Patient Activity after Total Hip Arthroplasty Declines with Advancing Age

Kinkel, Stefan; Wollmerstedt, N.; Kleinhans, J.A.; Hendrich, Christian; Heisel, Christian

doi:10.1007/s11999-009-0756-3

Cited by 55 publications

(36 citation statements)

References 24 publications

(94 reference statements)

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“…Notably, patients receiving metal-on-metal bearing surfaces in the present study were younger on average compared with conventional THA. Activity after THA is related to patient age with patients between the ages of 50 and 59 the most active [13]. Anticipated activity level after surgery is part of our preoperative selection criteria for metal-on-metal bearings, creating potential bias.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Bartelt

Yuan

Trousdale

et al. 2010

Clinical Orthopaedics &Amp; Related Research

112

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Background Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon. Questions/purposes We compared the rate of groin pain after THA or hip resurfacing using metal-on-metal to those of other bearing surfaces. Methods We identified 347 (334 patients) primary total hip (n = 301) or resurfacing (n = 46) arthroplasties. Complete preoperative, operative, and postoperative data were available for 282 hips. We retrospectively reviewed the charts for the presence or absence of groin pain at a minimum of 1 year after surgery with a specific focus on etiologic factors. The minimum followup was 12 months (mean, 14 months; range 12 to 24 months). Results The rate of groin pain was 7% (15 of 217 patients) after THA with conventional bearing surfaces, 15% (4 of 26 patients) with metal-on-metal THA and 18% (7 of 39 patients) with total hip resurfacing. Younger patients were more likely to report groin pain postoperatively and more likely to have metal-on-metal bearing surfaces.Conclusions Our data at short-term followup suggest increased rates of groin pain after metal-on-metal THA or resurfacing arthroplasty versus THA using polyethylene or ceramic bearing surfaces. The reasons are not clear but they appear to be associated with younger age. Potential factors include impingement, activity level and possibly higher expectations for patients receiving metal-on-metal bearing surfaces that may make those patients more likely to report postoperative pain.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Bartelt

Yuan

Trousdale

et al. 2010

Clinical Orthopaedics &Amp; Related Research

112

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“…One factor that challenges the long-term success of THA is polyethylene wear and the effects of polyethylene particulate debris leading to resorption of bone, osteolysis, and implant loosening. The effect of polyethylene wear has been more severe in younger patients presumably because of their high level of activity compared with an older population of patients [5,7,8,10,26,32,38,39]. It is also likely that this population of young patients is still employed and has expectations for a functional hip throughout their working years as well as their lifetime.…”

mentioning

confidence: 99%

Low Wear Rates Seen in THAs With Highly Crosslinked Polyethylene at 9 to 14 Years in Patients Younger Than Age 50 Years

Garvin

White

Dusad

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients 50 years or younger are at high risk for wear-related complications of their total hip arthroplasty (THA) because of their generally higher levels of activity. Highly crosslinked polyethylene (HXLPE) is believed to be more durable for this population than conventional polyethylene because of its improved wear; however, limited information is available on the wear of HXLPE in this population, particularly the wear of HXLPE when it articulates with alternative bearings like Oxinium (Smith & Nephew, Memphis, TN, USA).Questions/purposes The purpose of this study was to evaluate two questions relative to this population of patients undergoing THA. First, what was the linear and volumetric wear rate of HXLPE in patients 50 years or younger at a minimum followup of 9 years and was osteolysis observed in any of these hips? Given the potential for damage to the Oxinium femoral head surface, was the wear of HXLPE in the patients with this material similar to the other bearings or was there accelerated or runaway wear that was visible in any of the patients? Methods From November 1999 to April 2005, 105 THAs were performed in 95 patients 50 years of age or younger (mean, 42 years; range, 20-50 years). The mean body mass index was 30 kg/m 2 (range, 17-51 kg/m 2 ).The mean followup was 12 years (range, 9-14 years). Two patients died, five patients (one bilateral) were lost to followup, and one hip was revised elsewhere for pain. The patients' information was not included in the study, which left 87 patients with 96 hips for analysis. Highly crosslinked polyethylene was the acetabular bearing for all of the hips. We analyzed the linear and volumetric wear of all of the hips using the Martell method. Eighty hips had the same diameter head (28 mm) allowing us to more accurately compare the different bearing materials. The type of femoral head used was related to our sequential use of materials beginning with cobalt chrome (14), ceramic (23) followed by Oxinium (43) in the hips with 28-mm heads. Although cobalt-chrome was used early in this study, our previous experience with ceramic on polyethylene encouraged us to use it as an alternative bearing. The Oxinium was used consecutively for the remaining hips. Results The mean wear of the HXLPE after 1 year of bedding-in (true linear wear)was 0.022 mm/year (95% confidence interval [CI], 0.015-0.030 mm/year). The mean volumetric wear of HXLPE after 1 year of bedding-in (true volumetric wear) was 9 mm 3 /year (95% CI, 4-14 mm 3

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“…Interestingly, we found an increase in the weight in our patients between the time of index surgery and the latest follow-up pointing indirectly to the decrease in physical activity [42]. This may be interpreted such that some of the patients decrease their overall physical activity after THA surgery [46].…”

Section: Discussionmentioning

confidence: 52%

“…Both of these can be related to a lower level of physical activities [41,42]. The physical activity of the patient strongly affects the implant survival in terms of aseptic loosening and periprosthetic osteolysis in THA (thus the phrase "wear is a result of load and use") [43].…”

Section: Discussionmentioning

confidence: 99%

Long-term survival of the uncemented Balgrist total hip replacement cup

Gallo

Lošťák

Langová

2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the longterm clinical and radiographic outcomes of the Balgrist total hip replacement cup. Methods We report the results of a retrospective review of 195 total hip prostheses with Balgrist cup implanted in 178 patients. There were 59 men and 119 women with a mean age at surgery of 52.3 years (range, 19-72). Cox regression was used to determine the influence of independent variables on the survivorship of the prosthesis. Results There were 117 (66 %) of 178 patients, and 131 (67 %) of 195 hips available for assessment at a mean follow-up of 17.4 years. A total of 21 patients (22 hips) were lost from follow-up (12 %). A total of 25 patients (27 hips) required some type of re-operation during the follow-up period. Eight of 27 re-operations (30 %) were directly caused by the Balgrist cup failure due to fatigue fracture of the metallic shell (n=5; 19 %), polyethylene wear (n=2; 7 %) and aseptic loosening (n=1; 4 %). The mean polyethylene wear rate was 0.068 mm/year (range, 0.008-0.230; SD=0.043). The risk of re-operation for any reason was decreased with dysplastic hip as a primary diagnosis (hazard ratio; HR=0.250; 95 % CI 0.086-0.725) and with greater age at the time of surgery (HR =0.923; 95 % CI 0.880-0.969). The 19-year survivorship with re-operation for any reason was 75.6 % (95 % CI 67.0-84.2). The 19-year survivorship with re-operation for the Balgrist cup failure was 90.5 % (95 % CI 83.4-97.6).Conclusions The Balgrist cup continues to provide excellent clinical and radiological outcomes. This is associated at least in part with a low polyethylene wear rate. The main reason for the Balgrist cup failure is fatigue fracture of the metallic shell.

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Patient Activity after Total Hip Arthroplasty Declines with Advancing Age

Cited by 55 publications

References 24 publications

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Low Wear Rates Seen in THAs With Highly Crosslinked Polyethylene at 9 to 14 Years in Patients Younger Than Age 50 Years

Long-term survival of the uncemented Balgrist total hip replacement cup

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