To define the ‘patient acceptable symptom state’ (PASS) and ‘minimum important change’ (MIC) for the Oxford Hip Score (OHS) following aseptic revision total hip arthroplasty (rTHA), and identify factors associated with their achievement. A prospective cohort of 135 patients (138 hips) undergoing aseptic rTHA at a single centre were followed up at one and two years postoperatively. Demographics, health-related quality of life (HRQoL; EQ-5D) and OHS were recorded at each timepoint. Anchor techniques were used to define the MIC and PASS. Regression models identified factors associated with PASS and MIC achievement. The OHS PASS was 31.5 and 33.5 at one and two years postoperatively, respectively. The MIC was 8.5 at both timepoints. A greater preoperative EQ-5D was independently associated with PASS achievement at both timepoints. One-year MIC achievement was independently associated with lower BMI (p = 0.042) and lower preoperative OHS (p = 0.007), whilst lower preoperative OHS (p = 0.016) alone was independently associated with two year MIC achievement (p = 0.016). Lower preoperative EQ-5D and ASA grade 3 were associated with failure to achieve either PASS or MIC at one year (p = 0.030) and two years (p = 0.013) postoperatively, respectively. The PASS and MIC thresholds for the OHS following aseptic rTHA contextualise the score and can inform study design. Greater preoperative HRQoL was independently associated with PASS achievement, whilst worse preoperative function was independently associated with MIC achievement. These thresholds should be considered in conjunction when assessing outcomes following aseptic rTHA.

BACKGROUND:To assess whether a cemented short (125 mm) polished taper slip stem offered an equivalent hip-specific outcome, health-related quality of life, satisfaction, and survival compared to the standard (150 mm) stem when used for total hip arthroplasty. METHODS:A multicenter double-blind randomized controlled trial was conducted. There were 220 patients randomized to either a standard or a short stem. Patient-reported outcome measures were completed preoperatively and at 1 (n = 193), two (n = 180), five (n = 116), and seven (n = 148) years postoperatively. Radiographic assessment was undertaken postoperatively, at 1 year (n = 210) and at a median follow-up of six years (n = 188). RESULTS:There were no significant (P ≥ 0.428) differences in Oxford hip score between the groups at any time point, with a marginal mean difference of 0.5 (95% confidence interval [CI] -2.1 to 4.4, P = 0.681) over the postoperative period. Similarly, there were no significant (P ≥ 0.083) differences in forgotten joint score, EuroQol -5 dimension, EuroQol -visual analog scale, and short form-12 between the groups at any postoperative assessment or in the mean difference over the follow-up period (P ≥ 0.550). There were no differences in satisfaction at 1, two, five, or seven years postoperatively (P ≥ 0.438). A greater subsidence (mean 0.7 mm, 95% CI 0.1 to 1.3, P = 0.035) was observed for the standard stem. There were three short-stem patients who demonstrated medial cortical femoral hypertrophy. Survivorship was comparable between the standard stem (98.2%, 95% CI 95.7 to 100) and short stem (98.1%, 95% CI 95.6 to 100; P = 0.994). CONCLUSION:The short polished taper slip stem had equivalent hip-specific outcomes, health-related quality of life, patient satisfaction, and survival when compared to the standard stem at seven years following total hip arthroplasty but was associated with reduced subsidence and proximal femoral hypertrophy.

