Patient reported outcome measures correlate with step-count in total hip arthroplasty.

Smartphone-based apps that measure step-count and patient reported outcomes (PROMs) are being increasingly used to quantify recovery in total hip arthroplasty (THA). However, optimum patient-specific activity level before and during THA early-recovery is not well characterised. This study investigated 1) correlations between step-count and PROMs and 2) how patient demographics impact step-count preoperatively and during early postoperative recovery.Smartphone step-count and PROM data from 554 THA patients was retrospectively reviewed. Mean age was 64±10yr, BMI was 29±13kg/m2, 56% were female. Mean daily step count was calculated over three time-windows: 60 days prior to surgery (preop), 5-6 weeks postop (6wk), and 11-12 weeks postop (12wk).Linear correlations between step-count and HOOS12 Function and UCLA activity scores were performed. Patients were separated into three step-count levels: low (<2500steps/day), medium (2500-5500steps/day), and high (>5500steps/day). Age >65years, BMI >30, and sex were used for demographic comparisons.Student's t-tests determined significant differences in mean step-counts between demographic groups and in mean PROMs between step-count groups.UCLA correlated with step-count at all time-windows (p<0.01). HOOS12 Function correlated with step-count preoperatively and at 6wk (p<0.01). High vs low step count individuals had improved UCLA scores preoperatively (∆1.8,p<0.001), at 6wk (∆1.1,p<0.05), and 12wk (∆1.6,p<0.01), and improved HOOS12 Function scores preoperatively (∆8.4,p<0.05) and at 6wk (∆8.8,p<0.001).Younger patients had greater step-count preoperatively (4.1±3.0k vs 3.0±2.5k, p<0.01) and at 12wk (5.1±3.3k vs 3.6±2.9k, p<0.01). Males had greater step-count preoperatively (4.1±3.0k vs. 3.0±2.7k, p<0.001), at 6wk (4.5±3.2k vs 2.6±2.5k, p<0.001), and at 12wk (5.2±3.6k vs. 3.4±2.5k, p<0.001). Low BMI patients had greater step-count at 6wk (4.3±3.3k vs. 2.6±2.7k, p<0.01) and 12wk (5.0±3.6k vs. 3.6±2.6k, p<0.05).Daily step-count is significantly impacted by patient demographics and correlates with PROMs, where patients with high step count exhibit improved PROMs. Generic recovery profiles may therefore not be appropriate for benchmarking across diverse populations.

What's New in Hip Replacement.

Highlights of the 2021 American Joint Replacement Registry Annual Report.

Challenging the Status Quo: Debunking the Necessity of 5-Year to 10-Year Patient-Reported Outcome Measures in Total Hip and Knee Arthroplasties

Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel

Hip Resurfacing vs Total Hip Arthroplasty in Patients Younger than 35 Years: A Comparison of Revision Rates and Patient-Reported Outcomes

The aim of this study was to assess the variations in the positioning of components between sides in patients who underwent staged bilateral total hip arthroplasty (THA), and whether these variations affected patient-reported outcome measures (PROMs). A retrospective review included 207 patients who underwent staged bilateral THA between June 2017 and November 2022. Leg length, the height and anteversion of the acetabular component, and the coronal and sagittal angles of the femoral component were assessed radiologically and compared with the contralateral THA. The effect of the surgical approach and the technology used on this variation was also assessed. Linear regression was used to investigate the variations between the two THAs and the PROMs. Between the two sides, the mean leg length varied by 4.6 mm (0.0 to 21.2), the mean height of the acetabular component varied by 3.3 mm (0.0 to 13.7), the mean anteversion varied by 8.2° (0.0° to 28.7°), the mean coronal alignment of the femoral component varied by 1.1° (0.0° to 6.9°), and the mean sagittal alignment varied by 2.3° (0.0° to 10.5°). The use of the direct anterior approach resulted in significantly more variation in the alignment of the femoral component in both the coronal (1.3° vs 1.0°; p = 0.036) and sagittal planes (2.8° vs 2.0°; p = 0.012) compared with the use of the posterior approach. The posterior approach generally led to more anteversion of the acetabular component than the anterior approach. The use of robotics or navigation for positioning the acetabular compoment did not increase side-to-side variations in acetabular component-related positioning or leg length. Despite considerable side-to-side variations, the mean Hip disability and Osteoarthritis Outcome, Joint Replacement (HOOS JR) score was not affected by variations in the postioning of the components. Staged bilateral THA resulted in considerable variation in the positioning of the components between the two sides. The direct anterior approach led to more variations in anteversion of the acetabular component and sagittal alignment of the femoral component than the posterior approach. The use of computer navigation and robotics did not improve the consistency of the positioning of the components in bilateral THA. Variations in the positioning of the components was not associated with differences in PROMs, indicating that patients can tolerate these differences.

