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Introduction: The ability to "forget" a joint implant in everyday life is considered to be the ultimate objective in arthroplasty. Recently, a scoring system, the Forgotten Joint Score (FJS-12), was published based on a self-administered questionnaire comprising 12 questions assessing how far patients had been able to forget their hip or knee prosthesis. The main objective of the present study was to translate, adapt and assess a French-language version of the FJS-12 in total hip arthroplasty (THA) patients., Patients and Methods: The questionnaire was translated by 2 orthopedic surgeons and a medical physician, all bilingual, then back-translated into English by two native English-speaking translators unacquainted with the original. A concertation meeting adopted a beta-version of this Score de Hanche Oubliée (SHO-12), which was then tested on 15 randomly selected THA patients and adapted according to their comments. The final version was validated following the international COSMIN methodology. Data collection was prospective, included all patients operated on by a single surgeon using a single technique. Reference questionnaires comprised Oxford Hip Score (OHS-12) and modified Harris Hip Score (HHS). The 3 assessments were conducted with a minimum 1 year's follow-up. The SHO-12 was administered twice, with a 1-week interval. Statistical tests assessed construct validity (Pearson correlation test), internal coherence (Cronbach alpha), reliability (intraclass correlation coefficient) and feasibility (percentage missing values, administration time and ceiling and floor effects)., Results: Translation/back-translation encountered no particular linguistic problems. Fifty-eight patients (63 THAs) responded to all questionnaires: 22 female, 36 male; mean age, 62.7±15.2 years. Mean follow-up was 1.6±0.4 years. SHO-12 correlated strongly with OHS-12 and HHS. Internal coherence was good (alpha=0.96) and reproducibility excellent. No floor or ceiling effects were found., Conclusion: SHO-12, the French-language version of the FJS-12 in THA, is a valid, reproducible self-administered questionnaire, comparable to the English-language version., Level of Evidence: I, Testing of previously developed diagnostic criteria on consecutive patients - Diagnostic study., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Disarticulation has been used less and less often in the treatment of musculoskeletal neoplasms; however, in some cases it allows the patient to achieve good oncological and functional outcomes. The aim of this paper is to present the possibilities, surgical technique and treatment outcomes of patients after hip disarticulation and stump lengthening with a modular prosthesis., Material and Methods: Three classic hip disarticulation surgeries and 2 hip disarticulation procedures with stump lengthening with a modular prosthesis were performed at the Department of Oncological Orthopaedics in Brzozów in 2013 and 2014. The present paper discusses the indications, surgical technique and outcomes. Pain intensity was assessed in a VAS scale and physical function was measured with the Karnofsky scale. The mental status of the patients was analysed in the Beck Depression Inventory and the ability to perform daily living activities was evaluated according to Katz. The ability to walk after surgery was assessed., Results: Patients after hip disarticulation showed considerably worse functional outcomes. The mean physical function score was 53 points in the Karnofsky scale and 3.33 points in the Katz scale. The patients had difficulty walking and did not ambulate with their prostheses. They reported problems with sitting and using the toilet. Patients with lengthened stumps showed visibly better physical function scores, achieving, on average, 65 points in the Karnofsky scale and 5.5 points in the Katz scale. These patients used their prostheses, ambulated efficiently and were independent., Conclusions: Stump lengthening with a modular prosthesis in patients after hip disarticulation results in significantly better outcomes than the classic procedure.

