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.     

Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus

OBJECTIVE: To describe the short and medium term results of total hip arthroplasty (THA) for avascular necrosis in patients with systemic lupus erythematosus (SLE). METHODS: Nineteen patients with SLE and avascular necrosis of the femoral head (AVNFH), who underwent 26 THA were retrospectively reviewed with a minimum followup of 2 years. To determine whether these patients had results similar to those of patients with other conditions, we formed a control group of 19 patients who had 29 THA. They were matched for age, sex, and followup to the patients with SLE. Controls had THA for juvenile rheumatoid arthritis (n = 7), osteoarthritis (5), adult onset rheumatoid arthritis (8), developmental dysplasia of the hip (4), and other diagnoses (5). Outcome measures included a 10 point visual analog scale (VAS) for pain, the Harris hip score, and the SF-36 self-administered health outcome questionnaire. We used the methods of Delee, Harris, and Engh for radiological assessment. RESULTS: Mean age at surgery was 46 years (range 21-71 years) and average followup was 4 years, 7 months (range 1 yr 9 mo to 9 yrs 6 mo), similar in both groups. Technical problems, mostly consisting of small, nonpropagating cracks of the calcar in uncemented stems, were encountered in 4 SLE hips and 1 control hip. Six complications were noted in the SLE group, including 2 early, nonrecurrent dislocations, 1 patient with thigh pain for 1 year, 1 pericarditis, 1 sick-sinus syndrome, and 1 urinary tract infection. There was one case of urinary tract infection in the control group. One SLE patient developed a low grade prosthetic infection and underwent successful revision 2 years after primary surgery. Clinical outcome measures had similar scores in the 2 groups: average VAS pain score = 2.00 in SLE hips (maximum 10) and 1.97 in control hips; mean Harris hip score = 86.7 in SLE patients (maximum 100) and 81.9 in controls; average SF-36 score = 63.4 in SLE patients (maximum 100) and 60.5 in controls. There was no radiological evidence of implant loosening in controls; there was 1 asymptomatic cup migration in the SLE group. CONCLUSION: In the short and medium term, patients with SLE and AVN had good results after THA. Results were similar in patients who had hip replacement for other diagnoses. Less favorable clinical outcomes of hip replacement have been reported in young patients who have AVN of other etiology (e.g., alcoholic, post-traumatic), but this was not the case in our young patients who had AVN and SLE. Thus, AVNFH and SLE should not constitute a contraindication to hip replacement.     

Outcome of total hip arthroplasty for avascular necrosis of femoral head in systemic lupus erythematosus patients: A comparative study

BackgroundAvascular necrosis (AVN) is a major cause of disability in systemic lupus erythematosus (SLE) patients which directly affects the functionality and quality of life. Total hip arthroplasty (THA) is indicated for severe cases with major disability and severe pain. It is still debatable if SLE is an independent risk factor for poor outcome in THA or not.Aim of the workTo evaluate the result of THA for AVN of the femur head in SLE patients.Patients and methods22 THAs were performed in 20 SLE patients and were compared with the results of 25 hips of 22 patients who had THA due to AVN with non-SLE conditions. All patients were followed up after the surgery at 6 weeks, 3, 6 and 12 months post-operatively, and then yearly for functional and radiological outcomes.ResultsThe Harris hip score (HHS) increased from a preoperative average of 26 points to 93.52 at the most recent follow-up. In the control group, the mean HHS was 26 preoperatively and 95.52 postoperatively at the last follow-up. Visual analog scale for pain (VAS pain) decreased from 8 in SLE and 6 in the non-SLE group to 2 and 1 respectively. No significant difference was found between SLE patients and non-SLE patients regarding complications except for more chest infections in the SLE group. No mortality was recorded in both groups in the postoperative follow-up period of a mean of thirty months.ConclusionTHA outcome is as favorable in AVN patients with SLE as in non-SLE.     

