Session 6: Hip arthroplasty
14. November
09:30 - 11:00
Lokale: Sal B
Chair: Rajzan Joanroy & Christian Wied
Troels Kjeldsen1,2,3, Søren T Skou3,4, Ulrik Dalgas5, Lisa U Tønning1,2, Kim G Ingwersen6,7, Sara Birch2,8,9, Pætur M Holm3,4,10, Thomas Frydendal1,2,6,11, Mette Garval12, Claus Varnum7,13, Bo M Bibby14, Inger Mechlenburg1,2,5
1) Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark 2) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark 3) The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark 4) Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark 5) Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark 6) Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Denmark 7) Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Denmark 8) Department of Neurology, Physiotherapy and Occupational Therapy, Gødstrup Regional Hospital, Herning, Denmark 9) Department of Orthopedic Surgery, Gødstrup Regional Hospital, Herning, Denmark 10) Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands 11) Department of Clinical Research, University of Southern Denmark, Odense, Denmark 12) Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark 13) Department of Orthopedic Surgery, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Denmark 14) Department of Biostatistics, Institute of Public Health, Aarhus University, Aarhus, Denmark
Background: Exercise is recommended as first-line treatment for patients with hip osteoarthritis (OA). Interestingly, content and dose of exercise interventions seem to be important for the effect of exercise interventions, but the optimal content and dose is unknown. This warrants randomized controlled trials providing evidence for the optimal exercise program in Hip OA.
Aim: To investigate whether progressive resistance training (PRT) is superior to neuromuscular exercise (NEMEX) for improving functional performance, hip pain and hip-related quality of life in patients with hip OA.
Materials and Methods: This was a multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial. 160 participants with clinically diagnosed hip OA were recruited from hospitals and physiotherapy clinics and randomly assigned to twelve weeks of PRT or NEMEX. The PRT intervention consisted of 5 high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention included 10 exercises and emphasized sensorimotor control and functional stability. The primary outcome was change in the 30-second chair stand test (30s-CST). Key secondary outcomes were changes in scores on the pain and hip-related quality of life (QoL) subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS).
Results: The mean changes from baseline to 12-week follow- up in the 30s-CST were 1.5 (95% CI, 0.9 to 2.1) chair stands with PRT and 1.5 (CI, 0.9 to 2.1) chair stands with NEMEX (difference, 0.0 [CI, 0.8 to 0.8] chair stands). For the HOOS pain subscale, mean changes were 8.6 (CI, 5.3 to 11.8) points with PRT and 9.3 (CI, 5.9 to 12.6) points with NEMEX. For the HOOS QoL subscale, mean changes were 8.0 (CI, 4.3 to 11.7) points with PRT and 5.7 (CI, 1.9 to 9.5) points with NEMEX.
Interpretation / Conclusion: In patients with hip OA, PRT is not superior to NEMEX for improving functional performance, hip pain, or hip-related QoL.
1) Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark 2) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark 3) The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark 4) Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark 5) Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark 6) Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Denmark 7) Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Denmark 8) Department of Neurology, Physiotherapy and Occupational Therapy, Gødstrup Regional Hospital, Herning, Denmark 9) Department of Orthopedic Surgery, Gødstrup Regional Hospital, Herning, Denmark 10) Faculty of Health Sciences, University of Faroe Islands, Tórshavn, Faroe Islands 11) Department of Clinical Research, University of Southern Denmark, Odense, Denmark 12) Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark 13) Department of Orthopedic Surgery, Lillebaelt Hospital - Vejle, University Hospital of Southern Denmark, Denmark 14) Department of Biostatistics, Institute of Public Health, Aarhus University, Aarhus, Denmark
Background: Exercise is recommended as first-line treatment for patients with hip osteoarthritis (OA). Interestingly, content and dose of exercise interventions seem to be important for the effect of exercise interventions, but the optimal content and dose is unknown. This warrants randomized controlled trials providing evidence for the optimal exercise program in Hip OA.
Aim: To investigate whether progressive resistance training (PRT) is superior to neuromuscular exercise (NEMEX) for improving functional performance, hip pain and hip-related quality of life in patients with hip OA.
Materials and Methods: This was a multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial. 160 participants with clinically diagnosed hip OA were recruited from hospitals and physiotherapy clinics and randomly assigned to twelve weeks of PRT or NEMEX. The PRT intervention consisted of 5 high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention included 10 exercises and emphasized sensorimotor control and functional stability. The primary outcome was change in the 30-second chair stand test (30s-CST). Key secondary outcomes were changes in scores on the pain and hip-related quality of life (QoL) subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS).
Results: The mean changes from baseline to 12-week follow- up in the 30s-CST were 1.5 (95% CI, 0.9 to 2.1) chair stands with PRT and 1.5 (CI, 0.9 to 2.1) chair stands with NEMEX (difference, 0.0 [CI, 0.8 to 0.8] chair stands). For the HOOS pain subscale, mean changes were 8.6 (CI, 5.3 to 11.8) points with PRT and 9.3 (CI, 5.9 to 12.6) points with NEMEX. For the HOOS QoL subscale, mean changes were 8.0 (CI, 4.3 to 11.7) points with PRT and 5.7 (CI, 1.9 to 9.5) points with NEMEX.
Interpretation / Conclusion: In patients with hip OA, PRT is not superior to NEMEX for improving functional performance, hip pain, or hip-related QoL.
