Patient-Reported Outcomes After Total Hip Arthroplasty in a Low-Resource Country by a Visiting Surgical Team.

BACKGROUND: Total hip arthroplasty (THA) is a highly successful procedure but limited in many low-resource nations. In response, organizations globally have conducted service trips to provide arthroplasty care to underserved populations. Few outcomes data are currently available related to these trips. Our study aims to demonstrate the feasibility of tracking patient-reported outcomes and complications after THA in a low-resource setting and that outcomes are comparable to those in developed countries. METHODS: We completed an arthroplasty service trip to Brazil in 2017 where we performed 46 THAs on 38 patients. The mean patient age was 48.8 years. Forty-seven percent were female. Patient-reported outcome scores were collected preoperatively and postoperatively at 2, 6, and 12 weeks and 1 year. A multivariate regression analysis was performed to identify associations between patient factors and 12-week outcomes. RESULTS: The mean modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Patient-Reported Outcome Measurement Information System Short Form (PROMIS-SF) Pain Interference, and PROMIS-SF Physical Function all improved significantly compared to baseline at 2, 6, and 12 weeks and 1 year postoperatively. At 1 year, only 29% of patients (11 of 38) were reachable by phone for follow-up.Multivariate regression analysis at 12 weeks found that females had more improvement in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores (P = .003) and PROMIS-SF Pain Interference scores (P = .01) than males, and patients with rheumatoid arthritis had more improvement in PROMIS-SF Pain Interference scores (P = .008) compared with all other diagnoses. CONCLUSION: Patients in low-resource countries benefitted significantly from THA performed by a visiting surgical team. However, following up patients is difficult in low-resource countries once they leave the hospital.

Hylan G-F 20 improves hip osteoarthritis: a prospective, randomized study.

We compared the efficacy and safety of intra-articular hylan G-F 20 with methylprednisolone acetate (MPA) for treating symptomatic Kellgren-Lawrence grade (KLG) 2 or 3 hip osteoarthritis in a prospective, randomized, multicenter, double-blind trial (N = 313). Two injections of hylan G-F 20 were administered 2 weeks apart (n = 150), or 1 injection of 40 mg MPA and 1 sham injection 2 weeks later (n = 155). The Western Ontario and McMaster Universities Arthritis Index (WOMAC) (total and subscale), clinician observations, and patient global assessments were collected at baseline and at weeks 4, 8, 12, 16, 20, and 26 (intent-to-treat population was analyzed; n = 305). Responder rates were assessed by WOMAC domain A, and criteria were established by the Outcome Measures in Rheumatology Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI). At week 26, WOMAC A improved by 16.6 mm for hylan G-F 20 versus 13.6 mm for MPA. Response rates were higher with hylan G-F 20 versus MPA in patients with more advanced disease (KLG 3) and were similar between hylan G-F 20 and MPA in patients with less advanced disease (KLG 2). Adverse events were similar between groups and between patients with KLG 2 or 3. Hylan G-F 20 provided clinically meaningful improvements in pain and function, comparable with those of MPA, with good safety and tolerability. Thus, we conclude it is an appropriate option for treating hip osteoarthritis.

Functional improvement with hylan G-F 20 in patients with knee osteoarthritis.

A systematic review of randomized, controlled, prospective clinical studies is described (8 trials; N = 1674 patients), with > 100 patients in each, which evaluated functional outcomes with hylan G-F 20 in secondary analyses. Hylan G-F 20 significantly improved Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function versus appropriate/conventional care or corticosteroid, it significantly improved loss of activity versus saline, and it had similar functional improvements compared with progressive knee exercises or nonsteroidal anti-inflammatory drugs. Functional improvements with hylan G-F 20 also improved with pain relief. Hylan G-F 20 should be considered as part of a multimodal arthritis treatment regimen that focuses on improving function.

Predicting total knee replacement pain: a prospective, observational study.

To describe the natural history of pain after total knee arthroplasty and to identify factors predicting excessive postoperative pain, we used a prospective, observational study assessing clinical and radiographic variables preoperatively and at 1, 3, 6, and 12 months after knee replacement. Data sources included the visual analog pain scale and other measures of patient health, psychologic state, and component reliability. Regression analyses were conducted to identify specific factors predictive of postoperative pain, controlling for inequality of variables, and confirmed using regression diagnostics. For 116 patients (149 knees; mean age, 66 years; 55.2% women), significant pain was reported by 72.3%, 44.4%, 22.6%, 18.4%, and 13.1%, respectively. No intergroup differences existed for anesthesia, weight, age, or gender. Patients with greater preoperative pain had more postoperative pain, used more home therapy, and postoperative manipulations. Preoperative depression and anxiety were associated with heightened pain at 1 year. Pain after knee replacement resolves quickly, declining to approximately (1/2) by 3 months. However, one in eight patients report moderate to severe pain 1 year after surgery despite an absence of clinical or radiographic abnormalities. Development of office-based preoperative screening tools and interventions for these patients may reduce postoperative costs and improve patient-perceived outcomes.