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PubMed2002

Health-related quality of life and mobility of patients awaiting elective total hip arthroplasty: a prospective study.

BACKGROUND: Waits for elective total hip arthroplasty for osteoarthritis are common in publicly funded health care systems, but they may lead to poorer postoperative outcomes and loss of health-related quality of life (HRQOL) through progressive pain and immobility during the wait. These issues have not been examined from the time of referral for surgery. Our primary objective was to test whether a longer wait was associated with poorer postoperative HRQOL. METHODS: Patients needing possible total hip arthroplasty for osteoarthritis were identified upon referral to a surgeon in London, Ont. Outcome measures, including the Western Ontario McMaster (WOMAC) Osteoarthritis Index and mobility in the 6-Minute Walk, were assessed at baseline and every 3-6 months thereafter until at least 3 months after the surgery. RESULTS: Of 553 potentially eligible patients referred for surgical assessment, 123 were placed on a waiting list for total hip arthroplasty; 114 underwent the procedure, and 99 of them returned for postoperative assessment. No significant differences in HRQOL or mobility were seen postoperatively between patients with short waits and those with long waits (a priori definitions < or = 6 months and > 6 months respectively). At referral, however, patients with short waits had poorer HRQOL and were less mobile than those with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score, 0.001 for pain, 0.009 for stiffness and 0.008 for function; p = 0.006 for 6-Minute Walk results). Patients with short waits experienced larger gains in these measures from the time of referral until the postoperative assessment than did patients with long waits (p = 0.002 for WOMAC Osteoarthritis Index total score, < 0.001 for pain, 0.005 for stiffness and 0.005 for function; p = 0.06 for 6-Minute Walk results). For patients with long waits, increases in the WOMAC Osteoarthritis Index total score exceeded 10% and losses in walking distance exceeded 30 m from the time of referral to surgery. INTERPRETATION: The length of wait for elective total hip arthroplasty is not associated with postoperative HRQOL and mobility. However, patients who undergo the procedure within 6 months after referral have greater disability at referral, and realize greater gains in HRQOL and mobility after surgery, than patients waiting more than 6 months. Clinically important losses in HRQOL and mobility occur in patients waiting more than 6 months.

Aged↗
PubMed2002

Synovial entrapment: a complication of posterior stabilized total knee arthroplasty.

BACKGROUND: We observed a complication of posterior stabilized total knee arthroplasty involving hypertrophy of tissue proximal to the patella associated with pain during active knee extension from 90 degrees of flexion. The purpose of this paper was to describe synovial entrapment and to determine if design features of the prosthesis predispose patients to the complication. METHODS: Between April 1990 and June 1999, we performed 459 consecutive posterior stabilized primary total knee arthroplasties using three prosthetic designs with different femoral intercondylar geometries. We identified twenty-six patients (twenty-seven knees) in whom arthroscopic débridement of the knee or open arthrotomy with débridement of the knee had been subsequently performed because of a diagnosis of synovial entrapment. We reviewed the records of these patients to identify the knee components that had been used and the symptoms and conditions that necessitated additional treatment. RESULTS: Symptoms (grating, crepitation, and pain with active knee extension from 90 degrees) necessitating subsequent débridement occurred in 13.5% (nineteen) of 141 knees treated with the Anatomic Modular Knee-Congruency implant, 3.8% (eight) of 212 treated with the Anatomic Modular Knee-Posterior Stabilized implant, and none of the 106 treated with the Press Fit Condylar Sigma-Posterior Stabilized implant. All patients had difficulty rising from a chair and climbing stairs; however, none had symptoms when standing or walking. No patient had a patellar clunk. The symptoms occurred at a mean of seven months after the arthroplasty in the patients with an Anatomic Modular Knee-Congruency implant and at a mean of twenty months after the arthroplasty in those with an Anatomic Modular Knee-Posterior Stabilized implant. Débridement of the frond-like hypertrophic synovial tissue at the distal aspect of the quadriceps tendon alleviated symptoms in all patients. No nodules were identified during the arthroscopy. CONCLUSIONS: Synovial entrapment is characterized by hypertrophic synovial tissue at the superior pole of the patella. Use of a posterior stabilized femoral component with a proximally positioned or wide femoral box is more likely to result in this complication.