Peter Bo Jørgensen1,2, Morten Humilius2, Daan Koppens1, Torben Bæk Hansen1, Maiken Stilling2
1. University Clinic for hand, hip, and knee surgery, Department of Orthopaedics, Gødstrup Hospital; 2. Department of Orthopaedics, Aarhus University Hospital
Background: The Tri-Lock bone preserving stem is a new collarless proximal-coated tapered-wedge design providing metaphyseal contact for rotational and axial stability to increase biological fixation and preserve bone. The Summit femoral stem is a classic well-proven collarless proximal-coated with a long and round-tapered design intended to eliminate hoop stress and provide initial stability to ensure biological metaphyseal fixation.
Aim: Our aim was first to compare femoral stem fixation (subsidence) of the newer metaphyseal ultra-porous-coated taper-wedge Tri-Lock stem with the classic metaphyseal porous-coated longer round-tapered Summit stem, and second to compare the change in periprosthetic bone mineral density (BMD) between stem groups.
Materials and Methods: In a patient-blinded RCT, 52 patients at mean age 60 (CI 58 — 62) received Tri-Lock (n=26) or Summit (n=26) femoral stems in combination with a Pinnacle cup, a cross- linked polyethylene liner, and a 32- or 36-mm CoCr head. Patients were followed for 5 years with RSA, DXA, and PROMs.
Results: At 2-year follow-up, the mean difference in stem subsidence was 0.14 mm (95% confidence interval [CI] 0.27 – 0.56). At the 5-year follow-up, mean subsidence for Tri- Lock and Summit was -0.38 (CI 0.72 – 0.04) and -0.24 (CI -0.57 – 0.09) and retroversion was 1.68° (CI 0.80 – 2.55) and 1.53° (CI 0.68 – 2.37), respectively. At 3-month follow-up, periprosthetic bone resorption of 4% - 16% around the stem (Gruen zones 1–6) and 20% in the calcar region was seen for both stems. At 5 years follow-up, the Tri-Lock stem preserved the metaphyseal bone the best whereas the Summit stem preserved or even increased the diaphyseal bone medial to the femoral stem.
Interpretation / Conclusion: The Tri-Lock and the Summit stems are intended for metaphyseal bone fixation and show similar migration until mid-term. However, the wedge-taper design stimulates metaphyseal BMD preservation while the long and round-tapered design preserves or even increases diaphyseal BMD. The long-term effect of this difference is unknown.
1. University Clinic for hand, hip, and knee surgery, Department of Orthopaedics, Gødstrup Hospital; 2. Department of Orthopaedics, Aarhus University Hospital
Background: The Tri-Lock bone preserving stem is a new collarless proximal-coated tapered-wedge design providing metaphyseal contact for rotational and axial stability to increase biological fixation and preserve bone. The Summit femoral stem is a classic well-proven collarless proximal-coated with a long and round-tapered design intended to eliminate hoop stress and provide initial stability to ensure biological metaphyseal fixation.
Aim: Our aim was first to compare femoral stem fixation (subsidence) of the newer metaphyseal ultra-porous-coated taper-wedge Tri-Lock stem with the classic metaphyseal porous-coated longer round-tapered Summit stem, and second to compare the change in periprosthetic bone mineral density (BMD) between stem groups.
Materials and Methods: In a patient-blinded RCT, 52 patients at mean age 60 (CI 58 — 62) received Tri-Lock (n=26) or Summit (n=26) femoral stems in combination with a Pinnacle cup, a cross- linked polyethylene liner, and a 32- or 36-mm CoCr head. Patients were followed for 5 years with RSA, DXA, and PROMs.
Results: At 2-year follow-up, the mean difference in stem subsidence was 0.14 mm (95% confidence interval [CI] 0.27 – 0.56). At the 5-year follow-up, mean subsidence for Tri- Lock and Summit was -0.38 (CI 0.72 – 0.04) and -0.24 (CI -0.57 – 0.09) and retroversion was 1.68° (CI 0.80 – 2.55) and 1.53° (CI 0.68 – 2.37), respectively. At 3-month follow-up, periprosthetic bone resorption of 4% - 16% around the stem (Gruen zones 1–6) and 20% in the calcar region was seen for both stems. At 5 years follow-up, the Tri-Lock stem preserved the metaphyseal bone the best whereas the Summit stem preserved or even increased the diaphyseal bone medial to the femoral stem.
Interpretation / Conclusion: The Tri-Lock and the Summit stems are intended for metaphyseal bone fixation and show similar migration until mid-term. However, the wedge-taper design stimulates metaphyseal BMD preservation while the long and round-tapered design preserves or even increases diaphyseal BMD. The long-term effect of this difference is unknown.
Simon Storgaard Jensen1, Lei Wang1, Nadia R. Gadgaard1, Henrik T. Sørensen1, Alma B. Pedersen1
1. Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Background: Orthopedic registries have provided valuable input about risk for and prognosis after total hip arthroplasties (THA). However, registries are often limited by the lack of data on lifestyle factors, health- related quality of life and behavior, and social background. These data are readily available in surveys.
Aim: We aimed to examine if participants of the Danish self-reported questionnaire-based public health survey “How are you” are representative of THA patients.
Materials and Methods: THA patients were identified in the Danish Hip Arthroplasty Register and combined with survey data (from 2010, 2013, 2017) on the individual-level. Data on age, sex, comorbidity, medication, markers of socioeconomic position, and health-care utilization were assessed from the Danish medical databases. We calculated proportions of a wide range of variables, comparing patients who had and those who had not participated in surveys before THA.
