Quantification of progressive joint space narrowing in osteoarthritis of the hip: longitudinal analysis of the contralateral hip after total hip arthroplasty

OBJECTIVE: The rate of progressive joint space narrowing in the contralateral hip after total hip arthroplasty (THA) for osteoarthritis (OA) and the factors which may predispose patients to more aggressive joint space narrowing remain undefined. The current study sought to evaluate the rate and pattern of, and risk factors for, progressive joint space narrowing in the contralateral hip after THA for OA. METHODS: Each patient who underwent THA for OA in 1984-1985 was followed up longitudinally, and annual anteroposterior (AP) pelvis radiographs were obtained. The radiographic joint space width (JSW) of each contralateral hip joint was quantified, and the rates of JSW narrowing were determined. Evaluation of potential risk factors for accelerated progression of joint space narrowing included age, sex, side of surgery, weight, height, body mass index (BMI), hip pain, etiology of OA, and Kellgren/Lawrence radiographic grade. RESULTS: Ninety-nine patients and 619 AP pelvis radiographs were evaluated. The median initial JSW was 3.48 mm (interquartile range 1.55). JSW declined in a linear manner at a median rate of 0.10 mm/year. The rate of decline between baseline and followup in 20 months was predictive of the overall slope. Two subpopulations were identified. Eighty-five percent of patients maintained a slow decline in JSW (< or =0.2 mm/year), and 15% exhibited an accelerated decline in JSW (>0.2 mm/year). Kellgren/ Lawrence radiographic grade > or =2 and a diagnosis of primary OA were each associated with a more rapid decline in JSW (P = 0.006 and P = 0.02, respectively). Initial JSW, age, sex, weight, height, BMI, and hip pain were not risk factors for rapid decline in JSW. CONCLUSION: Radiographic hip JSW may be reliably quantified and followed up longitudinally using standard AP radiographs. Progression of JSW narrowing in the contralateral hip after THA for OA proceeds in a linear manner over several years. A subpopulation of patients with accelerated narrowing of contralateral JSW may be identified within 20 months, and may represent a suitable population with which to assess the potential efficacy of new disease-modifying agents.     

Quantitative measurement of joint space narrowing progression in hip osteoarthritis: a longitudinal retrospective study of patients treated by total hip arthroplasty

OBJECTIVES: To evaluate the rate of progression of radiological joint space narrowing (JSN) in patients operated on for hip osteoarthritis (OA) and to determine its predictive factors. METHODS: Study design: retrospective longitudinal trial of 61 patients who underwent total hip arthroplasty (THA) for hip OA (69 operated hips). Mean follow-up 81.2 +/- 9.9 months. Collected data: (1) standing frontal radiographs of the pelvis from diagnosis to surgery (246 films) for morphological evaluation and quantitative measurement of joint space width (JSW) (computerized reading of digitized X-rays); (2) demographic data (sex, age, body mass index, smoking status, professional and sporting activities, family history of OA); (3) clinical data (age at onset- diagnosis and THA, drug consumption, time from diagnosis to permanent disability, OA at other joints, previous THA of the contralateral hip). Statistics: multivariate analysis. RESULTS: The yearly mean narrowing (YMN) of MeanJSW was 0.43 +/- 0.43 mm/yr (median 0.29, range 0.03- 2.55). YMN correlated inversely with joint space width at operation and follow-up duration, and was increased in atrophic OA (r = 0.71). The time between diagnosis and THA correlated with JSW at diagnosis, and was inversely correlated with age at onset and YMN. It was longer in patients with hypertrophic OA (r = 0.69). CONCLUSION: Rapid progression of JSN, older age and absence of osteophytes appear to be the main factors leading to THA.      