Aged↗
PubMed2002

Osteolysis in failed total knee arthroplasty: a comparison of mobile-bearing and fixed-bearing knees.

BACKGROUND: Osteolysis is an important complication associated with total knee arthroplasty. The purpose of this study was to compare the prevalence of osteolysis after failed total knee arthroplasty with a mobile-bearing prosthesis and after failed arthroplasty with a fixed-bearing prosthesis. METHODS: Eighty revision total knee arthroplasties performed between 1995 and 1998 were included in this study. All had radiographic evidence of advanced polyethylene wear. The mobile-bearing group consisted of thirty-four knees with a Low Contact Stress implant, and the fixed-bearing group included forty-six knees. The average time (and standard deviation) from the primary operation to the revision was 102.8 +/- 26.5 months in the mobile-bearing group and 96.0 +/- 30.1 months in the fixed-bearing group. The prerevision radiographs and operative findings were reviewed. RESULTS: The prevalence of osteolysis was significantly higher in the mobile-bearing group (47%; sixteen of thirty-four knees) than in the fixed-bearing group (13%; six of forty-six knees) (p = 0.003). The distal part of the femur was involved in thirteen knees in the mobile-bearing group and in four knees in the fixed-bearing group. Seventeen knees had osteolysis in the posterior aspect of the femoral condyle, which was the most common site of osteolysis; however, twelve of them had no evidence of osteolysis on prerevision radiographs. CONCLUSIONS: The prevalence of osteolysis was higher in the knees with a mobile-bearing prosthesis than in those with a fixed-bearing prosthesis. The osteolysis was predominantly on the femoral side, adjacent to the posterior aspect of the condyle. Radiographic evaluation of osteolysis in the distal part of the femur may not be reliable and usually leads to an underestimation of the degree of osteolysis.

Aged↗
PubMed2003

Trapezial arthroplasty with silicone rubber implantation for advanced osteoarthritis of the trapeziometacarpal joint of the thumb.

INTRODUCTION: Arthritis in the trapeziometacarpal joint of the thumb can cause swelling and loss of motion. Treatment options include arthrodesis, replacement arthroplasty and interposition arthroplasty. Our objective in this clinical study was to determine outcomes after trapezial arthroplasty with a silicone rubber implant and the relationship between self-reported and measured outcomes. METHODS: At the Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ont., a tertiary care centre, we reviewed a series of 26 patients with advanced osteoarthritis who underwent silicone rubber trapezial arthroplasty. The follow-up averaged 6.5 years. We assessed the outcomes subjectively, and by clinical, functional and radiographic examination. RESULTS: Although 88% of patients reported some improvement in pain and satisfaction, when quantified the improvement was less impressive: only 5.7 (on a visual analogue scale of 1-10, poor-excellent) for pain and 5.6 for satisfaction. Superior subjective results were reported by patients older than 60 years. Osteoarthritic changes had caused pronounced functional impairment in the hands of patients who underwent surgery and those who did not, so that any long-term benefit of surgery was not measurable. Patients had difficulty manipulating both small and large objects on the Jebsen's hand function test. Peri-implant and carpal radiographic lytic changes were observed in 90% of patients. Six patients (20%) required revision surgery (3 early, 3 late), including 1 with a pathologic scaphoid fracture. CONCLUSIONS: Although clinical, functional and radiographic results were poor, they did not predict either satisfaction or pain improvement reported by patients, illustrating the need for a comprehensive standardized outcome evaluation to make informed decisions on the value of surgical intervention for osteoarthritis of the trapeziometacarpal joint.

Adult↗
PubMed1976

The development of a total wrist arthroplasty.

