Lower Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery

Smith, Matthew V.; Klein, Sandra E.; Clohisy, John C.; Baca, Geneva; Brophy, Robert H.; Wright, Rick W.

doi:10.2106/jbjs.j.01822

Cited by 95 publications

(68 citation statements)

References 109 publications

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“…Differences in EQ-5D and HHS must be observed with caution as they did not reach minimal clinically important differences. The EQ-5D has been shown to have a mean minimal clinically important difference in patients having THA of 0.31 [25], while the HHS has minimal clinically important differences of 7 to 9 [32]. There is no established minimal clinically important difference for the UCLA activity score.…”

Section: Discussionmentioning

confidence: 99%

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Donahue

Lindgren

Galea

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Female patients undergoing hip resurfacing arthroplasties may be at greater risk of revision surgery than males, but it is unclear whether this is related to sex or other factors. We focused our analysis on data from a prospective multicenter cohort study monitoring the ASR TM hip resurfacing arthroplasty prosthesis on the potential association of sex on patient-reported outcome measures (PROMs), metal ion levels, revision surgery, and presence of adverse local tissue reaction. As thousands of patients with the ASR TM prosthesis are still undergoing followup it is critical to optimize the protocol for monitoring these patients.Questions/purposes We wished (1) to assess the associations between sex and implant survival, and adverse local tissue reaction; and (2) to report the differences between sexes in metal ion levels and patient-reported outcome measures. Methods One thousand two hundred fifty-two patients (1390 hips) who underwent hip resurfacing arthroplasty with implantation of the ASR TM prosthesis from April 2003 to July 2010 were eligible for enrollment in a multicenter followup study of the ASR TM Hip Resurfacing System after the voluntary recall of this device was initiated by DePuy in 2010. Nine hundred seventy patients (1098 hips) were enrolled at a mean of 7 years after surgery, with a mean followup of 2 years (range, 1-3.5 years). One of the authors (OM), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin (Cirencester, UK), Iconacy (Warsaw, IN, USA), Renovis (Redlands, CA, USA), Conformis (Burlington, MA, USA), Aston Medical (Saint-É tienne, France), Meril Healthcare (Vapi, Gujarat, India), Arthex (Naples, FL, USA), Mako Surgical Corp, Cambridge Polymer Group (Boston, MA, USA), and Orthopedic Technology Group (Boston, MA, USA). One of the authors (HM), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Zimmer Inc, Biomet, Corin, and RSA Biomedical (Umeå, Sweden Nine hundred fifty-eight patients (1084 hips) met the inclusion criteria: ability to provide informed consent, complete PROMs, and continued routine followup. A subset of patients (150 patients, 171 hips), who all were from one center, with annual metal artifact reduction sequence MRI were analyzed. Ninety-three percent of patients from this center had routine MRI performed. The EuroQoL (EQ-5D), Harris hip score (HHS), University of California Los Angeles (UCLA) activity score, VAS pain, radiographs, patient and surgery details, and blood cobalt and chromium levels were obtained. Cox regression analysis was conducted to identify factors associated with implant survival, using any revision as the end point, and presence of adverse local tissue reaction. Results In patients who had unilateral surgery, the only variable found to be associated with revision surgery was HHS (hazard ratio [HR], 0.96; 95% CI, 0.9...

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Section: Discussionmentioning

confidence: 99%

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Donahue

Lindgren

Galea

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Although improvements in mean postoperative functional scores were statistically significant as a result of the large number of patients included in this study, these differences are generally smaller than the minimum clinically important differences (MCIDs) that have been reported for THA. Smith et al [31] reported an MCID range for HHS between 7 and 9 points and an MCID for WOMAC physical function subscore as 12% of baseline score or 6% of maximum score (5-6 points). Furthermore, although activity levels may be helpful in defining patients at risk, it is important to note that the majority of failures after THA may not be related to wear.…”

Section: Discussionmentioning

confidence: 99%

Are Younger Patients Undergoing THA Appropriately Characterized as Active?

Keeney

Nunley

Baca

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Surgeons perform THA to address a variety of conditions in younger patients, including osteoarthritis (OA), osteonecrosis, inflammatory arthritis, and congenital deformities. Younger patients aged 50 years or younger have been characterized as active in the literature, but a direct relationship between age and activity level has not been well substantiated. Younger patients with OA may engage in higher activity levels; however, associated medical conditions in patients with other surgical indications may not support a generalization that age is a surrogate for activity level. We recently evaluated these issues in younger patients undergoing total knee arthroplasty (TKA) and noted that the majority would not be considered active. Given this observation, we considered whether younger patients undergoing THA are characterized by high activity levels, which is relevant to understanding the long-term risk of wear-related failures.Questions/purposes (1) Do demographic features of younger patients undergoing THA support high activity expectations? (2) Do preoperative or postoperative functional activity measures support projections that younger patients are active after THA? Methods We retrospectively compared demographic characteristics and functional activity profiles (as determined by preoperative and postoperative UCLA activity scores, Harris hip scores [HHS], and SF-12 and WOMAC physical function subscores) of 704 patients who had undergone THA and were aged younger than 50 years (822 hips) with those of 484 patients (516 hips) aged between 65 and 75 years, who had undergone THA, with a minimum followup at 1 year after surgery (range, 12-160 months). Results Compared with patients aged 65 to 75 years, younger patients undergoing THA were more often men (51%, 95% confidence interval [CI], 48.8%-53.2% versus 40%, 95% CI, 37.1%-42.9% women; p \ 0.01) or had undergone surgery for osteonecrosis (29% versus 4%; 95% CI, 2.8%-5.

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“…The study cohort and the total population of younger TKA patients and non-included younger TKA patients were similar with respect to gender (74.1% vs 67.7% female, p = 0.23), mean age (50.1 vs 50.0 years, p = 0.99), and mean BMI (34.2 vs 33.0, p = 0.21). Patients in the study cohort reported higher mean WOMAC physical function scores compared to non-included younger TKA patients (48.1 vs 43.0 points, p = 0.03) and demonstrated a trend towards higher mean WOMAC pain scores (43.3 vs 39.1 points, p = 0.06), although both of these differences are below the minimal clinically important difference (MCID) for these measures (Table 1) [21]. Among the older TKA patients, the study cohort included a higher proportion of female patients (71.4% vs 60.3%, p = 0.06), but there was no difference in mean age, (69.5 vs 69.5 years, p = 0.85) or mean BMI (31.1 vs 32.1 kg/m 2 , p = −0.23).…”

Section: Methodsmentioning

confidence: 96%

Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

et al. 2017

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Lower Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery

Abstract: "Lower extremityspecific measures of disability and outcomes in orthopaedic surgery

Cited by 95 publications

References 109 publications

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Are Females at Greater Risk for Revision Surgery After Hip Resurfacing Arthroplasty With the Articular Surface Replacement Prosthesis?

Are Younger Patients Undergoing THA Appropriately Characterized as Active?

Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty

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