Risk of contralateral avascular necrosis (AVN) after total hip arthroplasty (THA) for non-traumatic AVN

The risk of developing bilateral disease progressing to total hip arthroplasty (THA) among patients who undergo unilateral THA for non-traumatic avascular necrosis (AVN) remains poorly understood. An analysis of the time-course to contralateral THA, as well as the effects of underlying AVN risk factors, is presented. Forty-seven consecutive patients who underwent THA for AVN were evaluated. Peri-operative and annual post-operative antero-posterior pelvis radiographs were examined for evidence of contralateral involvement. Patient age, weight, height, underlying AVN risk factor(s), date of onset of contralateral hip pain if occurred, and date of contralateral THA if performed, were recorded. Bone scan, computerized tomography and magnetic resonance imaging data were utilized when available. Twenty-one patients (46.6%) underwent contralateral THA for AVN within a median of 9 months after the initial THA (range 0–93, interquartile range 28.5 months). The median follow-up for patients without contralateral THA was 75 months (range 3–109, interquartile range 69 months). Thirty-four patients had radiographic findings of contralateral AVN at study entry; 25 were symptomatic bilaterally at entry and 7 developed contralateral symptoms within a mean time of 12 months (median 10 months, interquartile range 12 months). None of the 13 patients who were free of radiographic evidence of contralateral AVN at study entry developed evidence of AVN during the follow-up. AVN associated with glucocorticoid use was more likely to manifest as bilateral disease than either idiopathic AVN or ethanol-associated AVN (P=0.02 and P=0.03 respectively). Radiographically-evident AVN in the contralateral hip at THA is unlikely to remain asymptomatic for a prolonged period of time. Conversely, asymptomatic contralateral hips without radiographic evidence of AVN are unlikely to develop clinically significant AVN.     

A composite index for total hip arthroplasty in patients with hip osteoarthritis

OBJECTIVE: We propose a composite index for considering total hip arthroplasty (THA) in hip osteoarthritis (OA). METHODS: We carried out a 3 year longitudinal study of patients with painful hip OA from 137 centers. Clinical data were collected at baseline and every 3 months; radiographs were taken at entry and each year. The decision to have surgery was made by the patient, the rheumatologist, and the surgeon, with no reference to outcome measures. Statistical analysis included discrete Cox analysis with time dependent covariates, on 3 month interval grouped data. The dependent variable was THA during the 3 months following the evaluated visit. Time dependent covariates collated at each evaluated visit included radiological joint space width (JSW), percentage decrease in JSW during the year preceding, patient's global assessment. Lequesne index, pain, and nonsteroidal antiinflammatory drug and analgesic intake. We compared 2 analyses differing in symptomatic variables entered: values obtained at a single time point vs mean values between 2 visits at a 3 month interval. Selection of the index was based on the best combination of variables to predict occurrence of THA. RESULTS: Of the 508 patients recruited for study, 42 were excluded. During the 3 year followup, 75 patients underwent THA. Symptomatic, therapeutic, and radiological variables were included in the index resulting from the 2 analyses. Based on the selected cutoff, the positive and negative predictive values for occurrence of THA in the 2 years following were 54.3 and 90.6%, respectively (single point model), and 52.9 and 86.7%, respectively (model using mean values of symptomatic variables between 2 visits). CONCLUSION: The poor positive predictive value of the composite indices obtained in this study suggests that there are other unmeasured factors determining access to surgery. On the other hand, the high negative predictive values suggest that these composite measures should be used by clinicians to determine which patients should not be referred to THA.     

