Clinical Practice Guideline: Total Hip Replacement for Osteoarthritis–Evidence-Based and Patient-Oriented Indications

Relevant Predictors in the Association Between Patients' Functional Status and Scar Outcomes After Total Hip Arthroplasty

BACKGROUND

We aimed to investigate the relevant predictors in the association between the functional status and the consequences of the persistence of scars in patients with traumatic versus non-traumatic coxarthrosis after total hip arthroplasty (THA).

METHODS

A total of 203 patients undergoing THA after traumatic or non-traumatic coxarthrosis were asked to complete the Mekeres' Psychosocial Internalization Scale (MPIS), in which they self-evaluated on a Likert scale (between one and five) by selecting the rating that corresponded to their personal opinion and the activities of daily living (ADL) form at six months postoperative. The statistical data were processed using the IBM SPSS Statistics software version 22.0 (IBM Corp., Armonk, NY). A combined assessment of the internalization of scars using MPIS and ADL forms after THA allowed for the identification of relevant predictors of the quality of life six months post-surgery in patients with traumatic or non-traumatic coxarthrosis.

RESULTS

Depending on the coxarthrosis etiology (traumatic or non-traumatic), the results were further processed by a univariate ANOVA, considering the independent variables represented by symptoms, the number of surgical procedures, and the postoperative evolution, which are acting on the outcomes of physical functioning (the dependent variable) in the postoperative phase. In the case of the traumatic group, our results suggest that the number of surgical interventions, the ability to internalize scars, and autonomy in terms of body care are predictors of the quality of life. In patients with non-traumatic coxarthrosis, an important role in predicting quality of life is played by the administered treatment and the ability to maintain their autonomy regarding self-hygiene six months post-surgery.

CONCLUSIONS

The predictive regression equation suggests that the quality of life in patients with traumatic coxarthrosis can be predicted by the number of surgical interventions, the administered treatment, the ability to internalize scars, and the autonomy regarding body care activities. On the other hand, for patients with non-traumatic coxarthrosis, an important role in predicting the quality of life is played by the treatment and the ability to maintain autonomy in terms of body hygiene activities.

Experiences with and perception of patient-reported outcome measurement in patients undergoing knee and hip replacement in Germany

BACKGROUND

Patient-reported outcome measures - PROMs - have been developed to provide an assessment of patients' physical function, symptoms, and health-related quality of life. With patient-centered care becoming increasingly important, several national strategies have been initiated for PROM measurement. However, Germany is only at the beginning of this process. The objective of this study is to assess patients' experience with and perception of completing PROMs in patients undergoing knee and hip replacement in Germany.

METHODS

This study used survey data from patients undergoing hip or knee replacement surgery in a hospital in Germany. Before surgery, patients completed a PROMs survey. After at least 6 months, patients were re-contacted to fill in a questionnaire about their experiences with and perception of the PROMs data collection.

RESULTS

Most patients either agreed or totally agreed that the time to fill in the questionnaire was appropriate (89%), that the purpose of the PROMs collection was clear (85%), that the questionnaire's content applied to their appointment (73%), and that this systematic assessment was beneficial (81%). The corresponding proportions were 54% for feeling productive while waiting and 50% for feeling that the information in the questionnaire affected the patient-doctor interaction positively. Only few significant associations were found between patient characteristics and the favorability of patients' ratings. There were no significant differences between hip and knee replacement surgery patients regarding the favorability rating on any survey question.

CONCLUSIONS

The results of this study suggest that PROMs collection in the context of hip and knee replacement surgery is practicable and partly also perceived beneficial by patients. Orthopedic procedures could serve as a starting point for broader use and routine PROMs collection in Germany.

Incidence and Duration of Sick Leave Due to Work-Related Musculoskeletal Disorders in the Accommodation and Food Services Activities Sector in Slovenia: A Nationwide 5-Year Observational Study

OBJECTIVES

The aim of this study was to analyze Slovenian data on sick leave (SL) due to the most common work-related musculoskeletal disorders (MSDs) among workers in sector I "accommodation and food services activities" from the NACE Rev2 classification.

METHODS

We investigated both SL incidence (i.e., number of cases) and disease severity (i.e., average SL duration) by body site, gender, age and divisions within the sector. In addition, trends in SL data (difference between 2015 and 2019) were analyzed. The effect of age group, gender and division was also assessed with relative risk (RR).