Background: Negative news media reports regarding potential health hazards of implanted medical devices and pharmaceuticals can lead to a 'negative halo effect,' a phenomenon whereby judgments about a product or product type can be unconsciously altered even though the scientific support is tenuous. To determine how a 'negative halo effect' may impact the rates of use and/or explantation of medical products, we analyzed the occurrence of such an effect on three implanted medical devices and one drug: 1) intrauterine contraceptive devices (IUDs); 2) silicone gel-filled breast implants (SGBI); 3) metal-on-metal hip implants (MoM); and 4) the drug Tysabri., Methods: Data on IUD use from 1965 to 2008 were gathered from the Department of Health and Human Services Vital and Health Statistics and peer-reviewed publications. Data regarding SGBI implant and explantation rates from 1989 to 2012 were obtained from the Institute of Medicine and the American Society of Plastic Surgeons. MoM implant and explantation data were extracted from the England and Wales National Joint Registry and peer-reviewed publications. Tysabri patient data were reported by Elan Corporation or Biogen Idec Inc. Data trends for all products were compared with historical recall or withdrawal events and discussed in the context of public perceptions following such events., Results: We found that common factors altered public risk perceptions and patterns of continued use. First, a negative halo effect may be driven by continuing patient anxiety despite positive clinical outcomes. Second, negative reports about one product can spill over to affect the use of dissimilar products in the same category. Third, a negative halo effect on an entire category of medical devices can be sustained regardless of the scientific findings pertaining to safety. Fourth, recovery of a product's safety reputation and prevalent use may take decades in the U.S., even while these products may exhibit widespread use and good safety records in other countries., Conclusions: We conclude that the 'negative halo effect' associated with a stigma, rather than an objective risk-benefit assessment of medical products can increase negative health outcomes for patients due to reduced or inappropriate product usage.

Aim: Patient's satisfaction after total hip arthroplasty is influenced by many surgical and rehabilitation aspects, but is not available in the literature, a study that analyses the correlation between patient's psychology and clinical results of this procedure. The aim of this study was to investigate the relationship between memory of pain, clinical outcome and subjective satisfaction with the Multidimensional Health Locus of Control., Methods: We conducted a cross-sectional study on a cohort of 69 patients operated of total hip arthroplasty in our department from November 2008 to August 2011. Pre- and post-operative hip function was assessed by the Harris Hip Score. At the follow-up visit, patient satisfaction was assessed by means of the Patient Satisfaction Questionnaire. The memory of pain was evaluated by a modified questionnaire of pain experience. Multidimensional Health Locus of Control was evaluated in all patients, and results were connected with patient's subjective satisfaction and pain indexes., Results: Patients were divided into two groups about patient satisfaction, those with GPS > 15 and those with GPS ≤ 15. Patients very satisfied showed a significantly higher mean value of IHLC. Regarding pain experience, patients were divided into two categories: those recalling less pain with OvP score ≤11 (Q1 < 3, avg. score Q2-Q4 ≤ 3) and those recalling more pain with OvP score >11. IHLC score resulted significantly higher in patients recalling less pain., Discussion: Multidimensional Health Locus of Control can be considered a predictor of patient's satisfaction after an invasive surgical procedure as total hip arthroplasty.

Purpose: The Forgotten Joint Score-12 (FJS-12) is for patients to forget their artificial joint and is reportedly a useful patient-reported outcome tool for artificial joints. The purpose of this study was to determine whether the FJS-12 is as useful as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) in Japan., Methods: All patients who visited our hospital's hip joint specialists following unilateral THA from August 2013 to July 2014 were evaluated. Medical staff members other than physicians administered three questionnaires. Items evaluated were (1) the reliability of the FJS-12 and (2) correlations between the FJS-12 and the total and subscale scores of the WOMAC or JHEQ., Results: Of 130 patients, 22 were excluded. Cronbach's α coefficient was 0.97 for the FJS-12. The FJS-12 showed a significantly lower score than the WOMAC or JHEQ (p < 0.01). The FJS-12 was moderately correlated with the total WOMAC score (r = 0.522) and its subscale scores for "stiffness" (r = 0.401) and "function" (r = 0.539) and was weakly correlated with the score for "pain" (r = 0.289). The FJS-12 was favorably correlated with the total JHEQ score (r = 0.686) and its subscale scores (r = 0.530-0.643)., Conclusion: The FJS-12 was correlated with and showed reliability similar to that of the JHEQ and WOMAC. The FJS-12, which is not affected by culture or lifestyle, may be useful in Japan.