BACKGROUND:Bone loss presents a technical challenge in total knee arthroplasty (TKA). Despite increasing utilization, there is limited evidence concerning the functional outcomes and implant survivorship associated with the use of medial tibial block augments. METHODS:A retrospective single-center study was conducted to compare patient-reported outcome measures (PROMs) and survivorship of TKA using augments in both primary (pTKA) and revision (revTKA) procedures against a cohort of pTKA without augments. A total of 89 patients underwent aseptic revTKA, and 34 underwent pTKA using an augment. Patients who underwent TKA using five or 10 mm augments between 2011 and 2020 were identified from an institutional implant registry and linked to a prospectively collected PROMs database. The PROMs included the Oxford Knee Score (OKS) and EQ-5D-3L questionnaire, assessed preoperatively and at 12 months postoperatively. RESULTS:At a mean follow-up of eight years, there were no revisions and one periprosthetic fracture, which resulted in a reoperation survival of 98.8% (95% confidence interval 96.5 to 100%). Improvements in PROMs were not significantly (P ≥ 0.212) or clinically meaningfully different between revTKA or pTKA with augments and pTKA without augments after adjustment for confounders. However, pTKA with an augment had significantly worse preoperative OKS (mean difference 4.6, P = 0.001), but was not different postoperatively (P = 0.078) because of greater improvement. Where revTKA was performed for medial unicompartmental knee arthroplasty, clinically meaningful worse improvements in the OKS (-3.1, P = 0.064), EQ-5D (-0.078, P = 0.112), and EQ-VAS (-5.0, P = 0.162) compared to pTKA without an augment were found, but without statistical significance. CONCLUSIONS:Tibial augment use in primary and aseptic revision TKA was associated with excellent implant survival and comparable PROMs to standard pTKA. These findings support the use of augments as a reliable reconstructive strategy for medial tibial bone loss.

AIMS:To assess the survival, complications, patient-reported outcomes and radiographic integration of the uncemented Trident® II tritanium acetabular component when used for aseptic revision total hip arthroplasty (rTHA). METHODS:A single-centre prospective cohort study of 101 aseptic rTHA in 100 patients was undertaken. Inclusion criteria were patients suitable for the use of the uncemented acetabular component, aged 18-95 years, willing and able to comply with the study protocol, and provide informed consent. Those with inadequate bone stock to support fixation of the prosthesis were excluded. Functional assessments included the Oxford hip score, Forgotten joint score, EQ-5D, EQ-VAS, pain VAS and satisfaction. Radiographic assessment included acetabular lucent lines and lysis according to Delee and Charnley zones and loosening. RESULTS:The mean age was 72.5 (standard deviation 11.6) and consisted of 54 females and 46 males. Mean follow-up was 3.1 (range 2 to 4.9) years during which 10 patients died. Indication for rTHA included: loosening of the acetabulum (n = 82), instability (n = 11), broken femoral stem (n = 3), metal on metal with pain and pseudotumour (n = 2), pain (n = 2) and loosening of femoral component (n = 1). There were two re-revisions for deep infection. This resulted in a 1-year all-cause survival of 99.0% (95% CI 97.1 to 100) and 4-year survival of 96.2% (95% CI 90.5 to 100). There was only one case with lucent lines in all three zones and had not osseointegrated, but the component remained stable at 3-years follow-up. All PROMs demonstrated a clinically meaningful improvement, which was significant (p < 0.001) at both 1- and 2-years. Patient satisfaction with their revision THA was 85.6% and 85.3% at 1- and 2-years. CONCLUSION:The uncemented highly porous 3-dimensional printed Trident® II tritanium acetabular component was associated with excellent survivorship, clinically meaningful improvements in PROMs, and high patient satisfaction in the short term when used for aseptic rTHA.

