Predictors of physical activity recovery after total hip arthroplasty: a prospective observational study.

PURPOSE: Little is known about the changes and the factors in physical activity as following total hip arthroplasty (THA). There are potential discrepancies between subjective and objective measurements of physical activity. Thus, our porpose is to compare objective and subjective measurements of activity levels in patients undergoing THA preoperatively, three months and one year following surgery, and investigated the factors that predicts the objective activity level after THA. METHODS: This prospective observational study included 42 patients with unilateral symptomatic hip osteoarthritis who underwent THA. The objective activity level (step counts, sit-to-stands, and upright time) by using a tri-axial accelerometer, PRO (Oxford hip score; OHS and University of California, Los Angeles activity score; UCLA score), and muscle volume around the hip joint by using preoperative computed tomography were measured. RESULTS: The number of steps, OHS, and UCLA score before, at three months, and one year after THA averaged 5092, 6532, and 6545 steps, 30.3, 43.0, and 44.2 points, and 3.4, 4.8, and 4.6 points, respectively, with significant postoperative increases (P < 0.05). No significant difference was found between three months and one year postoperatively. In multivariate analysis, younger age and higher preoperative contralateral gluteal medius volume were the predictors of higher postoperative step counts (P < 0.05). CONCLUSIONS: Physical activity, including step counts, OHS, and UCLA score increased significantly until three months after unilateral THA. Early surgical intervention before contralateral muscle declines and preoperative rehabilitation including contralateral side may additionally improve postoperative activity levels.

Interaction between functional capability and sleep quality at midterm after total knee arthroplasty: a Japanese retrospective cohort study.

No report has clarified the frequency and interacting factors affecting sleep disturbance among Asian patients at midterm after total knee arthroplasty (TKA). This study aimed to evaluate the frequency of sleep disturbance at midterm after TKA in a Japanese cohort and to identify intervening factors for sleep. We hypothesized that residual knee pain and decreased functional capability negatively interact with sleep quality after TKA. A total of 209 Japanese participants (average age: 77.1 ± 8.3 years; postoperative follow-up period: 4.5 ± 1.9 years) who underwent primary TKA for knee osteoarthritis were included in this study. Sleep quality, satisfaction, pain, functional capability, joint awareness, and mental condition were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Knee Society Score (KSS) 2011, Forgotten Joint Score (FJS)-12, and 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS). Multivariable analysis was performed to determine the influencing factors on PSQI. The scores for the PSQI, satisfaction with pain level while lying in bed, pain during level walking, functional activity category in the KSS 2011, awareness of the artificial joint in bed at night in the FJS-12, and SF-12 MCS were 6.7 ± 3.0, 5.8 ± 1.8, 1.6 ± 2.3, 62 ± 22, 1.5 ± 1.4, and 56 ± 9.3 on average, respectively. Sleep disturbance (PSQI ≥ 5.5) occurred in 54% of the Japanese participants. Multivariable analysis revealed that high functional capability was a significant factor associated with sleep quality improvement (p < 0.05). Decreased functional capability, not residual knee pain, negatively interacted with sleep quality. The sleep disturbance rate was high during the middle postoperative period after TKA in the Japanese cohort.

Contralateral Hip Abductor Muscle Strength Associated with Comfort of Getting into and out of the Car after Total Hip Arthroplasty.

There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as comfortable were defined as the comfort group; others were placed in the discomfort group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the comfort and discomfort groups, respectively. Patients in the discomfort group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.

Reverse dynamics analysis of contact force and muscle activities during the golf swing after total hip arthroplasty.

There are no reports on hip kinetics including contact forces and muscle activities during the golf swing after total hip arthroplasty (THA). The aim of this study was to identify the characteristics of three-dimensional dynamics during the golf swing. Ten unilateral primary THA patients participated in motion capture test of their driver golf swing. The driver swing produced approximately 20-30° of rotation in both lead and trail replaced hips. The mean hip contact forces (HCFs) of lead and trail replaced hips were 5.1 and 6.6 × body weight, respectively. Left and right THAs showed similar HCFs of lead and trail hips. More than 60% of the Percent maximum voluntary isometric contraction was found in bilateral iliopsoas muscles in all unilateral THA. Three factors [female sex, lower modified Harris Hip Score, and higher HCF of surgical side] were associated with the golf-related replacement hip pain. Golf is an admissible sport after THA because driver swings do not contribute excessive rotation or contact forces to hip prostheses. HCF could be reduced through swing adjustments, which may allow patients with golf-related replacement hip pain to develop a comfortable golf game free from pain.

A propensity score-matched comparison of patient satisfaction following periacetabular osteotomy or total hip arthroplasty for developmental dysplasia of the hip in an Asian cohort.