Background: Awareness of functional status of patients after arthroplasty helps therapists to select suitable topics of education that will enable the patients to continue rehabilitation on their own and improve the quality of life among hip joint prosthesis recipients., Material and Methods: The study involved a group of 60 patients (41 men and 19 women) after arthroplasty who were hospitalised in medical rehabilitation wards of Lodz hospitals. The average age of the patients was 65.0±11.2 years (65.4±11.5 years among women and 63.9±10.8 years among men). The functional status of the patients was assessed using the modified Rankin Scale (mRS) for self-evaluation of disability, Barthel Index (BI) to determine the degree of independence in performance of daily living activities and a survey prepared by the authors., Results: The degree of disability of the study subjects may be assessed as moderate (mRS score: 2.8 overall, 2.6 for women and 3.1 for men). The distributions of disability scores indicate a clinically significant difference in the assessment of disability level between women and men. The functional status of patients with regard to performance of daily living activities was evaluated as moderately severe (BI: 77.7±18.2 overall, 76.8±17.2 for women, 79.5±16.6 for men). The women after hip arthroplasty assessed their ability to dress and undress as significantly poorer than the men did., Conclusions: 1. The patients assessed their functional status as moderate disability. 2. The study participants faced the most serious problems with bathing, walking up and down stairs, grooming, and dressing and undressing. 3. The women assessed their ability to dress and undress as significantly poorer than the men did. 4. Physiotherapists and nurses were indicated as the main sources of education.

The aim of this study was to evaluate the clinical and radiological results of treatment and quality of life, and impact of surgical approach in patients after arthroplasty using anatomical stem ABG II in the Department of Orthopaedics and Trauma Regional Hospital. St. Luke in Tarnów of years 2008-2011. The material consisted of 68 patients operated using a Proxima stem (surgical approaches; anterolateral--34 cases, posterior lateral---34 cases similarly). The average age was 62.2 years. Patients stayed in the hospital an average of 8 days. Term follow-up was determined after 6 weeks, 3 months and then once a year. Postoperative results were evaluated using the scale: Harris and WOMAC NRS. X-rays were evaluated for setting and migration of the prosthesis components. In assessing patients with HHS to scale achieved 73.5% of very good and good. Compared to the pre-operative assessment resulted in a significant improvement in mobility of the hip after arthroplasty. According to the standardized WOMAC extended the average score of treatment was 77.0 points. During the study showed significant reduction in pain intensity after surgery. Average NRS score before surgery was 6.4 points and 1.4 points after surgery. In the material appropriate settings were 51 and 17 axial axis of the prosthesis. No effect on clinical outcomes set in the HHS and WOMAC scales. There was no effect on the results of surgical treatment.

Background: The sensitivity of airport security screening measures has increased substantially during the past decade, but few reports have examined how this affects patients who have undergone hip arthroplasty. The purpose of this study was to determine the experiences of patients who had hip prostheses and who passed through airport security screenings., Methods: A consecutive series of 250 patients who presented to the office of a high-volume surgeon were asked whether they had had a hip prosthesis for at least one year and, if so, whether they had flown on a commercial airline within the past year. Patients who responded affirmatively to both questions were asked to complete a written survey that included questions about which joint(s) had been replaced, the number of encounters with airport security, the frequency and location of metal detector activation, any additional screening procedures that were utilized, whether security officials requested documentation regarding the prosthesis, the degree of inconvenience, and other relevant information., Results: Of the 143 patients with hip replacements who traveled by air, 120 (84%) reported triggering the alarm and required wanding with a handheld detector. Twenty-five of these patients reported subsequently having to undergo further inspection, including additional wanding, being patted down, and in two cases having to undress in a private room to show the incision. Ninety-nine (69%) of the 143 patients reported that the prosthetic joint caused an inconvenience while traveling., Conclusions: This study provides interesting and critical information that allows physicians to understand the real-world implications of implanted orthopaedic devices for patients who are traveling where there has been heightened security since September 11, 2001. Patients should be counseled that they should expect delays and be prepared for such inconveniences, but that these are often only momentary. This information could relieve some anxiety and concerns that patients may have prior to traveling.