Asymptomatic avascular necrosis in patients with primary antiphospholipid syndrome in the absence of corticosteroid use: a prospective study by magnetic resonance imaging

OBJECTIVE: To evaluate the prevalence of avascular necrosis (AVN), using magnetic resonance imaging (MRI), in patients with primary antiphospholipid syndrome (APS) and in patients with systemic lupus erythematosus (SLE), with or without anticardiolipin antibodies (aCL), who are asymptomatic for AVN and have not taken corticosteroids. METHODS: Seventy-nine subjects who were asymptomatic for AVN were evaluated by MRI of the femoral heads: 30 patients with primary APS who had never received corticosteroids, 19 SLE patients who had never received steroids (divided into 2 groups, aCL positive and aCL negative, in order to examine any association between AVN and aCL), and 30 healthy subjects who were age- and sex-matched with patients with primary APS. Established MRI criteria were used for a diagnosis of AVN. RESULTS: Asymptomatic AVN was evident in 6 (20%) of 30 patients with primary APS: 3 of them (1 man, 2 women) had intermediate bilateral AVN, and 3 (all women) had early AVN (bilateral in 1 patient). Results of hip and pelvis radiography and dynamic scintigraphy were negative. Followup MRI 6 months later revealed no changes. At the time of the initial MRI examination, the mean (+/-SD) age of patients in whom AVN was identified was 31.2 +/- 7.3 years, and that of patients without AVN was 42.4 +/- 11.9 years (P = 0.036). Livedo reticularis occurred significantly more commonly in the group with AVN (P = 0.041). None of the healthy subjects and none of the patients with SLE demonstrated AVN on MRI. CONCLUSION: AVN can be detected by MRI in 20% of patients with primary APS. Younger patients tend to develop AVN more frequently than do older patients, and the presence of livedo reticularis may identify individuals at risk for AVN. Clinicians should be aware of this possible clinical manifestation of primary APS, because early diagnosis can lead to early intervention.     

Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study

OBJECTIVE: To study the efficacy of alendronate, in the treatment of avascular necrosis (AVN) of the hip. METHODS: Sixty patients with AVN of the hip (100 hips with AVN) were studied. The follow-up period ranged from 3 months to 5 yr. The most common cause of AVN was steroids. Parameters studied were walking time, standing time, pain and disability on a visual analogue scale (VAS), range of motion of the hip, X-ray and MRI of the hip. All patients were treated with alendronate 10 mg/day (or 70 mg/week) along with 500-1000 mg of daily calcium and vitamin D supplements, and were advised to avoid weight-bearing. NSAIDs and analgesics were permitted as needed and were recorded. RESULTS: Forty-one patients (71 AVN hips) with AVN have been followed up for a minimum of 1 yr, 24 patients (42 AVN hips) for 2 yr and 21 patients (37 AVN hips) for more than 2 yr (average 37 month). Fourteen patients have been followed up for less than 1 yr (3-9 months). Significant reduction in pain and disability scores (P < 0.001) and significant increase in standing and walking time (P < 0.001) were observed. All hip movements improved at 1 yr (P value 0.000-0.009) with an insignificant decline after that (P > 0.001). Radiologically, the hips either stabilized in the same grade or progressed by one grade. MRI showed a decrease in marrow oedema in most cases at the 1-yr follow-up. Six patients (10 hips) required surgery and there were two (three hips) dropouts. The drug was well tolerated and there was a reduction in NSAID requirement. CONCLUSION: Alendronate reduces pain, improves function and retards AVN progression. Early surgical intervention can be avoided in most patients.     

Avascular necrosis after treatment of aplastic anaemia with antilymphocyte globulin and high-dose methylprednisolone

Summary. Avascular necrosis of bone (AVN) occurring in patients with aplastic anaemia (AA) treated with antilymphocyte globulin (ALG) followed by high-dose methylprednisolone (HDMP) has been studied retrospectively. Out of 49 patients treated at two centres, seven have developed AVN at a median of 14 months (range 6–30) following treatment. The cumulative incidence of AVN is 21% (95% confidence intervals 7–35%). The hip was involved in six patients, bilaterally in five. Two patients had more than two joints affected. Surgical intervention was necessary in five patients, three of whom required total hip replacement. In contrast, there were no cases of AVN in a historical group of 61 patients with aplastic anaemia treated with an indentical regimen of ALG but using a short course of low-dose prednisolone. Lack of convincing evidence for benefit, the considerable morbidity from AVN, and increased risk of early life-threatening infection, suggest that high-dose methyl prednisolone should be omitted from ALG treatment protocols for aplastic anaemia.     

Radiographic progression of hospital referred osteoarthritis of the hip.

