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David W. Murray - One of the best experts on this subject based on the ideXlab platform.
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The effect of rheumatoid arthritis on patient-reported outcomes following knee and Hip replacement: evidence from routinely collected data.
Rheumatology (Oxford England), 2019Co-Authors: Edward Burn, Rafael Pinedo-villanueva, Nigel K. Arden, David W. Murray, Christopher J. Edwards, Alan J. Silman, Cyrus Cooper, Daniel Prieto-alhambraAbstract:Objectives To compare outcomes of total knee replacement (TKR) and total Hip replacement (THR) for individuals with RA and OA. Methods We performed a cohort study using routinely collected data. Oxford Knee Score, Oxford Hip Score, and EuroQol 5-dimension 3-level (EQ-5D-3L) questionnaires were collected before and 6 months after surgery. Multivariable regressions were used to estimate the association between diagnosis and post-operative Scores after controlling for pre-operative Scores and patient characteristics. Results Study cohorts included 2070 OA and 142 RA patients for TKR and 2030 OA and 98 RA patients for THR. Following TKR, the median Oxford Knee Score was 37 [interquartile range (IQR) 29-43] for OA and 36 (27-42) for RA while the median EQ-5D-3L was 0.76 (0.69-1.00) and 0.69 (0.52-0.85), respectively. After THR, the Oxford Hip Score was 42 (IQR 36-46) for OA and 39 (30-44) for RA while the EQ-5D-3L was 0.85 (0.69-1.00) and 0.69 (0.52-1.00), respectively. The estimated effect of RA, relative to OA, on post-operative Scores was -0.05 (95% CI -1.57, 1.48) for the Oxford Knee Score, -0.09 (-0.13, -0.06) for the EQ-5D-3L following TKR, -1.35 (-2.93, -0.22) for the Oxford Hip Score, and -0.08 (-0.12, -0.03) for the EQ-5D-3L following THR. Conclusion TKR and THR led to substantial improvements in joint-specific Scores and overall quality of life. While diagnosis had no clinically meaningful effect on joint-specific outcomes, improvements in general quality of life were somewhat less for those with RA, which is likely due to the systemic and multijoint nature of rheumatoid disease.
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Recovery of function following Hip resurfacing arthroplasty: a randomized controlled trial comparing an accelerated versus standard physiotherapy rehabilitation programme
Clinical rehabilitation, 2013Co-Authors: Karen Barker, M Newman, Tamsin Hughes, Catherine Sackley, Hemant Pandit, Amit Kiran, David W. MurrayAbstract:To identify if a tailored rehabilitation programme is more effective than standard practice at improving function in patients undergoing metal-on-metal Hip resurfacing arthroplasty. Randomized controlled trial. Specialist orthopaedic hospital. 80 men with a median age of 56 years. Tailored post-operative physiotherapy programme compared with standard physiotherapy. Primary outcome - Oxford Hip Score (OHS), Secondary outcomes: Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol (EQ-5D-3L) and UCLA activity Score. Hip range of motion, Hip muscle strength and patient selected goals were also assessed. At one year the mean (SD) Oxford Hip Score of the intervention group was higher, 45.1 (5.3), than the control group, 39.6 (8.8). This was supported by a linear regression model, which detected a 5.8 unit change in Oxford Hip Score (p < 0.001), effect size 0.76. There was a statistically significant increase in Hip disability and Osteoarthritis Outcome Score of 12.4% (p < 0.0005), effect size 0.76; UCLA activity Score differed by 0.66 points (p < 0.019), effect size 0.43; EQ 5D showed an improvement of 0.85 (p < 0.0005), effect size 0.76. A total of 80% (32 of 40) of the intervention group fully met their self-selected goal compared with 55% (22 of 40) of the control group. Hip range of motion increased significantly; Hip flexion by a mean difference 17.9 degrees (p < 0.0005), Hip extension by 5.7 degrees (p < 0.004) and abduction by 4 degrees (p < 0.05). Muscle strength improved more in the intervention group but was not statistically significant. A tailored physiotherapy programme improved self-reported functional outcomes and Hip range of motion in patients undergoing Hip resurfacing.