Aims: The aims of this study were to evaluate the incidence of reoperation (all-cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following total hip arthroplasty (THA) incorporating a cemented collarless polished taper slip (PTS) femoral component. Methods: This study included a consecutive series of THAs performed with an Exeter PTS between January 2011 and December 2013 at a single centre. Patient demographics, diabetes, American Society of Anesthesiologists (ASA) grade, and admission type were collected. Co-primary outcomes were reoperation and death. Results: The cohort consisted of 2,177 patients (mean age 66.9 years (SD 11.8)). The median follow-up was 11 years (IQR 10.5 to 11.8). The indications for reoperation were PFF (n = 35, 1.6%), dislocation (n = 15, 0.7%), aseptic cup loosening (n = 13, 0.6%), and infection (n = 10, 0.5%). No femoral components were revised for aseptic loosening. The ten-year aseptic survival for the femoral components was 96.5% (95% CI 95.3 to 97.7). ASA grade III to IV was associated with a higher risk of both all-cause reoperation (hazard ratio (HR) 1.86, p = 0.017) and aseptic reoperation (HR 1.82, p = 0.031). The ten-year PFF-related femoral component survival was 97.7% (95% CI 96.9 to 98.5) and older age (HR 1.05, p = 0.004) and diabetes (HR 2.32, p = 0.048) were independently associated with the occurrence of PFF. Overall patient survival at ten years was 66.1% (95% CI 63.4 to 68.8), with male sex (HR 1.23, p = 0.010), older age (HR 1.08, p < 0.001), ASA grade II to IV (HR 2.22, 4.14 and 6.74, respectively, p ≤ 0.001), and THA undertaken for trauma (HR 1.79, p < 0.001) being independently associated with an increased mortality risk. Conclusion: The cemented PTS demonstrated excellent long-term survival in THA, but PFF was the most common reason for reoperation. Older age and diabetes were independently associated with PFFs. Higher ASA grade was linked to increased risk of both all-cause and aseptic reoperations. Mortality at ten years was influenced by male sex, older age, higher ASA grade, and trauma-related THA. Cite this article: Bone Jt Open 2025;6(5):544–552.

Background/Objectives: As the rate of revision total hip arthroplasty (THA) has risen, there has been a drive to improve the technology in the manufacturing of the implants used. One recent advance has been 3-D printing of trabecular titanium implants to improve implant stability and osteointegration. The aim of this study was to review the clinical and radiological outcomes of these acetabular implants in revision THA. Methods: A manual search of the databases of the US National Library of medicine (PubMed/MEDLINE), Embase, and the Cochrane library was performed. The following keywords of “revision total hip arthroplasty” AND “acetabulum” AND “titanium” AND “porous” were utilised. Results: In total, 106 abstracts were identified during manual search of databases. In total, 11 studies reporting 4 different implants, with a total of 597 operated joints in 585 patients were included in this review. There were 349 (59.7%) female patients, and the mean age per study ranged from 56.0 to 78.4 years. The all-cause survival rate was 95.52% (95% CI: 92.37–97.96) at a mean follow up of 3.8 years (95% CI: 2.6–5.1). The 40 cases that required re-operation included 17 (2.8%) for infection, 14 (2.3%) instability, 2 (0.3%) for shell migration and 5 (0.8%) for aseptic loosening. The most commonly used patient reported outcome measure was the Harris Hip Score with the mean post-operative score of 86.7 (95% CI: 84.3–89.1). Conclusions: Trabecular titanium acetabular implants, when used in revision THA, resulted in excellent short- to mid-term outcomes with improved hip specific outcomes and a survivorship of 95.52% over the reported follow-up period. Future prospective studies evaluating long term outcomes are needed to make comparisons between more established solutions used in revision THA.

To assess the survival, complications, patient-reported outcomes and radiographic integration of the uncemented Trident® II tritanium acetabular component when used for aseptic revision total hip arthroplasty (rTHA). A single-centre prospective cohort study of 101 aseptic rTHA in 100 patients was undertaken. Inclusion criteria were patients suitable for the use of the uncemented acetabular component, aged 18–95 years, willing and able to comply with the study protocol, and provide informed consent. Those with inadequate bone stock to support fixation of the prosthesis were excluded. Functional assessments included the Oxford hip score, Forgotten joint score, EQ-5D, EQ-VAS, pain VAS and satisfaction. Radiographic assessment included acetabular lucent lines and lysis according to Delee and Charnley zones and loosening. The mean age was 72.5 (standard deviation 11.6) and consisted of 54 females and 46 males. Mean follow-up was 3.1 (range 2 to 4.9) years during which 10 patients died. Indication for rTHA included: loosening of the acetabulum (n = 82), instability (n = 11), broken femoral stem (n = 3), metal on metal with pain and pseudotumour (n = 2), pain (n = 2) and loosening of femoral component (n = 1). There were two re-revisions for deep infection. This resulted in a 1-year all-cause survival of 99.0

