Session 18: Hip Arthroplasty
18. November
12:45 - 13:35
Lokale: Vingsal 2
Chair: Stig S. Jakobsen and Martin Kirkegaard
Inger mechlenburg1,2,3, Jens Knak4, Sebastian Breddam Mosegaard4 , Mette Axelsen5 , Niels Krarup Jensen6 , Torben Bæk Hansen2,4, Maiken Stilling1,2
1Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark. 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 3Department of Public Health, Aarhus University, Aarhus, Denmark. 4Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark. 5Department of Occupational and Physical Therapy, Viborg Regional Hospital, Viborg, Denmark. 6Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark.
Background: Hip dislocation is a frequent and costly complication after total hip arthroplasty and patients are at increased risk of re-dislocations and morbidity. It is unknown if the use of a hip bandage can prevent re-dislocation in this group of patients.
Aim: To investigate if using a hip bandage is more effective than standard care in the prevention of total hip arthroplasty re-dislocation in patients with a previous total hip arthroplasty dislocation.
Materials and Methods: At two regional hospitals, 99 patients, 51 women, mean 70.7 (SD 9.9) years were enrolled in an un-blinded, clinical randomized controlled trial. Participants with at least one previous total hip arthroplasty dislocation were randomized to either wearing a bandage reducing flexion, adduction, and internal rotation of the hip (intervention group) or to standard care (control group). The participants were followed for 12 weeks. Main follow-up measures were as follows: number of re- dislocations (primary outcome), hip disability measured with the Oxford Hip Score (0-48, 48 best), quality of life measured with the 36- Item Short Form Survey (0-100, 100 best), satisfaction with treatment and serious adverse events. Statistical analyses followed the intention-to-treat principle.
Results: No significant group differences were observed for the primary outcome re-dislocations (9 versus 15, P = 0.143) or for disability (11.3 versus 14.4, P = 0.161), quality of life (57.7 versus 48.3, P = 0.050) or satisfaction with treatment (P = 0.562). There were 3 serious adverse events leading to total hip arthroplasty revision in the intervention group and 4 in the control group.
Interpretation / Conclusion: We found that a hip bandage is not superior to standard care in the prevention of total hip arthroplasty re-dislocation in those with a previous total hip arthroplasty dislocation.
1Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark. 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 3Department of Public Health, Aarhus University, Aarhus, Denmark. 4Department of Orthopaedic Surgery, University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark. 5Department of Occupational and Physical Therapy, Viborg Regional Hospital, Viborg, Denmark. 6Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark.
Background: Hip dislocation is a frequent and costly complication after total hip arthroplasty and patients are at increased risk of re-dislocations and morbidity. It is unknown if the use of a hip bandage can prevent re-dislocation in this group of patients.
Aim: To investigate if using a hip bandage is more effective than standard care in the prevention of total hip arthroplasty re-dislocation in patients with a previous total hip arthroplasty dislocation.
Materials and Methods: At two regional hospitals, 99 patients, 51 women, mean 70.7 (SD 9.9) years were enrolled in an un-blinded, clinical randomized controlled trial. Participants with at least one previous total hip arthroplasty dislocation were randomized to either wearing a bandage reducing flexion, adduction, and internal rotation of the hip (intervention group) or to standard care (control group). The participants were followed for 12 weeks. Main follow-up measures were as follows: number of re- dislocations (primary outcome), hip disability measured with the Oxford Hip Score (0-48, 48 best), quality of life measured with the 36- Item Short Form Survey (0-100, 100 best), satisfaction with treatment and serious adverse events. Statistical analyses followed the intention-to-treat principle.
Results: No significant group differences were observed for the primary outcome re-dislocations (9 versus 15, P = 0.143) or for disability (11.3 versus 14.4, P = 0.161), quality of life (57.7 versus 48.3, P = 0.050) or satisfaction with treatment (P = 0.562). There were 3 serious adverse events leading to total hip arthroplasty revision in the intervention group and 4 in the control group.
Interpretation / Conclusion: We found that a hip bandage is not superior to standard care in the prevention of total hip arthroplasty re-dislocation in those with a previous total hip arthroplasty dislocation.