Objective: In this pilot study we want to determine how often fear of falling occurs in geriatric patients visiting a fall clinic and to study the characteristics of fear of falling and its consequences., Design: Retrospective study of patient's records., Method: A random sample of 100 medical records of geriatric patients of the fall clinic of the Jeroen Bosch Ziekenhuis in Den Bosch was systematical examined., Results: The mean age of the patients was 79.8 +/- 6 years. Before visiting the fall clinic, the patients had a history of falling during 34.6 months, and 62% of them visited a hospital due to the consequences of falling. In the fall clinic a mean number of 2.5 probable causes per fall was diagnosed. In this study 31% of the patients had fear of falling. The demographic characteristics and the causes of falling of the patients with or without fear of falling, were almost the same. Patients with fear of falling had a hip prothesis in 26%, whereas patients without fear of falling only in 7% had a hip prothesis (P < 0.05). In patients with fear of falling, in 90% extra diagnostic investigation was needed, whereas in patients without fear of falling extra diagnostic investigation only occurred in 53% (P < 0.01). Finally, patients with fear of falling needed 1.8 more times physical therapy compared to patients without fear of falling (P < 0.01)., Conclusion: After a fall, fear of falling occurs often in geriatric patients. In this study, no causes for fear of falling could be determinated, although hip prothesis are associated with fear of falling. In patients with fear of falling more medical consumption occurs. In medical practice as in science fear of falling needs more attention.

A majority of hip disarticulations are performed in young people, with malignancy being the most common cause. The exoskeletal Canadian Hip Disarticulation prosthesis had been widely used as a standard total hip disarticulation prosthesis until recently when an endoskeletal modular version became the prosthesis of choice. However, the "basket-shaped" socket provided by the standard total hip disarticulation prostheses has been a source of discomfort and a reason for prosthetic rejection by many patients. This report concerns two patients with true lower limb disarticulation at the hip joint. Both of the patients failed to adapt to the standard total hip disarticulation prosthesis but successfully used a new total contact suction socket design. This new prosthesis provided improved suspension, better patient compliance, and enhanced prosthetic acceptance and mobility.

This paper reports the results of a descriptive study of elderly subjects undergoing orthopaedic hip surgery under two qualitatively different events; planned surgery for hip replacement and unplanned emergency surgery following hip fracture. Its purpose was to describe sleep satisfaction, pain perceptions and psychological concerns of subjects undergoing similar procedures but having differential contexts for their experience and different outcomes. Delirium is a common phenomenon following orthopaedic hip surgery. The extent to which an individual's integrity is disrupted by psychological distress, pain and changes in sleep satisfaction as manifested by delirium was investigated. The results revealed that the context or nature of the experience strongly influences the perceptions of subjects despite their having undergone treatments of similar magnitude and their having received similar postoperative care. Pain was greater for unplanned surgery subjects and in particular for unplanned surgery subjects who succumbed to delirium. Sleep satisfaction was markedly poorer among subjects who experienced delirium. The findings are discussed with respect to nursing practice priorities and attitudes toward pain management.

This study aimed to understand what post-operative patients perceived was important about the nursing care they had experienced. The participants were nine women recovering from total hip replacement surgery which had been performed in a large public, acute care hospital in south Australia. Participants volunteered to be involved in the study and were interviewed pre- and post-operatively and interviews continued in their home environment following discharge. The study took place during 1995 within a 10-month time frame. Methodological guidance was sought from the phenomenology literature, with the ideas from Husserl and Heideggar providing shape for the interpretive framework. The analysis of data utilized Colaizzi's (1978) seven procedural steps. For the purposes of this paper the authors have selected to focus only on the findings of this study. Two major themes emerged from the conversations with women. Patients described nurses as being engaged or detached with their nursing care. These themes will be explicated in this paper. In the light of these dominant themes the nursing literature around engagement and detachment are examined. The implications for nursing practice are discussed.