Concentration and localization of YKL-40 in hip joint diseases

OBJECTIVE: YKL-40 is a major secretory protein from human chondrocytes and synovial fibroblasts. We evaluated the concentrations and localization of YKL-40 in hip joint diseases, and analyzed the possibility of YKL-40 as a new inflammatory joint marker. METHODS: The concentration of YKL-40 in synovial fluid (SF) was measured by a sandwich-type ELISA. SF samples were collected from 19 hips with osteoarthritis (OA) of the hip joint, 21 hips with osteonecrosis of the femoral head (ONFH), and 5 hips with failed total hip arthroplasty (failed THA). In all cases of failed THA, cartilage tissue in hip joints was removed completely during the previous THA. The localization of YKL-40 was determined through immunohistochemical analysis using a specific antibody. RESULTS: The mean SF concentration of YKL-40 was significantly higher in ONFH and failed THA than in OA. Comparison by OA grade was not significantly different. In staging of ONFH, Ficat stage III with collapsed femoral head showed significantly higher YKL-40 concentrations than the other stages. Immunohistochemical studies showed that YKL-40 was localized in chondrocytes in the superficial and middle layers of the cartilage. In the synovium, YKL-40 was localized in fibroblasts and macrophages. CONCLUSION: YKL-40 reflects the degree of inflammation rather than cartilage metabolism. YKL-40 may be a useful inflammatory marker of hip joint diseases.     

Influence of hip joint dysfunction on motor disorders in Japanese patients with osteoarthritis of the hip: Assessment of the JHEQ and GLFS-25 scores and hip muscle strength

BackgroundMotor disorders are caused by orthopedic problems that are mainly related to aging. These disorders can lead to a decline of physical activity and impairment of ADL. When evaluating a patient’s motor function after treatment, it is necessary to determine whether or not the level of function is age-appropriate. To investigate the influence of hip joint dysfunction on motor disorders, we determined the JHEQ and GLFS-25 scores and performed muscle strength testing in female patients with hip osteoarthritis.MethodsThe subjects were 108 women who had received THA, 56 women scheduled for THA, and 64 women on conservative treatment. The JHEQ score (evaluation scale for hip joint function) and GLFS-25 score (evaluation scale for ADL) were determined and muscle strength testing was conducted at a routine outpatient visit.ResultsA strong correlation was found between the total JHEQ score and the GLFS-25 score (r = - 0.837). Patients after THA and patients with successful conservative treatment aged 60–79 years showed similar motor function to healthy persons of the same age. There was a significant difference of straight leg raising and abduction strength (both p < 0.01) between patients in GLFS-25 levels 1–3 and patients in GLFS-25 levels 4–7.ConclusionWhile hip joint dysfunction has a strong influence on overall motor function, the patients after THA and patients with successful conservative treatment showed similar motor function to healthy persons of the same age. And patients with hip osteoarthritis must preserve or increase SLR strength to maintain adequate motor function.     

Asymmetric knee loading in advanced unilateral hip osteoarthritis

OBJECTIVE: Subjects with unilateral end-stage hip osteoarthritis (OA) who undergo total hip replacement (THR) preferentially require subsequent replacement of the contralateral knee compared with the ipsilateral knee. We investigated whether this nonrandom, preferential evolution of lower extremity OA from the hip to the contralateral knee joint may be related to asymmetries in dynamic joint loading at the knees, particularly the peak external knee adduction moment, which has been associated with the progression of knee OA. METHODS: Gait analysis was performed on 50 subjects who were preoperative for unilateral THR. Twenty-two of these subjects were reevaluated postoperatively 10-23 months after undergoing successful THR. At each analysis, dynamic joint loads in the contralateral knee were compared with those in the ipsilateral knee. RESULTS: Prior to THR, the peak external knee adduction moment and peak medial compartment load were significantly higher in the contralateral knee. This asymmetry persisted after THR. CONCLUSION: Subjects with unilateral end-stage hip OA preferentially require subsequent replacement of the contralateral knee, as compared with the ipsilateral knee. Among patients with unilateral end-stage hip OA, the contralateral knee is subjected to higher dynamic joint loads than is the ipsilateral knee, and this asymmetric loading persists long after subjects have undergone successful THR. Biomechanical factors appear to be involved in the multiarticular evolution of OA of the lower extremities.     