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Hip resurfacings revised for inflammatory pseudotumour have a poor outcome
The Journal of bone and joint surgery. British volume, 2009Co-Authors: George Grammatopoulos, David J Beard, David W. Murray, Hemant Pandit, Young-min Kwon, R Gundle, P. Mclardy-smith, Harinderjit GillAbstract:Inflammatory pseudotumours occasionally occur after metal-on-metal Hip resurfacing and often lead to revision. Our aim was to determine the severity of this complication by assessing the outcome of revision in these circumstances and by comparing this with the outcome of other metal-on-metal Hip resurfacing revisions as well as that of matched primary total Hip replacements. We identified 53 Hips which had undergone metal-on-metal Hip resurfacing and required revision at a mean of 1.59 years (0.01 to 6.69) after operation. Of these, 16 were revised for pseudotumours, 21 for fracture and 16 for other reasons. These were matched by age, gender and diagnosis with 103 patients undergoing primary total Hip replacement with the Exeter implant. At a mean follow-up of three years (0.8 to 7.2) the outcome of metal-on-metal Hip resurfacing revision for pseudotumour was poor with a mean Oxford Hip Score of 20.9 (SD 9.3) and was significantly worse (p < 0.001) than the outcome for fracture with a mean Oxford Hip Score of 40.2 (SD 9.2) or that for other causes with a mean Oxford Hip Score of 37.8 (SD 9.4). The clinical outcome of revision for pseudotumour was also significantly worse (p < 0.001) than the outcome of matched primary total Hip replacements. By contrast, the outcome for fracture and other causes was not significantly different from that of matched primary total Hip replacements (p = 0.065). After revision for pseudotumour there were three cases of recurrent dislocation, three of palsy of the femoral nerve, one of stenosis of the femoral artery and two of loosening of the component. Five Hips required further revision. In three of these there was evidence of recurrent pseudotumour, and one is currently awaiting further revision. The incidence of major complications after revision for pseudotumour (50%) was significantly higher (p = 0.018) than that after revision for other causes (14%). The outcome of revision for pseudotumour is poor and consideration should be given to early revision to limit the extent of the soft-tissue destruction. The outcome of resurfacing revision for other causes is good.
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Which approach for total Hip arthroplasty: anterolateral or posterior?
Clinical orthopaedics and related research, 2008Co-Authors: J Palan, J. G. Andrew, David J Beard, David W. Murray, J. NolanAbstract:The best approach to use when performing THA is controversial. We did a prospective, nonrandomized multicenter study of 1089 THAs to evaluate patient-centered Hip Scores and dislocation and revision rates when comparing anterolateral and posterior Hip approaches at 5 years’ followup. Patients were divided into two groups depending on which surgical approach was used: anterolateral or posterior. The primary outcome measure was change in Oxford Hip Score. At 5 years, there were no differences in change in Oxford Hip Score and in dislocation or revision rates between the groups.
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Obesity in total Hip replacement
The Journal of bone and joint surgery. British volume, 2008Co-Authors: J. G. Andrew, David W. Murray, J Palan, H V Kurup, P. H. Gibson, David J BeardAbstract:A prospective, multi-centre study was carried out on 1421 total Hip replacements between January 1999 and July 2007 to examine if obesity has an effect on clinical outcomes. The patients were categorised into three groups: non-obese (body mass index (BMI) 40 kg/m(2)). The primary outcome measure was the change in Oxford Hip Score at five years. Secondary outcome measures included dislocation and revision rates, increased haemorrhage, deep infection, deep-vein thrombosis and pulmonary embolism, mean operating time and length of hospital stay. Radiological analysis assessing heterotopic ossification, femoral osteolysis and femoral stem positioning was performed. Data were incomplete for 362 Hips (25.5%) There was no difference in the change in the Oxford Hip Score, complication rates or radiological changes at five years between the groups. The morbidly obese group was significantly younger and required a significantly longer operating time. Obese and morbidly obese patients have as much to gain from total Hip replacement as non-obese patients.
