Franziska Beyer

Revision Rate and Patient-Reported Outcome After Hip Resurfacing Arthroplasty: A Concise Follow-Up of 1064 Cases.

We investigated survival and outcomes in 1064 HRA hips operated on between 1998 and 2009. After a mean of 7.8 years, 771 patients (72.4%) completed questionnaires, with a further 160 (15.0%) contacted by phone and 18 (1.7%) had died. There were 54 revisions. Overall implant survival at 10 years was 94.4%. Independent predictors of lower survival were female gender (P=0.015) and cup inclination ≥55° (P<0.001). Woman with cup inclination ≥55° had the highest failure rate with 10-year survival of 69.3%. Vertical cup inclination ≥55° did worse than cups <55° in both men and women. Overall men did better than women, and men with cups <55 degrees did best. Men had significantly better patient-reported outcome scores than woman.

Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty

PurposeThe aim of this study was the comparison of intraoperative kinematics, stability, and range of motion (ROM) between the native osteoarthritic knee and cruciate-substituting fixed-bearing total knee arthroplasty (TKA) using both an ultracongruent (UC) and a posterior-stabilized (PS) insert design in the same patient. We hypothesized less knee flexion and less antero-posterior stability in the UC TKA.MethodsIntraoperative measurements of kinematics, stability, and ROM were performed in 40 patients before soft-tissue release and bone cuts, and after implantation of the final femoral and tibial implants with both a UC insert and a PS insert. All measurements were performed using a navigation system.ResultsKinematics changed significantly from a constant posterior femoral rollback before surgery to a paradoxical anterior translation during initial knee flexion with both inserts, but less pronounced with the PS insert (p < 0.001). There was significantly more posterior femoral rollback with the PS insert compared to the UC insert (p < 0.01). Stability measurements demonstrated no differences at full extension and 30° of knee flexion but significantly increased antero-posterior translation in 60° and 90° of knee flexion with the UC insert compared to the PS insert (p < 0.001). ROM measurements demonstrated improvement of knee flexion from 118° at the beginning of the surgery to 123° with the UC insert and 128° with the PS insert (p < 0.001).ConclusionThe use of a UC insert intraoperatively resulted in less antero-posterior stability and slightly less knee flexion compared to a PS insert. Surgeons should be aware of these differences when deciding for one of these options to substitute the posterior cruciate ligament (PCL). The impact of these findings on clinical outcome needs further investigation.Level of evidenceII.

Patient-reported outcomes and outcome predictors after primary total hip arthroplasty: results from the Dresden Hip Surgery Registry.

Purpose To investigate response rates and predictors of treatment success in patients treated with total hip arthroplasty (THA). Methods A prospective register-based cohort study including all consecutive primary THAs was conducted between 01/2006-12/2011. Primary outcomes were changes in WOMAC, according to OMERACT-OARSI, and minimal important difference (MID) in quality of life (EQ-5D) between baseline and 6-month follow-up. Socioeconomic and clinical predictors on treatment success were analysed by bivariate/multivariate regression. Results The study population included 2,553 patients (mean age 60.8 years; 52.8% female) and 2,391 (93.7%) at follow-up. 2,194 (93.8%) (OMERACT-OARSI) and 2,131 (83.5%) (EQ-5D MID) patients were classified as responders. Predictors for treatment success vs treatment failure were not identified. Obese patients and patients living alone showed less pronounced, and patients with higher educational level more pronounced, improvements in the WOMAC at follow-up. Conclusions Treatment with THA leads to improvement in function, decline in pain and increase in quality of life in the vast majority of patients.

Midterm Results After Coated and Uncoated TKA: A Randomized Controlled Study.

