Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. Quality of life and functional outcome after primary total hip replacement. A five-year follow-up. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. The management of intracapsular hip fractures in the 'young elderly' internal fixation or total hip replacement? A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial Comparison of total hip replacement with and without cement in patients younger than 50 years of age: the results at 18 years. Effect of local anaesthetic infiltration on chronic postsurgical pain after total hip and knee replacement: the APEX randomised controlled trials Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use. Patient Relevant Outcomes after total hip replacement. A comparison between different surgical techniques Risk factors for total hip replacement due to primary osteoarthritis: a cohort study in 50,034 persons. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intra-articular sodium hyaluronate (MW 1,500–2,000 kDa) ORTOBRIX study Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip®) and the lateral, transgluteal (Bauer) approach for primary total hip replacement Spine surgery research: on and beyond current strategies. Prevention of deep-vein thrombosis after total hip and knee replacement. Low-molecular-weight heparin in combination with intermittent pneumatic compression. Stanmore compared with Charnley total hip replacement. A prospective study of 413 arthroplasties. Leg length discrepancy, dislocation rate, and offset in total hip replacement using a short modular stem: navigation vs conventional freehand. Single tranexamic acid dose to reduce perioperative morbidity in primary total hip replacement: a randomised clinical trial A systematic review of psychological interventions in total hip and knee arthroplasty Predictive factors of total hip replacement due to primary osteoarthritis: a prospective 2 year study of 505 patients. Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients. Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study) The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. Comparison between patient-controlled analgesia and subcutaneous morphine in elderly patients after total hip replacement. Autologous blood transfusion in hip replacement. No effect on blood loss but less increase of plasminogen activator inhibitor in a randomized series of 80 patients. Reproducible Research Practices and Transparency across the Biomedical Literature Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study Effect of preparatory information prior to elective total hip replacement on psychological coping outcomes. Long-term comparison of Charnley and Stanmore design total hip replacements.
Objectives To assess how costs and quality of life ( measured by EuroQoL-5 Dimensions ( EQ-5D ) ) before and after total hip replacement ( THR ) and total knee replacement ( TKR ) vary with age , gender and preoperative Oxford hip score ( OHS ) and Oxford knee score ( OKS ) . Design Regression analyses using prospect ively collected data from clinical trials , cohort studies and administrative data bases . Setting UK secondary care . Participants Men and women undergoing primary THR or TKR . The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years . The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years . The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year . Outcome measures EQ-5D-3L quality of life before and after surgery , costs of primary arthroplasty , costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement . Results Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile . The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10 . However , postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44 . In contrast , costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS . For example , costs of hospital readmissions within 12 months after primary THR/TKR were £ 740/£888 for patients at the 5th percentile compared with £ 314/£404 at the 95th percentile of the OHS/OKS distribution . Conclusions Our findings suggest that costs and quality of life associated with total joint replacement vary systematic ally with preoperative symptoms measured by OHS/OKS The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery . We have studied 102 patients of mean age 80 years , with an acute displaced fracture of the femoral neck . They were r and omly placed into two groups , treated either by internal fixation ( IF ) with two cannulated screws or total hip replacement ( THR ) . None showed severe cognitive dysfunction , all were able to walk independently , and all lived in their own home . They were review ed at four , 12 and 24 months after surgery . Outcome measurements included hip complications , revision surgery , hip function according to Charnley and the health-related quality of life ( HRQoL ) according to EuroQol ( EQ-5D ) . The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications ( 36 % and 4 % , respectively ; p < 0.001 ) , and the number of revision procedures ( 42 % and 4 % , p < 0.001 ) . Hip function was significantly better in the THR group at all follow-up review s regarding pain ( p < 0.005 ) , movement ( p < 0.05 except at 4 months ) and walking ( p < 0.05 ) . The reduction in HRQoL ( EQ-5D index score ) was also significantly lower in the THR group than in the IF group , comparing the pre-fracture situation with that at all follow-up review s ( p < 0.05 ) . The results of our study strongly suggest that THR provides a better outcome than IF for elderly , relatively healthy , lucid patients with a displaced fracture of the femoral neck We have evaluated the quality of life and functional outcome after  unilateral primary total hip replacement ( THR ) . Between 5 January 1998 and 31 July 2000 , we recruited a consecutive series of 627 patients undergoing this procedure and investigated them prospect ively . Each was assessed before operation and review ed after six months , 18 months , three years and five years . The  Short Form-36 Health Survey ( SF-36 ) and Harris Hip scores  were evaluated at each appointment . All dimensions of the SF-36 except for mental health and general health perception , improved significantly after operation and this was maintained throughout the follow-up . The greatest improvement was seen at the six-month assessment . On average , women reported lower SF-36 scores pre-operatively , but the gender difference did not continue post-operatively . The Harris Hip scores improved significantly after operation , reaching a plateau after 18 months . The improved quality of life was sustained five years after THR A prospect i ve study of displaced femoral neck fractures was conducted with patients r and omized into three groups :  cemented total hip replacement ( THR ) , cemented hemiarthroplasty ( UHR-C ) , and noncemented hemiarthroplasty ( UHR-NC ) .  