The Influence of Obesity on Hip Pain, Function, and Satisfaction 10 Years Following Total Hip Arthroplasty.

BACKGROUND: The prevalence of obesity is rising, and increasing numbers of joint arthroplasty surgeries are being performed on obese patients. Concern exists that obesity increases surgical risk; however, its impact on function following total hip arthroplasty (THA) is inconsistently affirmed and less understood. A paucity exists in the literature pertaining long-term objective functional measures. Therefore, we investigated the impact of obesity on hip pain, function, and satisfaction 10 years following THA. METHODS: This single-center, prospective, observational study categorized consecutive THA patients according to their body mass index to nonobese (<30 kg/m2) and obese (≥30 kg/m2) groups. Preoperative assessment included a numerical pain rating and the Oxford Hip Score. These were repeated along with a 6-minute walk test and a Likert satisfaction scale at 3 months, 1, 5, and 10 years postoperatively. RESULTS: The series included 191 primary THA patients. No significant differences were found in hip pain or function between the obese and nonobese groups. Obese patients however had poorer walking capacity (P = .008), were more likely to use walking aids (P = .04), and were less satisfied (P = .04) at 10 years. CONCLUSION: THA confers significant long-term symptom resolution irrespective of obesity; however, despite undergoing surgery, obese patients can be counseled they may not be as satisfied as or achieve the same walking capacity as nonobese individuals.

Piriformis-Sparing Minimally Invasive Versus the Standard Posterior Approach for Total Hip Arthroplasty: A 10-Year Follow-Up of a Randomized Control Trial.

BACKGROUND: Despite the popularity of minimally invasive approaches in total hip arthroplasty, studies regarding their impact on soft tissues and long-term benefits are lacking. This study aims to compare the 10-year functional outcome of the piriformis-sparing minimally invasive approach to the standard posterior approach for total hip arthroplasty surgery. METHODS: Hundred patients were randomized, 48 patients to the piriformis-sparing approach and 52 to the standard approach. Primary outcomes were hip function and piriformis muscle volume and grade on magnetic resonance imaging. Secondary outcomes were pain, satisfaction score, and complications. Evaluators were blinded to allocation. Participants were followed up to 10 years. RESULTS: Ten years following surgery, both groups reported excellent pain relief, improved hip function, and high satisfaction. The significant differences were improvement in piriformis muscle volume (P = .001) and muscle grade (P = .007) in the piriformis-sparing group compared to the standard group. There were no significant differences in all other outcomes. CONCLUSION: Aside from being less injurious to the piriformis muscle, the piriformis-sparing approach offered the same long-term functional benefits as the standard posterior approach at 10 years.

Solid Cup vs Cluster Hole in Total Hip Arthroplasty: A 10-Year Randomized Control Trial.

BACKGROUND: Acetabular osteolysis is a major complication of total hip arthroplasty. It is caused in part by wear debris. It has been suggested that this debris can migrate through screw holes in the acetabular component. Solid-backed components have been used to prevent this migration and reduce osteolysis. Newer materials, however, have reduced wear debris. This study aimed to evaluate whether using solid-backed instead of cluster-hole components actually reduces osteolysis. This could open up the possibility of screws being used for greater stability where required. METHODS: This prospective trial randomized 100 patients undergoing cementless total hip arthroplasty to receive either cluster-hole or solid-backed acetabular components. A cementless cup and highly cross-linked polyethylene was used in all patients. Computed tomography, performed at 5 and 10 years after surgery, was assessed by a blinded radiologist for the presence of osteolysis. RESULTS: Of the 100 patients, 14 required screws for stability, and so were moved into a third "screw" group for per-protocol analysis. At 10 years after surgery, osteolytic lesions were discovered in 18.2% of patients. There was no difference in incidence or volume of osteolysis between patients with cluster-hole acetabular components and those with solid-backed components. CONCLUSION: This study reveals a low number of patients with osteolytic lesions 10 years after total hip arthroplasty performed with a modern cup design and highly cross-linked polyethylene liner. There was no clear benefit to using solid-backed acetabular components. Cluster-hole components, however, offer the option of screw augmentation when required.