A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR) Functional Outcome, Revision Rates and Mortality after Primary Total Hip Replacement – A National Comparison of Nine Prosthesis Brands in England Failure of the Uncoated Titanium ProxiLock Femoral Hip Prosthesis Outcome after total hip arthroplasty: Part II. Disease-specific follow-up and the Swedish National Total Hip Arthroplasty Register A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement. Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: II. Clinical proof of concept—40 patients followed for 2 years Cementless primary total hip replacement. Four to eight year results with the Zweymüller-Alloclassic prosthesis. A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Resurfacing hip prostheses revisited: failure analysis during a 16-year follow-up. Medium Term Follow up of the Biodynamic Neck Sparing Prosthesis Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach A randomised controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses: the Knee Arthroplasty Trial (KAT). Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: a randomized pilot trial Long-term clinical and radiological results of the Lord total hip prosthesis. A prospective study. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Early, intensified home-based exercise after total hip replacement--a pilot study. Leg length discrepancy, dislocation rate, and offset in total hip replacement using a short modular stem: navigation vs conventional freehand.
Objective : To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement . Design : Single blinded feasibility r and omised controlled trial , with data collection prior to the intervention , and at 4 , 12 , and 26 weeks following surgery . Setting : Recruitment from two NHS orthopaedic outpatient centres in the West Midl and s , UK . Subjects : Patients awaiting primary total hip replacement due to osteoarthritis were recruited . Following pre-operative assessment , patients were individually r and omised to intervention or control by a computer-generated block r and omisation algorithm stratified by age and centre . Interventions : The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations , assessed home safety , and provided appropriate adaptive equipment . The control group received treatment as usual . Outcomes : The study assessed the feasibility of recruitment procedures , delivery of the intervention , appropriateness of outcome measures and data collection methods . Health related quality of life and re source use were recorded at 4 , 12 and 26 weeks . Results : Forty-four participants were recruited , 21 were r and omised to the  occupational therapy  intervention and 23 to usual care . Analysis of 26 week data included 18 participants in the intervention group and 21 in the control . The intervention was delivered successfully with no withdrawals or crossovers ; 5/44 were lost to follow-up with further missing data for participation and re source use . Conclusions : The feasibility study provided the information required to conduct a definitive trial . Burden of assessment would need to be addressed . A total of 219 patients would be required in an efficacy trial Background The number of prosthesis br and s used for hip replacement has increased rapidly , but there is little evidence on their effectiveness . We compared patient-reported outcomes , revision rates , and mortality for the three most frequently used br and s within each prosthesis type : cemented ( Exeter V40 Contemporary , Exeter V40 Duration and Exeter V40 Elite Plus Ogee ) , cementless ( Corail Pinnacle , Accolade Trident , and Taperloc Exceed ) , and hybrid ( Exeter V40 Trilogy , Exeter V40 Trilogy , and CPT Trilogy ) . Methods and Findings We used three national data bases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome ( Oxford Hip Score ( OHS ) ranging from 0 ( worst ) to 48 ( best ) ) in 43,524 patients at six months . We analysed revisions and mortality in 187,201 patients . We used multiple regression to adjust for pre-operative differences . Prosthesis type had an impact on post-operative OHS and revision rates ( both p<0.001 ) . Patients with hybrid prostheses had the best functional outcome ( mean OHS 39.4 , 95%CI 39.1 to 39.7 ) and those with cemented prostheses the worst ( 37.7 , 37.3 to 38.1 ) . Patients with cemented prostheses had the lowest reported 5-year revision rates ( 1.3 % , 1.2 % to 1.4 % ) and those with cementless prostheses the highest ( 2.2 % , 2.1 % to 2.4 % ) . Differences in mortality according to prosthesis type were small and not significant ( p = 0.06 ) . Functional outcome varied according to br and among cemented ( p = 0.05 , with Exeter V40 Duration having the best ) and cementless prostheses ( p = 0.01 , with Corail Pinnacle having the best ) . Revision rates varied according to br and among hybrids ( p = 0.05 , with Exeter V40 Trident having