Recovery expectations of hip resurfacing compared to total hip arthroplasty: a matched pairs study

Objective

Expectations of higher activity levels associated with hip resurfacing arthroplasty (HRA) may be driving better outcomes in this group compared to total hip arthroplasty (THA). Previous studies evaluated patient expectations before consulting with the surgeon, although these expectations were likely unrealistic and would change after the consultation. We compared HRA and THA patient expectations after consultation with the surgeon.

Methods

In a prospective registry setting, patients awaiting HRA were matched to THA patients by age, sex, and a preoperative Lower Extremity Activity Scale score (range 1–18, with 18 indicating levels of highest activity). Patients completed preoperatively a validated 18‐item expectations survey. Mean overall expectation scores were first compared. Exploratory factor analysis (EFA) was then performed to determine if the grouping of individual expectations items represented meaningfully different underlying factors in the 2 groups.

Results

We matched 123 pairs. The mean ± SD expectation scores were similar (85.2 ± 15.5 for HRA and 87.3 ± 13.9 for THA; P = 0.249). The EFA showed that HRA and THA patients shared the common expectations of pain relief and improvement in daily activities (9 items) and eliminating pain medications, the need for a cane, and improving sexual activity (3 items). THA patients perceived the remaining 6 items as an overall third expectation of participation in higher‐level activities. However, HRA patients perceived a fourth expectation of normal range of motion (2 items) independent of the other higher‐level activities (4 items).

Conclusion

Even after consulting with a surgeon, patients' expectations differed between HRA and THA patients regarding higher‐level activities. More counseling for patients seeking hip arthroplasty is therefore needed.     

Factors influencing surgeons' decisions in the indication for total joint replacement in hip osteoarthritis in real life

OBJECTIVE: To evaluate factors influencing orthopedic surgeons' decision in daily practice to recommend or not recommend total hip arthroplasty (THA) in patients with hip osteoarthritis (OA). METHODS: General practitioners and rheumatologists were asked to prospectively include 1 patient with hip OA for whom a consultation with an orthopedic surgeon was planned to determine whether or not THA was indicated. The following variables were obtained: age, sex, occupational status, body mass index, comorbidities, duration of hip OA, patient's global assessment, Western Ontario and McMaster Universities Osteoarthritis Index pain and functioning subscale scores, New Zealand score, quality of life, and structural parameters on radiographs. The surgeon's decision was obtained by followup questionnaires. Statistical analysis evaluated potential predictors of the surgeon's decision (indication for THA within the next 6 months, yes or no) using univariate and multivariate analysis. RESULTS: A total of 558 patients were included (249 men, 300 women, mean age 68.4 years, mean disease duration 4.9 years). The surgeon's decision, available for 486 patients, was to prescribe THA in 60.7% of patients. On multivariate analysis, the variables related to the surgeon's decision were the presence or absence of severe cardiovascular disease, Short Form 12 physical subscale score, and amount of joint space narrowing. CONCLUSION: While the amount of structural degradation is only slightly or not at all taken into account in numerous criteria and/or recommendations on indications for THA, it is an independent predictor of the surgeon's decision in daily practice. Such a discrepancy should be evaluated and understood in further studies.     

Transfusion practice in hip arthroplasty--a nationwide study

Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA) in Denmark. Materials and Methods We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Results Six thousand nine hundred thirty‐two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71% and between 26 and 85% in THA and RTHA patients, respectively. Patients receiving RBC transfusion had longer length of stay and for THA patients an increased odds‐ratio (5·5) of death within 90 days. Conclusion Despite established guidelines, RBC transfusion practice in hip arthroplasty remains highly variable between Danish hospitals. The effect of RBC transfusion on outcome after hip arthroplasty should be established in prospective randomized controlled trials.     

Effects of hip joint center location and femoral offset on abductor muscle strength after total hip arthroplasty

Abstract

Objectives. The purposes of this study were 1) to examine the changes in the hip joint center (HJC) position and the femoral offset (FO) after total hip arthroplasty (THA) and 2) to investigate the effects of the HJC and FO on isometric abductor muscle strength.