Kristina Lund, Simon Storgaard Jensen, Jeppe Lange
Department of clinical medicine, Aarhus University; Department of clinical medicine, Aarhus University; Department of clinical medicine, Aarhus University & Department of Orthopedic surgery, Horsens Regional Hospital
Background: Current literature presents a variety of surgical interventions aimed at modifying the iliotibial band (ITB) at the hip to relieve the symptoms of Coxa Saltans Externa (CSE) and Greater Trochanteric Bursitis (GTB). The surgical procedures are internationally widely performed, although very little information exists on the long-term clinical as well as patient reported outcomes.
Aim: The hypothesis of this systematic review was that patients with GTB without clear description of snapping would not benefit from ITB surgery, whereas patients with CSE would. The purpose of this systematic review was to evaluate ITB surgery in Greater Trochanteric Pain Syndrome patients with CSE or GTB in relation to pain, snapping, use of non-surgical treatments postoperatively and repeated surgery following ITB surgery at the hip.
Materials and Methods: The study was reported in accordance with PRISMA. A systematic search of literature on PubMed and Embase as well as bibliography screening, included 21 studies, mainly smaller retrospective case-series, of adult patients undergoing isolated ITB- surgery with or without additional bursectomies.
Results: 360 patients were considered eligible for inclusion. The CSE and GTB cohort consisted of 150 and 210 patients, respectively. The mean follow-up time in the CSE group was 30 months, and the GTB group was 19 months. Complete pain relief was not achieved in 12% of patients in the CSE cohort, and 36% of the patients in the GTB cohort. In the CSE cohort snapping was eliminated in 95% of patients. Five of 150 patients (3%) in the CSE-cohort had repeated surgery. Eight of nine GTB studies reported information regarding repeated surgery, in which seven of 205 patients (3%) received repeated surgery.
Interpretation / Conclusion: In the CSE cohort, current literature indicates a positive short-term outcome regarding elimination of snapping, pain reduction, reuse of non-surgical treatment and repeated surgery. Contrary to the CSE cohort, we found limited evidence supporting ITB surgery in the GTB cohort, indicating ITB surgery in GTB patients with no CSE may not be warranted. This systematic review shows that high quality research is severely needed to access the value of ITB surgery at the hip in general.
Department of clinical medicine, Aarhus University; Department of clinical medicine, Aarhus University; Department of clinical medicine, Aarhus University & Department of Orthopedic surgery, Horsens Regional Hospital
Background: Current literature presents a variety of surgical interventions aimed at modifying the iliotibial band (ITB) at the hip to relieve the symptoms of Coxa Saltans Externa (CSE) and Greater Trochanteric Bursitis (GTB). The surgical procedures are internationally widely performed, although very little information exists on the long-term clinical as well as patient reported outcomes.
Aim: The hypothesis of this systematic review was that patients with GTB without clear description of snapping would not benefit from ITB surgery, whereas patients with CSE would. The purpose of this systematic review was to evaluate ITB surgery in Greater Trochanteric Pain Syndrome patients with CSE or GTB in relation to pain, snapping, use of non-surgical treatments postoperatively and repeated surgery following ITB surgery at the hip.
Materials and Methods: The study was reported in accordance with PRISMA. A systematic search of literature on PubMed and Embase as well as bibliography screening, included 21 studies, mainly smaller retrospective case-series, of adult patients undergoing isolated ITB- surgery with or without additional bursectomies.
Results: 360 patients were considered eligible for inclusion. The CSE and GTB cohort consisted of 150 and 210 patients, respectively. The mean follow-up time in the CSE group was 30 months, and the GTB group was 19 months. Complete pain relief was not achieved in 12% of patients in the CSE cohort, and 36% of the patients in the GTB cohort. In the CSE cohort snapping was eliminated in 95% of patients. Five of 150 patients (3%) in the CSE-cohort had repeated surgery. Eight of nine GTB studies reported information regarding repeated surgery, in which seven of 205 patients (3%) received repeated surgery.
Interpretation / Conclusion: In the CSE cohort, current literature indicates a positive short-term outcome regarding elimination of snapping, pain reduction, reuse of non-surgical treatment and repeated surgery. Contrary to the CSE cohort, we found limited evidence supporting ITB surgery in the GTB cohort, indicating ITB surgery in GTB patients with no CSE may not be warranted. This systematic review shows that high quality research is severely needed to access the value of ITB surgery at the hip in general.
