Restriction in participation in leisure activities after joint replacement: an exploratory study.

BACKGROUND: currently, assessment of outcomes after joint replacement is predominantly centred on impairment and activity limitation (e.g. walking), with little consideration of participation restriction. METHOD: structured telephone interviews about participation in leisure activities were conducted with 56 total hip replacement (THR) and 60 total knee replacement (TKR) patients before and 1 year after joint replacement. FINDINGS: before surgery, THR patients participated in 209 leisure activities, with an average of four leisure activities per person. TKR patients participated in 171 leisure activities, with an average of three leisure activities per person. The leisure activities were coded into four categories: sports/exercise, hobbies, social activities and holidays. Between 89 and 95% of leisure activities were rated as important by THR and TKR patients prior to surgery. Before surgery, THR patients rated 82% of leisure activities as difficult to perform because of joint problems, which decreased to 25% of leisure activities by 1-year after surgery. TKR patients rated 86% of leisure activities as difficult to perform because of joint problems, which decreased to 32% after surgery. CONCLUSION: this research highlights that participation in leisure activities is important to patients undergoing joint replacement, but that approximately a quarter of patients are unable to perform their valued leisure activities after surgery.

Evaluation of the Personal Impact Health Assessment Questionnaire (PI HAQ) to capture the impact of disability in osteoarthritis.

AIM: Measuring facts about disability may not reflect their personal impact. An individualized values instrument has been used to weight difficulty in performing activities of daily living in rheumatoid arthritis, and calculate personal impact (Personal Impact Health Assessment Questionnaire; PI HAQ). This study aimed to evaluate the PI HAQ in osteoarthritis (OA). STUDY DESIGN: Study 1: 51 people with OA completed short and long versions of the value instrument at 0 and 1 week. Study 2: 116 people with OA completed the short value instrument, disability and psychological measures at 0 and 4 weeks. RESULTS: Study 1: The eight-category and 20-item value instruments correlated well (r = 0.85) and scores differed by just 2.7%. The eight-category instrument showed good internal consistency reliability (Cronbach's alpha = 0.85) and moderate one-week test-retest reliability (r = 0.68, Wilcoxon signed-rank test p = 0.16, intra-class correlation coefficient [ICC] 0.62). Study 2: Values for disability were not associated with disability severity or clinical status. After weighting disability by value, the resulting PI HAQ scores were significantly associated with dissatisfaction with disability, perceived increase in disability, poor clinical status and life dissatisfaction, and differed significantly between people with high and low clinical status (convergent and discriminant construct validity). There was moderate association with the disease repercussion profile disability subscale (r = 0.511; p < 0.001) (criterion validity). The PI HAQ was stable over four weeks (ICC 0.81). CONCLUSIONS: These studies provide an initial evaluation of an instrument to measure the personal impact of disability in people with OA, setting disability within a personal context. Further studies, including sensitivity to change, are required.

Determination of digitised radiograph magnification factors for pre-operative templating in hip prosthesis surgery.

OBJECTIVE: With digital radiography development, information technology (IT) companies have developed specific software for templating procedures, requiring individual magnification assessments for each patient. The aim of this study was to determine the mean magnification factor of digital radiographs and to evaluate the possibility of using the mean magnification factor or clinical information in templating. MATERIALS AND METHODS: We retrospectively evaluated 100 primary total hip arthroplasty digital radiographs using the femoral head prosthesis as a calliper to determinate the mean magnification factor. Working on the assumption that altitude of the hip during radiograph is decisive in modification of magnification factors, we also looked for a correlation between weight, body mass index (BMI), altitude and magnification factor. RESULTS: The magnification factor was 126% (121-130%). A relationship was found between magnification factor (Mf) and weight (Mf = 7.10(-4)x weight (kg) + 1.21), but not BMI. In 98% of cases, if the weight-correlated formula is used, the sizing is correct or the error is +/- 1 mm. With the mean method the sizing is correct or within 1 mm in only 78.2% of cases. CONCLUSION: Levels of accuracy for the mean magnification factor and the weight-correlated formula are not as high as individual assessments using a calliper; however, they could be used in everyday practice where individual magnification factors have not been calculated.

Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute.

BACKGROUND AND PURPOSE: One of the greatest problems of revision hip arthroplasty is dealing with lost bone stock. Good results have been obtained with impaction grafting of allograft bone. However, there have been problems of infection, reproducibility, antigenicity, stability, availability of bone, and cost. Thus, alternatives to allograft have been sought. BoneSave is a biphasic porous ceramic specifically designed for use in impaction grafting. BoneSave is 80% tricalcium phosphate and 20% hydroxyapatite. Previous in vitro and in vivo studies have yielded good results using mixtures of allograft and BoneSave, when compared with allograft alone. This study is the first reported human clinical trial of BoneSave in impaction grafting. METHODS: We performed a single-institution, multi-surgeon, prospective cohort study. 43 consecutive patients underwent revision hip arthroplasty using BoneSave and allograft to restore missing bone in the acetabulum. 9 patients had cemented acetabular components implanted and 34 uncemented. 10 patients had cemented femoral components implanted and 1 had an uncemented femoral component. 32 patients did not have their femoral component revised. RESULTS: No patients were lost to follow-up. At a mean follow-up of 24 (11-48) months, there were no re-revisions and there was no implant migration. 1 acetabular component had confluent lucent lines at the implant-graft interface. Complications were rare (1 fracture, 2 dislocations). Patient satisfaction with the procedure was high. INTERPRETATION: Short-term results indicate that impaction grafting of BoneSave and allograft is an effective method of dealing with loss of bone stock at revision hip surgery.