Eighty-nine patients were treated for displaced ( Garden type 3 or 4 ) fracture with a prosthesis ; 39 patients had THR , 37 had UHR-C , and 13 had UHR-NC .  No difference was found in the level of pain , ambulation , or aids required between the THR group and the UHR-C group , except for active community ambulators , who demonstrated decreased endurance capability when treated with UHR-C. The patients treated with UHR-NC had increased pain and decreased ambulation and required assistive devices . The most significant complication was dislocation , which occurred in 7 patients with THR and 2 with UHR-C. The mortality rate at 2 years was 18 % ; all but two of the deaths were in patients with one of five different medical diseases : clinical ly significant cardiac or pulmonary disease , cancer , alcoholism , or psychosis . The mortality rate was insignificant in patients younger than 70 years of age . Roentgenographic review showed only 2 of 76 cemented stems with progressive cement-bone demarcation , with one patient requiring revision for a loose prosthesis . No evidence of protrusio was seen with the use of the bipolar cap . The uncemented hemiarthroplasties demonstrated lucency between the metal and bone in the proximal femur in 9 of 13 stems . The authors make recommendations regarding hip replacement There is a lack of consensus about how to treat intracapsular hip fractures in the ' young elderly ' ( 50 - 75 years ) . Evidence for older more mobile patients seems to point towards Internal Fixation ( IF ) for undisplaced fractures and Total Hip Replacement ( THR ) for displaced fractures . Radiographs of 263 patients from the Norfolk and Norwich University Hospital , who have suffered an intracapsular hip fracture between 2000 - 2009 were review ed . The complication and mortality rates were noted . A Hip function question naire ( Oxford hip score ( OHS ) ) and Numeric pain score ( NPS ) were sent out to patients , then methods of treatment ( IF and THR ) were compared . In displaced fractures THR compared favourably to IF , OHS ( 16.0 vs. 20.0 p 0.029 ) , NPS ( 2.0 vs. 4.0 p 0.007 ) , complications ( Odds Ratio ( OR ) 2.90 ; p 0.006 ) and death rate ( OR 3.61 ; p 0.007 ) . Although not statistically significant when stratified for age , the youngest age group ( 50 - 60 ) still achieved better function with a THR ( 13.0 vs. 18.0 ; p 0.129 ) . There was little difference in the results for undisplaced fractures . This retrospective cross-sectional study showed IF is associated with a much higher complication rate than THR for patients who sustained a displaced hip fracture . THR also showed a better functional outcome and reduced pain .  IF should be used in undisplaced fractures as there was no difference in functional outcome or complication rate . A large r and omised controlled trial is needed to confirm these results The ideal bearing surface for young patients undergoing total hip replacement ( THR ) remains controversial . We report the five-year results of a r and omised controlled trial comparing the clinical and radiological outcomes of 102 THRs in 91 patients who were < 65 years of age . These patients were r and omised to receive a cobalt-chrome on ultra-high-molecular-weight polyethylene , cobalt-chrome on highly cross-linked polyethylene , or a ceramic-on-ceramic bearing . In all , 97 hip replacements in 87 patients were available for review at five years . Two hips had been revised , one for infection and one for peri-prosthetic fracture . At the final follow-up there were no significant differences between the groups for the mean Western Ontario and McMaster Universities osteoarthritis index ( pain , p = 0.543 ; function , p = 0.10 ; stiffness , p = 0.99 ) , Short Form-12 ( physical component , p = 0.878 ; mental component , p = 0.818 ) or Harris hip scores ( p = 0.22 ) . Radiological outcomes revealed no significant wear in the ceramic group . Comparison of st and ard and highly cross-linked polyethylene , however , revealed an almost threefold difference in the mean annual linear wear rates ( 0.151 mm/year versus 0.059 mm/year , respectively ) ( p < 0.001 ) Background Exercise treatment is recommended for all patients with hip osteoarthritis ( OA ) , but its effect on the long-term need for total hip replacement ( THR ) is unknown . Methods We conducted a long-term follow-up of a r and omised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the 6-year cumulative survival of the native hip to THR in 109 patients with symptomatic and radiographic hip OA . Results regarding the primary outcome measure of the trial , self-reported pain at 16 months follow-up , have been reported previously . Results There were no group differences at baseline . The response rate at follow-up was 94 % . 