Janni Jensen¹,²,?, Ole Graumann¹,², Søren Overgaard5,¹°, Oke Gerke4,7, Michael Lundemann6, Martin Haagen Haubro³, Claus Varnum³,¹¹,¹², Lene Bak¹, Janne Rasmussen8, Lone Olsen¹, Benjamin SB Rasmussen¹,²,8
Department of Radiology, Odense University Hospital, Odense, Denmark¹; Research and Innovation Unit of Radiology. University of Southern Denmark, Odense, Denmark²; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark³; Department of Clinical Research, University of Southern Denmark, Odense, Denmark4; Copenhagen University Hospital, Bispebjerg. Department of Orthopaedic Surgery and Traumatology5; Radiobotics, Copenhagen, Denmark6; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark7; Department of Radiology, Odense University Hospital, Svendborg, Denmark8; Open Patient data Explorative Network, OPEN, Odense University?; University of Copenhagen. Department of Clinical Medicine, Faculty of Health and Medical Sciences, Denmark¹°; Department of Orthopedic Surgery, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark¹¹; Department of Regional Health Research, University of Southern Denmark¹²
Background: Hip dysplasia (HD) is a leading cause of hip pain in young patients and may lead to osteoarthritis. Initial diagnosis is typically based on measurements from pelvic radiographs. Algorithms based on artificial intelligence (AI) have been shown reliable for measuring angles on knee radiographs. An algorithm for radiographic measurements of adult HD has not been described
Aim: To assess reliability of an algorithm designed to read pelvic radiographs and estimate agreement between algorithm and human observers for measuring: lateral center edge angle (LCEA), acetabular index angle (AIA), and Alpha angle (AA)
Materials and Methods: 78 pelvic radiographs were retrospectively collected. 2 orthopedics, 2 radiologists and 1 radiographer (8, 5, 21, 3 and 12 years of experience) measured LCEA, AIA, and AA. Agreement between algorithm and human observers were estimated by Bland-Altman (BA) with limits of agreement (LoA)
Results: The algorithm was able to read 71 of the radiographs, and was highly reliable offering consistent measurement outputs. Agreement between algorithm and manual measurements ranged from good to poor. Bias (95% Confidence interval (CI) and [LoA] for right LCEA ranged from 0.37° (95% CI: -0.61 to 1.36) [LoA: -7.79 to 8.53] for the senior orthopedic, to 9.56° (95% CI: 8.14 to 10.97) [LoA: -2.16 to 21.27] for the senior radiologist. Bias and LoA for right AIA ranged from -0.58° (95% CI: -1.32 to 0.16) [LoA: -6.69 to 5.5] to 1.70° (95% CI: 0.88 to 2.53) [LoA: -5.11 to 8.53], junior radiologist and senior orthopedic respectively. Systematic discrepancy was evident, for right LCEA were specialists consistently reported higher values than algorithm output but only 0.4° for the orthopedic specialist (Not of clinical significance). Mean measured LCEA for specialists ranged from 25.8 to 35.0° versus 25.4° as measured by the algorithm
Interpretation / Conclusion: Agreement between algorithm and specialists was varying. The algorithm was consistent and displayed the highest agreement with the senior orthopedic. With further development, the algorithm may be a good alternative to humans when diagnosing HD
Department of Radiology, Odense University Hospital, Odense, Denmark¹; Research and Innovation Unit of Radiology. University of Southern Denmark, Odense, Denmark²; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark³; Department of Clinical Research, University of Southern Denmark, Odense, Denmark4; Copenhagen University Hospital, Bispebjerg. Department of Orthopaedic Surgery and Traumatology5; Radiobotics, Copenhagen, Denmark6; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark7; Department of Radiology, Odense University Hospital, Svendborg, Denmark8; Open Patient data Explorative Network, OPEN, Odense University?; University of Copenhagen. Department of Clinical Medicine, Faculty of Health and Medical Sciences, Denmark¹°; Department of Orthopedic Surgery, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark¹¹; Department of Regional Health Research, University of Southern Denmark¹²
Background: Hip dysplasia (HD) is a leading cause of hip pain in young patients and may lead to osteoarthritis. Initial diagnosis is typically based on measurements from pelvic radiographs. Algorithms based on artificial intelligence (AI) have been shown reliable for measuring angles on knee radiographs. An algorithm for radiographic measurements of adult HD has not been described