Various factors have been considered important in the rate of progression of osteoarthritis of the hip, though few data are available from large longitudinal studies. One hundred and thirty six patients referred to hospital (85 women, 51 men; mean age 65 years, range 29-86 years) with osteoarthritis of the hip (192 affected hips) were followed up for a median of 27 (range 3-72) months. One hundred and six patients (144 affected hips) were reviewed for a minimum of one year (median 28, range 12-72 months). Fifty three per cent of all osteoarthritic hips required an operation at a median of 14 (range 3-48) months from entry. All radiographs before and after entry were examined (median four films for each patient over a median of three years, range 0.5-19 years). Hips showing rapid radiographic progression on prospective films more often had superior migration, or an atrophic bone response; those with no progression more often had an indeterminate, medial, or axial migration pattern, protrusio or mild osteoarthritis at presentation. A higher occurrence of rapid progression was seen in women, in those of older age at symptom onset, and in hips with a higher Kellgren grade at entry; men more often showed no progression. Age at presentation, body mass index, symptom duration, or presence of chondrocalcinosis, hand osteoarthritis/nodes, or Forestier's disease did not influence progression. This study supports the contention that, at the time of hospital referral, certain patient characteristics and radiographic features at the hip may help to identify those at high risk of rapidly progressive hip osteoarthritis.     

Bilateral synchronous total hip arthroplasty for end-stage arthropathy in hemophilia A patients: A retrospective study

Total hip arthroplasty (THA) has been an effective tool of advanced hemophiliac hip arthritis. There are only limited data of bilateral synchronous THA for end-stage arthropathy in hemophilia A patients.The aim of this retrospective study was to analyze clinical outcome and complication rate of bilateral THA for hemophilia A patients with end-stage arthropathy of hip and review the operative strategy.From August 2012 to July 2016, 48 hips of 24 patients with hemophilia A patients underwent THA by a single experienced chief orthopedic surgeon. Clinical and radiological evaluations were included of operation time, blood loss, the quantity of blood transfusion, clotting factor consumption, duration of hospitalization, modified Harris hip score, complication rate, and radiographic assessment.All the 24 patients successfully completed the operation, followed up for 5 to 8 years, and the mean time was 6.5 years. The average operation time was 140 minutes (range, 120–180 minutes). The average total blood loss was 225 mL (range, 150–400 mL). The mean red blood cell transfusion amount was 2.4 U (range, 0–6 U). the mean hospitalization time was 24 days (range, 16–46 days). The mean amount of clotting factor VIII used in the perioperative period for management of hemophilia A was 30,600 U (range, 18,000–52,000 U). Average modified Harris hip score increased from 46.6 (range 28–70) points preoperatively to 90.2 (range 75–98) points at final follow-up, complications were few.With excellent operative techniques and hematological management, bilateral synchronous THA for end-stage arthropathy in hemophilia A patients can provide satisfactory outcomes.     

Lack of evidence for gender bias in the utilization of total HIP arthroplasty among olmsted county,minnesota residents with osteoarthritis

Objective. To evaluate whether women have more advanced osteoarthritis (OA) than men prior to total hip arthroplasty (THA). Methods. Preoperative clinical and radiographic severity of hip OA was determined among Olmsted County, Minnesota residents who underwent THA. The time from first radiographic changes and first symptoms to THA was compared between genders. Results. Fifty men and 80 women underwent their first THA between 1985 and 1990. Men had higher disease activity levels preoperatively; however, 16 other clinical severity variables and 2 summary measures of OA severity were similar for both genders. Men had radiographically more advanced hip OA preoperatively. The time from first symptom of hip OA to THA was similar for both genders, while the time from first radiographic change to THA was significantly longer for men. Conclusion. These results fail to support the hypothesis that hip OA prior to THA is more severe among women compared with men.     

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.

     

Gait analysis in an osteoarthritis patient with restoration of the hip joint space following contralateral total hip arthroplasty: a case report

We present the case of a patient who, after undergoing unilateral total hip arthroplasty (THA), achieved pain reduction in the contralateral hip accompanied by restoration of the radiographic joint space. We conducted gait analysis to clarify the dynamic factors affecting the natural course of osteoarthritis (OA). Our findings revealed that the patient walked with exaggerated adduction of the hip following the contralateral THA, causing substantial regeneration of joint loading.     