Patients undergoing total knee arthroplasty (TKA) who have hypersensitivity to metals usually receive hypoallergenic TKA implants. Coating of a standard implant is a common solution. Although in vitro tests have demonstrated reduction in polyethylene wear for these coatings, it is unknown whether these costly implants have a clinical benefit for patients. One hundred twenty patients undergoing TKA were randomly assigned to receive a novel 7-layer-coating implant or a standard TKA implant. One revision occurred in the standard group, resulting in a calculated 5-year survival of 100% in the coated group and 98.1% in the standard group. The Oxford Knee Score improved substantially in both groups from a mean of 21.6 points preoperatively in the coated group and 21.9 points in the standard group to 39.2 points and 39.2 points, respectively. The current authors observed no adverse effects with the new coating during midterm follow-up. However, longer follow-up time is needed to evaluate possible advantages of this coating. [Orthopedics. 2016; 39(3):S13-S17.].

How Much Improvement in Patient Activity Can Be Expected After TKA

Most patients expect an improvement of physical activity after total knee arthroplasty (TKA). The aim of this study was to evaluate improvement in physical activity after TKA. An accelerometer was used to measure activity in 221 patients before and 1 year after TKA. The measurements included the total number of steps and time spent lying, sitting/standing, or walking. Threshold for achievement of health-enhancing physical activity (HEPA) guidelines and step-defined lifestyle were applied to the data. Measured steps per day improved from 5371 to 6587. Only 50 patients (22.6%) met the HEPA guidelines, whereas 31% achieved an active lifestyle. Improvement in daily step number was influenced by age (P<.001), body mass index (P<.001) and preoperative activity (P<.001). After TKA, patients improved in physical activity and one-third achieved an active lifestyle. Patient-specific characteristics and preoperative levels of physical activity had a relevant influence on activity after TKA. [Orthopedics. 2016; 39(3):S18-S23.].

TKA for Posttraumatic Osteoarthritis Is More Complex and Needs More Surgical Resources.

The purpose of this study was to evaluate the surgical effort of total knee arthroplasty (TKA) for posttraumatic osteoarthritis (PTOA) compared with primary osteoarthritis (OA). A total of 1841 TKAs were analyzed, including 170 patients with PTOA, that resulted from soft tissue trauma in 83 patients and fractures in 87 patients. Results showed that patients were significantly younger at the time of surgery in the posttraumatic group (62 vs 71 years; P<.001). Furthermore, fracture was associated with 3.7 years earlier need of TKA compared with soft tissue trauma. Operation time was significantly longer for both of the posttraumatic groups compared with OA (P<.001). Patients undergoing TKA after knee injuries are younger and surgical treatment is more challenging compared with TKA for OA. Extended operation time and implant systems with higher constraint and modular options are required. [Orthopedics. 2016; 39(3):S36-S40.].

Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty

Introduction Patients who undergo either primary or revision total hip arthroplasty (THA) mainly expect improvement in pain, function/activity and quality of life. The purpose of the study was to measure the degree of short-term and medium-term improvement and the differences in patient-reported outcome that can be expected in patients undergoing revision THA, compared to patients undergoing primary THA. Methods In this study, the results of patient-reported outcome measurements were compared in 124 matched patients, who underwent revision surgery and primary THA between 01/2007 and 12/2009. Assessment was performed at short-term and medium-term follow-up and included the WOMAC score, the UCLA activity score and EuroQol scores. Results 6 months after revision THA, the mean total WOMAC score improved by 22.1 points, the UCLA activity score by 0.6 points and the EuroQol-Index by 0.2 points. After primary THA, the improvement was 41.4 points on the WOMAC, 1.1 points on the UCLA and 0.3 points on the EuroQol-Index. At medium-term follow-up, 3.6 years after revision surgery and 2.3 years after primary THA, patients undergoing revision THA showed significantly less overall improvement, as well as lower final outcome scores, than patients undergoing primary THA. Conclusions Patients undergoing revision arthroplasty, as well as patients undergoing primary THA, can expect major improvement in function, activity and quality of life postoperatively. However, overall level of improvement, as well as peak attainable outcome levels, are lower after revision surgery than after primary THA. Appropriate information for patients who undergo hip revision surgery is necessary in order to avoid unrealistic expectations and postoperative dissatisfaction.