Results: We included 165,416 THA patients, of which 7,824 (4.7%) participated in surveys. Mean time from survey to THA was 3.7 years. Participants and non- participants had similar sex distribution (43%), median age of 71 and 69 years, while proportion of patients aged 75+ years was 32% and 27% respectively. The two groups had similar proportion of patients with no comorbidity (74% vs 76%) and various medications with only minor differences (<2%). The proportion of patients with high income and high educational level was 48% vs 35% and 22% vs 16% for participants vs non-participants, respectively. The participants had a slightly lower number of hospitalizations, outpatients-, and emergency room visits.
Interpretation / Conclusion: The survey data provided a sample that appeared to be representative of the entire THA population based on a number of patient and healthcare characteristics. Thus, the survey data could be a valuable tool for further understanding the risk and outcome of THA patients. Slight difference was observed for socioeconomic markers.
1. Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Background: Orthopedic registries have provided valuable input about risk for and prognosis after total hip arthroplasties (THA). However, registries are often limited by the lack of data on lifestyle factors, health- related quality of life and behavior, and social background. These data are readily available in surveys.
Aim: We aimed to examine if participants of the Danish self-reported questionnaire-based public health survey “How are you” are representative of THA patients.
Materials and Methods: THA patients were identified in the Danish Hip Arthroplasty Register and combined with survey data (from 2010, 2013, 2017) on the individual-level. Data on age, sex, comorbidity, medication, markers of socioeconomic position, and health-care utilization were assessed from the Danish medical databases. We calculated proportions of a wide range of variables, comparing patients who had and those who had not participated in surveys before THA.
Results: We included 165,416 THA patients, of which 7,824 (4.7%) participated in surveys. Mean time from survey to THA was 3.7 years. Participants and non- participants had similar sex distribution (43%), median age of 71 and 69 years, while proportion of patients aged 75+ years was 32% and 27% respectively. The two groups had similar proportion of patients with no comorbidity (74% vs 76%) and various medications with only minor differences (<2%). The proportion of patients with high income and high educational level was 48% vs 35% and 22% vs 16% for participants vs non-participants, respectively. The participants had a slightly lower number of hospitalizations, outpatients-, and emergency room visits.
Interpretation / Conclusion: The survey data provided a sample that appeared to be representative of the entire THA population based on a number of patient and healthcare characteristics. Thus, the survey data could be a valuable tool for further understanding the risk and outcome of THA patients. Slight difference was observed for socioeconomic markers.
Simon Kornvig1,2, Henrik Kehlet3,4, Christoffer Calov Jørgensen3,4, Anders Fink-Jensen5, Poul Videbech6, Thomas Jakobsen7, Kirill Gromov8, Claus Varnum1,2
1 Department of Orthopeadic Surgery, Lillebaelt Hospital - Vejle 2 Department of Regional Health Research, University of Southern Denmark, 3 Section for Surgical Pathophysiology, Copenhagen University Hospital 4 Centre for Fast-track Hip and Knee Replacement, Rigshospitalet 5 Mental Health Center, Frederiksberg and University of Copenhagen 6 Mental Health Center, Glostrup and University of Copenhagen 7 Department of Orthopeadic Surgery, Aalborg University Hospital - Farsø 8 Department of Orthopeadic Surgery, Hvidovre Hospital
Background: Preoperative psychopharmacological treatment is a potent risk factor for increased length of stay at hospital and readmission rate after hip and knee arthroplasty. However, no studies have investigated the effect of psychotropic drugs on patient-reported outcomes at baseline and several follow-ups in a multicenter fast- track setting.
Aim: The primary aim was to investigate whether preoperative psychopharmacological treatment influences improvements in Oxford Hip/Knee Score (OHS/OKS) 12 months after hip and knee arthroplasty. Secondary aims included evaluating EQ- 5D-3/5L and EQ VAS as well and assessing additional time points (3/6 and 24 months).
Materials and Methods: This consecutive cohort study included 4,020 primary hip and 3,222 primary knee arthroplasties performed from 2016 to 2020 at three fast-tack centers in Denmark. OHS/OKS, EQ-5D-3/5L and EQ VAS were collected at baseline and 3/6, 12 and 24 months after surgery. Exposure status was assigned using dispensed psychotropics obtained from the Danish National Prescription Registry. Marginal mean differences with 95% confidence intervals (CI) were estimated using multilevel tobit regression and adjusted for age, sex and Charlson Comorbidity Index obtained from the Danish National Patient Register.
Results: No significant associations were found between preoperative psychopharmacological treatment and improvements in OHS (-0.5, CI: -1.4; 0.4) or OKS (-0.3, CI: -1.2; 0.5) after 12 months. However, treated patients had significantly decreased baseline OHS (-1.4, CI: -2.2; -0.6) and OKS (-2.1, CI: -2.9; -1.3) and 12 months follow-up OHS (-1.9, CI: -2.8; -1.1) and OKS (-2.4, CI: -3.2; -1.6) compared to untreated patients. Similar patterns were found at other time points and using EQ- 5D-3/5L or EQ VAS.
Interpretation / Conclusion: Psychopharmacological treatment is not associated with poorer patient-reported improvements after hip or knee arthroplasty. However, treated patients have significantly lower baseline and follow-up scores than untreated patients. Nevertheless, this small difference is clinically irrelevant.