22 patients in the group receiving both exercise therapy and patient education and 31 patients in the group receiving patient education only underwent THR during the follow-up period , giving a 6-year cumulative survival of the native hip of 41 % and 25 % , respectively ( p=0.034 ) . The HR for survival of the native hip was 0.56 ( CI 0.32 to 0.96 ) for the exercise therapy group compared with the control group . Median time to THR was 5.4 and 3.5 years , respectively . The exercise therapy group had better self-reported hip function prior to THR or end of study , but no significant differences were found for pain and stiffness . Conclusions Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by 44 % in patients with hip OA . Clinical Trials.gov number NCT00319423 ( original project protocol ) and NCT01338532 ( additional protocol for long-term follow-up ) There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements ( THRs ) in patients younger than 50 years of age . We prospect ively review ed 78 patients ( 109 hips ) with a hybrid THR having a mean age of 43.4 years ( 21 to 50 ) and 79 patients ( 110 hips ) with a cementless THR with a mean age of 46.8 years ( 21 to 49 ) . The patients were evaluated clinical ly using the Harris hip score , the Western Ontario and McMaster Universities ( WOMAC ) osteoarthritis score and the University of California , Los Angeles ( UCLA ) activity score .  Radiographs and CT scans were assessed for loosening and osteolysis . The mean follow-up was for 18.4 years ( 16 to 19 ) in both groups . The mean post-operative Harris hip scores ( 91 points versus 90 points ) , the mean WOMAC scores ( 11 points versus 13 points ) and UCLA activity scores ( 6.9 points versus 7.1 points ) were similar in both groups . The revision rates of the acetabular component ( 13 % versus 16 % ) and the femoral component ( 3 % versus 4 % ) , and the survival of the acetabular component ( 87 % versus 84 % ) and the femoral component ( 97 % versus 96 % ) were similar in both groups . Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outst and ing , wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients Abstract Total hip replacement ( THR ) and total knee replacement ( TKR ) are usually effective at relieving pain ; however , 7 % to 23 % of patients experience chronic postsurgical pain . These trials aim ed to investigate the effect of local anaesthetic wound infiltration on pain severity at 12 months after primary THR or TKR for osteoarthritis . Between November 2009 and February 2012 , 322 patients listed for THR and 316 listed for TKR were recruited into a single-centre double-blind r and omised controlled trial . Participants were r and omly assigned ( 1:1 ) to receive local anaesthetic infiltration and st and ard care or st and ard care alone . Participants and outcomes assessors were masked to group allocation . The primary outcome was pain severity on the WOMAC Pain Scale at 12 months after surgery . Analyses were conducted using intention-to-treat and per- protocol approaches . In the hip trial , patients in the intervention group had significantly less pain at 12 months postoperative than patients in the st and ard care group ( differences in means : 4.74 ; 95 % confidence interval [ CI ] : 0.95 - 8.54 ; P = 0.015 ) , although the difference was not clinical ly significant . Post hoc analysis found that patients in the intervention group were more likely to have none to moderate pain than severe pain at 12 months than those in the st and ard care group ( odds ratio : 10.19 ; 95 % CI : 2.10 - 49.55 ; P = 0.004 ) . In the knee trial , there was no strong evidence that the intervention influenced pain severity at 12 months postoperative ( difference in means : 3.83 ; 95 % CI : −0.83 to 8.49 ; P = 0.107 ) . In conclusion , routine use of infiltration could be beneficial in improving long-term pain relief for some patients after THR OBJECTIVE The association between osteoarthritis ( OA ) and fractures remains unclear . OA patients have increased bone mass , but no corresponding decrease in fracture rate . This study was undertaken to determine the fracture rates in patients with hip OA undergoing a total hip replacement ( THR ) , as compared with disease-free controls , and to assess the association between bisphosphonate use and postsurgery fracture risk . METHODS We conducted a population -based parallel-cohorts study . All patients in the UK General Practice Research Data base undergoing a THR for hip OA between 1986 and 2006 constituted the exposed cohort ( n = 14,133 ) . Five disease-free controls were matched with each patient by age , sex , and practice site . Subjects were followed up for 5 years before and after surgery . Fracture rates and rate ratios ( RRs ) were estimated using Poisson regression . In addition , bisphosphonate use was identified among patients undergoing THR , and the data , stratified by the presence or absence of a previous fracture and by treatment propensity score , were assessed using fitted Cox models to study the effect of bisphosphonate use on the risk of fracture postsurgery . RESULTS Patients undergoing a THR had a similar fracture risk as that in controls in the 5 years before THR , but had higher rates postsurgery , which peaked at years 2.5 - 5 ( adjusted RR 1.24 , 95 % confidence interval [ 95 % CI ] 1.02 - 1.52 ) . Use of bisphosphonates lowered the fracture risk among THR patients who received bisphosphonates as primary prevention ( hazard ratio [ HR ] 0.56 , 95 % CI 0.38 - 0.82 ) and also among THR patients who had experienced a previous osteoporotic fracture ( HR 0.48 , 95 % CI 0.23 - 0.99 ) . CONCLUSION This study identified a 25 % increase in fracture risk at 2.5 - 5 years postsurgery among patients undergoing a THR . Bisphosphonate use reduced the post-THR risk of fracture when administered both as primary prevention and as secondary prevention , by 44 % and 52 % , respectively . This must be further confirmed in r and omized controlled trials Objective To investigate differences in pre- and postoperative patient-relevant outcome between hybrid total hip replacement ( THR ) and cemented THR in patients with primary osteoarthritis ( OA ) . Methods 245 consecutive patients were included in the study . 68 of the patients ( mean age 62 ) were operated on with hybrid THR and 177 ( mean age 74 ) were operated on with cemented THR .  