The Influence of Obesity on Hip Pain, Function, and Satisfaction 10 Years Following Total Hip Arthroplasty.

BACKGROUND: The prevalence of obesity is rising, and increasing numbers of joint arthroplasty surgeries are being performed on obese patients. Concern exists that obesity increases surgical risk; however, its impact on function following total hip arthroplasty (THA) is inconsistently affirmed and less understood. A paucity exists in the literature pertaining long-term objective functional measures. Therefore, we investigated the impact of obesity on hip pain, function, and satisfaction 10 years following THA. METHODS: This single-center, prospective, observational study categorized consecutive THA patients according to their body mass index to nonobese (<30 kg/m2) and obese (≥30 kg/m2) groups. Preoperative assessment included a numerical pain rating and the Oxford Hip Score. These were repeated along with a 6-minute walk test and a Likert satisfaction scale at 3 months, 1, 5, and 10 years postoperatively. RESULTS: The series included 191 primary THA patients. No significant differences were found in hip pain or function between the obese and nonobese groups. Obese patients however had poorer walking capacity (P = .008), were more likely to use walking aids (P = .04), and were less satisfied (P = .04) at 10 years. CONCLUSION: THA confers significant long-term symptom resolution irrespective of obesity; however, despite undergoing surgery, obese patients can be counseled they may not be as satisfied as or achieve the same walking capacity as nonobese individuals.

Sliding hip screws versus cancellous screws for femoral neck fractures: a systematic review and meta-analysis.

PURPOSE: Both sliding hip screws (SHS) and cancellous screws are used in the surgical management of intracapsular femoral neck fracture. However, there is paucity of information as to which is the superior treatment modality. We performed this systematic review and meta-analysis study to compare the clinical outcomes of SHS and cancellous screws for the treatment of femoral neck fractures in adult patients. METHODS: We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL, up to December 2017. Randomized controlled trials (RCTs) directly comparing the clinical outcomes of SHS and cancellous screws for femoral neck fractures were retrieved with no language or publication year restrictions. Data retrieved included operative details, nonunion rate, avascular necrosis, reoperation, infection and mortality, hip pain, functional hip scores, and medical complications. These were pooled as risk ratio or mean difference (MD) with their corresponding 95% confidence interval (CI). Heterogeneity was assessed by Chi-square test. RESULTS: Ten RCTs involving 1934 patients were included in the final analysis. The pooled estimate showed that the SHS group was associated with more intraoperative blood loss (MD = 110.01 ml, 95% CI [52.42, 167.60], p = 0.00002) than the cancellous screws. There was no significant difference in terms of operative time, postoperative hip function, nonunion, avascular necrosis, reoperation rate, infection, fracture healing, hip pain, medical complications, and mortality rate. CONCLUSION: Based on our study, the cancellous screws group was associated with less intraoperative blood loss in comparison with the SHS group. No other significant differences were found between the two interventions.

Metal ion levels not sufficient as a screening measure for adverse reactions in metal-on-metal hip arthroplasties.

This study aims to assess the accuracy of metal ion analysis in the diagnosis of adverse reaction to metal debris (ARMD) in patients with metal-on-metal hip arthroplasties by comparing the cobalt and chromium levels in 57 patients (62 hips) to findings on metal artifact reduction magnetic resonance imaging (MRI). An ARMD was detected using MRI in 18 (29%) of the hips. Forty patients had cobalt levels less than 7 µg/L, and 33 had chromium levels less than 7 µg/L, but 8 of these had an ARMD on MRI and only minimal symptoms (Oxford Hip Score ≥ 44/48). The incidence of ARMD was significantly higher when chromium concentration was above 7 µg/L (P = .02), but normal metal ion levels can be misleading and metal artifact reduction MRI imaging is advised in all patients.

The influence of obesity on early outcomes in primary hip arthroplasty.

Obesity is considered an independent risk factor for adverse outcome after arthroplasty surgery. Data on 191 consecutive total hip arthroplasties were prospectively collected. Body mass index (BMI) was calculated for each patient and grouped into nonobese (BMI <30 kg/m(2)), obese (BMI 30-34.9 kg/m(2)), and morbidly obese (BMI ≥35 kg/m(2)). Primary outcomes included functional improvement (Oxford hip score, 6-minute walk test and Short Form-12 Health Survey general health questionnaire) and postoperative complications. Subgroup analysis of surgeons' overall perception of operative technical difficulty was also performed. This study shows that total hip arthroplasties in obese patients were perceived, by the surgeon, to be significantly more difficult. However, this did not translate to an increased risk of complications, operation time, or blood loss, nor suboptimal implant placement. In addition, our results suggest that obese patients gain similar benefit from hip arthroplasty as do nonobese patients, but morbidly obese patients have significantly worse 6-minute walk test scores at 6 weeks.

Imaging Metal-on-Metal Hip Replacements: the Norwich Experience.

BACKGROUND: Adverse reaction to metal debris is a relatively recently described and often a silent complication of metal-on-metal (MOM) total hip replacements (THR). The Norfolk & Norwich University Hospital has been performing metal artefact reduction (MARS) MRI for 8 years in a variety of different types of MOM THR. QUESTIONS/PURPOSES: The aims of this review are to describe the experience of using MARS MRI in Norwich and to compare our experience with that published by other groups. METHODS: A MEDLINE keyword search was performed for studies including MRI in MOM THR. Relevant publications were reviewed and compared with published data from the Norfolk & Norwich University Hospital. The similarities and differences between these data were compared and possible explanations for these discussed. RESULTS: MARS MRI appears to be the most useful tool for diagnosing, staging and monitoring adverse reactions to metal debris (ARMD). There appears to be no clinically useful association between clinical and serological markers of disease and the severity of MR findings. Although severe early ARMD is associated with significant morbidity, mild disease is often stable for years. If patients with normal initial MR examinations develop ARMD, this usually occurs 7 years. A 1-year interval between MRI examinations is reasonable in asymptomatic patients. CONCLUSIONS: There is a general international consensus that ARMD is prevalent in symptomatic and asymptomatic patients with MOM THR and that while appearances vary with the type of prosthesis, there are characteristic features that make MARS MRI essential for diagnosis, staging and surveillance of the disease.

Reliability of the radiological assessments of radiolucency and loosening in total hip arthroplasty using PACS.

We evaluated the reliability of three commonly used radiological assessments of total hip arthroplasty (THA) using the electronic picture archiving and communications system (PACS). Thirty-three patients were selected at random at a mean of 7.2 years after THA. The Barrack, Gruen and Hodgkinson evaluations of cementing quality, loosening/radiolucency were graded. Three observers assessed each radiograph (one consultant orthopaedic surgeon, one senior orthopaedic registrar and one senior house officer). Four weeks after the initial assessment, each radiograph was reviewed a second time. The findings indicated that the intra- and inter-observer reliability of the Barrack, Gruen and Hodgkinson methods were questionable. Inter-observer reliability using the Gruen system was poor, using the Barrack system it was moderate to good, and fair to good using the Hodgkinson assessment. Intra-observer reliability was moderate to good for Barrack assessment, poor to good using Gruen zone assessments, but good to very good for the Hodgkinson assessment. The use of Barrack, Gruen and Hodgkinson assessments to evaluate femoral and acetabular loosening should be questioned since these exhibit limited inter- and intra-observer reliability on PACS radiographs, but of the three, the Hodgkinson system is the most reliable.