1 Department of Orthopeadic Surgery, Lillebaelt Hospital - Vejle 2 Department of Regional Health Research, University of Southern Denmark, 3 Section for Surgical Pathophysiology, Copenhagen University Hospital 4 Centre for Fast-track Hip and Knee Replacement, Rigshospitalet 5 Mental Health Center, Frederiksberg and University of Copenhagen 6 Mental Health Center, Glostrup and University of Copenhagen 7 Department of Orthopeadic Surgery, Aalborg University Hospital - Farsø 8 Department of Orthopeadic Surgery, Hvidovre Hospital
Background: Preoperative psychopharmacological treatment is a potent risk factor for increased length of stay at hospital and readmission rate after hip and knee arthroplasty. However, no studies have investigated the effect of psychotropic drugs on patient-reported outcomes at baseline and several follow-ups in a multicenter fast- track setting.
Aim: The primary aim was to investigate whether preoperative psychopharmacological treatment influences improvements in Oxford Hip/Knee Score (OHS/OKS) 12 months after hip and knee arthroplasty. Secondary aims included evaluating EQ- 5D-3/5L and EQ VAS as well and assessing additional time points (3/6 and 24 months).
Materials and Methods: This consecutive cohort study included 4,020 primary hip and 3,222 primary knee arthroplasties performed from 2016 to 2020 at three fast-tack centers in Denmark. OHS/OKS, EQ-5D-3/5L and EQ VAS were collected at baseline and 3/6, 12 and 24 months after surgery. Exposure status was assigned using dispensed psychotropics obtained from the Danish National Prescription Registry. Marginal mean differences with 95% confidence intervals (CI) were estimated using multilevel tobit regression and adjusted for age, sex and Charlson Comorbidity Index obtained from the Danish National Patient Register.
Results: No significant associations were found between preoperative psychopharmacological treatment and improvements in OHS (-0.5, CI: -1.4; 0.4) or OKS (-0.3, CI: -1.2; 0.5) after 12 months. However, treated patients had significantly decreased baseline OHS (-1.4, CI: -2.2; -0.6) and OKS (-2.1, CI: -2.9; -1.3) and 12 months follow-up OHS (-1.9, CI: -2.8; -1.1) and OKS (-2.4, CI: -3.2; -1.6) compared to untreated patients. Similar patterns were found at other time points and using EQ- 5D-3/5L or EQ VAS.
Interpretation / Conclusion: Psychopharmacological treatment is not associated with poorer patient-reported improvements after hip or knee arthroplasty. However, treated patients have significantly lower baseline and follow-up scores than untreated patients. Nevertheless, this small difference is clinically irrelevant.
Afrim Iljazi1, Michala Skovlund Sørensen1,2,5, Matilde Winther-Jensen3, Søren Overgaard4,5, Michael Mørk Petersen1,5
1. Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet 2. Department of Orthopedic Surgery, Zealand University Hospital 3. Department of Data, Biostatistics and Pharmacoepidemiology, Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg-Frederiksberg 4. Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg-Frederiksberg 5. Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
Background: Hip precautions have been recommended postoperatively following total hip arthroplasty (THA), however, the evidence supporting this practice is scarce. We conducted a population- based study evaluating if the discontinuation of recommending hip precautions following THA has affected the risk of early dislocation.
Aim: To determine the association between the risk of early post-operative dislocation and the removal of hip precautions from the regional guideline on post- operative mobilization following primary THA for osteoarthritis (OA) in the Capital Region of Denmark.
Materials and Methods: The study is a cohort study from the Danish Hip Arthroplasty Register and The Danish National Patient Register. We included patients receiving THA for OA at public hospitals in the Capital Region of Denmark using the posterior approach. The hip precautions group included patients operated between 2004-2009 (n=5,769). The no precautions group were operated between 2014-2019 (n=9,030). We used absolute risk regression to compare the crude and adjusted dislocation risk within 3 months and 2 years between groups, taking the competing risk of death into account.
Results: The cumulative incidence of dislocation was 2.9% (CI 2.5-3.3) within 3 months and 5.5% (CI 4.9-6.0) within 2 years in the hip precautions group and 3.5% (CI 3.1-3.9) and 5.0% (CI 4.5- 5.4) in the no precautions group. We saw an increased use of 36mm heads, uncemented prosthesis’ and patients with comorbidities over time. There was no increased risk of dislocation in the no precautions group within 3 months (ARR: 1.2, 95% CI: 0.88-1.6, p=0.26) or within 2 years (ARR: 1.0, 95% CI: 0.80-1.3, p=0.95). The findings remained consistent after adjusting for femoral head size, age, sex, cementation, dementia, lumbar spinal fusion, neuromuscular dysfunction and alcohol overuse (3 months: ARR: 1.3, 95% CI: 0.96-1.9, p=0.08; 2 years: ARR: 1.2, 95% CI: 0.93-1.5, p=0.17).
Interpretation / Conclusion: We found no increase in the risk of early dislocation after removal of hip precautions from the guideline on post-operative mobilization following THA despite an increased proportion of patients with comorbidities. We speculate that the increased use of 36mm femoral heads mitigates the change in risk.
1. Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet 2. Department of Orthopedic Surgery, Zealand University Hospital 3. Department of Data, Biostatistics and Pharmacoepidemiology, Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg-Frederiksberg 4. Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg-Frederiksberg 5. Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
Background: Hip precautions have been recommended postoperatively following total hip arthroplasty (THA), however, the evidence supporting this practice is scarce. We conducted a population- based study evaluating if the discontinuation of recommending hip precautions following THA has affected the risk of early dislocation.