For many individuals the preservation of wrist motion is essential for augmentation of fine motor control of the hand and fingers. When significant functional disability exists at the wrist, currently available surgical treatment includes soft tissue arthroplasty, carpectomy, or arthrodesis. A total wrist joint arthroplasty offers the patient the potential of a pain-free, stable, and mobile wrist. Based upon the principles of total joint replacement as applied to the hip and knee, the prosthesis is secured to the carpus and radius with methylmethacrylate cement, following removal of the navicular, lunate, and head of the capitate. The design of the prosthesis provides for the two planes of motion normally seen at the wrist; 90 degrees of flexion and extension and 50 degrees of radial ulnar deviation are permitted by the design. Candidates for total wrist arthroplasty are patients who exhibit far-advanced disease at the wrist and who might be considered as candidates for arthrodesis, but in whom the permanent loss of motion would represent a significant handicap. To date 17 arthroplasties have been performed in 14 patients. The longest follow-up is 14 months. All but 2 patients have gained a useful range of motion. All patients have noted dramatic relief of pain and deformity, permitting them to perform tasks which were preoperatively impossible.

Arthroplasty↗
PubMed2003

Total hip arthroplasty in patients younger than 21 years: a minimum, 10-year follow-up.

INTRODUCTION: To evaluate the function, radiographic results and implant survival in patients younger than 21 years at the time of operation and with at least a 10-year follow-up, we reviewed the course of young adults who underwent total hip arthroplasty at McGill University Health Centre. PATIENTS AND METHODS: Twelve patients (16 hips) met the criteria for inclusion in this study. They ranged in age from 10-20 years (median 16.5 yr). One patient (1 hip) died 5 years after the index surgery and was excluded from the study. Functional results were measured by the Harris hip score, and radiographs of surviving implants were assessed for radiolucencies, osteolysis and eccentric polyethylene wear. RESULTS: Eleven arthroplasties were cementless, 2 were hybrid and 2 were cemented. At follow-up ranging from 10 to 25 years (mean 13.6 yr), the Harris hip score ranged from 34.2-97.2 (mean 64.5). Four (26%) acetabular components were revised and (at the time of writing) 1 required revision. Only 1 (7%) femoral stem was revised. Radiographically, there was a high prevalence of eccentric polyethylene wear, but none of the surviving implants were found to be loose. Overall, 67% (10 of 15) of the total hip arthroplasties continued to function well at a mean of 13.6 years postoperatively. CONCLUSIONS: Total hip arthroplasty remains a reasonable option in adolescence and early adulthood in selected patients with severe debility from multiple joint disease. Polyethylene wear is a particularly significant problem in this group of active young people.

Adolescent↗
PubMed2003

Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty.

Metal-on-metal (MOM) bearings for hip arthroplasty are increasing in popularity. Concern remains, however, regarding the potential toxicological effects of the metal ions which these bearings release. The serum levels of cobalt and chromium in 22 patients who had undergone MOM resurfacing arthroplasty were compared with a matched group of 22 patients who had undergone 28 mm MOM total hip arthroplasty (THA). At a median of 16 months (7 to 56) after resurfacing arthroplasty, we found the median serum levels of cobalt and chromium to be 38 nmol/l (14 to 44) and 53 nmol/l (23 to 165) respectively. These were significantly greater than the levels after 28 mm MOM THA which were 22 nmol/l (15 to 87, p = 0.021) and 19 nmol/l (2 to 58, p < 0.001) respectively. Since the upper limit for normal patients without implants is typically 5 nmol/l, both groups had significantly raised levels of metal ions. MOM bearings of large diameter, however, result in a greater systemic exposure of cobalt and chromium ions than bearings of small diameter. This may be of relevance for potential long-term side-effects. It is not known to what extent this difference is due to corrosion of the surfaces of the component or of the wear particles produced.

Adult↗
PubMed2004

Response bias: effect on outcomes evaluation by mail surveys after total knee arthroplasty.