Total hip arthroplasty (THA) aims to restore function and reduce pain for patients suffering from hip pathologies. However, some procedures require revision THA, with the most common reasons including: mechanical failure, aseptic loosening, infection, and component malposition leading to dislocations. Computed tomography (CT) scan-based, three-dimensional imaging operating techniques can help address some of these issues by helping to provide more optimal implant positioning, which can potentially confer improved outcomes. To date, only a few studies have evaluated the utilization of CT scan-based robotic-arm assisted THA in total hip arthroplasty, and those that do are not necessarily of the high-methodological quality. Therefore, the purpose of this review was to select the most recent and good- to high-quality studies focusing on robotic-assisted THA, to help provide a more comprehensive representation of postoperative outcomes. Specifically, we evaluated each study independently as well as performed a cumulative assessment of this most recent high-quality data. An extensive, cross-platform search of total hip arthroplasty on August 1, 2022 was performed. Studies were included only if they addressed robotic-assisted THA in comparison to manual techniques. Additional inclusion criteria consisted of studies scoring excellent (100 to 85 points) or good (84 to 70 points) based on their Coleman methodology score. Studies were evaluated as individual pieces of work, as well as a cumulative assessment. Specific outcomes evaluated were: component placement in safe zones, leg- length discrepancies, dislocation rates, clinical outcomes, patient clinical scores, patient-reported outcome measures (PROMS), lengths of stay, and costs. Overall, 24 studies were included for analyses. CT scan-based robotic-arm assisted THA had some potential key advantages as compared to manual techniques. Specifically, robotic-assisted THA was associated with more accurate component placement in safe zones, fewer chances of leg-length discrepancies, and lower risks of dislocation. Patient satisfaction and reported outcome measures were superior for CT scan-based robotic-arm assisted THA. Costs were also lower. Overall, 23 of 24 studies were positive for this technology, with one study of cases done between 2010 and 2014 more neutral. The robot led to positive findings for component placement in safe zones, leg-length discrepancies, dislocation rates, clinical outcomes, PROMS, lengths of stay, and costs. The current literature suggests potential advantages for CT scan-based robotic-arm assisted THA compared to manual THA. Surgeons should consider CT scan-based robotic-arm assisted THA for their patients given the multiple added benefits of improved clinical scores and PROMS, less dislocations (with a few exceptions reported), more component placements in safe zones, less leg-length discrepancies, decreased lengths of stay, and decreased episode-of-care costs.

Preoperative Diagnostic Factors Associated With Early MCID Achievement in BCTQ Outcomes Following Carpal Tunnel Release.

This study aims to describe a cohort of patients who underwent conversion to total hip arthroplasty (THA), comparing surgical approach and robotic assistance. Patients ≥ 18 years who underwent conversion to THA between January 1, 2015 and May 6, 2024, were retrospectively reviewed, and additionally contacted via telephone for updated patient reported outcome measures (PROMs), including the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) questionnaire. Surgical approach and robotic assistance were per surgeon preference, with consideration for the approach of the previous hip surgery. Descriptive statistics were calculated, and continuous variables analyzed using the Student's T-Test, the Wilcoxon Ranked Sum Test. Categorical variables were compared using Chi-Squared Tests and Fisher's Exact Tests, and outcomes analyzed with logistic regression in R statistical software. 83 patients met inclusion (53% anterior approach; 26.5% robotic assistance). Conversion via anterior approach demonstrated shorter operative times than posterior (by 45.9min; p < 0.001), in addition to fewer postoperative transfusions (22.7% vs. 53.8%; p = 0.006). Length of stay (LOS), and fluoroscopy time were not significant. When stratified by previous surgery 37 patients were converted from prior intramedullary nail, 16 via the anterior approach. Mean operative time remained shorter (p = 0.003) and transfusion remained less (p = 0.015) compared to posterior conversion in this subset. Robotic assistance was associated with shorter operative times (by 44.9min p < 0.001), and shorter LOS (p < 0.001). Zero robotic-assisted patients required transfusion within 24h postoperatively compared to 50.8% of non-robotic cases (p < 0.001), although transfusion risk was not significant considering approach or robotic assistance after multivariable regression controlling for preoperative hemoglobin. PROMs were equivocal between compared groups (mean HOOS Jr 11.0 ± 5.1, response rate 42.2%). Conversion THA demonstrates acceptable outcomes, with documented overall improvements in postoperative function. The anterior approach and robotic assistance were associated with significantly shorter surgical times, and less risk of transfusion, potentially demonstrating some advantage in this conversion scenario, although patient selection may have also influenced outcomes.