Aim: To determine the association between the risk of early post-operative dislocation and the removal of hip precautions from the regional guideline on post- operative mobilization following primary THA for osteoarthritis (OA) in the Capital Region of Denmark.
Materials and Methods: The study is a cohort study from the Danish Hip Arthroplasty Register and The Danish National Patient Register. We included patients receiving THA for OA at public hospitals in the Capital Region of Denmark using the posterior approach. The hip precautions group included patients operated between 2004-2009 (n=5,769). The no precautions group were operated between 2014-2019 (n=9,030). We used absolute risk regression to compare the crude and adjusted dislocation risk within 3 months and 2 years between groups, taking the competing risk of death into account.
Results: The cumulative incidence of dislocation was 2.9% (CI 2.5-3.3) within 3 months and 5.5% (CI 4.9-6.0) within 2 years in the hip precautions group and 3.5% (CI 3.1-3.9) and 5.0% (CI 4.5- 5.4) in the no precautions group. We saw an increased use of 36mm heads, uncemented prosthesis’ and patients with comorbidities over time. There was no increased risk of dislocation in the no precautions group within 3 months (ARR: 1.2, 95% CI: 0.88-1.6, p=0.26) or within 2 years (ARR: 1.0, 95% CI: 0.80-1.3, p=0.95). The findings remained consistent after adjusting for femoral head size, age, sex, cementation, dementia, lumbar spinal fusion, neuromuscular dysfunction and alcohol overuse (3 months: ARR: 1.3, 95% CI: 0.96-1.9, p=0.08; 2 years: ARR: 1.2, 95% CI: 0.93-1.5, p=0.17).
Interpretation / Conclusion: We found no increase in the risk of early dislocation after removal of hip precautions from the guideline on post-operative mobilization following THA despite an increased proportion of patients with comorbidities. We speculate that the increased use of 36mm femoral heads mitigates the change in risk.
Martin Bækgaard Stisen1,2, Alma Becic Pedersen1,3, Katie Sheehan4, Inger Mechlenburg1,2
1. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 2. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; 3. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; 4. Bone & Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
Background: Patients who undergo revision total hip replacement (THR) are at higher risk of prolonged opioid use postoperatively compared to those who undergo primary THR. Effective pain management remains challenging, impacting satisfaction and recovery. Prolonged opioid use raises safety concerns due to associated serious adverse effects. However, the risk profile of these patients is not well understood.
Aim: The aim of this study is to identify trajectories of opioid use within 2 years of revision THR and clinical characteristics associated with high and prolonged opioid use.
Materials and Methods: A population-based cohort of 12,435 patients who underwent revision THR between 1995 and 2018. The prevalence of opioid use was calculated across eight quarters (Q1-Q8) post-revision. Group-based trajectory models were used to identify clusters of patients with similar trends of morphine milligram equivalent (MME) values per day over the 2-year follow-up period. Risk ratios were estimated to predict influential factors in trajectory group assignment.
Results: Opioid use prevalence decreased from 71% in Q1 to 29% in Q2, and further to 23% in Q8. We identified three distinct groups of trajectory MME use per day post-revision: Minimal users (77% - mean MME/day at Q1=5.4, Q8=0.6), steady users (18% - mean MME/day at Q1=31.0, Q8=22.3), and high users (5% - mean MME/day at Q1=101.2, Q8=108.7). Patients who were female, younger, had high comorbidity burden, used preoperative opioids and other pain medications, had mental disorders, had low educational levels, lived alone, and had low wealth were more likely to be high users compared to minimal users.
Interpretation / Conclusion: Two years after revision THR, 23% of patients were opioid users, raising concern about potentially related serious adverse events. We identified several clinical characteristics associated with high opioid use during the 2 years post-revision. These characteristics could be used to tailor interventions to optimize pain management and possibly reduce unnecessary opioid use post-revision THR.
1. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 2. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark; 3. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; 4. Bone & Joint Health, Blizard Institute, Queen Mary University of London, London, UK.
Background: Patients who undergo revision total hip replacement (THR) are at higher risk of prolonged opioid use postoperatively compared to those who undergo primary THR. Effective pain management remains challenging, impacting satisfaction and recovery. Prolonged opioid use raises safety concerns due to associated serious adverse effects. However, the risk profile of these patients is not well understood.
Aim: The aim of this study is to identify trajectories of opioid use within 2 years of revision THR and clinical characteristics associated with high and prolonged opioid use.
Materials and Methods: A population-based cohort of 12,435 patients who underwent revision THR between 1995 and 2018. The prevalence of opioid use was calculated across eight quarters (Q1-Q8) post-revision. Group-based trajectory models were used to identify clusters of patients with similar trends of morphine milligram equivalent (MME) values per day over the 2-year follow-up period. Risk ratios were estimated to predict influential factors in trajectory group assignment.
Results: Opioid use prevalence decreased from 71% in Q1 to 29% in Q2, and further to 23% in Q8. We identified three distinct groups of trajectory MME use per day post-revision: Minimal users (77% - mean MME/day at Q1=5.4, Q8=0.6), steady users (18% - mean MME/day at Q1=31.0, Q8=22.3), and high users (5% - mean MME/day at Q1=101.2, Q8=108.7). Patients who were female, younger, had high comorbidity burden, used preoperative opioids and other pain medications, had mental disorders, had low educational levels, lived alone, and had low wealth were more likely to be high users compared to minimal users.