Aim: To assess reliability of an algorithm designed to read pelvic radiographs and estimate agreement between algorithm and human observers for measuring: lateral center edge angle (LCEA), acetabular index angle (AIA), and Alpha angle (AA)
Materials and Methods: 78 pelvic radiographs were retrospectively collected. 2 orthopedics, 2 radiologists and 1 radiographer (8, 5, 21, 3 and 12 years of experience) measured LCEA, AIA, and AA. Agreement between algorithm and human observers were estimated by Bland-Altman (BA) with limits of agreement (LoA)
Results: The algorithm was able to read 71 of the radiographs, and was highly reliable offering consistent measurement outputs. Agreement between algorithm and manual measurements ranged from good to poor. Bias (95% Confidence interval (CI) and [LoA] for right LCEA ranged from 0.37° (95% CI: -0.61 to 1.36) [LoA: -7.79 to 8.53] for the senior orthopedic, to 9.56° (95% CI: 8.14 to 10.97) [LoA: -2.16 to 21.27] for the senior radiologist. Bias and LoA for right AIA ranged from -0.58° (95% CI: -1.32 to 0.16) [LoA: -6.69 to 5.5] to 1.70° (95% CI: 0.88 to 2.53) [LoA: -5.11 to 8.53], junior radiologist and senior orthopedic respectively. Systematic discrepancy was evident, for right LCEA were specialists consistently reported higher values than algorithm output but only 0.4° for the orthopedic specialist (Not of clinical significance). Mean measured LCEA for specialists ranged from 25.8 to 35.0° versus 25.4° as measured by the algorithm
Interpretation / Conclusion: Agreement between algorithm and specialists was varying. The algorithm was consistent and displayed the highest agreement with the senior orthopedic. With further development, the algorithm may be a good alternative to humans when diagnosing HD
Anne Rosendahl Kristiansen¹, Anders Holsgaard Larsen¹, Morten Bøgehøj¹, Søren Overgaard ², Martin Lindberg-Larsen¹, Ole Ovesen¹
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark¹; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences²
Background: Periacetabular osteotomy (PAO) is a wellknown procedure for acetabular dysplasia (AD), however it is also used for other diagnoses; acetabular retroversion (AR), congenital dislocation of the hip (CDH) and Calvé-Legg- Perthes disease (CLPD). No studies have included all these diagnoses and compared the outcome after PAO.
Aim: The primary aim was to report the hip survival of PAO with total hip arthroplasty (THA) as primary endpoint. Secondary, to report the risk of subsequent hip related operations other than THA.
Materials and Methods: We reviewed the entire consecutive cohort of 1501 hips (1203 patients) who underwent PAO from the introduction of the procedure in 1997 to December 2021 in a single center (Odense University Hospital). We identified conversions to THA and other subsequent hip related operations through patient files and the Danish National Patient Registry (DNPR). Hip related operations were defined as potentially related to PAO surgery (e.g. removal of screws, arthroscopy, re- PAO).
Results: 98(6.5%) of the total cohort of 1501 hips were converted to THA within the study period. For the total cohort, the Kaplan-Meier hip survival rate was 78% (95% CI 69-85) at 20 years with a mean follow-up of 7.8 years (0.02-24.6). The individual Kaplan-Meier hip survival rates at 15 years were 87% (95% CI 83-90) for AD, 95% (95% CI 92-97) for AR, 84% (95% CI 66-93) for CDH and 71% (95% CI 54-83) for CLPD. The risk of additional hip related operations was 48% for screw removal, 4% for arthroscopy and 1% for re-PAO.
Interpretation / Conclusion: Encouraging, overall PAO preserved 78% hips at 20 years. We found that AR patients presented with the highest (95%) PAO survivorship at 15 years compared to the other indications. AD and CDH patients had lower (87% and 84%) but also acceptable PAO survival thus, PAO is a valid procedure also for these patients. In a clinical perspective CLPD patients had a poorer (71%) outcome after PAO. Almost half of PAO patients may undergo other additional surgeries, with screw removal as the largest risk, which is also relevant and important information to the patients.
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark¹; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences²
Background: Periacetabular osteotomy (PAO) is a wellknown procedure for acetabular dysplasia (AD), however it is also used for other diagnoses; acetabular retroversion (AR), congenital dislocation of the hip (CDH) and Calvé-Legg- Perthes disease (CLPD). No studies have included all these diagnoses and compared the outcome after PAO.