Although there have been many studies focusing on the increasingly important assessment of patients' satisfaction, few studies have specifically addressed this tissue for total hip arthroplasty (THA). The goals of this study were to measure patients' satisfaction with THA and to evaluate the relationships of expectations and outcome to patients' satisfaction. A total of 180 patients were surveyed 2 to 3 years after THA about their experiences with THA. Patients cited 45 different expectations, which were grouped into five categories reflecting improvement in pain, walking, psychological state, essential activities, and nonessential activities. Overall, 89% of patients were satisfied with the results of surgery. Lower rates of satisfaction were found in patients who had a better preoperative condition (as measured by the surgeons with The Hospital for Special Surgery Hip Scale), in patients who expected improvement in nonessential activities, and in patients who reported worse postoperative condition (as measured by self-assessment with the Hip Rating Questionnaire and the Medical Outcomes Study Short-form General Health Survey). Patients were also asked how they came to THA. Nearly 50% of patients were first referred to an orthopaedist by family or friends or based on their own knowledge. Seventy-four percent either had subsequently referred others for THA or would have done so if they knew someone with hip pain. This study demonstrates that satisfaction with THA is a complex phenomenon, affected by expectations, outcome, and what patients know about the procedure from their community network. A better understanding of THA satisfaction will enable better future selection of patients and an additional dimension of outcome, both of which are important to patients and payers.

Background: Assessment of total hip replacement has been performed without careful attention to the patients' perceived health. The objective of this study is to assess, in a standardized way, the benefit of hip replacement in terms of hip pain, mobility, and function and as an increase in general perceived health. And to quantify clinical complications of the procedure., Patients and Methods: Observational study of a series of 131 consecutive patients of a tertiary hospital to whom two health questionnaires (one specific and the other generic) were administered before and one year after total hip replacement. The specific instrument, the Hip Pain and Function (HPF) scale, measures the functional capacity of the hip gathering information on pain, function and mobility. Scores for the HPF range from 0 (maximal limitation of functional capacity) to 85 (no limitation). The generic instrument used, the Nottingham Health Profile (NHP) measures perceived health and scores range from 0 (best health status) to 100 (worse)., Results: Mean age of patients was 63 years; ostheo-arthritis was the most frequent diagnosis (78%), with 42% of the patients with associated pathology. An improvement in both hip functional capacity and perceived general health was observed after one year. HPF scores increased from 26.6 at baseline to 69.9 (p < 0.001). Improvements was important and statistically significant in each of the three dimensions of the specific instrument: Pain, Function and Mobility. Overall score for the NHP changed from 50.9 (at baseline) to 18.1 (p < 0.001). Regression analysis showed only two variables associated with improvement: a higher improvement hip function for patients with no other joints affected; and a higher improvement of perceived health in patients over 70 years with cemented prosthesis, that had a worse initial perceived health status., Conclusion: Total hip replacement decreases pain and significantly improves hip mobility and function, as well as the general perceived health. The improvement of perceived health was higher in patients over 70 years.

The objectives of this study were to assess the impact of major joint replacements in reducing pain and disability and to describe the burden of pain and disability that could be avoided by ordering the queues with respect to severity of disease. A secondary goal was to compare the uses of a general health status measure, the Short Form Health Survey (SF-36), and a disease-specific measure, the Western Ontario McMaster Osteoarthritis Index (WOMAC), for accomplishing the objectives. The results are based on interviews with 209 patients before and after they had surgery. Only 15.9% of the patients had surgery within 3 months' waiting time, 19.2% waited 4-6 months, 30.7% waited 7-9 months, and the remaining 34.1% waited a year or more. The waiting times were unrelated to the severity of pain or disability reported in the initial interview. Following surgery, there were large reductions in the WOMAC scores for pain, stiffness and difficulty in functioning. The SF-36 showed substantial improvements in relief from pain and in physical functioning, and reductions in role limitation due to physical problems, but not for scores related to mental health. The WOMAC scores were more responsive to the benefits of surgery than the SF-36 scores. Queuing systems keyed on burden of symptoms could reduce the burden of pain and disability suffered by patients awaiting surgery. The improvements from hip and knee replacements suggest that equitable access for these procedures should be a priority in Ontario.

The functional results in terms of quality of life 10 to 20 years after cemented total hip arthroplasty due to primary arthrosis were evaluated in 187 patients with nonrevised hips by use of the Nottingham Health Profile questionnaire. Function was impaired compared with age- and sex-matched random control subjects.