the lowest ) . Conclusions Functional outcomes were better with cementless cups and revision rates were lower with cemented stems , which underlies the good overall performance of hybrids . The hybrid Exeter V40 Trident seemed to produce the best overall results . This br and should be considered as a benchmark in r and omised trials New prostheses should be evaluated for stability and clinical performance . In a prospect i ve r and omized clinical trial , we implanted 22 titanium ( Ti ) and 20 hydroxyapatite-coated ( HA ) ProxiLock femoral hip prostheses during total hip arthroplasty in 42 patients . The patients were followed for 24 months with clinical , radiographic and radiostereometric analysis . Full weightbearing was allowed immediately postoperatively . One patient with a titanium stem was lost to followup . During the first two months , 34 of the 41 stems subsided and /or rotated towards retroversion , regardless of stem type . At the 24-month followup 35 of the 41 prostheses were either fully stabilized ( 16 HA and 11 Ti stems ) or had clinical irrelevant migration ( four HA and four Ti stems ) . Six Ti prostheses showed continuous migrations with maximums of 4.7 mm translation and 12.2 ° retroversion ; four of these were revised , the other two had no clinical complaints . Clinical relevance : The migration pattern we found indicates insufficient primary fixation of the ProxiLock stem in an immediate full weightbearing protocol . The HA coating improves the secondary stability of the prosthesis compared to the uncoated stem . Early migration is associated with an increased risk of possible future loosening and revision , and therefore we discontinued the use of this prosthesis . Level of Evidence : Therapeutic Level I. See Guidelines for Authors for a complete description of levels of evidence The Swedish National Total Hip Arthroplasty Register records primary hip replacements , revisions and surgical technique/environmental factors . The end-point for failure is revision . A prosthesis still in place , however , does not mean success . Clinical and radiographic outcomes should describe in more detail the efficacy of hip replacement surgery instead of the relatively blunt outcome measure that the register can provide . We performed a clinical outcome analysis on patients with primary total hip replacement thus testing the adequacy of the end-point for failure in the Swedish register . 1,113 r and omly selected patients who had had total hip replacement surgery between 1986 and 1995 answered a diseasespecific self-administered question naire ( WOMAC ) . A cohort of 344 patients was studied , using the  Harris Hip Score and a conventional radiographic examination  as outcome measures . We found clinical failure rates of 13 % and 20 % for all implants after 10 years , using 60 points or revision as the definition of failure in the Harris Hip Score and WOMAC , respectively . The result , according to the register during the same period , was a 7 % revision rate . The clinical failure rate depended on the type of evaluation tool , definition of failure and demographics , which made it difficult to decide whether there was a need for revision . With the exception of pain measured by the Harris Hip Score , the results showed no significant correlation between clinical failure and radiographic failure . Hence , with the knowledge that there is a difference between the revision rate according to the register and clinical outcome , the strict definition of failure in the register is useful as an end-point for primary hip replacement surgery 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 We have developed a bone-conserving commercially pure titanium hip replacement system using osseointegration principles : a metaphyseal loading proximal femoral component affixing into the retained neck and metaphysis only , leaving the femoral canal untouched . The acetabular cup closely fits a dual-geometry cavity , avoiding stress protection at the dome . Patients and methods After extensive laboratory and clinical pilot trial investigations , the surface-engineered implants were su bmi tted to a prospect i ve r and omized controlled clinical trial involving 40 patients ( 40 hips ) , in which they were compared to the cemented Spectron femoral component and cementless Trilogy cup as control implant . The following clinical measures were used to monitor progress at regular intervals for the first 2 postoperative years : radiostereometric analysis ( RSA ) , Harris Hip Score , pain score , WOMAC , and SF-36 . Results After 2 years of follow-up , no statistically significant differences were seen between the groups concerning rotation or translation along the cardinal axes . The patients receiving the Gothenburg osseointegrated titanium ( GOT ) system had significantly higher Harris Hip Score at 6 months , suggesting more rapid recovery . WOMAC , SF-36 and pain analysis were similar for the first 2 postoperative years . Interpretation Our RSA data suggest that osseointegration was achieved for all patients receiving the GOT hip system . This bone-conserving prosthesis may provide a good alternative , especially for young and active patients One hundred and twenty-nine consecutive cementless primary total hip arthroplasties with Zweymüller-Alloclassic grit-blasted titanium components  were evaluated prospect ively at an average follow-up of 5.9 years . The clinical results were grade d as excellent or good in 116 hips ( 90 % ) , fair in 12 , and poor in one due to a fracture of the femoral shaft at operation leading to early stem loosening and delayed ring loosening . Failure was defined as definite aseptic loosening , and the final survivorship at 8 years was 99.3 % for the SL-stem , and 99.1 % for the CSF-threaded cup . These early results compare favourably with those of total hip arthroplasties using new cementing techniques The success of a total hip arthroplasty ( THA ) is dependent on many more parameters than simply the prosthesis used . This study has demonstrated that a r and omized controlled clinical trial of 250 patients comparing two types of hip prostheses ( cemented versus cementless ) with virtually complete follow-up examination is feasible . It also demonstrates that patients are willing to answer extensive quality -of-life question naires that allow complete assessment of the impact of hip arthroplasty on the patient 's overall health-related quality of life . This study has also demonstrated that THA is an extremely effective intervention when one assesses its ability to impact on patients health-related quality of life with no difference between cement versus cementless at two years ' follow-up examination We conducted a prospect i ve study of the clinical and radiographic variables related to the survival of 114 cementless resurfacing double-cup hip replacements ( RHR ) with a mean follow-up of 9 ( range : 1 - -16 ) years . Three patients died , and 22 were unavailable for the final review in 2003 . Sixty-one RHRs had to be revised to a total hip replacement . Failure analysis of these revised RHRs showed femoral head and neck resorption under the prosthesis in 33 , acetabular protrusion in seven , both femoral and acetabular resorption in 14 and a femoral-neck fracture in three . One hip had dislocated , and there were three hips with unexplained pain . The Kaplan-Meier 5-year mean survival was 92 % , the 10-year survival was 47 % ( 95 % CI 37 - -57 % ) and the 15-year survival was 30 % ( 95 % CI 20 - -40 % ) . Pre-operative joint destruction ( grade 1 ) , a high degree of radiological osteoporosis , a body mass index > 25 and prosthesis mismatch were significantly related to failure of the RHR . We believe that in young , non-obese patients with pre-operative radiological central destruction but without severe proximal femoral osteoporosis , a resurfacing arthroplasty may have some value . Our failures were mainly due to femoral resorption under the prosthetic femoral component Hip resurfacing ( HR ) and neck sparing prostheses ( NSP ) have been advocated for the treatment of arthritis in younger patients . Some complications following HR have been documented in the recent literature , but NSP are not yet supported by clinical follow-up studies of sufficient duration . We present an assessment of the neck sparing “ Biodynamic ” prosthesis .  153 patients were evaluated in a longitudinal cohort prospect i ve study , with survival analysis , clinical score and radiographic assessment of stability and osteointegration at 41.8 months average follow up . Survival and clinical outcome were similar to most traditional prostheses in the literature . On radiographic analysis we recorded good neck preservation and osteointegration . Only two stem failures were recorded . Poor clinical outcome was related to misalignment of prostheses implanted during the ‘ learning curve ’ . The NSP system described may be a good alternative to HR for younger patients . The system is characterized by good survival and clinical and radiographic outcome combined with bone stock preservation Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients BACKGROUND In the late 1990s , new developments in knee replacement were identified as a priority for research within the NHS . The newer forms of arthroplasty were more expensive and information was needed on their safety and cost-effectiveness . OBJECTIVES The Knee Arthroplasty Trial examined the clinical effectiveness and cost-effectiveness of four aspects of knee replacement surgery : patellar resurfacing , mobile bearings , all-polyethylene tibial components and unicompartmental replacement . DESIGN This study comprised a partial factorial , pragmatic , multicentre r and omised controlled trial with a trial-based cost-utility analysis which was conducted from the perspective of the NHS and the patients treated . Allocation was computer generated in a 1 : 1 ratio using a central system , stratified by eligible comparisons and surgeon , minimised by participant age , gender and site of disease . Surgeons were not blinded to allocated procedures . Participants were unblinded if they requested to know the prosthesis they received . SETTING The setting for the trial was UK secondary care . PARTICIPANTS Patients were eligible for inclusion if a decision had been made for them to have primary knee replacement surgery . Patients were recruited to comparisons for which the surgeon was in equipoise about which type of operation was most suitable . INTERVENTIONS Patients were r and omised to receive a knee replacement  with the following : patellar resurfacing or no patellar resurfacing irrespective of the design of the prosthesis used ; a mobile bearing between the tibial and femoral components or a bearing fixed to the tibial component ; a tibial component made of either only high-density polyethylene ( ' all polyethylene ' ) or a polyethylene bearing fixed to a metal backing plate with attached stem ; or unicompartmental or total knee replacement . MAIN OUTCOME MEASURES The primary outcome was the Oxford Knee Score ( OKS ) . Other outcomes were Short Form 12 ; EuroQol 5D ; intraoperative and postoperative complications ; additional surgery ; cost ; and cost-effectiveness . Patients were followed up for a median of 10 years ; the economic evaluation took a 10-year time horizon , discounting costs and quality -adjusted life-years ( QALYs ) at 3.5 % per annum . RESULTS A total of 116 surgeons in 34 centres participated and 2352 participants were r and omised : 1715 in patellar resurfacing ; 539 in mobile bearing ; 409 in all-polyethylene tibial component ; and 34 in the unicompartmental comparisons . Of those r and omised , 345 were r and omised to two comparisons . We can be more than 95 % confident that patellar resurfacing is cost-effective , despite there being no significant difference in clinical outcomes , because of increased QALYs [ 0.187 ; 95 % confidence interval ( CI ) -0.025 to 0.399 ] and reduced costs ( -£104 ; 95 % CI -£630 to £ 423 ) . We found no definite advantage or disadvantage of mobile bearings in OKS , quality of life , reoperation and revision rates or cost-effectiveness . We found improved functional results for metal-backed tibias : complication , reoperation and revision rates were similar . The metal-backed tibia was cost-effective ( particularly in the elderly ) , costing £ 35 per QALY gained . CONCLUSIONS The results provide evidence to support the routine resurfacing of the patella and the use of metal-backed tibial components even in the elderly . Further follow-up is required to assess the stability of these findings over time and to inform the decision between mobile and fixed bearings . TRIAL REGISTRATION Current Controlled Trials IS RCT N45837371 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and the orthopaedic industry . It will be published in full in Health Technology Assessment ; Vol . 18 , No. 19 . See the NIHR Journals Library website for further project information Objective : To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly . Design : A single-blind , r and omized clinical pilot trial . Setting : Outpatient physiotherapy department . Subjects : Frail elderly with hip osteoarthritis awaiting total hip replacement . Interventions : A short ( 3—6 weeks ) tailor-made , therapeutic exercise programme was compared with usual care . Main measures : Feasibility was assessed through patient satisfaction , adherence , occurrence of adverse events and the number of eligible non-volunteers . Preliminary preoperative effectiveness was assessed with performance and self-reported measures of pain , functioning , physical activity and quality of life . Postoperatively we measured functional recovery and length of hospital stay . Results : Sixty-two eligible patients were approached of whom 21 ( mean age 76 years ) agreed to participate . Exercisers ( n = 10 ) , rated the intervention as very good 8.9 ( 8—10 ) ( 10-point rating scale ) . No serious adverse events occurred . Forty-one ( 66 % ) eligible patients did not participate , mainly because of logistic considerations , result ing in selection bias . The intervention group ( trainings sessions participated 91 % ) showed relevant preoperative improvements on the chair-rise time ( delta —2.9 seconds ; 95 % confidence interval ( CI ) —6.2 to 0.4 ) and timed-up- and -go ( delta —4.4 seconds ; 95 % CI —9.3 to 0.5 ) . Postoperatively , no significant differences were seen . Conclusions : A short , tailor-made , exercise programme is well tolerated and appreciated in elderly patients awaiting total hip replacement . However , a larger r and omized clinical trial in the same setting is not warranted , because of the high number of eligible non-volunteers We enrolled 98 patients ( 107 hips ) with a mean age of 47 years ( SD 8.6 ) into a prospect i ve study of the Madreporic Lord THR ; 34 hips had primary and 73 secondary osteoarthritis . After ten years , the survival rate using revision as the endpoint for failure was 70 % ( + /-9 ) for the cup and 98 % ( + /-0.3 ) for the stem . The combined clinical and radiological survival rates were 46 % ( + /-11 ) and 81 % ( + /-10 ) , respectively . Osteoporosis due to stress-shielding was observed in the proximal femur . Hips with radiologically dense bone postoperatively showed the most pronounced bone loss . We recommend continued radiological follow-up of patients with this type of implant to allow revision to be performed before there is severe bony destruction of the pelvis UNLABELLED Stockton KA , Mengersen KA . Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement : a r and omized controlled trial . OBJECTIVE To determine whether increasing physiotherapy input from once to twice per day will result in earlier achievement of functional milestones ( ie , independence in mobility and transfers ) and decreased length of stay ( LOS ) in patients undergoing a primary total hip replacement . DESIGN R and omized controlled trial . SETTING Metropolitan private hospital . PARTICIPANTS Patients ( N=57 ) with primary total hip replacement were r and omly assigned to the twice daily ( treatment , n=30 ) and once daily ( control , n=27 ) groups . Patients who chose to attend hydrotherapy  were excluded from the r and omization process ; however , they gave consent for outcome measures to be collected for comparison with the r and omized groups . INTERVENTIONS The control group received usual care , and the treatment group received twice-daily physiotherapy from day 1 after surgery to discharge . MAIN OUTCOME MEASURES The Iowa Level of Assistance at postoperative days 3 and 6 and LOS . RESULTS This study demonstrates that patients who received twice-daily l and -based  physiotherapy  after primary total hip replacement attained earlier achievement of functional milestones than patients that received once-daily physiotherapy . A statistically significant ( P=.041 ) but not clinical ly significant difference was evident in the Iowa Level of Assistance score at day 3 . There was no difference between the groups in Iowa Level of Assistance measures on day 6 or on LOS . CONCLUSIONS Patients who received twice-daily physiotherapy showed a trend toward earlier achievement of functional milestones ; however , this finding did not translate to decreased LOS BACKGROUND AND PURPOSE Despite a successful surgical procedure , deficits in muscle strength and physical function are documented 1 - 2 years after total hip replacement ( THR ) . There is a lack of evidence concerning which rehabilitation strategy is the most effective after THR . The purpose of this pilot study was to investigate the feasibility of an early-initiated intensified , home-based training regime and to form the basis of future studies with regard to exercises , outcome measures and power calculations . METHODS The trial is a single-blinded , cluster-r and omized controlled trial performed at an orthopaedic physiotherapy department in a public hospital in Denmark . A consecutive sample of 46 patients undergoing primary THR surgery for osteoarthritis between September 2008 and January 2009 was included . Forty-four patients completed the trial ( 96 % follow-up ) . Participants were r and omly assigned to an intervention group ( IG , n = 23 ) receiving 12 weeks of intensified exercises ( e.g. rubber b and resistance ) or a control group ( CG , n = 21 ) receiving st and ard rehabilitation exercises without external resistance . The outcome measurements were maximal gait speed , isometric hip abductor muscle strength , one-legged stance , health-related quality of life ( EuroQol-5 Dimensions ) , patient satisfaction , and patient-evaluated function , stiffness and pain ( Western and Ontario McMasters University Osteoarthritis Index ) . RESULTS There were significant increases in both groups in all the measurements during the 12 weeks of exercises . All participants in the IG were satisfied or very satisfied with the exercises compared with 85 % in the CG ( P = 0.095 ) . In the IG , four participants ( 17.4 % ) had difficulties when performing the intensified exercises at home . Hip abduction strength was significantly weaker in the leg operated compared with the leg not operated on after the intervention in both groups ( P < 0.01 ) . CONCLUSION This pilot study indicates that the majority of THR patients tolerated early-initiated intensified exercises without additional pain and with high patient satisfaction . It seems that some of the patients need supervision to perform intensified exercises 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
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 .