Risk factors for poor hip flexion after total hip arthroplasty for the treatment of ankylosing spondylitis a multivariate analysis

The purpose of this study is to investigate the clinical and radiographic results of total hip arthroplasty (THA) for the treatment of ankylosing spondylitis (AS) and to evaluate the effects of patient, prosthesis design, and surgical technique-related risk factors on postoperative functional results. We retrospectively reviewed the clinical and radiographic results of THA performed in 167 hips for 100 patients with AS. The average follow-up period was 54.8 months (range, 32–129 months). The hip passive-flexion arc averaged only 0 ° (0–40.0 °) before surgery, compared with 100.0 ° (85.0–110.0 °) at the most recent follow-up examination (P?C-reactive protein, use of a 32-mm femoral head, and postoperative heterotopic ossification. In patients with AS with severe pain, limited motion and posture, as well as deformity, the overall outcomes after THA were found to be favorable with an encouraging midterm prosthetic survivorship, a low complication rate and a high level of patients’ satisfaction. It seemed these patients were particularly predisposed to relative poor range of motion of the involved hips after THA which was closely related to patients’ satisfaction. The surgeons should pay careful attention to all possible risk factors perioperatively and develop a comprehensive treatment regimen.     

Individuals with severe knee osteoarthritis (OA) exhibit altered proximal walking mechanics compared with individuals with less severe OA and those without knee pain

Objective

To examine hip, pelvis, and trunk walking biomechanics in individuals with medial compartment knee osteoarthritis (OA) of varying radiographic disease severities and others without knee pain.

Methods

Hip, pelvis, and trunk kinematics and hip kinetics were assessed in 75 individuals with radiographically confirmed OA and 20 asymptomatic individuals. Differences in peak hip adduction and abduction angles, the amount of contralateral pelvic drop, and peak lateral trunk lean measured by 3‐dimensional gait analysis were examined using analyses of variance. Peak external hip abduction and adduction moments were compared using analyses of covariance, with gait speed as a covariate.

Results

Those with severe OA disease exhibited significantly less peak hip adduction (5.0°), but more ipsilateral trunk lean toward the study extremity (5.0°) than all other groups (P < 0.001). Those in the severe (1.1°) and asymptomatic (0.9°) groups also exhibited significantly less lateral trunk lean toward the non‐study extremity (P = 0.004). No significant differences in hip joint moments or contralateral pelvic drop were observed between the groups (P > 0.02).

Conclusion

Gait changes at the hip and trunk were evident across the groups based on radiographic disease severity and compared with those without knee pain. Although not conclusive from this cross‐sectional study design, the results provide initial evidence to support increased lateral trunk lean as being a compensatory response to the disease.     

Long‐term outcome following total hip arthroplasty: A controlled longitudinal study

Objective

To assess long‐term outcome and predictors of prognosis following total hip arthroplasty (THA) for osteoarthritis (OA).

Methods

We studied 282 patients from 2 English health districts ～8 years after THA, along with 295 controls selected from the general population. Baseline data were collected by interview and examination, on sex, age, comorbidity, body mass index (BMI), and Short Form 36 (SF‐36) functional status, and preoperative radiographic severity of OA was graded. Functional status was reassessed at followup by postal questionnaire. Predictors of change in physical functioning were analyzed by linear regression.

Results

Over followup, cases who had THA reported a median improvement of 10 points in SF‐36 score for physical functioning, whereas in controls there was a median deterioration of 10 points (P < 0.0001). Mental health improved by a median of 12 points in both cases and controls. Change in physical functioning was significantly worse in women and at older ages among both cases and controls. In cases, Croft grade 5 OA was associated with a physical functioning score improvement 19.4 points (95% confidence interval 7.7, 31.2) greater than the improvement in grades 0–3, but BMI was unrelated to change in physical functioning.

Conclusion

Improvements in physical functioning following THA for OA are sustained in the long term and are more frequent in patients with more severe radiographic features preoperatively. We found no indication that patients who are overweight benefit less from THA, but further evidence is needed on the prognostic influence of more severe obesity.     