Aim: The primary aim was to report the hip survival of PAO with total hip arthroplasty (THA) as primary endpoint. Secondary, to report the risk of subsequent hip related operations other than THA.
Materials and Methods: We reviewed the entire consecutive cohort of 1501 hips (1203 patients) who underwent PAO from the introduction of the procedure in 1997 to December 2021 in a single center (Odense University Hospital). We identified conversions to THA and other subsequent hip related operations through patient files and the Danish National Patient Registry (DNPR). Hip related operations were defined as potentially related to PAO surgery (e.g. removal of screws, arthroscopy, re- PAO).
Results: 98(6.5%) of the total cohort of 1501 hips were converted to THA within the study period. For the total cohort, the Kaplan-Meier hip survival rate was 78% (95% CI 69-85) at 20 years with a mean follow-up of 7.8 years (0.02-24.6). The individual Kaplan-Meier hip survival rates at 15 years were 87% (95% CI 83-90) for AD, 95% (95% CI 92-97) for AR, 84% (95% CI 66-93) for CDH and 71% (95% CI 54-83) for CLPD. The risk of additional hip related operations was 48% for screw removal, 4% for arthroscopy and 1% for re-PAO.
Interpretation / Conclusion: Encouraging, overall PAO preserved 78% hips at 20 years. We found that AR patients presented with the highest (95%) PAO survivorship at 15 years compared to the other indications. AD and CDH patients had lower (87% and 84%) but also acceptable PAO survival thus, PAO is a valid procedure also for these patients. In a clinical perspective CLPD patients had a poorer (71%) outcome after PAO. Almost half of PAO patients may undergo other additional surgeries, with screw removal as the largest risk, which is also relevant and important information to the patients.
Merete Nørgaard Madsen¹ , Lone Ramer Mikkelsen¹ ², Michael Skovdal Rathleff³, Kristian Thorborg4 5, Thomas Kallemose6, Thomas Bandholm5 6 7
Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark¹; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark²; Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark³; Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark4; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Occupational and Physical Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark5; Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark6; Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark7
Background: Postoperative rehabilitation exercise is commonly prescribed after total hip arthroplasty (THA), but its efficacy compared to no or minimal rehabilitation exercise has been questioned. Preliminary efficacy would be indicated if a dose-response relationship exists between the amount of performed exercise and degree of postoperative recovery.
Aim: To indicate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA, based on the relationship between performed exercise dose and change in performance-based function (gait speed) from 3 (start of intervention) to 10 weeks (end of intervention) after surgery.
Materials and Methods: A pre-registered prospective cohort study was conducted (registry: NCT03109821, protocol: PMID 31448107). Patients scheduled for primary THA were consecutively recruited and postoperatively performed home-based rehabilitation exercise using elastic bands. Performed exercise dose (repetitions/week) was objectively measured using attached sensor technology. Primary outcome was change in gait speed (40m fast-paced walk test). Secondary outcomes included patient reported hip disability (Hip disability and Osteoarthritis Outcome Score (HOOS)). In primary analysis, a linear regression model was used.
Results: Ninety-four patients (39 women) with a median age of 66.5 years participated. They performed a median of 339 repetitions/week (range: 28-1812). Across outcomes, significant improvements from 3 to 10- week follow-up were found. There were no significant association between the number of performed repetitions/week (in hundreds) and the change in gait speed (0.0086 m/sec [95% CI: -0.0053; 0.0225]) or HOOS (subscale ADL) (0.58 [-0.11; 1.26]).
Interpretation / Conclusion: Preliminary efficacy of home-based rehabilitation exercise using elastic bands was not indicated, as we found no significant associations between performed exercise dose and changes across outcomes. We did not include a non-exercise comparator, and trials using non-exercise comparators are needed to assess confirmatory exercise efficacy.
Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark¹; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark²; Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark³; Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark4; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Occupational and Physical Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark5; Clinical Research Centre, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark6; Department of Physical and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark7
Background: Postoperative rehabilitation exercise is commonly prescribed after total hip arthroplasty (THA), but its efficacy compared to no or minimal rehabilitation exercise has been questioned. Preliminary efficacy would be indicated if a dose-response relationship exists between the amount of performed exercise and degree of postoperative recovery.
Aim: To indicate the preliminary efficacy of home-based rehabilitation using elastic band exercise on performance-based function after THA, based on the relationship between performed exercise dose and change in performance-based function (gait speed) from 3 (start of intervention) to 10 weeks (end of intervention) after surgery.
Materials and Methods: A pre-registered prospective cohort study was conducted (registry: NCT03109821, protocol: PMID 31448107). Patients scheduled for primary THA were consecutively recruited and postoperatively performed home-based rehabilitation exercise using elastic bands. Performed exercise dose (repetitions/week) was objectively measured using attached sensor technology. Primary outcome was change in gait speed (40m fast-paced walk test). Secondary outcomes included patient reported hip disability (Hip disability and Osteoarthritis Outcome Score (HOOS)). In primary analysis, a linear regression model was used.
Results: Ninety-four patients (39 women) with a median age of 66.5 years participated. They performed a median of 339 repetitions/week (range: 28-1812). Across outcomes, significant improvements from 3 to 10- week follow-up were found. There were no significant association between the number of performed repetitions/week (in hundreds) and the change in gait speed (0.0086 m/sec [95% CI: -0.0053; 0.0225]) or HOOS (subscale ADL) (0.58 [-0.11; 1.26]).
Interpretation / Conclusion: Preliminary efficacy of home-based rehabilitation exercise using elastic bands was not indicated, as we found no significant associations between performed exercise dose and changes across outcomes. We did not include a non-exercise comparator, and trials using non-exercise comparators are needed to assess confirmatory exercise efficacy.
Sofie Bech-Jørgensen(a), Josefine Beck Larsen(a,b), João Barroso(c), Stig Storgaard Jakobsen(a,b), Inger Mechlenburg(a,b,d)
a) Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; b) Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark, c) Orthopaedic Department, Hospital Pedro Hispano, Senhora da Hora, Portugal, d) Department of Public Health, Aarhus University, Aarhus N, Denmark.
Background: Outcomes for patients treated with PAO and subsequent total hip arthroplasty (THA) remain unclear. We evaluated patient-reported outcomes among patients treated with PAO and subsequent THA and investigated differences in the number of additional surgical procedures after PAO among patients treated with PAO and subsequent THA and patients treated with PAO only.
Aim: The aim of this study was to investigate patient- reported outcome scores among patients treated with PAO and subsequent THA. Furthermore, to describe additional surgery performed after PAO up to conversion to THA. Finally, to compare any differences in the number of additional hip surgeries performed after PAO among patients treated with PAO and subsequent THA and patients treated with PAO only.
Materials and Methods: 1378 hips underwent PAO and subsequently 66 hips were treated with THA. The Hip disability and Osteoarthritis Outcome Score (HOOS) and physical activity questions were completed for those. Additional surgery after PAO was identified through inquiry to the Danish National Patient Registry.
Results: 13% undergoing PAO and subsequent THA reported a HOOS pain score =50 indicating a clinical failure. The risk difference for hip arthroscopy after PAO within 2 and 4 years was 14% (CI 5%-23%) and 26% (CI 15%-38%) in favor of hips treated with PAO only. Similarly, the risk difference for screw removal within 2 and 4 years was 19% (CI 8%-29%) and 23% (CI 12%-34%).
Interpretation / Conclusion: 87% of patients undergoing PAO and subsequent THA had little or no hip pain. However, these patients received a high number of additional surgeries after PAO. Surgeons and patients may consider if additional surgery after PAO may be the first choice in a series of actions leading to conversion to THA.
a) Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; b) Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark, c) Orthopaedic Department, Hospital Pedro Hispano, Senhora da Hora, Portugal, d) Department of Public Health, Aarhus University, Aarhus N, Denmark.
Background: Outcomes for patients treated with PAO and subsequent total hip arthroplasty (THA) remain unclear. We evaluated patient-reported outcomes among patients treated with PAO and subsequent THA and investigated differences in the number of additional surgical procedures after PAO among patients treated with PAO and subsequent THA and patients treated with PAO only.
Aim: The aim of this study was to investigate patient- reported outcome scores among patients treated with PAO and subsequent THA. Furthermore, to describe additional surgery performed after PAO up to conversion to THA. Finally, to compare any differences in the number of additional hip surgeries performed after PAO among patients treated with PAO and subsequent THA and patients treated with PAO only.