The aim of the study was to evaluate the effect of preparatory information on a patient's post-operative physical coping outcomes following a Total Hip Replacement (THR). The research design was quasi-experimental. Eighty-two healthy individuals, scheduled for an elective THR were used and selected using non-random techniques, and placed into one of two groups on an alternating basis. 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 provided for each experimental subject to support the verbal information. Subjects in the control group only received the advice and support that would routinely be given to THR patients by ward, medical and nursing staff. The study measured a number of physical outcomes using a "Physical Indicators of Coping Questionnaire" developed to measure physiological and physical outcomes post-operatively. In addition, a Linear Analogue Coping Scale was developed to assess a patient's personal perception of their overall coping ability with the THR. The study demonstrated that preparatory information, given pre-operatively, post-operatively and pre-discharge had positive effects on the physical recovery and coping outcomes measured. Subjects in the experimental group had significantly less post-operative intramuscular analgesia, mobilized sooner with a Zimmer frame and walking sticks and lastly, their length of stay was on average, 2 days less than the control group. The Linear Analogue Coping Scale demonstrated that patients in the experimental group did perceive they were coping more effectively post-operatively. Preparatory information of various types and in different forms appear to have positive effects on the ability of patients to cope with and recover physically from a THR in the immediate post-operative period.

In-hospital education can reduce anxiety, improve coping and shorten hospital stays of surgical patients. However, hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching. This study evaluated prehospital education for total hip replacement (THR) surgery. Half of the patients waiting for admission for THR surgery were randomly selected to receive a THR education booklet in the mail 4-6 weeks before their scheduled THR surgery. Compared to the No-Booklet patients, patients who had received the booklet were less anxious at the time of hospital admission and at discharge, were more likely to have practised physiotherapy exercises prior to hospitalization, and required significantly less occupational therapy and physiotherapy while in hospital. There were no group differences for length of hospital stay.

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 nonrandom 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 standard questionnaires, Hospital Anxiety and Depression Scale (HADS) measuring anxiety and depression, Rosenburg Self-Esteem Scale measuring self-esteem, and Health Illness Questionnaire 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 standard questionnaires. 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.

There are many studies of long-term recovery from major point arthroplasty, but little is known about the first days and weeks after operation. We measured function, emotional state and life evaluation before arthroplasty and at seven and 50 days after in a consecutive series of 40 hip and 23 knee replacements. Pain was relieved significantly at seven days after hip arthroplasty and even more at 50 days. In knee patients, pain relief was modest and was not apparent until 50 days. Functional ability was much improved by 50 days in hip patients, but hardly changed in knee patients. Positive mood and life satisfaction did not improve in either group. Our findings will help with more accurate information for patients before operation and also in judging the rate of recovery.

Objectives: To compare the performance of a disease specific and a general health questionnaire in assessing changes resulting from total hip replacement., Design: Two stage prospective study of patients undergoing total hip replacement surgery involving an assessment at a clinic before and six months after surgery. 60(32%) patients were followed up by post., Setting: Outpatient departments at a specialist orthopaedic hospital and peripheral clinics within Oxfordshire., Patients: 188 patients admitted for unilateral total hip replacement between February and mid-August 1994., Main Measures: Patients' self assessed scores with the 12 item Oxford hip score and SF-36 general health questionnaire together with surgeons' assessment with Charnley hip score obtained before and again at six months after surgery., Results: 186 patients were followed up six months after total hip replacement; a subsample (n=60) by post. Of the 60 postal patients, 59(98.3%) fully completed the Oxford hip score compared with 44(73.3%) who fully completed the SF-36. For the followup sample as a whole, post operative changes in scores produced a large effect size of 2.75 on the Oxford hip score, compared with -1.89 physical function (SF-36), -2.13 pain (SF-36). With the exception of physical function and role (physical), postoperative SF-36 scores were shown to be similar to or better than those found by two population surveys on patients of comparable age. The responsiveness of a disease specific questionnaire, the Oxford hip score, and relevant sections of a general questionnaire, SF-36, were found to be similar as assessed by three different criteria., Conclusions: A disease specific questionnaire, the Oxford hip score, and a general state of health questionnaire, SF-36, performed similarly in assessing outcomes of total hip replacement except that the disease specific questionnaire resulted in a higher completion rate and greater responsiveness in some sections. On the other hand the general health questionnaire drew attention to broader problems of physical function not considered by the Oxford hip score. The health questionnaires examined here offer a valid and practical means of monitoring outcomes of hip replacement surgery.