All patients were investigated preoperatively and 0.5 , 1 and 3.6 years postoperatively with two self-administered question naires , SF-36 and WOMAC ( Western Ontario and MacMaster Universities Osteoarthritis Index , LK 3.0 ) . Results Preoperatively , there was a difference in the SF-36 subscales RP ( role physical ) and GH ( general health ) where the patients with the hybrid THR attained better scores . At 3.6-years the patients with the hybrid THR reached better scores in all SF-36 subscales except BP ( bodily pain ) and GH . Further , they had better scores in WOMAC function . However , after adjusting for age , sex , follow-up time and baseline values there were no differences in outcome between the two different surgical techniques . Conclusion This medium term ( 3–5 years ) , controlled , open cohort study , using patient-relevant outcome measures , did not reveal any differences between hybrid THR and cemented THR for OA at 3.6 years after surgery . Since the study had 75–94 % power to detect the clinical ly significant score difference of 10 points , we suggest that any difference in outcome between these two methods is small and may require a large-scale , blinded , r and omized trial to show OBJECTIVE To identify prospect ively the possible risk factors for  total hip replacement ( THR ) due to primary osteoarthritis in a large cohort . METHODS Data from a cardiovascular screening were matched with 9 years of national data on THR . Mean age at the start of followup was 54.9 years , and the 50,034 participants were followed up for an average of 9 years . During followup , 672 persons had a first THR due to primary osteoarthritis . RESULTS We found dose-response associations between body mass index ( BMI ) , body weight , and the level of physical activity at work and THR for primary osteoarthritis . The highest versus the lowest quarter of BMI had a relative risk of 2.0 ( 95 % confidence interval [ 95 % CI ] 1.4 - 2.9 ) among men and 3.0 ( 95 % CI 2.1 - 4.1 ) among women . The highest versus the lowest quarter of body weight had a relative risk of 2.1 ( 95 % CI 1.4 - 3.2 ) among men and 3.4 ( 95 % CI 2.4 - 4.9 ) among women . Intensive versus sedentary physical activity at work had a relative risk of 2.1 ( 95 % CI 1.5 - 3.0 ) among men and 2.1 ( 95 % CI 1.3 - 3.3 ) among women . No association was found between physical activity in leisure and THR for primary osteoarthritis . CONCLUSION Intensive physical activity at work  and a high BMI each contribute significantly to the overall risk of undergoing THR due to primary osteoarthritis . Lowering the exposure to these risk factors may substantially reduce the need for hip replacement Hip osteoarthritis is very common and costly . The European League Against Rheumatology Committee agenda asks for research to investigate treatments able to slow down the progression of hip osteoarthritis ( OA ) , to delay joint replacement , and to determine the comparative effectiveness and cost-effectiveness of non-surgical and surgical treatment modalities as well as criteria relating to the indications for and timing of total hip replacement ( THR ) . After publishing the results of a r and omized controlled trial and a cohort study on the efficacy of Intra-articular sodium hyaluronate ( MW 1,500–2,000 kDa ) on symptomatic hip OA , we performed this retrospective study in patients suffering from hip OA treated with ultrasound-guided intra-articular injections of HyalOne ( Hyalubrix 60 Italian br and name ) involving a group of THR expert orthopedic surgeons to appraise whether or not considered eligible for THR and the frequency and timing of THR . Six orthopedists , not routinely performing hip intra-articular injections , each independently assessed whether 176 patients suffering from hip OA and treated with ultrasound-guided intra-articular injections of sodium hyaluronate ( MW 1,500–2,000 kDa ) were c and i date s for THR according to the clinical data ( age , body mass index , Pain Visual Analog Scale , Lequesne Algofunctional Index , global patient assessment , global physician assessment , nonsteroidal anti-inflammatory drug intake , and hip X-ray ) collected at the first intra-articular sodium hyaluronate injection visit and provided as anonymous electronic data . At 24 months , 159 out of 76 ( 90 % ) patients did not undergo to THR . At 48 months , 82 % ( N = 144 ) of the study population treated with intra-articular hyaluronic acid avoided THR . In the group of 93 patients considered c and i date s for THR ( that is , in which 4 , 5 , or 6 orthopedic surgeons agreed that the patient was a suitable c and i date for THR ) , only 17 had undergone THR , with survival results of 82 % at 24 months . At 48 months , this percentage reduced to 66 % in this group . In the other groups of patients ( in which respectively 3 , 2 , 1 or no surgeons were in agreement that the patient was a c and i date for THR ) arthroplasty is not recorded . Sodium hyaluronate ( MW 1,500–2,000 kDa ) given by ultrasound-guided injection seems to delay THR in the real context of actual overall management of symptomatic hip OA patients . Although further studies are necessary to confirm these data and to identify outcome predictors , hip viscosupplementation should be considered as conservative treatment to perform before proposing patients for THR Background and purpose There is still conflicting evidence about the true benefit of minimally invasive ( MI ) techniques in total hip replacement ( THR ) . The aim of this prospect i ve study was to evaluate the safeness of a MI approach during the learning curve of a single surgeon . Second , clinical and radiographic results among the  MI THR group were compared with the results using a st and ard transgluteal ( Bauer ) approach . Methods 86 primary unilateral total hip arthroplasties ( THAs ) through a MI , anterior ( Micro-hip ® ) approach were performed by a single senior surgeon ( ES ) , representing a consecutive series of patients after beginning with the MI technique . Cases were compared to a matched cohort of patients who were treated with a st and ard transgluteal ( Bauer ) approach .  