Aims: Unicompartmental knee arthroplasty (UKA) is associated with an accelerated recovery, improved functional outcomes, and retention of anatomical knee kinematics when compared to manual total knee arthroplasty (mTKA). UKA is not universally employed by all surgeons as there is a higher revision risk when compared to mTKA. Robotic arm-assisted (ra) UKA enables the surgeon to position the prosthesis more accurately when compared to manual UKA, and is associated with improved functional outcomes and a lower early revision risk. Non-randomized data suggests that, when compared to mTKA, raUKA has a clinically meaningful greater functional benefit. This protocol describes a randomized controlled trial that aims to evaluate the clinical and cost-effectiveness of raUKA compared to mTKA for individuals with isolated medial compartment osteoarthritis (OA). Methods: The total versus robotic-assisted unicompartmental knee arthroplasty (TRAKER) trial is a patient- and assessor-blinded, pragmatic parallel two-arm randomized superiority trial of adults undergoing elective primary knee arthroplasty for primary medial compartment OA at a single NHS hospital (ClinicalTrials.gov NCT05290818). Participants will be randomly allocated on a 1:2 basis to either raUKA or mTKA, respectively. The primary analysis will compare the Oxford Knee Score (OKS) six months after surgery. Secondary outcomes measured at three, six, and 12 months include the OKS, Forgotten Joint Score, patient expectations, EuroQol five-dimension questionnaire (EQ-5D), and EQ-visual analogue scale (EQ-VAS), patient satisfaction, range of motion, postoperative complications, need for further surgery, resource use, and financial costs. Cost-effectiveness will be measured over a ten-year time span. A total of 159 patients will be randomized (n = 53 raUKA vs n = 106 mTKA) to obtain 80% power to detect a five-point difference in OKS between the groups six months after surgery. Conclusion: The trial findings will provide evidence about the clinical and cost-effectiveness of raUKA compared to mTKA in patients with isolated medial compartment OA. This will inform future National Institute for Health and Care Excellence guidelines on primary knee arthroplasty in the UK. Cite this article: Bone Jt Open 2025;6(2):164–177.

Bone marrow adipose tissue (BMAT) comprises >10% of total adipose mass in healthy humans. It increases in diverse conditions, including ageing, obesity, osteoporosis, glucocorticoid therapy, and notably, during caloric restriction (CR). BMAT potentially influences skeletal, metabolic, and immune functions, but the mechanisms of BMAT expansion remain poorly understood. Our hypothesis is that, during CR, excessive glucocorticoid activity drives BMAT expansion. The enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) amplifies glucocorticoid activity by catalysing intracellular regeneration of active glucocorticoids from inert 11-keto forms. Mice lacking 11β-HSD1 resist metabolic dysregulation and bone loss during exogenous glucocorticoid excess; thus, we hypothesised that 11β-HSD1 knockout mice would also resist excessive glucocorticoid action during CR, thereby restrining BMAT expansion and bone loss. To test this, we first confirmed that 11β-HSD1 is expressed in mouse and human bone marrow. We then investigated the effects of CR in male and female control and 11β-HSD1 knockout mice from 9 to 15 weeks of age. CR increased Hsd11b1 mRNA in adipose tissue and bone marrow. Deletion of Hsd11b1 did not alter bone or BMAT characteristics in mice fed a control diet and had little effect on tibial bone microarchitecture during CR. Notably, Hsd11b1 deletion attenuated the CR-induced increases in BMAT and prevented increases in bone marrow corticosterone in males but not females. This was not associated with suppression of glucocorticoid target genes in bone marrow. Instead, knockout males had increased progesterone in plasma and bone marrow. Together, our findings show that knockout of 11β-HSD1 prevents CR-induced BMAT expansion in a sex-specific manner and highlights progesterone as a potential new regulator of bone marrow adiposity.