Interpretation / Conclusion: Two years after revision THR, 23% of patients were opioid users, raising concern about potentially related serious adverse events. We identified several clinical characteristics associated with high opioid use during the 2 years post-revision. These characteristics could be used to tailor interventions to optimize pain management and possibly reduce unnecessary opioid use post-revision THR.
Lisa Tønning1,2, Stig Jakobsen1, Joanne Kemp3, Michael O'Brien3, Ulrik Dalgas4, Inger Mechlenburg1,2,4
1. Department of Orthopedic Surgery, Aarhus University Hospital, Denmark 2. Department of Clinical Medicine, Aarhus University, Denmark. 3. La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia 4. Department of Public Health, Sports, Aarhus University, Denmark
Background: Symptomatic hip dysplasia is often treated with periacetabular osteotomy (PAO). Studies investigating the effect of PAO have primarily focused on radiographic measurements, pain- related outcomes, and hip survival whereas evidence related to sport participation is limited.
Aim: The primary aim of this study was to report the rate of participation in sports among patients with hip dysplasia before undergoing PAO compared to up to 20 years after surgery.
Materials and Methods: All patients in our institutional database were deemed eligible for this cohort study if they underwent PAO and had answered at least one question related to sport participation. Patients were asked if they were playing sport preoperatively, 6 months after PAO as well as 2, 5, 10, 15 and 20 years after. In addition, patients were asked if they were able to play their preferred sport, what type and at what level they were playing sport, and if surgery had improved their sport performance.
Results: Among 2398 patients surveyed, 1926 (80%) were included and 56% were playing sport 6 months after PAO. This number was 61% two years after PAO, and remained around that for the following years, before dropping 15 years after PAO. Between 56% and 71% of patients felt that their sporting performance improved following PAO at the different time points. Between 39% (6 months after PAO) and 63% (15 years after PAO) were able to participate in their preferred sport.
Interpretation / Conclusion: The majority of patients undergoing PAO due to hip dysplasia will return to, and maintain, sport after PAO. More than half of patients undergoing PAO believe that the surgery improved their sports performance, and long after the surgery more than half of patients undergoing PAO are able to play their preferred sport.
1. Department of Orthopedic Surgery, Aarhus University Hospital, Denmark 2. Department of Clinical Medicine, Aarhus University, Denmark. 3. La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia 4. Department of Public Health, Sports, Aarhus University, Denmark
Background: Symptomatic hip dysplasia is often treated with periacetabular osteotomy (PAO). Studies investigating the effect of PAO have primarily focused on radiographic measurements, pain- related outcomes, and hip survival whereas evidence related to sport participation is limited.
Aim: The primary aim of this study was to report the rate of participation in sports among patients with hip dysplasia before undergoing PAO compared to up to 20 years after surgery.
Materials and Methods: All patients in our institutional database were deemed eligible for this cohort study if they underwent PAO and had answered at least one question related to sport participation. Patients were asked if they were playing sport preoperatively, 6 months after PAO as well as 2, 5, 10, 15 and 20 years after. In addition, patients were asked if they were able to play their preferred sport, what type and at what level they were playing sport, and if surgery had improved their sport performance.
Results: Among 2398 patients surveyed, 1926 (80%) were included and 56% were playing sport 6 months after PAO. This number was 61% two years after PAO, and remained around that for the following years, before dropping 15 years after PAO. Between 56% and 71% of patients felt that their sporting performance improved following PAO at the different time points. Between 39% (6 months after PAO) and 63% (15 years after PAO) were able to participate in their preferred sport.
Interpretation / Conclusion: The majority of patients undergoing PAO due to hip dysplasia will return to, and maintain, sport after PAO. More than half of patients undergoing PAO believe that the surgery improved their sports performance, and long after the surgery more than half of patients undergoing PAO are able to play their preferred sport.
Rasmus Reinholdt Sørensen1, Signe Timm1,2, Lasse Enkebølle Rasmussen1, Claus Lohman Brasen3, Claus Varnum1,2
1. Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark; 2. Department of Regional Health Research, University of Southern; 3. Department of Immunology and Biochemistry, Lillebaelt Hospital, University Hospital of Southern Denmark
Background: The effect of metabolic syndrome (MetS) on the risk of revision after hip and knee arthroplasty is debated. Inconsistent use of MetS definitions, and the predominance of case-control studies in the existing literature, calls for further investigation in this field to provide specific risk assessment of these patients, for clinicians to use in their daily advisory.
Aim: The aim was to investigate the risk of short-term revision due to prosthetic joint infection (PJI) after hip and knee arthroplasty. Secondly, we aimed to investigate the risk of revision due to any cause and the mortality.
Materials and Methods: During May 2017 to November 2019 a cohort of 2,901 patients undergoing a total of 3,024 hip and knee arthroplasties was established. Data from national registries and a local database were used to determine the presence of MetS and revision surgeries with a follow-up of at least two years and eight months. Cox regression was applied to present hazard ratio (HR), associated 95% confidence intervals (CI) and P-values. Survival analyses were presented in a Kaplan- Meier plot.
Results: In the cohort, 62.1% met the criteria for MetS. The risk of PJI (HR 1.6 (0.5 to 4.9) P=0.380), any revision (HR 0.8 (0.4 to 1.3) P=0.295) and death (HR 1.3 (0.8 to 2.1) P=0.282) was not increased in patients suffering from MetS, compared to patients who did not have MetS. There was no PJI in patients not having MetS and receiving a knee arthroplasty. The risk of death was increased in the MetS-group receiving a knee arthroplasty (HR 2.7 (1.3 to 5.9) P=0.010), but not different from the MetS-group receiving a hip arthroplasty. There was no elevated risk of PJI when analyzing morbid obesity (body mass index over 40 kg/m2), male sex or diabetes as the exposure.