Operation time , incision length , perioperative blood loss , haemoglobin level and blood transfusions were monitored . Complications were documented and followed up 1 year postoperatively . The Harris Hip Score ( HHS ) , range of motion , use of analgetics , the Trendelenburg sign , sensibility of the lateral femoral cutaneous nerve and the acetabular/femoral component placement as well as potential heterotopic ossifications were analysed in both the groups after 12 months postoperatively . Results 74 MI THR patients and 60 st and ard THR patients were available for the one year follow-up . Operative time was significantly longer in the MI group , reduction in the haemoglobin level during the first 24 h was significant and the length of skin incision was significantly shorter . No significant differences were found for HHS , range of motion , use of analgetics , the Trendelenburg sign , and the acetabular/femoral component placement , heterotopic ossifications and intra- and postoperative complications . Sensibility of the lateral femoral cutaneous nerve was affected in three patients in the MI group . Radiographic evaluation revealed no component migration , implant subsidence or radiolucency signs in both the groups . DicussionConsistent with recent meta- analysis we found reduced blood loss , similar clinical /radiographic outcome and similar complication rates compared to st and ard THA . Our study shows , that MI THR is a safe procedure during the learning curve of an experienced surgeon BACKGROUND CONTEXT Systematic review s of the literature are powerful tools in evidence -based medicine . However , the design and report of systematic review s in spinal surgery contain many aspects amenable to improvement . PURPOSE To discuss the issues especially relevant for systematic review s in spinal surgery . METHODS From our experience of systematic review s and meta-analyses of clinical trials in  spinal surgery  , we infer guidance for the design and execution of systematic literature review s. RESULTS There are many difficulties associated with the design as well as conduct of clinical trials and consequently appraising evidence in spinal surgery . New treatments should be compared with the gold st and ard before other comparisons are investigated . Studies should present data as thoroughly as possible regarding all subgroups and follow-up moments , possibly in supplementary material . To provide the highest level of evidence , systematic review s should be as rigorously design ed as possible . CONCLUSIONS Gathering information on clinical effectiveness in spinal surgery can be improved both at the clinical study level and at the systematic review level . Alternatives to r and omized controlled trials such as comparative studies can be valuable tools on the clinical effectiveness of treatments in spinal surgery . The experience reflected in this article can support the scientific efforts in this field After total hip ( THR ) or knee replacement ( TKR ) , there is still an appreciable risk of developing deep-vein thrombosis despite prophylaxis with low-molecular-weight heparin ( LMWH ) . In a prospect i ve , r and omised study we examined the efficacy of LMWH in combination with intermittent pneumatic compression in patients undergoing primary unilateral THR or TKR . We administered 40 mg of enoxaparin daily to 131 patients combined with either the use of intermittent pneumatic compression or the wearing of graduated compression stockings . Compression ultrasonography showed no evidence of thrombosis after LMWH and intermittent pneumatic compression . In the group with LMWH and compression stockings the prevalence of thrombosis was 28.6 % ( 40 % after TKR , 14 % after THR ) . This difference was significant ( p < 0.0001 ) . In the early post-operative phase after THR and TKR , combined prophylaxis with LMWH and intermittent pneumatic compression is more effective than LMWH used with graduated compression stockings From 1982 to 1987 , we r and omised prospect ively 413 patients requiring primary total hip replacements to receive either a Stanmore or Charnley prosthesis .  They were review ed by an independent observer in an attempt to correlate a number of factors including femoral head size with longevity . There were 213 Stanmore hips and 200 Charnley prostheses .  At five to ten years ( mean 6.5 ) 76 patients had died and 16 arthroplasties had required revision . Seven were radiologically loose in asymptomatic patients . There was only one case of deep infection . We found no difference statistically in the clinical outcome or in the revision rate of 4 % in the two types of prosthesis . The revision rate was greater for trainees than for senior operating surgeons , and there were recognisable technical errors in seven of the nine Stanmore , and four of the seven Charnley replacements which required revision . Retrospective radiological analysis of a r and om subset of 51 Charnely and 57 Stanmore femoral components showed no difference in femoral subsidence , but in 14 patients who had had bilateral replacements with one femoral component of each type , there was greater early subsidence of the Stanmore prosthesis . Our results confirm that conventional cemented total hip replacements give acceptable results in a general teaching unit , and we found no evidence of any effect of the size of the femoral head on wear or loosening at five to ten years We present a match-paired study between computer-assisted and freeh and techniques using a short modular femoral stem ( Metha ; B. Braun Aesculap , Tuttlingen , Germany ) in  total hip replacement ( THR ) .  