Methods. We evaluated 51 patients who underwent unilateral primary THA. The FO, and horizontal and vertical distances from the HJC to the tip of the teardrop were measured and isometric hip abductor muscle strength was measured.

Results. The HJC of the affected side moved medially postoperatively compared with that of the unaffected side (p < 0.05), and the FO was reconstructed similarly to the unaffected side. There were significant negative correlations between the changes in the horizontal distance from the HJC and FO to the tip of the teardrop. An increase in the FO and infero-medial cup position optimized hip abductor muscle strength.

Conclusion. The HJC was reconstructed medially and superiorly, and the change in the FO after THA was influenced by the change in the horizontal distance of the HJC. Multiple regression analysis revealed that the medial and inferior HJC and increase in the FO constitute an effective procedure for restoring abductor strength.     

Bone loss after total hip arthroplasty

The aim of the present study is to evaluate periprosthetic bone loss and to compare it with the bone loss in other areas of the body. We also aim to shed light on the course of bone mineral density (BMD) in patients with cemented femoral prosthesis in comparison with those with uncemented ones. We analyzed the BMD using dual-energy X-ray absorptiometry (DEXA) in a consecutively recruited convenience sample of 50 patients with cemented and uncemented total hip arthroplasty (THA). BMD was measured within the first month after surgery as well as 1 year later. In ten of the patients (20%) previously undiagnosed osteoporosis was revealed. Osteoporosis was significantly more frequently detected in patients with cemented compared to those with uncemented femoral stem. We found a significant loss in BMD in the periprosthetic femoral region compared with no losses in other body regions (lumbar spine, radius, contralateral hip). The magnitude of this loss was the highest in Gruen-Zone 7 (mean 15.2% per year). We found no BMD loss difference between patients with cemented and uncemented prosthesis in the Gruen-Zone 2–7. In conclusion these periprosthetic losses may be due to local factors such as periprosthetic bone remodeling, as they contrast with the course of BMD in the lumbar spine, radius and not operated hip.     

Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study

OBJECTIVES: Different prevalences of generalised osteoarthritis (GOA) in patients with knee and hip OA have been reported. The aim of this investigation was to evaluate radiographic and clinical patterns of disease in a hospital based population of patient subgroups with advanced hip and knee OA and to compare the prevalence of GOA in patients with hip or knee OA, taking potential confounding factors into account. METHODS: 420 patients with hip OA and 389 patients with knee OA scheduled for unilateral total joint replacement in four hospitals underwent radiographic analysis of ipsilateral and contralateral hip or knee joint and both hands in addition to a standardised interview and clinical examination. According to the severity of radiographic changes in the contralateral joints (using Kellgren-Lawrence > or = grade 2 as case definition) participants were classified as having either unilateral or bilateral OA. If radiographic changes of two joint groups of the hands (first carpometacarpal joint and proximal/distal interphalangeal joints defined as two separate joint groups) were present, patients were categorised as having GOA. RESULTS: Patients with hip OA were younger (mean age 60.4 years) and less likely to be female (52.4%) than patients with knee OA (66.3 years and 72.5% respectively). Intensity of pain and functional impairment at hospital admission was similar in both groups, while patients with knee OA had a longer symptom duration (median 10 years) compared with patients with hip OA (5 years). In 41.7% of patients with hip OA and 33.4% of patients with knee OA an underlying pathological condition could be observed in the replaced joint, which allowed a classification as secondary OA. Some 82.1% of patients with hip and 87.4% of patients with knee OA had radiographic changes in their contralateral joints (bilateral disease). The prevalence of GOA increased with age and was higher in female patients. GOA was observed more often in patients with knee OA than in patients with hip OA (34.9% versus 19.3%; OR = 2.24; 95% CI: 1.56, 3.21). Adjustment for the different age and sex distribution in both patient groups, however, takes away most of the difference (OR = 1.32; 95% CI: 0.89, 1.96). CONCLUSION: The crude results confirm previous reports as well as the clinical impression of GOA being more prevalent in patients with advanced knee OA than in patients with advanced hip OA. However, these different patterns might be attributed to a large part to a different distribution of age and sex in these hospital based populations.     

