Socioeconomic Status Affects Patient-Reported Outcome Measures in Total Hip and Knee Arthroplasty: A Retrospective Dutch Registry Study.

BACKGROUND: To determine the association between socioeconomic status (SES) and patient-reported outcome measures in a Dutch cohort who have undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: A retrospective national registry study of all patients who underwent primary THA or TKA between 2014 and 2020 in the Netherlands was performed. Linear mixed effects regression models were used to assess the association between SES and patient-reported outcome measures for THA and TKA patients separately. The following measures were collected: numeric rating scale for pain, Oxford Hip/Knee Score, Hip/Knee disability and Osteoarthritis Outcome Score, and the EuroQol 5-Dimensions questionnaire. Sex, age, body mass index, American Society of Anesthesiologists classification, Charnley classification, and smoking status were considered as covariates in the models. RESULTS: THA patients (n = 97,443) were on average 70 years old with a body mass index of 27.4 kg/m2, and TKA patients (n = 78,811) were on average 69 years old with a body mass index of 29.7 kg/m2. Preoperatively, patients with a lower SES undergoing THA or TKA reported more severe symptoms and lower health-related quality of life. At 1-year follow-up, they also reported lower scores and less improvement over time compared to patients with a higher SES. CONCLUSIONS: Patients with lower SES report worse symptoms when admitted for surgery and less improvement after surgery. Future research must address potentially mediating factors of the association between SES and symptom reporting such as access to surgery and rehabilitation, subjectivity in reporting, and patient expectation for THA and TKA outcomes.

Results of Cemented Anatomically Adapted Total Hip Arthroplasty: A Follow-Up Longer Than 10 years.

This retrospective single-center study evaluated the >10-year follow-up (FU) and survival of 2 anatomically adapted cemented total hip arthroplasties (THAs) in a series of 308 patients (323 THAs) with a mean age of 76.2 years at operation. At a mean of 11 years of FU, patient-reported outcome measures, clinical examination, and plain radiography were analyzed. In 6 THAs, the femoral and/or acetabular component was revised. Reasons for revision were aseptic loosening and infection. At >10 years of FU, there was an overall survival for both THAs of 98.1%. Radiographic radiolucent lines were seen in 15 THAs affecting Gruen zone 4 and Delee and Charnley zone II. We conclude that both anatomically adapted cemented THAs have an excellent survival at 11 years of FU.

Poor intermediate-term survival of the uncemented Optan anatomically adapted femoral component.

PURPOSE: We evaluated the 5-year survival of the uncemented Optan anatomically adapted femoral stem, with revision for aseptic loosening as the endpoint. METHODS: Between January 2004 and March 2007, 432 total hip arthroplasties (THAs) were performed in 432 patients. After follow-up for a mean time of 5 years, the patients were evaluated using the WOMAC questionnaire and plain radiography. Patients who were unable to attend the follow-up visit were contacted by telephone to determine whether they had had any revision surgery of their THA. RESULTS: Within 5 years, 39 patients (9%) had died of unrelated causes and 63 patients (15%) had been lost to follow-up. Of the remaining cohort, 224 patients (68%) had full follow-up while 88 patients (27%) were evaluated with WOMAC only and 18 patients (5%) were evaluated with radiography only. The mean WOMAC score of all evaluated patients was 21 (10-100). At 5-year follow-up, there were 26 stem revisions reported (6%), 14 hips (3%) showed aseptic loosening, and 12 hips (3%) had had a periprosthetic femoral fracture. The 5-year survival to revision for any reason was 94%. Worst-case analysis yielded a 5-year survival of 79%. INTERPRETATION: The 5-year survival for aseptic loosening of the Optan anatomically adapted femoral component was disappointing. Radiographic evaluation showed evidence of proximal radiolucencies and distal cortical bone hypertrophy, which we attribute to insufficient proximal bone in-growth and increased load transfer at the tip of the stem. We do not recommend the use of the Optan femoral stem.