BACKGROUND: Mail survey questionnaires are increasingly being used for follow-up evaluations to gauge satisfaction and performance after total joint arthroplasty. Responses to questionnaires are subject to a variety of possible biases. We evaluated response behavior in a mail survey of patients who had had a total knee arthroplasty. METHODS: A ten-question survey that evaluated satisfaction, general health, and Knee Society knee function and clinical scores was mailed to 472 patients who had undergone consecutive primary total knee arthroplasties from 1996 to 1998. The 83% who responded were stratified as early, late, and repeat-mailing responders. The 17% who failed to respond after two mailings were considered nonresponders. All of the nonresponders were eventually contacted. The groups were compared with regard to their scores at the preoperative office visit, at the most recent office visit, and on the mail survey. RESULTS: In the mail survey, the patients who responded earliest gave the highest satisfaction ratings and the nonresponders gave the poorest ratings (p < 0.001). Similarly, the mean Knee Society knee score (and standard deviation) was significantly higher for the early responders (82.7 +/- 19.0) than for the nonresponders (66.9 +/- 16.0), as was the mean function score (68.8 +/- 24.1 compared with 48.4 +/- 12.5) and the mean pain score (39.8 +/- 13.9 compared with 27.0 +/- 9.7) (all p < 0.0001). The change between the preoperative and mail survey Knee Society knee scores was significantly higher for the early responders (46.12 +/- 25.71) than for the nonresponders (28.45 +/- 23.62), as was the change in the mean function scores (18.87 +/- 22.52 compared with 5.34 +/- 20.05) and the change in the mean pain scores (23.57 +/- 17.76 compared with 10.67 +/- 12.93) (all p < 0.0001). CONCLUSIONS: Patients who do not respond to mail surveys used for follow-up are unique in that they report significantly poorer outcomes than do responders. This potential response bias should be considered in all follow-up analyses. Because it may be difficult to attain 100% response rates in very large series of patients, division of the study cohort into more manageable segments is advised to achieve a more complete response rate. The assessment of patients who are lost to follow-up is an important and necessary component in the accurate analysis of outcomes after arthroplasty.

Adult↗
PubMedDate not supplied

Hip arthroplasty after femoral osteotomy.

Osteotomy of the proximal femur is performed to treat numerous hip pathologies in order to improve the load axis of the coxofemoral joint, thus improving coverage of the femoral head; despite this, arthrosis-related pathology may progress, and this nearly always results in hip arthroplasty. Many authors report that the time interval between osteotomy and arthroplasty is approximately 5 to 10 years. It is the purpose of this study to evaluate the complications and the clinical and radiographic results of hip arthroplasty performed after proximal femoral osteotomy, comparing them with a control group for hip arthroplasty without previous osteotomy.

Adolescent↗
PubMed2004

[Infection complications of total hip arthroplasty].

The authors present an overview of the current views on etiology and diagnostics of infectious complications of total hip arthroplasty and analyze the possibilities of individual therapeutic procedures (debridement with the preservation of total hip arthroplasty, revision of the endoprosthesis, long-term antibiotic therapy, final resection arthroplasty, arthrodesis). They discuss the pending issues relating to the therapy of infectious complications of total hip arthroplasty (the duration of antibiotic therapy, the interval between the extraction and revision surgery of the endoprosthesis, the use of antibiotic-containing cement). Based on their own experience they recommend the revision surgery with the preservation of the implant, debridement and irrigation as the first step only in case of an early post-operative infection and in case of a late hematogenous acute infection. In case of chronic infection they recommend a two-step revision surgery using the cement spacer and the antibiotic therapy for 3 to 6 months. During this period the laboratory and clinical signs of the infection must be back to their normal. Long-term antibiotic therapy in dependence on microbial sensitivity is recommended.

Anti-Bacterial Agents↗
PubMed2004

[Hip arthroplasty after failed internal fixation of the trochanteric fractures in aged patients with co-existent osteoporosis].

The authors present the results of hip arthroplasty of 67 patients treated after failed internal fixation of the osteoporotic, trochanteric fractures of the femur, which were primary stabilised with angular plate AO in 39 patients and with dynamic hip screw (DHS) in 28 patients. In the discussed material 16 persons were male and 51 female, in the age between 51 and 83 years old. According to the Evans classification in 4 cases we diagnosed type I of fracture, in 10--type II, 31--type III and in 22--type IV. Hip arthroplasty was made from the 3rd to the 39th week after primary fixation of the fracture. In 42 patients we made total hip arthroplasty, in 14 cases Austin-Moore hemiarthroplasty, and in 11 patients bipolar arthroplasty. According to the Postel and Merle d'Aubigne classification there were obtained 29 very good, 21 good and 17 satisfactory results.

Aged↗
PubMed2005

Total elbow arthroplasty after previous resection of the radial head and synovectomy.

