associations highlighted in this study can help guide the shared decision-making process by setting expectations before aseptic revision THA.

scholarly journals REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Amer Mohiuddin, BS ◽  
Justin Rice, BA ◽  
Mary Ziemba-Davis, BA ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Hip Arthroplasty ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Deep Infection ◽  
Oral Antibiotic ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision ◽  
One Year

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature.   Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented.   Results: Average age and BMI were 63 years and 30 kg/m2.  67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days.    Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI.  Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.   

Back Pain and Its Effects on Early Patient-Reported Outcome Measures in Total Hip Arthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 180-186
Author(s):  
Vivek Singh ◽  
Stephen Zak ◽  
David Yeroushalmi ◽  
Ran Schwarzkopf ◽  
Roy I. Davidovitch
Keyword(s):  
Back Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Smoking Status ◽  
Demographic Data ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Chi Square ◽  
Total Hip ◽  
Patient Reported

AbstractThe success of total hip arthroplasty (THA) may be negatively impacted in those with back pain as evidenced by patient-reported outcome (PRO) scores. The goal of this study was to determine whether the hip–spine relationship, as it relates to the presence of preoperative back pain, affected THA outcomes, and PRO scores. We retrospectively reviewed 243 patients who underwent primary THA and completed the Hip disability and Osteoarthritis Outcome Score Junior (HOOS Jr.), back pain questionnaire, and the Forgotten Joint Score-12 (FJS-12) preoperatively and at 12-weeks postoperatively. Patients were separated into two cohorts: those with preoperative back pain and those who were back pain free. Analysis was performed using t-test and chi-square to determine differences in demographic data. Regression analysis was utilized to account for differences in demographic data. There were significant demographic differences, which included body mass index, American Society of Anesthesiologists, smoking status, and length of stay between the two cohorts. Patients with preoperative back pain had lower preoperative HOOS Jr. scores than their counterparts (44.93 vs. 55.2; p = 0.029). Additionally, the preoperative back pain free group reported better FJS-12 and HOOS Jr. scores at 12-weeks postoperatively (FJS-12:62.00 vs. 43.32, p < 0.0001; HOOS Jr.: 81.33 vs. 75.68, p = 0.029). Patients with preoperative back pain had lower preoperative PRO scores and overall experienced less postoperative satisfaction and greater disability than patients who were back pain free. However, these patients' preoperative to postoperative improvement in PRO scores (delta change) was greater than that of the back pain free patients. These results suggest that THA may alter the hip-spine mechanics and potentially provide a reprieve from back pain.

No clinically meaningful difference in 1-year patient-reported outcomes among major approaches for primary total hip arthroplasty

2021 ◽  
pp. 112070002199201
Author(s):  
◽  
James B Bircher ◽  
Atul F Kamath ◽  
Nicolas S Piuzzi ◽  
Wael K Barsoum ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Consecutive Series ◽  
Total Hip ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Reported ◽  
Primary Total Hip Arthroplasty

Background: Debate continues around the most effective surgical approach for primary total hip arthroplasty (THA). This study’s purpose was to compare 1-year patient-reported outcome measures (PROMs) of patients who underwent direct anterior (DA), transgluteal anterolateral (AL)/direct lateral (DL), and posterolateral (PL) approaches. Methods: A prospective consecutive series of primary THA for osteoarthritis ( n = 2,390) were performed at 5 sites within a single institution with standardised care pathways (20 surgeons). Patients were categorised by approach: DA ( n = 913; 38%), AL/DL ( n = 505; 21%), or PL ( n = 972; 41%). Primary outcomes were pain, function, and activity assessed by 1-year postoperative PROMs. Multivariable regression modeling was used to control for differences among the groups. Wald tests were performed to test the significance of select patient factors and simultaneous 95% confidence intervals were constructed. Results: At 1-year postoperative, PROMs were successfully collected from 1842 (77.1%) patients. Approach was a statistically significant factor for 1-year HOOS pain ( p = 0.002). Approach was not a significant factor for 1-year HOOS-PS ( p = 0.16) or 1-year UCLA activity ( p = 0.382). Pairwise comparisons showed no significant difference in 1-year HOOS pain scores between DA and PL approach ( p  > 0.05). AL/DL approach had lower (worse) pain scores than DA or PL approaches with differences in adjusted median score of 3.47 and 2.43, respectively ( p  < 0.05). Conclusions: Patients receiving the AL/DL approach had a small statistical difference in pain scores at 1 year, but no clinically meaningful differences in pain, activity, or function exist at 1-year postoperative.

No Clinically Meaningful Differences in 1-Year Patient-Reported Outcome Measures between Hip Resurfacing and Total Hip Arthroplasty: An Age-Matched Prospective Cohort Study

2021 ◽  
Author(s):  
Marcelo Siqueira ◽  
Keyword(s):  
Total Hip Arthroplasty ◽  
Outcome Measures ◽  
Hip Arthroplasty ◽  
Prospective Cohort ◽  
Patient Reported Outcome Measures ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Total Hip ◽  
Patient Reported

AbstractThis study compared patient-reported outcome measures (PROMs), readmissions, and reoperations between hip resurfacing (HR) and total hip arthroplasty (THA) in a matched prospective cohort. Between 2015 and 2017, 4,268 patients underwent HR or THA at a single institution. A prospective cohort of 2,147 patients were enrolled (707 HRs, 1,440 THAs). PROMs were collected at baseline and 1-year follow-up. Exclusion criteria: females (n = 2,008), inability/refusal to complete PROMs (n = 54), and diagnosis other than osteoarthritis (n = 59). Each HR patient was age-matched to a THA patient. Multivariate regression models were constructed to control for race, body mass index, education, smoking status, Charlson Comorbidity Index, mental health, and functional scores. A significance threshold was set at p = 0.017. A total of 707 HRs and 707 THAs were analyzed and 579 HRs (81.9%) and 490 THAs (69.3%) were followed up at 1 year. There was no statistically significant difference for Hip Injury and Osteoarthritis Outcomes Score (HOOS) Pain subscale (p = 0.129) and HOOS-Physical Function Shortform (HOOS-PS) (p = 0.03). HR had significantly higher median University of California in Los Angeles (UCLA) activity scores (p = 0.004). Ninety-day readmissions for HR and THAs were 1.8 and 3.5%, respectively (p = 0.06), and reoperations at 1 year were 1.2 and 2.3%, respectively (p = 0.24). For male patients, differences in medians for UCLA activity scores were 0.383 points, which were statistically significant but may not be clinically relevant. No differences exist in 90-day readmissions, reoperations, and HOOSpain and HOOS-PS scores. Because patients undergoing HR are advised to return to full activity at 1-year postoperative, follow-up is required. Metal ion levels were not obtained postoperatively for either group.

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