Background:The health benefits of physical activity are well recognised. This study assessed whether golfers were more physically active after lower limb arthroplasty when compared to those that did not play golf (primary outcome). In addition pre and postoperative changes in health-associated quality of life (HAQoL) and joint specific outcomes between golfers and none golfers were assessed (secondary outcomes). Methods:There were 304 patients [THA (n = 155) or TKA (n = 149)] prospectively registered during a 4-month period undergoing lower limb arthroplasty. The mean age was 70.0 (range 37-92, standard deviation 10.2) years and included 188 (61%) females and 120 (39%) males. They completed pre and postoperative questionnaires assessing recreational activity, physical activity, HAQoL (EuroQol [EQ]), joint specific health (Oxford scores), and satisfaction. Results:Golfers (n = 33, 10.9%) were more likely to achieve longer than 3 hours of moderate activity during a week (48.5% vs 38.0%, odds ratio (OR) 3.4, p = 0.045) and achieved their recommended activity level (96.8% vs 77.7%, OR 8.6, p = 0.015) compared to non-golfers following arthroplasty. Postoperative EQ5D (p = 0.034) and EQVAS (p = 0.019) were significantly greater in golfers. The joint specific Oxford hip score was greater in golfers compared to non-golfers (mean difference 5.6, p = 0.022), however no difference was observed in the Oxford knee score following TKA (p = 0.495). Conclusion:Golfers were more likely to achieve their weekly recommended level of physical activity and had a greater HAQoL relative to those that did not play golf following lower limb arthroplasty. More specifically after THA golfers also had a greater postoperative joint specific outcome, but no such advantage was observed in those following TKA. Evidence Level:Level II, diagnostic study.

Aims The primary aim of this study is to assess the survival of the uncemented hydroxyapatite (HA) coated Trident II acetabular component as part of a hybrid total hip arthroplasty (THA) using a cemented Exeter stem. The secondary aims are to assess the complications, joint-specific function, health-related quality of life, and radiological signs of loosening of the acetabular component. Methods A single-centre, prospective cohort study of 125 implants will be undertaken. Patients undergoing hybrid THA at the study centre will be recruited. Inclusion criteria are patients suitable for the use of the uncemented acetabular component, aged 18 to 75 years, willing and able to comply with the study protocol, and provide informed consent. Exclusion criteria includes patients not meeting study inclusion criteria, inadequate bone stock to support fixation of the prosthesis, a BMI > 40 kg/m 2 , or THA performed for pain relief in those with severely restricted mobility. Results Implant survival, complications, functional outcomes and radiological assessment up to ten years following index THA (one, two, five, seven, and ten years) will be performed. Functional assessment will include the Oxford Hip Score, Forgotten Joint Score, 12-Item Short Form Health Survey, EuroQol five-dimension health questionnaire, and pain and patient satisfaction. Radiological assessment with assess for acetabula lucent lines, lysis, and loosening according to DeLee and Charnley zones. Conclusion This study is part of a stepwise introduction of a new device to orthopaedic practice, and careful monitoring of implants should be carried out as part of the Beyond Compliance principles. The results of this study will provide functional, radiological, and survival data to either support the ongoing use of the HA acetabulum or highlight potential limitations of this new implant before wide adoption. Cite this article: Bone Jt Open 2023;4(10):782–790.