We examined the effects of previous resection of the radial head and synovectomy on the outcome of subsequent total elbow arthroplasty in patients with rheumatoid arthritis. Fifteen elbows with a history of resection and synovectomy were compared with a control group of patients who had elbow arthroplasty with an implant of the same design. The mean age in both groups was 63 years. In the study group, resection of the radial head and synovectomy had been undertaken at a mean of 8.9 years before arthroplasty. The mean radiological follow-up for the 13 available patients in the study group was 5.89 years (0.3 to 11.0) and in the control group was 6.6 years (2.2 to 12.6). There were no revisions in either group. The mean Mayo elbow performance score improved from 29 to 96 in the study group, with similar improvement in the control group (28 to 87). The study group had excellent results in 13 elbows and good results in two. The control group had excellent results in seven and good results in six. Our experience indicates that previous resection of the radial head and synovectomy are not associated with an increased rate of revision following subsequent arthroplasty of the elbow. However, there was a higher rate of complication in the study group compared with the control group.

Aged↗
PubMed2005

Short-term survival analysis of the all-polyethylene tibial component in total knee arthroplasty.

OBJECTIVE: To report the clinical and radiological results of 24 total knee arthroplasty in which all-polyethylene tibial components were used. METHODS: Between December 2000 and December 2002, 24 cemented total knee arthroplasty in 21 patients were performed using all-polyethylene tibial components. The mean age of the 21 patients (9 men and 12 women) at operation was 55 years, ranging 48-61 years. The mean preoperative hospital for special surgery (HSS) score was 40.2 (range, 36-43). The diagnoses were degenerative osteoarthritis in 15 patients, rheumatoid arthritis in 5 and traumatic arthritis in 1. All the operations were performed by the same surgeon group and there were unilateral operations in 18 patients and bilateral operations in 3. RESULTS: Eighteen patients were followed up with a follow-up rate of 85.7%. The mean follow-up is 2.5 years (range, 1-3 years) and mean postoperative HSS scores was 87.5 (range, 83-89). Among them, 18 were excellent, 3 good, 3 poor and none was fair (the results of three lost patients were classified as poor). Of those reviewed, the prosthesis was all in situ and no revision occurred. Radiological assessment of these patients revealed 4 (16.67%) tibial components with radiolucent lines (mean width < or = 2 mm) distributed mainly in zone 1 and zone 4. None of these knees was symptomatic. CONCLUSIONS: The result of total knee arthroplasty using all-polyethylene tibial components is encouraging. The operative techniques are similar to those in arthroplasty using metal-backed tibial component.

Arthritis↗
PubMed2005

Extensor mechanism complications after total knee arthroplasty.

The patellofemoral joint is an important source of pain and complications following total knee arthroplasty. Anterior knee pain, patellar instability, fracture, rupture of the extensor mechanism, and a variety of miscellaneous problems affecting the patella can adversely affect the results of a total knee arthroplasty. Because patellofemoral complications after total knee arthroplasty often occur because of problems with patient selection, implant design, and surgical technique, it is important for orthopaedic surgeons treating patients with extensor mechanism complications after total knee arthroplasty to evaluate the entire knee replacement and base treatment on the etiology of the complication and not just the complication itself.

Arthroplasty, Replacement, Knee↗
PubMed2005

Translation and validation of the Dutch version of the Oxford 12-item knee questionnaire for knee arthroplasty.

BACKGROUND: In 1998, the Oxford 12-item knee questionnnaire was developed by Dawson et al. as a self-administered disease- and site-specific questionnaire, specifically developed for knee arthroplasty patients. Since then,it has proven to be an effective outcome questionnaire, and is widely used. Despite the positive psychometric properties for the Total Knee Arthroplasty (TKA) population, the 12-item knee questionnaire has only been translated into a few languages. We thus translated and validated the Oxford 12-item knee questionnaire for the Dutch population. METHODS AND RESULTS: After translation according to a forward/backward protocol, 174 knee arthroplasty patients were asked to answer the questionnaire together with an SF-36, an AKSS and a VAS. The reliability, validity, content validity and the sensitivity to change were all tested. Our Dutch version of the Oxford 12-item knee questionnaire achieved excellent scores in all of these properties. INTERPRETATION: The Dutch Oxford 12-item knee questionnaire proved to be an excellent evaluation instrument for the Dutch orthopedic surgeon and can be used for all total knee arthroplasty patients.