Surgical time , clinical outcome , dislocation rate , limb length , and offset in 44 patients with ideal indication for this more conservative implant were assessed . Despite both longer surgical time and similar early outcomes , the results showed how computer-assisted techniques allow easier management of limb length discrepancy and offset restoring . We believe that navigated short modular stems are safe for less invasive THR Introduction Although prophylactic tranexamic acid ( TXA ) is a safe , low-cost option to reduce bleeding in patients undergoing total hip replacement ( THR ) , its optimal dose and duration is unknown . We compared the safety and effectiveness of TXA given as either a single injection or continuous infusion in THR patients , hypothesising that a second TXA dose would not offer any clinical advantages over the single injection . Material s and methods One hundred and sixty-four patients undergoing unilateral THR were r and omised . Exclusion criteria were history of thromboembolic events ( TE ) , epilepsy , thrombophilia , and severe chronic renal failure . Patients received either a single dose of 30 mg/kg TXA on induction of surgery ( one shot [ OS ] group ) , or a loading dose of 10 mg/kg TXA followed two hours later by a continuous infusion of 2 mg/kg per hour for 20 hours ( one day [ OD ] group ) . The primary outcome was blood loss ( BL ) calculated from haematocrit levels . Secondary outcomes were mortality and TE events within 90 days postoperatively . Results All patients completed treatment , with none lost to follow-up . Mean BL was 1107 ± 508 ml in Group OS and 1047 ± 442 ml in Group OD ( p = 0.43 ) . No patients were transfused prior to Day 10 postoperatively . At final follow-up , no patients had died , and there were no occurrences of major TE . Conclusion The 30 mg/kg TXA single shot was as safe as continuous infusion . As it is also less cumbersome , we recommend it as part of routine care in THR patients Background The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality , anxiety , depression and negative thinking styles can influence outcomes and recovery from surgery . The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip ( THA ) and knee arthroplasty ( TKA ) , in improving patient reported joint outcomes . Methods An extensive literature search was conducted according to Preferred Reporting Items for Systematic review s and Meta-Analyses guidelines . Search terms included psychology , interventions , and orthopaedics . Articles were included if they were r and omised controlled trials ( RCTs ) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty . Results A total of 19,489 titles were screened . Seven studies met the inclusion criteria and were included . Five of seven studies did not show improvements in patient reported outcomes after surgery . Specifically , psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies . Conclusion The current literature does not support routine psychological interventions for TKA and THA . However , it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy . This gap in the literature is surprising , considering the importance of the role of psychological factors in recovery . Further RCTs with long term follow ups , multidisciplinary involvement , and more comprehensive and focused interventions that go beyond educating patients are needed . Future studies should account for the dem and effect , include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others , and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA OBJECTIVES To determine the 2 year total hip replacement ( THR ) rate and to identify factors predictive of THR due to primary osteoarthritis ( OA ) . METHODS A 2 year prospect i ve cohort study . Inclusion criteria were primary hip OA , with a history of pain for 6 months , and patients ' pain assessment of > or = 30 mm on a visual analogue scale ( 0 - 100 mm ) . Predictive factors of THR were identified by univariate then multivariate analysis using logistic regression . Potential predictors considered were demographic , radiographic ( localisation and severity of OA ) , and patients ' assessment of symptomatic severity of OA . RESULTS Of the 741 patients enrolled , 505 ( 68.2 % ) patients , mean ( SD ) age 64.0 ( 10.1 ) years , mean ( SD ) disease duration 4.7 ( 5.2 ) years , had complete 2 year data . There was no difference between the completer and non-completer groups . During follow up , 189/505 ( 37.4 % ) patients had a first THR . By multivariate analysis , predictors of THR were Kellgren-Lawrence radiographic grade ( grade III : odds ratio ( OR ) = 3.3 ( 95 % confidence interval ( 95 % CI ) 1.7 to 6.4 ) ; grade IV : OR = 5.3 ( 95 % CI 2.6 to 10.8 ) ) , high mean patient global assessment during the first 6 months ( OR = 2.2 ( 95 % CI 1.4 to 3.2 ) ) , and previous non-steroidal anti-inflammatory drug ( NSAID ) intake ( OR = 1.5 ( 95 % CI 1.0 to 2.4 ) ) . For two of these factors together , OR = 3.0 ( 95 % CI 1.6 to 5.9 ) , for three factors together , OR = 5.6 ( 95 % CI 2.6 to 12.2 ) . CONCLUSION The 2 year rate of THR was high in this group of patients with painful hip OA : 37.4 % . Radiological grade , mean patient global assessment , and the need for NSAIDs were predictive of THR The purpose of this study was to evaluate whether preoperative gait adaptations persist one year after THR in the same set of subjects . The hypothesis tested was that hip dynamic range of motion and peak external moments during walking return to normal after THR .  Hip kinematics and kinetics were measured for 28 subjects before and one year after THR  and compared to those of 25 subjects with radiographically normal hips . All THR subjects improved clinical ly after surgery with Harris hip scores improving from 33 - 85 ( average 53 ) to 61 - 100 ( average 95 ) ( sign test p<0.001 ) . Preoperatively dynamic hip range of motion ( ROM ) , and all peak external moments were reduced compared to normal ( Mann-Whitney p < or = 0.040 ) . Improvement was seen in the ROM and all but the frontal plane , and external rotation peak moments ( Friedman p < or = 0.023 ) . The preoperative and postoperative values of the ROM , and peak flexion , abduction and external rotation moments were all significantly correlated ( Spearman p<0.020 ) indicating a possible learned effect from before THR surgery . Postoperative THR subjects continued to have a significantly lower than normal ROM , and peak adduction and peak internal rotation moments ( Mann-Whitney p < or = 0.003 ) . Despite good to excellent clinical functional outcome , gait in THR patients does not return to normal by one year after surgery . Aggressive muscle strengthening is currently not emphasized after THR surgery . Some THR patients may benefit from more intensive rehabilitation before and after surgery Background The relationship between leisure time physical activity ( LPA ) and hip