Long-term outcome following total hip arthroplasty: a controlled longitudinal study

OBJECTIVE: To assess long-term outcome and predictors of prognosis following total hip arthroplasty (THA) for osteoarthritis (OA). METHODS: We studied 282 patients from 2 English health districts approximately 8 years after THA, along with 295 controls selected from the general population. Baseline data were collected by interview and examination, on sex, age, comorbidity, body mass index (BMI), and Short Form 36 (SF-36) functional status, and preoperative radiographic severity of OA was graded. Functional status was reassessed at followup by postal questionnaire. Predictors of change in physical functioning were analyzed by linear regression. RESULTS: Over followup, cases who had THA reported a median improvement of 10 points in SF-36 score for physical functioning, whereas in controls there was a median deterioration of 10 points (P < 0.0001). Mental health improved by a median of 12 points in both cases and controls. Change in physical functioning was significantly worse in women and at older ages among both cases and controls. In cases, Croft grade 5 OA was associated with a physical functioning score improvement 19.4 points (95% confidence interval 7.7, 31.2) greater than the improvement in grades 0-3, but BMI was unrelated to change in physical functioning. CONCLUSION: Improvements in physical functioning following THA for OA are sustained in the long term and are more frequent in patients with more severe radiographic features preoperatively. We found no indication that patients who are overweight benefit less from THA, but further evidence is needed on the prognostic influence of more severe obesity.     

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.      

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.     

Requirement for total hip arthroplasty: an outcome measure of hip osteoarthritis?

OBJECTIVE: To assess if total hip arthroplasty (THA) is a valid outcome measure of hip osteoarthritis (OA), in respect to clinical and radiological assessments. METHODS: A prospective 3 year study of patients who had painful hip OA with an initial radiographic joint space width > or =1 mm at the narrowest point. Dependent variable was THA. Patient data including body mass index, OA structural severity by radiograph, OA symptomatic severity (pain, function), and OA localization were recorded at entry. Pelvic radiographs were obtained before THA, when available, and once yearly during the study. RESULTS: During the study 106 of 506 patients underwent THA. Risk was estimated (Kaplan-Meier method) to be 8+/-1, 16+/-2, and 23+/-2% after 1, 2, and 3 years, respectively. Factors predisposing to requirement for surgery were: age > or =70 years, female sex, superolateral migration of the femoral head, joint space width <2 mm, Kellgren-Lawrence grade > or =3, pain (visual analog scale) > or =50 mm, and Lequesne index > or =10 with a relative risk of 1.65, 1.71, 1.96, 1.85, 1.89, 1.86, and 2.59, respectively. Mean change in joint space width was 0.22+/-0.50 vs 0.97+/-1.35 mm/year in patients without and with THA, respectively (p<0.0001). Changes in radiological joint space width during the first year were highly predictive of requirement for THA during the 2 following years (risk of 5, 13, 25, and 79% in patients with a radiological joint space width worsening during the first year of 0, < or =25, >25 and < or =50, and >50%, respectively). CONCLUSION: These data suggest that THA could be considered as a valid outcome measure in OA. However, further studies should be conducted in other countries with different health care systems to evaluate the inter-country reliability of this measurement.     

Total hip arthroplasty with bone graft for acetabular protrusion in rheumatoid arthritis

 Twenty-five hips in 19 rheumatoid arthritis (RA) patients with protrusio acetabuli were followed up, both clinically and radiographically, for more than 9 years after total hip arthroplasty (THA), that was performed with a bone graft to reinforce the medial acetabular wall. Radiographs were taken preoperatively and every 6 months postoperatively. Clinical assessments of pain, gait, and range of motion of the hips were obtained preoperatively and every year postoperatively using the Japanese Orthopaedic Association hip-scoring system. Radiographs showed that bony union had occurred in all cases. Six acetabular components were loose, but no femoral components became loose during the 9-year period. The clinical evaluation showed that relief of pain was very significant. The range of motion of the hip joints also improved from 12 points to 16.6 points after 9 years. Walking ability improved, but is becoming worse as time goes by. The radiographic results were compared with the results of a THA group with RA that had not had a bone graft. The rate of loosening of the THA without a bone graft was significantly higher than that of THA with a bone graft. We concluded that bone grafting for protrusio acetabuli was a very useful procedure. Received: September 21, 2001 / Accepted: February 1, 2002 Correspondence to: K. Kondo     

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.