Relevant change in radiological progression in patients with hip osteoarthritis. I. Determination using predictive validity for total hip arthroplasty

OBJECTIVE: To determine a cut-off point above which a change in joint space width (JSW) could be considered as relevant in patients with hip osteoarthritis (OA) on the basis of predicted need for subsequent total hip arthroplasty (THA). METHODS: A multicentre, prospective, longitudinal, 5-yr follow-up study was performed. A pelvic radiograph was obtained at entry and after 1 and 2 yr. For each film, the narrowest JSW was measured using a 0.1 mm graduated magnifying glass. The absolute and relative differences between baseline and 1 and 2 yr of follow-up were calculated. We determined the cut-off points above which an absolute or relative decrease in JSW between baseline and 1 and 2 yr of follow-up could be considered relevant on the basis of the predicted need for THA during the remaining years of the study. The need for THA was categorized as 'yes' or 'no'. Thereafter, for each observed change in JSW (0.1 per 0.1 mm or 1% per 1%), the sensitivity and specificity for subsequent THA were calculated. The choice of cut-off was based on maximal sensitivity and specificity, using the graphic representation of correct classification probabilities. In this way it was possible to obtain the best measured JSW threshold with maximal true positive and minimal false positive results. RESULTS: A total of 423 and 385 patients met the criteria for analysis using the decrease in JSW between baseline and 1 and 2 yr respectively. The best cut-off points were absolute decreases in JSW of 0.2 and 0.4 mm and relative decreases in JSW of 15 and 20% after 1 and 2 yr respectively, with corresponding ranges of sensitivity and specificity of 68-75 and 67-78%. CONCLUSION: This work determined the cut-off above which a change in JSW could be considered clinically relevant in patients with hip OA, on the basis of predicted subsequent need for THA. For validation, similar studies should be conducted in other countries with different health-care systems.     

Total hip arthroplasty in patients with chronic autoimmune inflammatory arthroplasties

Objective: Patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) often require total hip arthroplasties. We present a retrospective review of 32 total hip arthroplasties (THA) performed for patients with SLE, RA or AS from 2003 to 2008 in a tertiary hospital in Singapore. Materials and Methods: A total of 323 THAs performed between January 2003 to December 2008 were traced and cases of arthroplasties performed for such patients were isolated. Pre‐ and post‐operative range of motion, Harris hip score, limb length discrepancies and complications were studied. Results: Twenty‐six patients aged 24–66 years (mean 47 years) were reviewed, with two AS patients (7.7%), 16 RA patients (61.5%), seven SLE patients (26.9%) and one patient (3.8%) with both RA and SLE. Thirty‐two THA operations were conducted with six patients requiring bilateral THAs. The average follow‐up was 3.3 years. Mean Harris hip score for 25 patients (one excluded due to patient expiry 2 month post‐surgery) improved from 41.3 to 86.53 (P < 0.05). Mean pre‐operative hip flexion improved from 61.3 degrees (0–120) to 89.7 degrees (30–120) (P < 0.05). Seventeen cases had preoperative limb length discrepancies (median 1 cm) which were all corrected. There were no implants loosening, infective arthritis, dislocations or neurovascular injuries documented. Conclusion: Our series demonstrated the excellent outcome of THA for patients with chronic autoimmune arthropathies at the time of follow‐up. Careful patient selection remains a priority as long‐term outcomes for such patients of a significantly younger population is yet to be determined.     

The association between hip morphology parameters and nineteen‐year risk of end‐stage osteoarthritis of the hip: A nested case–control study

Objective

Subtle deformities of the hip joint are implicated in the etiology of osteoarthritis (OA) of the hip. Parameters that quantify these deformities may aid understanding of these associations. We undertook this study to examine relationships between such parameters and the 19‐year risk of total hip arthroplasty (THA) for end‐stage OA.