Background Robotic-assisted unicompartmental knee arthroplasty (UKA) improves implant accuracy, however whether this translates to patient function is less clear. Various outcomes have been reported but muscle recovery has not been previously investigated. Objective To explore sequential change in lower limb muscle strength following robotic-assisted UKA with isokinetic dynamometry. Results 12 participants undergoing rUKA for medial compartment osteoarthritis were assessed pre-operatively, and at 6- and 12-weeks post-operatively. Maximal muscle strength changed over time in both quadriceps (p = 0.006) and hamstrings (p = 0.018) muscle groups. Quadriceps strength reduced from 88.52(39.86)Nm to 74.47(27.58)Nm by 6-weeks (p = 0.026), and then recovered to 90.41(38.76)Nm by 12-weeks (p = 0.018). Hamstring strength reduced from 62.45(23.18)Nm to 54.12(20.49)Nm by 6-weeks (p = 0.016), and then recovered to 55.07(17.99)Nm by 12-weeks (p = 0.028). By 12-weeks quadriceps strength was 70% and hamstrings 83% of the values achieved in the un-operated limb. Substantial improvement was seen in all other measures over time, with sequential positive change in Timed-up-and-go test (p = 0.015), 10 m walk test (p = 0.021), range of knee flexion (p = 0.016) and PROMs (p < 0.025).

In this RCT the primary aim was to assess whether a short (125mm) Exeter V40 stem offered an equivalent hip specific function compared to the standard (150mm) stem when used for cemented total hip arthroplasty (THA). Secondary aims were to evaluate health-related quality of life (HRQoL), patient satisfaction, stem height and alignment, radiographic loosening, and complications between the two stems. A prospective multicentre double-blind randomised control trial was conducted. During a 15-month period, 220 patients undergoing THA were randomised to either a standard (n=110) or short (n=110) stem Exeter. There were no significant (p≥0.065) differences in preoperative variables between the groups. Functional outcomes and radiographic assessment were undertaken at 1- and 2-years. There were no differences (p=0.428) in hip specific function according to the Oxford hip score at 1-year (primary endpoint) or at 2-years (p=0.767) between the groups. The short stem group had greater varus angulation (0.9 degrees, p=0.003) when compared to the standard group and were more likely (odds ratio 2.42, p=0.002) to have varus stem alignment beyond one standard deviation from the mean. There were no significant (p≥0.083) differences in the Forgotten joint scores, EuroQol-5-Dimension, EuroQol-VAS, Short form 12, patient satisfaction, complications, stem height or radiolucent zones at 1 or 2-years between the groups. The Exeter short stem offers equivalent hip specific function, HRQoL, patient satisfaction, and limb length when compared to the standard stem at 2-years post-operation. However, the short stem was associated with a greater rate of varus malalignment which may influence future implant survival.

Aims: This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up. Methods: From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed. Results: At 15 years, 28 patients were lost to follow-up (6.1%) and 221 patients (51.9%) had died, with the mean age of the remaining cohort reducing by four years. PROMs response rates among surviving patients were: one-year 63%; five-year 72%; ten-year 94%; and 15-year 59%. OKS and SF-12 scores changed significantly over 15 years (p < 0.001). The mean improvement in OKS was 18.8 (95% confidence (CI) 16.7 to 19.0) at one year. OKS peaked at five years (median 43 years) declining thereafter (p < 0.001), though at 15 years it remained 17.5 better than preoperatively. Age and sex did not alter this trajectory. A quarter of patients experienced a clinically significant decline (≥ 7) in OKS from five to ten years and from ten to 15 years. The SF-12 physical component score displayed a similar trajectory, peaking at one year (p < 0.001). Patient satisfaction was 88% at one, five, and ten years, and 94% at 15 years. In all, 15-year Kaplan-Meier survival was 97.6% (95% CI 96.0% to 99.2%) for any revision, and 98.9% (95% CI 97.9% to 99.9%) for aseptic revision. Conclusion: Improvements in PROMs were significant and maintained following single radius TKA, with OKS peaking at five years, and generic physical health peaking at one year. Patient satisfaction remained high at 15 years, at which point 2.4% had been revised. Cite this article: Bone Jt Open 2023;4(10):808–816.