The purpose of this study is to determine if differences exist in patient-reported outcome measures (PROMs), revision rates, and postoperative health care utilization between individuals that have a history of taking anti-estrogen medication prior to total joint arthroplasty (TJA) and those who have not in matched cohorts. Patients undergoing primary TJA from 2015 to 2023 were reviewed retrospectively. Demographics, history of medication use, PROMs pre- and post-TJA, revision TJA history, and post-TJA hospital utilization were extracted from medical records. Propensity score matching was then performed at 10:1 control to patients with a history of taking anti-estrogen medication prior to TJA accounting for age, race, American Society of Anesthesiologists physical status classification, and body mass index. Patient PROMs, revision rate, and post-TJA hospital utilization were then compared. After applying exclusion criteria, stratifying the groups into total hip arthroplasty (THA) and total knee arthroplasty (TKA), and propensity score matching, the outcomes of 345 THAs and 549 TKAs were analyzed. Patients taking anti-estrogen medications who underwent THA had significantly higher Patient-Reported Outcome Measures Information System (PROMIS) Pain Interference scores; PROMIS Physical Function scores at 6 weeks, lower PROMIS Physical Function at 1 year; and higher rates of readmission at 90 days. There was no difference in PROMs or hospital utilization between groups in patients that underwent TKA. Patients with a history of taking anti-estrogen medications had meaningful improvement after THA and TKA. Although PROMs were similar between groups after TKA, PROMs suggest that patients taking anti-estrogen medication may have worse pain early after THA as well as worse overall function. (Journal of Surgical Orthopaedic Advances 34(3):142-151, 2025).

Value is defined as the ratio of patient outcomes to the cost of care. One method to assess value is through patient-level value analysis (PLVA). To our knowledge, this tool has not previously been implemented in the setting of total hip arthroplasty (THA). The purposes of this study were to perform PLVA for a 1-year episode of care among patients undergoing primary THA and to identify characteristics that affect value in a metropolitan health-care system. The patient-reported outcome (PRO) measure database of the institution was queried for all primary THAs from 2018 to 2019. The PRO measure that was utilized was the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Cost was evaluated with use of time-driven activity-based costing (TDABC) for a 1-year episode of care (consisting of the day of surgery, inpatient stay, discharge facility, postoperative appointments, and physical therapy). The primary outcome was the 1-year value quotient, or the ratio of the 1-year change in HOOS-JR to the cost of the episode of care (VHOOS). The value quotient was compared among all included patients and evaluated for variables that may affect the overall value of the episode of care. In total, 480 patients were included in the analysis. The mean improvement in the HOOS-JR was +34.9 ± 16.1 (95% confidence interval [CI]: 33.5, 36.3). The mean cost was $13,835 ± $3,471 (95% CI: $13,524, $14,146). The largest contributor to cost was implants (39.0%), followed by post-recovery care (i.e., inpatient stay and specialized nursing facilities; 24.1%). Change in the HOOS-JR was poorly correlated with the cost of care (r = -0.06; p = 0.19). THAs performed at an ambulatory surgery center (ASC) with discharge to home demonstrated higher value (VHOOS = 0.42) than THAs performed at a hospital with discharge to a rehabilitation facility (VHOOS = 0.15; analysis of variance F-test, p < 0.01). Our study found that PROs did not correlate with costs in the setting of primary THA. Implants were the largest cost driver. Surgical setting (an ASC versus a hospital) and discharge destination influenced value as well. PLVA is a value measurement tool that can be utilized to optimize components of the care delivery pathway. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