Methods

A new software program designed for measuring morphologic parameters around the hip was developed and validated in a reliability study. THA was the outcome measure for end‐stage OA. A nested case–control study was used with individuals from a cohort of 1,003 women who were recruited at year 1 in 1989 and followed up to year 20 (the Chingford Study). All hips with THA by year 20 and 243 randomly selected control hips were studied. Pelvis radiographs obtained at year 2 were analyzed for variations in hip morphology. Measurements were compared between the THA case group and the control group.

Results

Patients with THA had a higher prevalence of cam deformity than did their respective controls (median alpha angle 62.4° versus 45.8° [P = 0.001]; mean modified triangular index height 28.5 mm versus 26.9 mm [P = 0.001]) as well as a higher prevalence of acetabular dysplasia (mean lateral center edge angle 29.5° versus 34.3° [P = 0.001]; median extrusion index 0.25 versus 0.185 [P = 0.009]). Logistic regression analyses clustering by subject and adjusting for radiographic hip OA at year 2 showed that these morphologic parameters were still significantly associated with THA by year 20. The alpha angle and lateral center edge angle predicted the risk of THA independently when included in the same model.

Conclusion

This investigation describes measurements that predict the risk of THA for end‐stage OA by year 20, independently of the presence of radiographic hip OA at year 2. These measurements can be made on an anteroposterior pelvis radiograph, which is an inexpensive and commonly used clinical method of investigation.

     

The outcome of cementless total hip arthroplasty in haemophilic hip arthropathy

Summary.  Total hip arthroplasty (THA) in haemophilic arthropathy is reported to be less successful than in non-haemophilic indications. Although preliminary results are encouraging, the survival and functional outcome of cementless THA in haemophilia are not known. The aim of this study was to analyse mid-term results of cementless THA in haemophilia. Twenty-seven consecutive cementless THAs with 23 patients performed between June 1995 and June 2003 were reviewed. Mean age at time of operation was 36 years and mean follow-up period was 92 months (range, 60–156). Radiographic assessment was done for fixation of components, loosening, osteolysis, wear and bone responses around the implants. The factor requirements, amount of transfusion and complications associated with bleeding were studied. The mean preoperative Harris hip score changed from 57 to 95.9 at the latest follow-up. The survival at mean follow-up was 95.2%. One patient with osteolysis around acetabular cup was re-operated with bone-grafting and change of polyethylene liner. One loose cup was revised with a cemented cup. All other components were deemed stable at the latest follow-up. A standardized management protocol and dedicated team approach comprising of haematologist, physicians, physical therapist, nurses and coordinators is needed for excellent results. The present retrospective study shows that the functional results of cementless THA in haemophilia are satisfactory as it happens in osteoarthritic patients according to the current literature, mainly the younger. Thus, taking into account that the majority of haemophilia patients requiring a THA are relatively young, cementless THA is currently recommended.     

Cementless total hip arthroplasty for haemophilic arthropathy: follow‐up result of more than 10 years

The improvement of prophylaxis and adequate replacement of clotting factors, the quality of life and natural history of haemophilia have been significantly improved. However, significant functional impairment is inevitable. This study was performed to evaluate over 10 years clinical and radiographic outcomes of cementless total hip arthroplasty (THA) for treatment of haemophilic hip arthropathy. Between 1995 and 2003, 27cases of cementless total hip arthroplasties were performed in 23 haemophilic patients. A total of 21 cases from 17 patients were available for follow‐up analysis over 10 years. Modified Harris hip score, the range of motion of the hip joint, perioperative coagulation factor requirements and complications associated with bleeding were evaluated as part of the clinical assessment. For the radiographic assessment, fixation of component, osteolysis, loosening and other complications were evaluated. Clinically, the mean Harris hip score improved from 57 points before the operation to 94 points at the last follow‐up. The mean flexion contracture was 10° preoperatively and 0.9° at the final follow‐up. The further flexion improved from 68.4° to 90.5° after surgery. The mean monthly requirement of factor VIII reduced from 3150 units before surgery to 1800 units at the time of the last follow‐up. There were three cases of rebleeding. In one case, a progressive haemophilic pseudotumour was found. Reoperation for any reason including revision was performed in three cases. We believe that cementless THA in patient with haemophilic hip arthropathy can bring reliable pain relief and functional improvement for longer than 10 years.     

