Health-Related Quality-of-Life and Functional Outcomes in Short-Stem Versus Standard-Stem Total Hip Arthroplasty: An 18-Month Follow-Up Cohort Study.

BACKGROUND Osteoarthritis (OA) progressively produces symptoms and disability that may significantly reduce health-related quality of life (HRQoL). Total hip arthroplasty (THA) is an important treatment for symptomatic OA. An alternative to standard-stem THA for younger patients is short-stem THA. The aim of this study was to investigate potential HRQoL and functional outcome differences between these patient groups to provide additional data that will be clinically useful in the decision making between the types of prosthesis. MATERIAL AND METHODS In an 18-month follow-up longitudinal cohort study, we conducted Harris Hip Score (HHS) evaluations and SF-36 questionnaires in a study group and a control group undergoing short-stem and standard-stem THA preoperatively and during follow-up at 1, 3, 6, 12, and 18 months. Effect size was calculated to estimate the size of changes in scores during follow-up between chosen time intervals. RESULTS A total of 168 patients were included in the study. The total HHS score was significantly increased postoperatively from 46.9 to 87.0 in the standard-stem group, and from 42.7 to 85.1 in the short-stem group. All SF-36 scores improved after THA in both groups. No HRQoL or functional differences were found in the use of either surgical option in the HHS or SF-36 score results (all p>0.05). CONCLUSIONS As there were no differences in HRQoL in the two groups, we strongly recommend considering short-stem THA, especially in younger patients, due to the benefit of future revision options and a minimally invasive approach.

"Pros and cons" of total hip arthroplasty with metaphyseal Proxima endoprosthesis.

The authors present their own experience concerning total hip arthroplasty with the metaphyseal prosthesis Proxima. Proxima, a metaphyseal prosthesis, provides an innovative supplement to total hip arthroplasty. In this study, the authors present their own experience using Proxima in patients with hip osteoarthritis. This study was performed between 2008 to 2013 and comprised of 62 patients, of which 38 were male (61.3%) and 24 female (38.7%). All patients were operated on due to hip osteoarthritis using total hip arthroplasty with the metaphyseal prosthesis Proxima. The age of patients included into the study ranged from 23 years to 62 years with the mean age of 46 years. The authors paid close attention to the "pros and cons" of surgical techniques and assessed clinical and radiological results in both the short and long-term observation periods. The clinical evaluation was based on the Harris Hip Score and radiological assessment of fixation of the acetabular cup of the endoprosthesis was based on Pradhan's criteria. The endoprosthesis Proxima stem was positioned using the manufacturer's recommended method, evaluating the direction, scope and duration of the displacement in the marrow cavity of the proximal stump of the femur. According to the authors' analysis, the surgery gives good functional and radiological results both in the short- and long-term observation periods. The effectiveness depends on precise qualification for surgery, proper surgical techniques and specific anatomical conditions of the proximal femur stump. The most common reasons for primary and secondary dislocations of the metaphyseal endoprosthesis Proxima stem occur during the first three months post surgery. This is due to incorrect surgical techniques, which disregard the importance of specific anatomical conditions of the proximal femoral stump, which affects Proxima implantation, and cause deviations towards a varus or valgus orientation.

Preliminary psychometric validation of the Polish version of the EORTC elderly module (QLQ-ELD14).

AIM: The aim of our study was to report preliminary validation data on the EORTC translated, Polish version of the EORTC QLQ-ELD14 questionnaire to show that this tool is an acceptable and psychometrically robust measure to collect HRQoL data in Polish elderly patients with cancer. MATERIALS AND METHODS: Patients with histological confirmation of primary cancer were eligible for the study. All patients filled out the Polish version of the EORTC QLQ-ELD14 module in addition to EORTC QLQ-C30 and a demographic questionnaire. Standardized validity and reliability analyses were performed. RESULTS: Sixty-five patients (41 females - 63.1%) were enrolled into the study, with a mean age of 76.4 ± 5.7 years. Cronbach alpha coefficients, range 0.70-0.84, showed positive internal consistency. Satisfactory convergent and discriminant validity in multi-trait scaling analyses was seen. Strong correlations were observed between the EORTC QLQ-ELD14 (especially mobility and burden of illness), and the EORTC QLQ-C30 (r = -0.30-(-0.83); p <0.001). CONCLUSIONS: Basing on the preliminary data from this study, the Polish version of the EORTC QLQ-ELD14 module is a reliable and valid tool for measuring HRQoL in elderly cancer patients. However further research is needed to establish the full psychometric properties of the described module, especially in regards to test-retest and responsiveness over time.