and knee OA and subsequent joint replacement has not yet been clearly defined . Some studies have found the risk of knee replacement ( TKR ) to increase with high levels of LPA , while others have found no overall relationship to either TKR or hip replacement ( THR ) . The aim was to investigate the association between LPA and the risk of severe end-stage OA  , defined as THR or TKR due to primary OA , in a large population -based cohort . Methods Participants in the Nord-Trøndelag Health Study ( HUNT ) were followed prospect ively to identify THR and TKR using the Norwegian Arthroplasty Register . Self-reported LPA was classified as inactive , low , moderate or high . The Cox proportional hazards model was used to calculate hazard ratios ( HRs ) according to levels of LPA with adjustments for confounding variables . Analyses were performed by age ( < 45 , 45–59 and ≥60 years ) and sex . Results A total of 66 964 participants ( mean age 46.8 years ( SD 16.3 ) were included in the analyses . We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years ( median ) of follow-up . High LPA was significantly associated with THR for women < 45 years ( HR 1.78 , 95 % CI 1.08–2.94 ) and men between 45–59 years ( HR 1.53 , 95 % CI 1.10–2.13 ) at baseline . A significant trend was found only among women < 45 years at baseline ( p = 0.02 ) . We found that LPA was significantly associated with TKR for women only ( HR 1.45 , 95 % CI 1.03–2.04 ) . No measures of LPA were associated with TKR for men . Conclusion In this population -based study , high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women < 45 years at baseline . For TKR , high LPA was associated with increased risk only in women . In contrast to previous studies , this study shows a possible association between high LPA and the risk of THR Primary arthroplasty may be denied to very elderly patients based upon the perceived outcome and risks associated with surgery . This prospect i ve study compared the outcome , complications , and mortality of total hip ( TKR ) and total knee replacement ( TKR )  in a prospect ively selected group of patients aged ≥ 80 years with that of a control group aged between 65 and 74 years . There were 171 and 495 THRs and 185 and 492 TKRs performed in the older and control groups , respectively . No significant difference was observed in the mean improvement of Oxford hip and knee scores between the groups at 12 months ( 0.98 , ( 95 % confidence interval ( CI ) -0.66 to 2.95 ) , p = 0.34 and 1.15 ( 95 % CI -0.65 to 2.94 ) , p = 0.16 , respectively ) . The control group had a significantly ( p = 0.02 and p = 0.04 , respectively ) greater improvement in the physical well being component of their SF-12 score , but the older group was more satisfied with their THR ( p = 0.047 ) . The older group had a longer hospital stay for both THR ( 5.9 versus 9.0 days , p < 0.0001 ) and TKR ( 6.2 versus 8.3 days , p < 0.0001 ) . The rates of post-operative complications and mortality were increased in the older group BACKGROUND The goal of this study was to evaluate the effectiveness on postoperative pain , and cognitive impact , of patient-controlled analgesia ( PCA ) compared with subcutaneous ( s.c . ) injections of morphine in elderly patients undergoing total hip replacement ( THR ) . METHODS Forty patients older than 70 yr were r and omly assigned to two different postoperative analgesic techniques for 48 h : i.v . PCA morphine ( dose , 1 mg ; lockout interval , 8 min ; PCA group ) or regular s.c . morphine injections ( SC group ) . Postoperative pain was assessed at rest and when moving , using a visual analogue scale ( VAS ) every 4 h. A Mini Mental Status ( MMS ) examination was used to assess cognitive functions before surgery , at 2 h , 24 h and 48 h after surgery , and at hospital discharge . Side-effects were also recorded systematic ally during the first 48 h after surgery . RESULTS The PCA group showed significantly lower pain scores than the SC group both at rest and during mobilization . However , the clinical significance of pain scores was weak . There was no intergroup difference in postoperative MMS scores . The incidence of side-effects was similar in both groups . CONCLUSIONS We conclude that in healthy elderly subjects undergoing THR , the flexibility of the analgesic regimen is more important than the route of administration with regard to efficacy , adverse effects and recovery of cognitive function 80 patients underwent total hip replacement ( THR ) for primary coxarthrosis . In a r and omized study , half of them donated 2 units of blood before operation . One unit was collected 4 weeks and one 2 weeks before the scheduled THR . All except 1 patient tolerated the predonations well . Total blood losses were similar in both groups . Additional bank blood was given in 7/38 in the predonation group , compared to 29/40 in the control group .  Hemostatic parameters were studied in 10 consecutive patients in each group . Plasminogen activator inhibitor 1 ( PAI-1 ) , a possible risk parameter for thromboembolism , was significantly more increased postoperatively in the control group , which received only homologous blood . Platelet count , prothrombin complex , antithrombin III and von Willebr and factor antigen were significantly reduced and C reactive protein increased after surgery in both groups . We recommend predonation of 2 autologous units before a primary THR . In most cases , such predonation makes homologous blood transfusion unnecessary . The use of predonated blood causes no reduction of blood loss in THRs , but the increase in PAI-1 seen after homologous transfusions is avoided There is a growing movement to encourage reproducibility and transparency practice s in the scientific community , including public access to raw data and protocol s , the conduct of replication studies , systematic integration of evidence in systematic review s , and the documentation of funding and potential conflicts of interest . In this survey , we assessed the current status of reproducibility and transparency addressing these indicators in a r and om sample of 441 