Interpretation / Conclusion: Patients suffering from MetS do not have an increased risk of revision caused by PJI. In general, performing hip and knee arthroplasty on patients suffering from MetS seems without increased risk of revision surgery.
1. Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark; 2. Department of Regional Health Research, University of Southern; 3. Department of Immunology and Biochemistry, Lillebaelt Hospital, University Hospital of Southern Denmark
Background: The effect of metabolic syndrome (MetS) on the risk of revision after hip and knee arthroplasty is debated. Inconsistent use of MetS definitions, and the predominance of case-control studies in the existing literature, calls for further investigation in this field to provide specific risk assessment of these patients, for clinicians to use in their daily advisory.
Aim: The aim was to investigate the risk of short-term revision due to prosthetic joint infection (PJI) after hip and knee arthroplasty. Secondly, we aimed to investigate the risk of revision due to any cause and the mortality.
Materials and Methods: During May 2017 to November 2019 a cohort of 2,901 patients undergoing a total of 3,024 hip and knee arthroplasties was established. Data from national registries and a local database were used to determine the presence of MetS and revision surgeries with a follow-up of at least two years and eight months. Cox regression was applied to present hazard ratio (HR), associated 95% confidence intervals (CI) and P-values. Survival analyses were presented in a Kaplan- Meier plot.
Results: In the cohort, 62.1% met the criteria for MetS. The risk of PJI (HR 1.6 (0.5 to 4.9) P=0.380), any revision (HR 0.8 (0.4 to 1.3) P=0.295) and death (HR 1.3 (0.8 to 2.1) P=0.282) was not increased in patients suffering from MetS, compared to patients who did not have MetS. There was no PJI in patients not having MetS and receiving a knee arthroplasty. The risk of death was increased in the MetS-group receiving a knee arthroplasty (HR 2.7 (1.3 to 5.9) P=0.010), but not different from the MetS-group receiving a hip arthroplasty. There was no elevated risk of PJI when analyzing morbid obesity (body mass index over 40 kg/m2), male sex or diabetes as the exposure.
Interpretation / Conclusion: Patients suffering from MetS do not have an increased risk of revision caused by PJI. In general, performing hip and knee arthroplasty on patients suffering from MetS seems without increased risk of revision surgery.
Jens Laigaard1, Lone Nikolajsen2, Saber Muthanna Saber1, Ole Mathiesen3, Troels Haxholdt Lunn4, Søren Overgaard1
1. Dept. of Orthopaedic Surgery, Bispebjerg University Hospital; 2. Dept. of Anaesthesia, Aarhus University Hospital; 3. Dept. of Anaesthesia, Zealand University Hospital, Køge; 4. Dept. of Anaesthesia, Bispebjerg University Hospital
Background: Total hip arthroplasty (THA) is an effective treatment for patients with hip osteoarthritis when non-opioid analgesics and physiotherapy cannot control their pain. The latest assessment of long-term pain outcomes in patients operated with THA in Denmark was undertaken in 2004. We believe updated numbers are needed to accurately inform patients about postsurgical risks.
Aim: To investigate the satisfaction and incidence of persistent pain after primary THA for osteoarthritis.
Materials and Methods: This was a nationwide cross-sectional survey on satisfaction, pain of unselected patients who underwent TYA for osteoarthritis in March, April, or May 2022 (NCT05845177). Patients were identified from the Danish National Patient Register and Danish Hip Arthroplasty register and invited by Digital Post on 4th September 2023.
Results: We sent survey invitations to 2.764 patients, after exclusion of 86 (3%) patients with revision surgery and 16 (1%) patients with bilateral surgery within the inclusion period. The 2.035 (74%) respondents were similar to the non-respondents in terms of age, sex, BMI, ASA score and length of surgery. Of the respondents, 274 (14%) had moderate or severe persistent postsurgical pain (NRS=4). Still, 1826 (92%) were ‘satisfied’ or ‘very satisfied’ with the result of surgery and 1871 (95%) were willing to repeat surgery.
Interpretation / Conclusion: Fourteen percent of patients had moderate or severe persistent postsurgical pain 1.4 years after THA, yet 91% percent were satisfied with the result of surgery. The incidence of persistent postsurgical pain was consistent with a similar Danish study from 2004.
1. Dept. of Orthopaedic Surgery, Bispebjerg University Hospital; 2. Dept. of Anaesthesia, Aarhus University Hospital; 3. Dept. of Anaesthesia, Zealand University Hospital, Køge; 4. Dept. of Anaesthesia, Bispebjerg University Hospital
Background: Total hip arthroplasty (THA) is an effective treatment for patients with hip osteoarthritis when non-opioid analgesics and physiotherapy cannot control their pain. The latest assessment of long-term pain outcomes in patients operated with THA in Denmark was undertaken in 2004. We believe updated numbers are needed to accurately inform patients about postsurgical risks.
Aim: To investigate the satisfaction and incidence of persistent pain after primary THA for osteoarthritis.
Materials and Methods: This was a nationwide cross-sectional survey on satisfaction, pain of unselected patients who underwent TYA for osteoarthritis in March, April, or May 2022 (NCT05845177). Patients were identified from the Danish National Patient Register and Danish Hip Arthroplasty register and invited by Digital Post on 4th September 2023.