RESULTS

Female gender was associated with higher risk of MSDs in young (RR = 1.91 (1.53-2.43)) and older (RR = 2.24 (1.90-2.65)) subgroups. Older age was associated with greater SL incidence and longer SL duration, regardless of gender and division within sector I. This was also reflected in relative risk calculations between older and younger groups (females: RR = 4.43; CI = 3.75-5.01; p < 0.001; males: RR = 3.71; CI = 2.89-4.77; p < 0.001). Low back disorders were the most frequent cause for SL, while lower limb disorders tended to cause the longest average SL. The SL durations were similar across divisions within the sector, while the incidence rate tended to be higher in the "accommodation" than the "food and beverage services" division.

CONCLUSIONS

Special attention needs to be paid to reducing the risk of low back disorders, which are by far the most common cause of SL, and lower limb disorders, which cause the longest SL. We recommend the implementation of countermeasures that focus on early detection and rapid treatment/recovery of MSDs in older workers.

Comparison of Outcomes Following Total Hip Arthroplasty Between Patients Diagnosed with Association Research Circulation Osseous (ARCO) Stage III and Stage IV Osteonecrosis of the Femoral Head: A Retrospective Study of 302 Patients

BACKGROUND This retrospective study from a single center aimed to compare outcomes following total hip arthroplasty (THA) in 302 patients diagnosed with Association Research Circulation Osseous (ARCO) stage III and stage IV osteonecrosis of the femoral head (ONFH). MATERIAL AND METHODS The study included 302 patients who underwent THA for ONFH between January 2018 and September 2021. Patient groups included ARCO stage III (n=145) and ARCO stage IV (n=157). Outcomes measured included duration of disease, operative time, intraoperative blood volume, postoperative length of hospital stay, pain measured by the visual analog scale (VAS) score, Harris hip score (HHS), and forgotten joint score (FJS). RESULTS Patients with ARCO stage III ONFH had a significantly shorter operative time (P=0.009), shorter length of hospital stay (P=0.021), and reduced volume of intraoperative bleeding (P=0.021) compared with patients with ARCO stage IV ONFH. There were no significant differences in disease duration (P=0.310), postoperative complications (P=0.07), preoperative (P=0.086, P=0.156) and postoperative (P=0.062, P=0.173) HHS and VAS scores, respectively. Patients with stage III ONFH reported significantly higher FJS scores at 3 months, 6 months, and 1 year after THA. CONCLUSIONS Patients who underwent hip arthroplasty for ARCO stage III femoral head necrosis experienced shorter operative time and hospital stay, less intraoperative bleeding, and better restoration of hip function than those with ARCO stage IV. Moreover, stage III patients were more prone to "forget" their hip arthroplasty experience within 1 year of surgery.

Indication Criteria for Total Hip Arthroplasty in Patients with Hip Osteoarthritis—Recommendations from a German Consensus Initiative

Background: Osteoarthritis of the hip (hip OA) is a leading cause of pain and disability in elderly people. If non-surgical therapies become ineffective, patients may consider total hip arthroplasty (THA). The biggest challenge in recommending a THA is identifying patients for whom the benefits of this procedure outweigh the potential risks. The aim of this initiative was to develop a clinical practice guideline with accompanying algorithm to guide consultations on THA, supported by a pocket-sized checklist. Methods: The initiative “Evidence- and consensus-based indication criteria for total hip replacement (EKIT-Hip)” used a stepwise approach, starting with an inauguration workshop, where a multidisciplinary German stakeholder panel from various scientific societies agreed on the working process. A Project Coordinating Group (PCG) was formed, and it performed a comprehensive systematic literature search of guidelines and systematic reviews related to the indication criteria for THA, as well as factors influencing outcomes. Based on best-available evidence, preliminary recommendations were formulated by the PCG and discussed with the stakeholder panel during a consensus meeting. In addition, the panel was asked to assess the feasibility of an extracted algorithm and to approve a final checklist. Results: In total, 31 recommendations were approved by 29 representatives of 23 societies. These were used to underpin an algorithm (EKIT-Algorithm), which indicates the minimum requirements for a THA (confirmed diagnosis of hip OA, present and documented individual burden of illness, ineffectiveness of non-surgical therapies, and absence of any contraindications). Once these criteria are fulfilled, further considerations should encompass the medical implications of modifiable risk factors and patients’ individual treatment goals, as discussed during shared decision making. The subsequently developed checklist (EKIT-Checklist) lists relevant criteria for decision making. Conclusions: Adherence to the EKIT-Algorithm, conveniently accessed via the EKIT-Checklist, should improve the standardization of decision making leading to a recommendation for THA. By applying minimum requirements and patient-related risk factors, as well as considering patients’ individual goals, it is possible to identify patients for whom the benefits of THA may exceed the potential risks.