biomedical journal articles published in 2000–2014 . Only one study provided a full protocol and none made all raw data directly available . Replication studies were rare ( n = 4 ) , and only 16 studies had their data included in a subsequent systematic review or meta- analysis . The majority of studies did not mention anything about funding or conflicts of interest . The percentage of articles with no statement of conflict decreased substantially between 2000 and 2014 ( 94.4 % in 2000 to 34.6 % in 2014 ) ; the percentage of articles reporting statements of conflicts ( 0 % in 2000 , 15.4 % in 2014 ) or no conflicts ( 5.6 % in 2000 , 50.0 % in 2014 ) increased . Articles published in journals in the clinical medicine category versus other fields were almost twice as likely to not include any information on funding and to have private funding . This study provides baseline data to compare future progress in improving these indicators in the scientific literature Objectives : To investigate prospect ively long term patient relevant outcomes after  unilateral total hip replacement ( THR ) for osteoarthritis ( OA ) . To identify non-responders to this intervention and patient related predictors of unsatisfactory outcome . Methods : A case-control study comparing health related quality of life of 219 patients ( mean age 71 ) after THR with that of a matched reference group of 117 subjects without hip complaints recruited from the community . Patients and reference group answered SF-36 and WOMAC question naires preoperatively , at 3 , 6 , 12 months , and at 3.6 years ( range 26–65 months ) postoperatively . Supplementary questions were asked at the final follow up . Results : 198/211 ( 94 % ) of the patients and 83/109 ( 76 % ) of the reference group participated at the final follow up . At follow up , the only difference between the two groups in the SF-36 was physical function , where patients scored worse . Patients also reported worse WOMAC function . 31 % of the patients had improved by < 10/100 WOMAC score points for pain and /or function at final follow up , compared with preoperatively . More pain preoperatively and higher age and postoperative low back pain predicted a worse outcome in WOMAC function . Conclusion : 3.6 years after THR for OA , health related quality of life was similar for patients and reference group except for function , where patients had worse function . Higher age and more pain preoperatively predicted a poor outcome . Patients with hip OA with musculoskeletal comorbidities , such as low back pain and OA of the non-operated hip , have less long term functional improvement after THR The objective of this study was to evaluate the effects of preparatory information on psychological coping outcomes among total hip replacement ( THR ) patients . A quasi-experimental design within an ethnographic clinical context was used . Eighty-two healthy individuals , scheduled for elective THR were recruited for the study and nonr and om selection techniques were used . The subjects in the experimental group were given procedural , sensory and coping information relating to the whole surgical procedure of a THR . In addition , written information was given to support the verbal information . Subjects in the control group received only the advice and support that would routinely be given to THR patients by ward , medical and nursing staff . The main outcomes were measured using st and ard question naires , Hospital Anxiety and Depression Scale ( HADS ) measuring anxiety and depression , Rosenburg Self-Esteem Scale measuring self-esteem , and Health Illness Question naire measuring sense of control . Lastly , a Linear Analogue Coping Scale was developed and applied to assess a subject 's personal perception of coping with a THR . Providing information had positive effects on the psychological coping outcomes measured . Subjects in the experimental group had significantly less anxiety and depression with a high self-esteem and sense of control . The Linear Analogue Coping Scale demonstrated a strong correlation between how subjects believed they were coping and that measured using the st and ard question naires . The study concluded that preparatory information of various types and in different forms appears to have positive effects on psychological coping outcomes for THR patients , which may have influenced postoperative recovery We review ed the records of the long-term outcome of 208 Charnley and 982 Stanmore total hip replacements ( THR ) performed by or under the supervision of one surgeon from 1973 to 1987 . The Stanmore implant had a better survival rate before revision at 14 years ( 86 % to 79 % , p = 0.004 ) , but the difference only became apparent at ten years . The later Stanmore implants did better than the early ones ( 97 % to 92 % at ten years , p = 0.005 ) , the improvement coinciding with the introduction of a new cementing technique using a gun . Most of the Charnley implants were done before most of the Stanmore implants so that the difference between the results may in part be explained by improved methods , but this is not the complete explanation since a difference persisted for implants carried out during the same period of time . We conclude that improved techniques have reduced failure rates substantially . This improvement was much greater than that observed between these two design s of implant . Proof of the difference would require a very large r and omised controlled trial over a ten-year period
The Charnley prosthesis had by far the best and most comprehensive evidence base with better than 90 % implant survival after about 10 years .
Some uncemented stems have shown promising medium-term outcome , but no combination of uncemented cup and stem fulfilled the benchmark criterion of > or = 90 % implant survival at 10 years , which we propose as a minimum requirement for unrestricted clinical use for prostheses used in primary THR .
We have conducted a systematic review of the scientific literature concerning outcome and clinical effectiveness of  prostheses used for primary total hip replacement ( THR ) in Norway .