Yukihide Iwamoto - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients with systemic lupus erythematosus
Orthopaedic Proceedings, 2012Co-Authors: Goro Motomura, Satoshi Ikemura, Kazu Suenaga, Yasuharu Nakashima, Takuaki Yamamoto, Taro Mawatari, Yukihide IwamotoAbstract:Introduction The objective of this study was to verify the long-term outcome of transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) in young patients with systemic lupus erythematosus (SLE). Methods Consecutive series of 21 symptomatic ONFH patients with SLE (33 Hips), aged 20 to 40 years, underwent ARO between 1980 and 1988. We reviewed the cases of 16 patients (25 Hips), which represents a 76% rate of follow-up. Patients included 4 men and 12 women who had a mean age of 29 years at the time of surgery. A Kaplan-Meier curve was used for the survivorsHip analysis of ARO. Patients with surviving Hips were evaluated by the modified Oxford Hip Score and the Medical Outcomes Study Short Form 36 (SF-36). Results Twelve Hips in 8 patients survived at the final follow-up. The average length of surviving was 25 years (range, 20 to 27 years). Three patients (6 Hips) had died of unrelated causes without any conversion at the mean time of 9 years after ARO. Based on Kaplan-Meier analysis with the end point defined as any conversion, the survival rate at 25 years was 73.7% (95% confidence interval, 53.9 to 93.5%). Based on the classification of the modified Oxford Hip Score, 5 Hips were classified as excellent, 2 Hips were good, and the remaining 5 Hips were fair. The average SF-36 physical component summary Score was 34 points and the average mental component summary Score was 46 points. The physical component summary Scores of 3 patients (53.0, 56.6, 57.1) exceeded the level of the Japanese population norm. Conclusion In ONFH patients with SLE, ARO achieved a 73.7% survival rate at 25 years.
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long term outcome of transtrochanteric anterior rotational osteotomy for osteonecrosis of the femoral head in patients with systemic lupus erythematosus
Lupus, 2010Co-Authors: Goro Motomura, Satoshi Ikemura, Kazu Suenaga, Yasuharu Nakashima, Takuaki Yamamoto, Taro Mawatari, Yukihide IwamotoAbstract:: This study sought to examine the long-term outcomes of transtrochanteric anterior rotational osteotomy (ARO) as treatment for osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Twenty-one patients (33 Hips), aged 20-40 years, underwent ARO between 1980 and 1988. We examined 16 patients (25 Hips), a 76% follow-up rate. A Kaplan-Meier curve was used for survivorsHip analysis. Patients with surviving Hips were evaluated by the modified Oxford Hip Score and Short Form 36 (SF-36). Twelve Hips in eight patients had survived at the final follow-up. The average length of Hip survival was 24.6 years (range: 20.1-27.2 years). Three patients (six Hips) had died of unrelated causes without any subsequent operation. Based on Kaplan-Meier analysis with the endpoint defined as the need for a subsequent operation, the Hip survival rate at 25 years was 73.7% (95% confidence interval, +/-19.8%). Based on classification by the modified Oxford Hip Score, five Hips were classified as excellent, two Hips were good, and the remaining five Hips were fair. The average SF-36 summary Score for the physical and mental components was 38.7 and 47.2 points, respectively. The physical component summary Scores for three patients exceeded the normal level of the Japanese population. Lupus (2010) 19, 860-865.
J. G. Andrew - One of the best experts on this subject based on the ideXlab platform.
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does the Oxford Hip Score reflect objective functional performance in patients undergoing total Hip arthroplasty
Orthopaedic Proceedings, 2018Co-Authors: T Okoro, Andrew B Lemmey, P J Maddison, J. G. AndrewAbstract:AimTo assess whether the Oxford Hip Score (OHS), is reflective of objectively assessed functional performance (timed up and go (TUG), 30 sec sit to stand (ST), 6 minute walk test (6MWT), stair climb performance (SCP), and gait speed (GS)) in patients undergoing total Hip arthroplasty (THA).Methods50 patients undergoing THA were prospectively recruited after ethical approval. Demographics and objective physical performance were assessed (TUG, ST, 6MWT, SCP, GS), as was the OHS preoperatively, and at 6 weeks, 6 months and 9 to 12 months postoperatively. Pearson's correlation coefficient was used to assess relationsHips, with p<0.05 statistically significant.ResultsAverage age of the cohort was (mean (SD)) 67.8 (9.4) years in males (n=21) and 64.2 (10.2) years in females (n=29). Due to loss to follow up, 32 patients were assessed at 6 weeks, 29 at 6 months and 26 at 9 to 12 months. Preoperatively OHS correlated weakly with TUG (r = − 0.327, p=0.022), ST (r = 0.345, p=0.015) and SCP (r = − 0.330, p=0.022). At...