BACKGROUND: No studies have compared patient satisfaction between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) for osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) in Asian cohorts. METHODS: Multivariate analyses were applied to determine whether patient demographics and postoperative patient-reported outcomes were correlated with postoperative patient satisfaction in 737 DDH patients (251 PAO and 486 THA patients). Additionally, postoperative patient satisfaction, Oxford Hip Score (OHS), University of California-Los Angeles (UCLA) activity score, and sports participation were compared between propensity-matched PAO and THA patients for OA secondary to DDH (Kellgren-Lawrence grade II: 32 PAO and 16 THA patients, grade III: 20 PAO and 40 THA patients). RESULTS: Of the 737 patients, 663 patients (90%) were postoperatively satisfied. Multivariate analysis demonstrated that THA was positively correlated with patient satisfaction. Furthermore, high postoperative OHS-pain, OHS-ADL, and UCLA scores were positively correlated with satisfaction. In propensity-matched PAO and THA patients, PAO elicited greater patient satisfaction than THA for KL grade II OA secondary to DDH, with comparable postoperative OHS (including the pain and ADL subscale), UCLA score, and sports participation rate. In contrast, THA resulted in better satisfaction and OHS-pain for KL grade III OA secondary to DDH, with comparable postoperative OHS-ADL, UCLA score, and sports participation rate in the 2 surgeries. CONCLUSIONS: Both PAO and THA procedures offer distinct patient satisfaction advantages based on preoperative OA severity. These findings can assist in the clinical decision-making process for the surgical treatment of middle-aged patients with symptomatic DDH.

Elucidation of target implant orientations with the safety range of hip rotation with adduction or abduction during squatting: Simulation based on in vivo replaced hip kinematics.

Objectives: The study aimed to elucidate target cup orientation and stem anteversions to avoid impingement between the liner and stem neck even at hip rotation with adduction during the deeply flexed posture. Methods: A computer simulation analysis was performed on 32 total hip arthroplasty patients applying patient-specific orientation of the components and in vivo hip kinematics obtained from three-dimensional analysis of the squatting motion. The anterior/posterior liner-to-neck distance and impingement were evaluated based on a virtual change in internal/external rotation (0°-60°) and adduction/abduction (0°-20°) at actual maximum flexion/extension during squatting. Cutoff values of cup orientations, stem anteversion, and combined anteversion to avoid liner-to-neck impingements were determined. Results: The anterior liner-to-neck distance decreased as internal rotation or adduction increased, and the posterior liner-to-neck distance decreased as external rotation or adduction increased. Negative correlations were found between anterior/posterior liner-to-neck distances at maximum flexion/extension and internal/external rotation. Anterior/posterior liner-to-neck impingements were observed in 6/18 hips (18/56%) at 45° internal/external rotation with 20° adduction. The range of target cup anteversion, stem anteversion, and combined anteversion to avoid both anterior and posterior liner-to-neck impingements during squatting were 15°-18°, 19°-34°, and 41°-56°, respectively. Conclusion: Simulated hip rotations caused prosthetic impingement during squatting. Surgeons could gain valuable insights into target cup orientations and stem anteversion based on postoperative simulations during the deeply flexed posture.

Three-dimensional kinematics and kinetics of getting into and out of a car in patients after total hip arthroplasty.

BACKGROUND: In modern society, car usage is one of the most important activities of daily living. However, the three-dimensional (3D) mechanics of getting into and out of a car in total hip arthroplasty (THA) patients have not been studied. RESEARCH QUESTION: This study aimed to elucidate the hip kinematics and kinetics of unilateral THA patients while getting into and out of a car. METHODS: 3D motion and ground reaction force data were collected for 40 unilateral primary THA and 30 control participants using motion capture of getting into and out of a car. Normalized joint power was used to determine the individual joint contribution and was calculated by dividing the power of each joint by the total lower-extremity power. These kinematic and kinetic data were compared between unilateral THA and control participants. RESULTS: When getting into the car using the surgical side as the pivot limb, the peak flexion, abduction angle, and normalized power of the pivot hip were significantly lower, and the normalized power of the contralateral ankle was significantly higher. The peak flexion and abduction angle of the pivot hip were significantly lower, and normalized contralateral hip power was significantly higher when getting out of the car. In getting into and out of the car using the contralateral side as the pivot limb, there was no significant difference in the range of motion (RoM) and normalized joint power. SIGNIFICANCE: The restoration of RoM and muscle strength in the surgical hip joint and adopting the normal side as the pivot limb may allow for a more appropriate balance in motion of getting into and out of a car, which will lead to safe mobility, assist in social participation, and improved quality of life. LEVEL OF EVIDENCE: Level III, therapeutic study.

Multiple Imputation to Salvage Partial Respondents: Analysis of the Forgotten Joint Score-12 After Total Hip Arthroplasty.