Materials and Methods: 1378 hips underwent PAO and subsequently 66 hips were treated with THA. The Hip disability and Osteoarthritis Outcome Score (HOOS) and physical activity questions were completed for those. Additional surgery after PAO was identified through inquiry to the Danish National Patient Registry.
Results: 13% undergoing PAO and subsequent THA reported a HOOS pain score =50 indicating a clinical failure. The risk difference for hip arthroscopy after PAO within 2 and 4 years was 14% (CI 5%-23%) and 26% (CI 15%-38%) in favor of hips treated with PAO only. Similarly, the risk difference for screw removal within 2 and 4 years was 19% (CI 8%-29%) and 23% (CI 12%-34%).
Interpretation / Conclusion: 87% of patients undergoing PAO and subsequent THA had little or no hip pain. However, these patients received a high number of additional surgeries after PAO. Surgeons and patients may consider if additional surgery after PAO may be the first choice in a series of actions leading to conversion to THA.
Anne Rosendahl Kristiansen¹, Anders Holsgaard Larsen¹, Morten Bøgehøj¹, Søren Overgaard², Ole Ovesen¹, Martin Lindberg-Larsen¹
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark¹; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences²
Background: Limited data exists on patient safety after periacetabular osteotomy (PAO).
Aim: The aim of this study is to describe the safety after PAO defined as risk of postoperative complications resulting in prolonged length of hospital-stay (> 4 days) (LOS) and readmission = 90 days after PAO.
Materials and Methods: We identified patients who underwent PAO between 1997 and 2021 in a single institution (Odense University Hospital). We assesed patient characteristics, LOS, in-hospital complications, and readmissions = 90 days postoperatively from our institutional database and patient files.
Results: A total of 1203 patients (1501 hips) underwent primary PAO. The mean patient age at the time of surgery was 29.7 years (range 11-63 years) and 77% were females. Initially, the mean length of stay (LOS) was 3.9 days (SD 2.7), but decreased over time to 2.6 days (SD 1.7) in 2021. 373 patients (hips) (25%) had a LOS >4 days. Prolonged LOS were seen in 246 hips (16%) after the PAO procedure. Most frequent causes were pain (n=90, 6%), nausea and vomiting (n=89, 6%) and low haemoglobin (n=64, 4%). The 90-day readmission risk was 3.2% (95% CI 2-4). The most frequent causes of readmission were wound problems (n=19, 1%) and pain (n=12, 1%). Only 4 (0.3%) major complications leading to additional surgery within 90 days of PAO were observed.
Interpretation / Conclusion: The PAO is a safe procedure with short and decreasing LOS, and only few readmissions within 90 days after surgery of which only 0.3% suffered from major complications leading to additional surgery.
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Denmark¹; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences²
Background: Limited data exists on patient safety after periacetabular osteotomy (PAO).
Aim: The aim of this study is to describe the safety after PAO defined as risk of postoperative complications resulting in prolonged length of hospital-stay (> 4 days) (LOS) and readmission = 90 days after PAO.
Materials and Methods: We identified patients who underwent PAO between 1997 and 2021 in a single institution (Odense University Hospital). We assesed patient characteristics, LOS, in-hospital complications, and readmissions = 90 days postoperatively from our institutional database and patient files.
Results: A total of 1203 patients (1501 hips) underwent primary PAO. The mean patient age at the time of surgery was 29.7 years (range 11-63 years) and 77% were females. Initially, the mean length of stay (LOS) was 3.9 days (SD 2.7), but decreased over time to 2.6 days (SD 1.7) in 2021. 373 patients (hips) (25%) had a LOS >4 days. Prolonged LOS were seen in 246 hips (16%) after the PAO procedure. Most frequent causes were pain (n=90, 6%), nausea and vomiting (n=89, 6%) and low haemoglobin (n=64, 4%). The 90-day readmission risk was 3.2% (95% CI 2-4). The most frequent causes of readmission were wound problems (n=19, 1%) and pain (n=12, 1%). Only 4 (0.3%) major complications leading to additional surgery within 90 days of PAO were observed.
Interpretation / Conclusion: The PAO is a safe procedure with short and decreasing LOS, and only few readmissions within 90 days after surgery of which only 0.3% suffered from major complications leading to additional surgery.