This study evaluates patient reported outcome measurement information system (PROMIS) scores after total hip arthroplasty (THA) and total ankle arthroplasty (TAA) in matched cohorts, while simultaneously evaluating implant survivorship and 90-day hospital utilization. It is hypothesized that while both procedures would yield similar PROMIS score improvements, THA would demonstrate superior mid-term implant survivorship.Primary THA and TAA patients from 2015–2022 with minimum one-year follow-up were retrospectively reviewed. After applying exclusion criteria, 2,092 THAs and 478 TAAs were included for analysis. Demographics, pre- and post-operative patient reported outcome measures (PROMs), revision surgeries, ED visits, and re-admissions were collected. THA and TAA patients were then propensity score matched at 2:1 ratio for age, sex, race, BMI, ASA, and comorbidities, resulting in a final cohort of 844 THAs and 455 TAAs for comparison.There were similar pre-operative PROMIS Pain Interference (PI) scores between THA and TAA, with both showing improvement at six weeks. However, THA patients exhibited lower PI scores at one year (53.0 versus 54.0; p=0.009). Pre-operative PROMIS Physical Function (PF) was worse in THA patients but showed greater improvement compared to TAA patients at both six weeks (p&lt;0.001) and one year (p&lt;0.001). Pre-operative PROMIS depression scores were similar and improved similarly in both groups. Joint-specific PROMs (HOOS for THA and FAAM for TAA) improved in both cohorts. THA demonstrated superior survivorship free of all-cause revision at five years compared to TAA (95% versus 77%; p&lt;0.0001).Patients undergoing THA or TAA experienced significant improvements in their general and joint-specific PROMs post-operatively. However, patients undergoing THA demonstrated higher PROMIS PI and PF scores at one-year when compared to TAA, as well as improved survivorship. Generic PRO instruments enable comparison of medical treatments in different anatomic sites to the patients overall health.

Preoperative Predictors of Unplanned Emergency Department Visits Following Total Hip Arthroplasty

BackgroundPrior to total hip and knee arthroplasty (THA/TKA), patients with low socioeconomic status (SES) report worse Patient-Reported Outcome Measures (PROMs), persisting postoperatively. This study explores which self-reported PROMs and their specific domains are most involved.MethodsWe obtained data from the Dutch Arthroplasty Registry (2014–2022), including over 100,000 THA/TKA patients with complete preoperative and 12-month follow-up PROMs. The EQ-5D-3L and EQ-5D-5L, EQ Visual Analogue Scale (VAS), Oxford Hip and Oxford Knee Score (OHS/OKS), and Numerical Rating Scales (NRS) for pain and satisfaction (TKA only, at 12-month follow-up) were obtained. The PROMs were transformed to a 0-100 scale for direct comparison. A SES-indicator based on neighborhood income, unemployment rate, and education level was divided into quintiles, which are equal groups representing 20% of the Dutch population, and was ranked from least to most deprived. Through linear regression we contrasted the most and least deprived groups, adjusting for patient and surgical characteristics. The contribution (percentage) of each domain to the overall health inequalities was estimated for the EQ-5D’s and the OHS/OKS.ResultsIn TKA patients, the most compared to the least deprived group had a lower preoperative EQ-5D-3L score: -2.1 [95% confidence interval − 2.6, -1.6], p < 0.001. At 12-month follow-up, the difference was smaller: EQ-5D-3L 1.3 [-1.9, -0.7], p < 0.001. A larger difference between the most and least deprived was present in OKS (preoperatively: -4.3 [-5.3, -3.4], p < 0.001; 12-month: -1.8 [-2.5, -1.2], p < 0.001). The difference in EQ VAS was smaller (preoperatively: -0.8 [-1.5, -0.1], p = 0.024; 12-month: -0.5 [-1.2, 0.1], p = 0.108). The difference in NRS pain (in rest) was comparable to those in EQ-5D-3L and OKS (preoperatively: -4.5 [-5.4, -3.5], p < 0.001; 12-month: -2.7 [-3.5, -1.9], p < 0.001), while no difference between the most and least deprived in NRS satisfaction was observed at 12 months. For EQ-5D-3L, the domain usual activities accounted for up to 46% of the difference between SES groups, while anxiety/depression played a limited role (up to 17%). For OHS/OKS, functioning contributed most in THA (up to 61%) and pain contributed most in TKA (up to 68%). Differences in PROM scores between SES groups, and how these differences compared across PROMs, were similar in THA patients. Overall, the EQ-5D-5L produced similar patterns compared to the EQ-5D-3L.ConclusionsDeprived THA/TKA patients have poorer pre- and postoperative health, which was primarily related to worse functioning and pain; the clinical relevance of these differences remain uncertain. These differences did not translate into worse overall health (EQ VAS) or into higher dissatisfaction among deprived patients. Future research should investigate whether the EQ VAS and satisfaction measure reflected health differences between SES groups or were biased by reporting heterogeneity, where respondents interpreted the wording differently.