BACKGROUND: Missing responses are common when Asian patients complete the Forgotten Joint Score-12 (FJS-12), which is widely used to evaluate total hip arthroplasty (THA). We aimed to provide orthopaedic researchers with a solution for handling missing values in such patient-reported outcome measures (PROMs). METHODS: Patients who had undergone primary THA between 1998 and 2016 (n = 1,021) were investigated in 2020. The FJS-12 and 9 other PROMs, including questions related to Asian lifestyle activities, were administered. Risk factors for missing FJS-12 items were investigated. Partial respondents were matched with complete respondents; then, in each pair, the items not completed by the partial respondent were deleted from the responses of the complete respondent. Predictive mean matching (PMM) was performed in an attempt to recover the deleted items, using 65 sets of imputation models. After the missing values had been imputed, we explored patient characteristics that affected the FJS-12, using data from all complete and partial respondents. RESULTS: A total of 652 patients responded to the survey (393 complete and 193 partial respondents). Partial respondents were older, more often female, and less active. Older respondents were more likely to skip items involving the bed, while those who reported a better ability to sit in the seiza style (traditional Japanese floor sitting) were more likely to skip items about chair sitting. The imputed FJS-12 value exhibited excellent reliability (intraclass correlation coefficient for agreement with the true scores, 0.985). FJS-12 values of complete respondents were significantly higher than those of respondents with 4 to 11 missing items (51.6 versus 32.8, p < 0.001). Older age was associated with higher FJS-12 values, which was revealed only via analysis of the multiply imputed data sets (p < 0.001). CONCLUSIONS: Analysis of only complete FJS-12 responses after THA resulted in a nonresponse bias, preferentially excluding older, female, and less active individuals and those with a traditional floor living style. Multiple imputation could provide a solution to scoring and analyzing PROMs with missing responses by permitting the inclusion of partial respondents. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Analysis of Factors That Influence Patient Satisfaction After Periacetabular Osteotomy: An Asian Cohort Study.

Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for developmental dysplasia of the hip. However, some patients report dissatisfaction after PAO. Because patient satisfaction is increasingly used as a health care quality metric, it is important to gain a better understanding of factors associated with patient satisfaction after PAO. The goal of this study was to investigate patient satisfaction among a cohort of Asian patients undergoing PAO. This study included 227 Asian patients who had undergone PAO at our institution between 1998 and 2016. The study participants completed a questionnaire assessing patient satisfaction, reasons for dissatisfaction, and postoperative Oxford Hip Score (OHS) and University of California, Los Angeles (UCLA), activity scale score. Based on their satisfaction levels, the participants were divided into 4 subgroups, and their demographic characteristics and postoperative patient-reported outcomes were compared. Of the 227 patients, 190 expressed satisfaction that correlated with OHS-pain, OHD-activities of daily living, and UCLA activity scale scores. Primary reasons for dissatisfaction after PAO were persistent pain (24 of 49, 49%), functional limitations (14 of 49, 29%), stiffness around the hip (4 of 49, 8%), unmet expectations (4 of 49, 8%), conversion to total hip arthroplasty (2 of 49, 4%), and complications (1 of 49, 2%). Multivariate analysis showed that preoperative Kellgren-Lawrence grades 1 and 3 were the significant predictive factors for satisfaction and dissatisfaction, respectively. The potential for lower patient satisfaction associated with Kellgren-Lawrence grade 3 because of persistent pain and functional limitations postoperatively suggests that consideration of preoperative severity of osteoarthritis could enhance patient satisfaction after PAO. [Orthopedics. 2022;45(5):297-303.].

Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study.

PURPOSE: This prospective randomized controlled study examined whether accelerometer-based navigation resulted in more accurate or precise cup orientation than a conventional mechanical guide. We used a simulation to evaluate how cup orientation affected potential hip range of motion (RoM) and freedom from prosthetic impingement. METHODS: Sixty hips were randomly allocated 1:1 to accelerometer-based portable navigation or conventional guidance. Procedures were performed through a standard posterolateral approach and combined anteversion technique. Cup inclination, cup anteversion, and stem anteversion were measured using computed tomography (CT). Using CT-based simulation, we evaluated impingement-free potential RoM and the proportion of hips with potential RoM required for daily activities. RESULTS: Absolute cup inclination and anteversion error averaged 4.3° ± 3.2° and 4.4° ± 2.9° for the navigation cohort and 5.6° ± 3.7° and 5.7° ± 4.2° for the conventional cohort, with no significant differences. Navigation resulted in significantly less variation in anteversion error than the conventional guide (p = .0049). Flexion, internal rotation (IR) at 90° of flexion, extension, and external rotation (ER) averaged 123° ± 12°, 46° ± 13°, 50° ± 10°, and 73° ± 23°, respectively, in the navigation cohort and 127° ± 10°, 52° ± 14°, 45° ± 10°, and 63° ± 12°, respectively, in the conventional cohort (p = .15, .15, .03, and .03, respectively). Flexion > 110°, IR > 30° at 90° of flexion, extension > 30°, and ER > 30° were achieved by 93%, 90%, 100%, and 100% of hips, respectively, in the navigation cohort and 97%, 93%, 97%, and 100% of hips, respectively, in the conventional cohort, with no significant differences. CONCLUSIONS: Cup anteversion with the navigation system was more precise, but not more accurate, than with the conventional guide. The navigation cohort exhibited greater potential extension and ER than the conventional cohort, but no significant difference in impingement within the potential RoM required for daily activities. TRIAL REGISTRATION NUMBER: 29036. Date of registration: November 14, 2017.