Results: We sent survey invitations to 2.764 patients, after exclusion of 86 (3%) patients with revision surgery and 16 (1%) patients with bilateral surgery within the inclusion period. The 2.035 (74%) respondents were similar to the non-respondents in terms of age, sex, BMI, ASA score and length of surgery. Of the respondents, 274 (14%) had moderate or severe persistent postsurgical pain (NRS=4). Still, 1826 (92%) were ‘satisfied’ or ‘very satisfied’ with the result of surgery and 1871 (95%) were willing to repeat surgery.
Interpretation / Conclusion: Fourteen percent of patients had moderate or severe persistent postsurgical pain 1.4 years after THA, yet 91% percent were satisfied with the result of surgery. The incidence of persistent postsurgical pain was consistent with a similar Danish study from 2004.
Trine Pedersen Ahlmann 1,2, Karina Dahl Steffensen2,3, Karen Sepucha4,5, Martin Lidberg-Larsen6,7, Charlotte Jensen Myhre6,7, Christina Nielsen Bræmer1, Kim Ingwardsen Gordon2,8, Claus Varnum1,2
1 Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark 2 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark 3 Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark 4 Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA 5 Harvard Medical School, Boston, Massachusetts, USA 6 Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 7 Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark. 8 Department of Physio- and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
Background: Severe osteoarthritis (OA) significantly affects quality of life, and treatment decisions can be complex. The Hip and Knee Decision Quality Instrument (HK-DQI) is a patient-centred questionnaire specifically designed to evaluate the quality of decision-making for arthroplasty in severe hip or knee OA. Comprising three sections with sum scores, it assesses decision-specific goals and concerns, decision-specific knowledge and the decision-making process.
Aim: This study aims to evaluate the psychometric properties of HK-DQI in a Danish population.
Materials and Methods: Following COSMIN guidelines, the Danish version of HK-DQI underwent translation and psychometric assessment. Content validity was established with 40 patient interviews. Psychometric properties were evaluated in a sample of 236 hip or knee OA patients. Reliability was assessed through a test-retest with 218 patients. IntraClass Correlation (ICC), Limits of Agreement and a Cronbach’s alpha (only on section 3 of the HK-DQI) were estimated, and Bland-Altman plots were constructed. Construct validity was evaluated through predefined hypotheses and compared to the questionnaires CollaboRATE and The Shared Decision-Making Questionnaire (SDM-Q-9).
Results: The content validity of HK-DQI was acceptable. The ICC indicated moderate reliability for individual questions in section 1 (ICC 0.62-0.69) and strong reliability for sum-score of sections 2 and 3 (ICC 0.63-0.86). An acceptable level of agreement, with no indications of systematic errors, and acceptable 95% Limits of Agreement on the Bland Altmann plot were found. Cronbach’s alpha was 0.74 in section 3. HK-DQI demonstrated acceptable construct validity, confirming 75% of a-priori hypothesized associations and correlations. Ceiling and floor effects was observed in section 1.
Interpretation / Conclusion: The content validity of HK-DQI was acceptable in the Danish context with only minor adjustments. HK- DQI is a valid and reliable measurement tool for assessing decision quality in hip and knee OA patients within a Danish context. These findings support its use in clinical practice and research to enhance decision-making processes for patients with severe OA.
1 Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark 2 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark 3 Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark 4 Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA 5 Harvard Medical School, Boston, Massachusetts, USA 6 Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 7 Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark. 8 Department of Physio- and Occupational Therapy, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
Background: Severe osteoarthritis (OA) significantly affects quality of life, and treatment decisions can be complex. The Hip and Knee Decision Quality Instrument (HK-DQI) is a patient-centred questionnaire specifically designed to evaluate the quality of decision-making for arthroplasty in severe hip or knee OA. Comprising three sections with sum scores, it assesses decision-specific goals and concerns, decision-specific knowledge and the decision-making process.
Aim: This study aims to evaluate the psychometric properties of HK-DQI in a Danish population.
Materials and Methods: Following COSMIN guidelines, the Danish version of HK-DQI underwent translation and psychometric assessment. Content validity was established with 40 patient interviews. Psychometric properties were evaluated in a sample of 236 hip or knee OA patients. Reliability was assessed through a test-retest with 218 patients. IntraClass Correlation (ICC), Limits of Agreement and a Cronbach’s alpha (only on section 3 of the HK-DQI) were estimated, and Bland-Altman plots were constructed. Construct validity was evaluated through predefined hypotheses and compared to the questionnaires CollaboRATE and The Shared Decision-Making Questionnaire (SDM-Q-9).
Results: The content validity of HK-DQI was acceptable. The ICC indicated moderate reliability for individual questions in section 1 (ICC 0.62-0.69) and strong reliability for sum-score of sections 2 and 3 (ICC 0.63-0.86). An acceptable level of agreement, with no indications of systematic errors, and acceptable 95% Limits of Agreement on the Bland Altmann plot were found. Cronbach’s alpha was 0.74 in section 3. HK-DQI demonstrated acceptable construct validity, confirming 75% of a-priori hypothesized associations and correlations. Ceiling and floor effects was observed in section 1.
Interpretation / Conclusion: The content validity of HK-DQI was acceptable in the Danish context with only minor adjustments. HK- DQI is a valid and reliable measurement tool for assessing decision quality in hip and knee OA patients within a Danish context. These findings support its use in clinical practice and research to enhance decision-making processes for patients with severe OA.