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does the Oxford Hip Score reflect objective functional performance in patients undergoing total Hip arthroplasty
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: T Okoro, Andrew B Lemmey, P J Maddison, J. G. AndrewAbstract:Aim To assess whether the Oxford Hip Score (OHS), is reflective of objectively assessed functional performance (timed up and go (TUG), 30 sec sit to stand (ST), 6 minute walk test (6MWT), stair climb performance (SCP), and gait speed (GS)) in patients undergoing total Hip arthroplasty (THA). Methods 50 patients undergoing THA were prospectively recruited after ethical approval. Demographics and objective physical performance were assessed (TUG, ST, 6MWT, SCP, GS), as was the OHS preoperatively, and at 6 weeks, 6 months and 9 to 12 months postoperatively. Pearson9s correlation coefficient was used to assess relationsHips, with p Results Average age of the cohort was (mean (SD)) 67.8 (9.4) years in males (n=21) and 64.2 (10.2) years in females (n=29). Due to loss to follow up, 32 patients were assessed at 6 weeks, 29 at 6 months and 26 at 9 to 12 months. Preoperatively OHS correlated weakly with TUG (r = − 0.327, p=0.022), ST (r = 0.345, p=0.015) and SCP (r = − 0.330, p=0.022). At 6 months, OHS correlated moderately with all the objective measures assessed; TUG (r = − 0.480, p=0.006), ST (r = 0.454, p=0.010), 6MWT (r=0.507, p = 0.004) and SCP (r = 0.534, p=0.002), with the relationsHips less evident at 6 weeks (no significant correlations) and 9 to 12 months (moderate correlation with 6MWT only (r = 0.512, p=0.009). Conclusions The OHS most accurately reflects objective functional performance at 6 months postoperatively, perhaps indicating this time point may be optimal in terms of postoperative recovery.
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MENTAL DISTRESS AND FUNCTIONAL OUTCOME BEFORE AND AFTER PRIMARY Hip REPLACEMENT – A MULTI-CENTRE PROSPECTIVE COHORT ANALYSIS.
2010Co-Authors: M. Hossain, D.j. Parfitt, D Beard, D Murray, J.p. Nolan, J. G. AndrewAbstract:Introduction: We investigated the relationsHip between psychological distress and outcome after total Hip replacement (THR) in the Exeter Primary Outcome Study (EPOS). Materials & Methods: Data were collected from a number of centres across England between January 1999 and January 2002 for patients undergoing primary Hip replacement using the cemented Exeter femoral component (Stryker). We recorded the Oxford Hip Score (OHS) for physical function and SF36 questionnaire for both physical and mental domain assessment annually for five years. We dichotomised the patients into the mentally distressed (MHS Results: Complete data were available for 455 (407 not distressed and 48 distressed) patients. Pre-operative OHS and SF-36 Score was significantly worse in the distressed group (both p Conclusion: Pre-operative psychological distress did not compromise functional outcome after Hip arthroplasty. There was a substantial improvement in mental distress in patients with mental distress prior to surgery. Both groups of patients experienced improvement in Oxford Hip Score, which was maximal by 1 year after surgery and was maintained over the 5 year follow up.
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Which approach for total Hip arthroplasty: anterolateral or posterior?
Clinical orthopaedics and related research, 2008Co-Authors: J Palan, J. G. Andrew, David J Beard, David W. Murray, J. NolanAbstract:The best approach to use when performing THA is controversial. We did a prospective, nonrandomized multicenter study of 1089 THAs to evaluate patient-centered Hip Scores and dislocation and revision rates when comparing anterolateral and posterior Hip approaches at 5 years’ followup. Patients were divided into two groups depending on which surgical approach was used: anterolateral or posterior. The primary outcome measure was change in Oxford Hip Score. At 5 years, there were no differences in change in Oxford Hip Score and in dislocation or revision rates between the groups.
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Obesity in total Hip replacement
The Journal of bone and joint surgery. British volume, 2008Co-Authors: J. G. Andrew, David W. Murray, J Palan, H V Kurup, P. H. Gibson, David J BeardAbstract:A prospective, multi-centre study was carried out on 1421 total Hip replacements between January 1999 and July 2007 to examine if obesity has an effect on clinical outcomes. The patients were categorised into three groups: non-obese (body mass index (BMI) 40 kg/m(2)). The primary outcome measure was the change in Oxford Hip Score at five years. Secondary outcome measures included dislocation and revision rates, increased haemorrhage, deep infection, deep-vein thrombosis and pulmonary embolism, mean operating time and length of hospital stay. Radiological analysis assessing heterotopic ossification, femoral osteolysis and femoral stem positioning was performed. Data were incomplete for 362 Hips (25.5%) There was no difference in the change in the Oxford Hip Score, complication rates or radiological changes at five years between the groups. The morbidly obese group was significantly younger and required a significantly longer operating time. Obese and morbidly obese patients have as much to gain from total Hip replacement as non-obese patients.