Aims: The primary aim of this study is to assess the survival of the uncemented hydroxyapatite (HA) coated Trident II acetabular component as part of a hybrid total hip arthroplasty (THA) using a cemented Exeter stem. The secondary aims are to assess the complications, joint-specific function, health-related quality of life, and radiological signs of loosening of the acetabular component. Methods: A single-centre, prospective cohort study of 125 implants will be undertaken. Patients undergoing hybrid THA at the study centre will be recruited. Inclusion criteria are patients suitable for the use of the uncemented acetabular component, aged 18 to 75 years, willing and able to comply with the study protocol, and provide informed consent. Exclusion criteria includes patients not meeting study inclusion criteria, inadequate bone stock to support fixation of the prosthesis, a BMI > 40 kg/m2, or THA performed for pain relief in those with severely restricted mobility. Results: Implant survival, complications, functional outcomes and radiological assessment up to ten years following index THA (one, two, five, seven, and ten years) will be performed. Functional assessment will include the Oxford Hip Score, Forgotten Joint Score, 12-Item Short Form Health Survey, EuroQol five-dimension health questionnaire, and pain and patient satisfaction. Radiological assessment with assess for acetabula lucent lines, lysis, and loosening according to DeLee and Charnley zones. Conclusion: This study is part of a stepwise introduction of a new device to orthopaedic practice, and careful monitoring of implants should be carried out as part of the Beyond Compliance principles. The results of this study will provide functional, radiological, and survival data to either support the ongoing use of the HA acetabulum or highlight potential limitations of this new implant before wide adoption. Cite this article: Bone Jt Open 2023;4(10):782–790.

Patients with Paget's Disease of Bone (PDB) more frequently require total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, controversy remains regarding their outcome. This project aims to evaluate the current literature regarding outcomes following THA and TKA in PDB patients. MEDLINE, EMBASE and Cochrane databases were searched on February 15th, 2022. Inclusion criteria comprised studies evaluating outcomes following THA/TKA in PDB patients. Quality of included studies was assessed using the Newcastle-Ottawa Scale. 19 articles (published between 1976–2022) were included, comprising 58,695 patients (48,766 controls and 10,018 PDB patients), from 209 potentially relevant titles. No study was of high quality. PDB patient pooled mortality was 32.5% at mean 7.8(0.1-20) years following THA and 31.0% at mean 8.5(2-20) years following TKA. PDB patient revision rate was 4.4% at mean 7.2(0-20) years following THA and 2.2% at mean 7.4(2-20) years following TKA. Renal complications, respiratory complications, heterotopic ossification, and surgical site infection were the most common medical and surgical complications. The largest systematic review, to date, evaluating outcomes following THA and TKA in PDB patients. All functional outcome scores improved. PDB patient revision rate was comparable to UK National Joint Registry. However, there is a significant need for prospective matched case-control studies to robustly compare outcomes in PDB patients with unaffected counterparts.

Aims Golf is a popular pursuit among those requiring total hip arthroplasty (THA). The aim of this study was to determine if participating in golf is associated with greater functional outcomes, satisfaction, or improvement in quality of life (QoL) compared to non-golfers. Methods All patients undergoing primary THA over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on outcomes. Results The study cohort consisted of a total of 308 patients undergoing THA, of whom 44 were golfers (14%). This included 120 male patients (39%) and 188 female patients (61%), with an overall mean age of 67.8 years (SD 11.6). Golfers had a greater mean postoperative Oxford Hip Score (OHS) (3.7 (95% confidence interval (CI) 1.9 to 5.5); p < 0.001) and EuroQol visual analogue scale (5.5 (95% CI 0.1 to 11.9); p = 0.039). However, there were no differences in EuroQoL five-dimension score (p = 0.124), pain visual analogue scale (p = 0.505), or Forgotten Joint Score (p = 0.215). When adjusting for confounders, golfers had a greater improvement in their Oxford Hip Score (2.7 (95% CI 0.2 to 5.3); p < 0.001) compared to non-golfers. Of the 44 patients who reported being golfers at the time of their surgery, 32 (72.7%) returned to golf and 84.4% of those were satisfied with their involvement in golf following surgery. Those who returned to golf were more likely to be male (p = 0.039) and had higher (better) preoperative health-related QoL (p = 0.040) and hip-related functional scores (p = 0.026). Conclusion Golfers had a greater improvement in their hip-specific function compared to non-golfers after THA. However, less than three-quarters of patients return to golf, with male patients and those who had greater preoperative QoL or hip-related function being more likely to return to play. Cite this article: Bone Jt Open 2022;3(2):145–151.