Sex differences in hip osteoarthritis: results of a longitudinal study in 508 patients

OBJECTIVE: To evaluate sex differences in the clinical and structural presentation, and natural history of hip OA. METHODS: A multicentre, prospective, longitudinal, five year follow up study of 508 patients (302 women, 206 men, mean age 63 (7) years) with painful hip OA. Data collected were baseline demographics, symptomatic, therapeutic, and structural variables; symptomatic variables and changes in joint space width (JSW) during the first year's follow up; requirement for total hip arthroplasty (THA) between the end of the first and fifth years. Statistical analysis: evaluation of sex differences (a) at baseline, in the main characteristics of hip OA using multivariate logistic regression; (b) during the first year of follow up, in the radiological progression of the disease; (c) during the five years of follow up, in the requirement for THA using Kaplan-Meier curves and the log rank test, and of the parameters related to THA, using a multivariate Cox analysis. RESULTS: At entry, women presented more frequently than men with polyarticular OA (mean (SD) articular score 306 (162) v 235 (127)), and superomedial migration of the femoral head (40% v 19%), and had more severe symptomatic disease (patient's overall assessment 46 (23) v 40 (26)). The change in JSW did not differ between women and men after one year, but a greater proportion of women had rapid structural progression (OR=2.34, 95% CI 1.1 to 5.2). THA was performed more often in women. Multivariate analysis suggested that the decision to perform surgery was related more closely to the symptomatic and structural severity of the disease than to the sex of the patient. CONCLUSION: Hip OA in women is more frequently part of a polyarticular OA, and displays greater symptomatic and structural severity.     

Clinical epidemiology of hip and knee joint arthroses: an overview of the results of the "Ulm Osteoarthrosis Study"

AIM OF STUDY: To summarize the strategy of patient recruitment, applied methods and published results within the Ulm Osteoarthritis Study, a multicenter cross-sectional survey of patients with advanced hip and knee osteoarthritis. METHODS: 420 patients with hip OA and 398 patients with knee OA scheduled for unilateral total joint replacement in four hospitals in the southwestern part of Germany underwent detailed clinical investigations and a standardized interview in addition to radiographic analyses of ipsilateral and contralateral hip or knee joint and both hands. Odds ratios and 95% confidence intervals for the association of different possible risk factors with OA patterns (unilateral, bilateral and generalized OA) were calculated with logistic regression, adjusting for potential confounders. RESULTS: In 41.7% of patients with hip OA and 33.4% of patients with knee OA, an underlying pathological condition allowed a classification as secondary OA. 82.1% of patients with hip and 87.4% of patients with knee OA had bilateral disease. Generalized OA (GOA) was found in 19.3 and 34.9%, respectively (after adjustment for different age and sex distribution in the two patient groups; however, this difference was not any more significant). A positive association could be observed between hypercholesterolemia and GOA in knee OA patients as well as between serum uric acid and GOA in hip OA patients. Obesity and overweight were associated with bilateral knee OA, but not bilateral hip OA nor GOA. DISCUSSION: Our innovative study design allows the non-invasive investigation of patient subgroups with established disease and a testing of relevant hypotheses in an appropriate setting. The data add to the evidence regarding the independent role of different systemic risk factors for OA. In an ongoing study the natural course of the disease of the contralateral, unoperated joint is currently being investigated in all recruited patients.