Hip resurfacing arthroplasty (HRA) is an alternative to traditional total hip arthroplasty (THA) in young active patients. While comparative implant survival rates are well documented, there is a paucity of studies reporting the patient mortality rates associated with these procedures. The purpose of this study was to evaluate the mortality rates in patients age 55 years and younger who underwent HRA versus THA and to assess whether the type of operation was independently associated with mortality. The database of a single high-volume surgeon was reviewed for all consecutive patients age 55 years and younger who underwent hip arthroplasty between 2002 and 2010. HRA became available in the United States in 2006. This yielded 504 patients who had undergone HRA from 2006 to 2010 and 124 patients who had undergone a THA. Patient characteristics were collected from the electronic medical record including age, gender, body mass index, Charleston comorbidity index, smoking status, and primary diagnosis. Mortality was determined through a combination of electronic chart reviews, patient phone calls, and online obituary searches. Univariate analysis was performed to identify a survival difference between the two cohorts. Multivariable Cox-Regression analyses were used to determine whether the type of operation was independently associated with mortality.Introduction
Patients and Methods
This study compared multiple sclerosis (MS) patients who underwent
primary total hip arthroplasty (THA) with a matched cohort. Specifically,
we evaluated: 1) implant survivorship; 2) functional outcomes (modified
Harris Hip Scores (mHHS), Hip Disability and Osteoarthritis Outcome
Score, Joint Replacement (HOOS JR), and modified Multiple Sclerosis
Impact Scale (mMSIS) scores (with the MS cohort also evaluated based
on the disease phenotype)); 3) physical therapy duration and return
to function; 4) radiographic outcomes; and 5) complications. We reviewed our institution’s database to identify MS patients
who underwent THA between January 2008 and June 2016. A total of
34 MS patients (41 hips) were matched in a 1:2 ratio to a cohort
of THA patients who did not have MS, based on age, body mass index
(BMI), and Charlson/Deyo score. Patient records were reviewed for complications,
and their functional outcomes and radiographs were reviewed at their
most recent follow-up.Aims
Patients and Methods
Patients who have multiple sclerosis (MS) may be at increased risk of developing complications after total hip arthroplasty (THA). The purpose of this study was to compare: 1) implant survivorship; 2) functional outcomes; 3) complication rates; and 4) radiographic findings after THA between MS patients and a matched cohort. A single institutional database was reviewed for patients who had a diagnosis of MS and underwent a THA. Thirty-four patients (41 hips) were matched to a 2:1 cohort who did not have MS using based on age, sex, body mass index (BMI), and Charlson/Deyo scores. This resulted in a matching cohort of 80 patients (82 hips). The available medical records were reviewed. Functional outcomes and complications were assessed. Postoperative radiographs were evaluated. The matching cohort had higher all-cause survivorship at 4-years postoperatively (99 vs. 93%). There were 3 revisions in the MS cohort and 0 revisions in the matching cohort. The MS cohort had lower mHHS scores (66 vs.74 points, p<0.001), lower HOOS JR scores (79 vs. 88 points, p<0.01), required more physical therapy (5 vs. 3 weeks, p<0.01), and took longer to return to their baseline functional level (7 vs. 5 weeks, p<0.05). MS patients had higher rate of complications (6 vs. 1, p<0.05). Excluding revision cases, there was no additional radiographic evidence of progressive radiolucency, loosening, or subsidence. We found that MS patients had lower implant survivorship, lower functional outcome scores, and increased complication rates. These findings may help orthopaedists to have a better knowledge of how MS patients do after THA.
Non-traumatic osteonecrosis of the femoral head
is a potentially devastating condition, the prevalence of which
is increasing. Many joint-preserving forms of treatment, both medical
and surgical, have been developed in an attempt to slow or reverse
its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is
available for the many forms of treatment considering the variation
in the demographics of the patients, the methodology and the outcomes
in the studies that have been published, so that it can be used
effectively. The purpose of this review, therefore, was to provide an up-to-date,
evidence-based guide to the management, both non-operative and operative,
of non-traumatic osteonecrosis of the femoral head. Cite this article:
