X-ref For other Roundups in this issue that cross-reference with Hip & Pelvis see: Trauma Roundup 3; Knee Roundup 4, 5; Research Roundup 7, 8.
Doing badly early – how to tell
Given the ever-increasing number of hip replacements being undertaken, any means of pre-operatively identifying those patients at risk of poor clinical and functional outcome is to be welcomed. A study team from Montreal (Canada) set out to do just this.1 The authors utilised a retrospective analysis of their prospectively recorded arthroplasty database. In what ended up as a rather small study, the results of 265 consecutive unilateral hip arthroplasties/resurfacings, which were all performed for primary osteoarthritis, were collated. Data available included one- to two-year post-operative self-reported PROMS data, as well as WOMAC scores. Although 2963 patients had been entered into their database during the period studied (2004 to 2014), many failed to meet the inclusion criteria or had incomplete data. In this series, around 15% were found to have a suboptimal result on the basis of PROMS outcome measures. The study team’s retrospective analysis of independent variables associated with a poorer outcome identified female gender, older age, elevated BMI (> 33.7 kg/m²), severe pain when walking on a flat surface, night pain and difficulty putting on socks. While this all might seem obvious, there is a surprising paucity of previous work in this area, and the authors propose an algorithm based on the above criteria, which their analysis suggests gives a sensitivity and specificity of around 75%. Although the clinical applications of this may be limited, and this study is certainly inhibited by the small population, it is worth considering that certain patient subgroups are likely to perform more poorly.
Outcomes in avascular necrosis of the hip
Treatments for avascular necrosis (AVN) of the hip are hit-and-miss to say the least. Ranging from simple drilling to vascularised fibular grafting and …