Arthroplasty, Replacement, Knee↗
PubMed2005

Proximal humeral fractures treated with arthroplasty.

OBJECTIVE: To explore arthroplasty in treating 3- and 4-part fractures of the proximal humerus. METHODS: A total of 132 patients with proximal humeral fractures were treated in our hospital from July 1997 to February 2003. According to Neer's classification, the fractures of 45 patients (14 males and 31 females, aged 31-78 years, 56.1 years+/-7.8 years on an average) belonged to 3- or 4-part fractures (10 patients with 4-part fracture and 35 with 3-part comminuted fracture) and they were treated with shoulder joint arthroplasty. Unipolar prosthesis replacement of the head of humerus was made in 28 cases, while bipolar prosthesis replacement in 2 cases and total shoulder joint replacement in 15 cases. RESULTS: During the follow-up period (range: 12-72 months, mean: 37.3 months+/-4.1 months), among the 45 patients who suffered from fractures of the proximal humerus and underwent arthroplasty surgery, 44 patients (97.8%) had no postoperative pain and were satisfied with the active range of motion and with the whole treatment results. And radiography showed that the prostheses were at their good position. One patient had postoperative pain because he had so narrow medullary cavity that the humeral prosthesis could not be put deeply enough and the prosthesis head was a little higher over the anatomic level. He did not have good postoperative active range of motion, either. Then he received a review surgery and got satisfied results. Temporary shoulder stiffness was observed in one patient. Manual release of these adhesions improved the shoulder function. No evidence of nonunion of the fracture segments around the humeral prosthesis stem was found. CONCLUSIONS: Shoulder arthroplasty is a dependable method to restore the comfort and function of the shoulder joints of the patients with 3- or 4-part fractures of the proximal humerus.

Adult↗
PubMed2005

[Simultaneous bilateral total hip arthroplasty in a single procedure].

OBJECTIVE: To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. METHODS: From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. RESULTS: The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1160 ml on average). All the 15 patients were followed up for 3 to 35 months (18 months on average). The Harris scores of the joint function after the operation ranged from 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (P<0.05). There was only 1 death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. CONCLUSION: Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing single-stage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.

Adult↗
PubMed2005

Do pain referral patterns determine patient outcome after total hip arthroplasty?

Quality of life outcome and patient satisfaction after total hip arthroplasty are complex phenomena and many confounding determinants have been identified. Degenerative disease of the hip joint may present with variable patterns of pain referral in the lower limb. However the effect of varied preoperative pain referral patterns on patient outcome and satisfaction after total hip arthroplasty has not previously been examined. From 2000 to 2003, 236 eligible patients scheduled to undergo primary total hip arthroplasty were prospectively enrolled. The principal pain referral pattern (as hip, thigh or knee) was identified in all patients. Health related quality of life (HRQOL) was examined using the Harris Hip score (HHS), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the 36-Item Short-Form Health Survey (SF-36) pre-operatively, 1 year and 2 years postoperatively and with the HHS at 3 months postoperatively. All patients were followed up for a minimum of 2 years. The frequency of the pain referral distributions were; hip pain 41%, knee pain 32% and thigh pain 27%. Patients in all groups were comparable preoperatively with respect to age, HHS, and both mean and domain specific WOMAC and SF-36 scores. The mean duration of symptoms was significantly greater in patients with knee pain when compared to the remaining two pain patterns. All patients demonstrated improvements in HHS, SF-36 and WOMAC scores after surgery. At all times postoperatively there were significant differences in mean HHS and mean and domain specific WOMAC and SF-36 scores between patients with hip or thigh pain and those with knee pain (p < 0.001). While notable, differences between hip and thigh pain were not as consistent however. Based on these findings, it appears that pre-operative pain referral patterns of hip arthritis are among the determinant factors for patient outcome and satisfaction after total hip arthroplasty, as measured using validated HRQOL scoring systems.

Aged↗