Ming Han Lincoln Liow - One of the best experts on this subject based on the ideXlab platform.
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are Oxford Hip Score and western ontario and mcmaster universities osteoarthritis index useful predictors of clinical meaningful improvement and satisfaction after total Hip arthroplasty
Journal of Arthroplasty, 2020Co-Authors: Malcolm Guan Hin Yeo, Graham Seowhng Goh, Jerry Yongqiang Chen, Seng Jin Yeo, Ming Han Lincoln LiowAbstract:Abstract Background Up to 15% of patients express dissatisfaction after total Hip arthroplasty (THA). Preoperative patient-report outcome measures (PROMs) Scores can potentially mitigate this by predicting postoperative satisfaction, identifying patients that will benefit most from surgery. The aim of this study was to (1) calculate the minimal clinically important difference (MCID) thresholds for Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) mental component summary (MCS) and physical component summary (PCS) Scores and (2) identify the threshold values of these PROMs that could be used to predict patient satisfaction and expectation fulfilment. Methods Prospectively collected registry data of 1334 primary THA patients who returned for 2-year follow-up from 1998 to 2016 were reviewed. All patients were assessed preoperatively and postoperatively at 2 years using the OHS, WOMAC, and SF-36 PCS/MCS Scores. The MCID for each PROMs was calculated, and the proportion of patients that attained MCID was recorded. The relationsHip between satisfaction, expectation fulfilment, and MCID attainment was analyzed using Spearman rank correlation. Optimal threshold Scores for each PROM that predicted MCID attainment and satisfaction/expectation fulfilment at 2 years were calculated using receiver operating curve analysis. Results The calculated MCID for OHS, WOMAC, SF-36 PCS, and SF-36 MCS were 5.2, 10.8, 6.7, and 6.2, respectively. A threshold value of 24.5 for the preoperative OHS was predictive of achieving WOMAC MCID at 2 years after THA (area under the curve 0.80, P Conclusion OHS and WOMAC Scores can be used to determine clinical meaningful improvement but are limited in their ability to predict patient satisfaction after THA.
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Are Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index Useful Predictors of Clinical Meaningful Improvement and Satisfaction After Total Hip Arthroplasty
The Journal of arthroplasty, 2020Co-Authors: Malcolm Guan Hin Yeo, Graham Seowhng Goh, Jerry Yongqiang Chen, Seng Jin Yeo, Ming Han Lincoln LiowAbstract:Up to 15% of patients express dissatisfaction after total Hip arthroplasty (THA). Preoperative patient-report outcome measures (PROMs) Scores can potentially mitigate this by predicting postoperative satisfaction, identifying patients that will benefit most from surgery. The aim of this study was to (1) calculate the minimal clinically important difference (MCID) thresholds for Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) mental component summary (MCS) and physical component summary (PCS) Scores and (2) identify the threshold values of these PROMs that could be used to predict patient satisfaction and expectation fulfilment. Prospectively collected registry data of 1334 primary THA patients who returned for 2-year follow-up from 1998 to 2016 were reviewed. All patients were assessed preoperatively and postoperatively at 2 years using the OHS, WOMAC, and SF-36 PCS/MCS Scores. The MCID for each PROMs was calculated, and the proportion of patients that attained MCID was recorded. The relationsHip between satisfaction, expectation fulfilment, and MCID attainment was analyzed using Spearman rank correlation. Optimal threshold Scores for each PROM that predicted MCID attainment and satisfaction/expectation fulfilment at 2 years were calculated using receiver operating curve analysis. The calculated MCID for OHS, WOMAC, SF-36 PCS, and SF-36 MCS were 5.2, 10.8, 6.7, and 6.2, respectively. A threshold value of 24.5 for the preoperative OHS was predictive of achieving WOMAC MCID at 2 years after THA (area under the curve 0.80, P < .001). 93.1% of patients were satisfied, and 95.5% had expectations fulfilled at 2 years. None of the PROMs were able to predict satisfaction. OHS and WOMAC Scores can be used to determine clinical meaningful improvement but are limited in their ability to predict patient satisfaction after THA. Copyright © 2020 Elsevier Inc. All rights reserved.