Purpose:The aim was to assess the cost-effectiveness of robotic arm-assisted total hip arthroplasty (rTHA) compared with manual total hip arthroplasty (mTHA) and to assess the influence of annual volume on the relative cost-effectiveness of rTHA.Methods:A database of both rTHA (n = 48 performed in a private centre) and mTHA (n = 512 performed in the National Health Service) was used. Patient demographics, preoperative Oxford hip score, forgotten joint score, EuroQol 5-dimensional 3-level (EQ-5D), and postoperative EQ-5D were recorded. Two models for incremental cost-effectiveness ratios using cost per quality-adjusted life year (QALY) for rTHA were calculated based on a unit performing 100 rTHAs per year: 10-year follow-up and a lifetime time horizon (remaining life expectancy of a 69-year-old patient).Results:When adjusting for confounding factors, rTHA was independently associated with a 0.091 (p=0.029) greater improvement in the EQ-5D compared to mTHA. This resulted in a 10-year time horizon cost per QALY for rTHA of £1,910 relative to mTHA, which increased to £2,349 per QALY when discounted (5%/year). When using the 10-year time horizon cost per QALY was approximately £3,000 for a centre undertaking 50 rTHAs per year and decreased to £1,000 for centre undertaking 200 rTHAs per year. Using a lifetime horizon, the incremental unadjusted cost per QALY gained was £980 and £1432 when discounted (5%/year) for rTHA compared with mTHA.Conclusions:Despite the increased cost associated with rTHA, it was a cost-effective intervention relative to mTHA due to the associated greater health-related quality of health gain, according to the EQ-5D outcome measure.

Purpose The primary aim of this study was to determine the cost-effectiveness of total hip arthroplasty (THA) in patients aged 25 years and under by calculating the cost per quality-adjusted life year (QALY) gained at 10 years post-operatively, and over the course of a lifetime. Secondary aims were to describe the change in health-related quality of life (HRQoL), Oxford hip score (OHS), and satisfaction in these patients. Methods From 2000 to 2016, 33 patients undergoing THA aged 25 and under had pre-operative and one-year post-operative EuroQol five-dimensions (EQ-5D) scores and OHS recorded prospectively. Post-operative change in EQ-5D allowed calculation of a health-utility score, which, when combined with life expectancy, gave total QALYs gained. Results The mean age was 20 years (range 13.3-24.9), with 23 females (72.7%). Mean number of QALYs gained was 21.1 (95% CI 14.1-28.2). Total lifetime cost per patient was £14641, giving a mean cost per QALY of £4183 at 10 years post-operatively, and £694 over the total remaining lifetime. Discounting total QALYs gained at a rate of 3.5% and 5% per remaining year of life expectancy increased the mean cost per QALY to £1652 and £2187, respectively. Mean pre- and post-operative EQ-5D index were 0.27 (SD 0.27) and 0.63 (SD 0.29), respectively (p=0.0001). Mean pre-operative and post-operative OHS was 37.5 (SD 7.9) and 19.7 (SD 6.94), respectively (p<0.00001). Conclusion THA remains a cost-effective intervention for patients aged 25 years and under. It is also associated with significant improvement in HRQoL, OHS, and high levels of patient satisfaction in this unique patient group.