Gordon C. Bannister - One of the best experts on this subject based on the ideXlab platform.
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Patient-reported outcomes after total Hip and knee replacement : comparison of mid-term results
Journal of Arthroplasty, 2009Co-Authors: Vikki Wylde, Ashley W Blom, Sarah L. Whitehouse, Adrian Taylor, Giles Pattison, Gordon C. BannisterAbstract:The aim of this study was to compare the mid-term functional outcomes of total knee replacement (TKR) and total Hip replacement (THR). A cross-sectional postal audit survey of all consecutive patients who had a primary joint replacement at one orthopaedic centre 5-8 years ago was conducted. Participants completed an Oxford Hip Score or Oxford knee Score, which are self-report measures of functional ability. Completed questionnaires were returned from 1112 THR patients and 613 TKR patients, giving a response rate of 72%. The median Oxford knee Score of 26 was significantly worse than the median Oxford Hip Score of 19 (p
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Patient-reported outcomes after total Hip and knee arthroplasty: comparison of midterm results.
The Journal of arthroplasty, 2008Co-Authors: Vikki Wylde, Ashley W Blom, Sarah L. Whitehouse, Adrian Taylor, Giles Pattison, Gordon C. BannisterAbstract:The aim of this study was to compare the midterm functional outcomes of total knee arthroplasty (TKA) and total Hip arthroplasty (THA). A cross-sectional postal audit survey of all consecutive patients who had a primary joint replacement at one orthopedic center 5 to 8 years ago was conducted. Participants completed an Oxford Hip Score or Oxford knee Score, which are self-report measures of functional ability. Completed questionnaires were returned from 1112 THA patients and 613 TKA patients, giving a response rate of 72%. The median Oxford knee Score of 26 was significantly worse than the median Oxford Hip Score of 19 (P < .001). In conclusion, TKA patients experience a significantly poorer functional outcome than THA patients 5 to 8 years postoperatively.
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Total Hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial.
The Journal of bone and joint surgery. American volume, 2006Co-Authors: R P Baker, B Squires, M.f. Gargan, Gordon C. BannisterAbstract:Hemiarthroplasty and total Hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total Hip arthroplasty or a hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford Hip Score, and final radiographs were assessed. After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23 mi (3.6 km) for the total Hip arthroplasty group, and the mean Oxford Hip Score was 22.3 for the hemiarthroplasty group and 18.8 for the total Hip arthroplasty group. Patients in the total Hip arthroplasty group walked farther (p=0.039) and had a lower (better) Oxford Hip Score (p=0.033) than those in the hemiarthroplasty group. Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the Hips in the hemiarthroplasty group dislocated, whereas three Hips in the total Hip arthroplasty group dislocated. In the hemiarthroplasty group, two Hips were revised to total Hip arthroplasty and three additional Hips had acetabular erosion severe enough to indicate revision. In the total Hip arthroplasty group, one Hip was revised because of subsidence of the femoral component. Total Hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.
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THE IMPORTANCE OF LEG LENGTH DISCREPANCY AFTER TOTAL Hip REPLACEMENT
2005Co-Authors: Arpad Konyves, Gordon C. BannisterAbstract:Introduction and aims: Leg length discrepancy (LLD) after total Hip arthroplasty (THA) has been associated with a number of complications. The aim of this study was to assess the influence of LLD on the outcome of THA by comparing patients’ perception and their Oxford Hip Score with their anatomical leg length. A secondary aim was to identify the site at which LLD was created intraoperatively. Methods: LLD and Hip function were assessed in 90 patients undergoing primary total Hip arthroplasty before and 3 months after surgery. Hip function was measured by the Oxford Hip Score (OHS). We measured leg length on pre- and postoperative radiographs and the position of the centre of rotation and the stem length on the postoperative radiographs. Results: Post operatively 62% of patients’ limbs were lengthened by a mean of 9 mm. This was perceived by 43% of the lengthened patients. The OHS in patients who perceived true lengthening was 27% worse than the rest of the population. In 98%, lengthening occurred in the femoral component. 20% perceived true shortening and their OHS was not affected. Conclusion: The problem of LLD after THA is lengthening. Accurate placement of the femoral component and especially avoiding overlengthening could significantly reduce patients’ perception of this.