A prospective randomized clinical trial comparing cemented to cementless total hip arthroplasty has been ongoing at the author's institution since 1987. All parameters assessed showed that there was no statistically significant difference in any of the health related quality of life measures used when patients with cement were compared with patients without cement at any of the followup periods as many as 4 years later. The improvement was dramatic and sustained. No components (cemented or cementless) have been revised to date (average, 4.8 years). A radiographic analysis showed probable loosening of the cemented socket in 24% and presumed minimal pelvic osteolysis in 8%. The cementless sockets showed a greater frequency and severity of pelvic osteolysis (14%). The cemented femoral component was judged to be possibly loose in 10%; however, none were considered probably loose. The patients who had cementless femoral components were doing extremely well with the components showing very little subsidence or proximal stress protection noted. Osteolysis on the femoral side was not seen in any of the cementless stems. Total hip replacement gives comparable clinical results when health related quality of life measures are analyzed; however, metal backed cemented acetabular components have a high rate of radiographic failure. Short-term stability of a non-cemented porous coated titanium stem, however, gave excellent clinical and radiographic results.

The impact of hip (THA) and knee arthroplasty (TKA) on patients' health-related quality of life (HRQOL), physical ability and functioning was assessed in a two year follow-up study of 276 hip and 176 knee patients. The eligibility criteria were a diagnosis of primary arthrosis, a primary operation, and total joint arthroplasty. Patients were interviewed by questionnaire prior to the operation and 6, 12 and 24 months after the surgery. Subjective health outcomes were assessed with the Nottingham Health Profile and the 15D, a fifteen dimensional HRQOL measure. Patients' physical ability was assessed using measures of activities of daily living, and of physical mobility. Patient related outcome variations were analyzed by regression models. Major improvements were observed for pain, sleep and physical mobility. On average, in most of the quality of life dimensions the patients attained a similar quality of life as the comparable general population and only 4.7% of hip and 9.7% of knee patients had a worse HRQOL score at all three post-operative measurements than at baseline. Naturally, those with the poorest HRQOL pre-operatively gained most from the operation. High age did not lessen HRQOL gains from THA, but in TKA the oldest patients gained least in terms of 15D scores. Hip, but not knee patients with a long education tended to have greater improvements in quality of life and functional ability.

From a demographic and health policy perspective, movement and sports are gaining increased importance in terms of their preventive, therapeutic and rehabilitative potential. Successful use of sports therapy and rehabilitation sports in rehabilitating paraplegics, breast cancer patients, and patients with total hip replacement have provided convincing proof of their positive physical, mental and social impact, hence of the substantial contributions they are able to make towards enhancing specific parameters of the quality of life. It is assumed that movement and sports are conducive in particular in chronic conditions, in line with the principle of "rehabilitation taking priority over care". Whether reduced health care spending will ensue, will in the final analysis have to be determined through controlled longitudinal studies, which have not been embarked upon as yet. Successful rehabilitation in this domain presupposes adequately qualified staffing in movement therapy-focussed rehabilitation facilities, both in- and out-patient, availability of an uninterrupted rehabilitation chain as well as appropriate follow-up for evaluation.

Researchers studied the expectations and experiences related to intraoperative nursing care of patients who underwent hip replacement procedures with regional anesthesia at University Hospital, Tampere, Finland. They used patients' perspectives to develop a conceptual framework that describes quality intraoperative nursing care.

A lack of consensus regarding the indications for total hip arthroplasty (THA) and total knee arthroplasty (TKA) has been cited as one reason for the variations in the rates of THA and TKA across the United States. The purposes of this study were to survey orthopaedists in a specific geographic area (New York City) regarding the candidacy of patients with osteoarthritis for THA or TKA and to compare indications for THA between orthopaedists at two academic medical centers, The Hospital for Special Surgery in the United States and McGill University in Canada. Orthopaedists were sent mail surveys asking about indications, factors affecting outcomes, and factors that might modify decisions for surgery. Approximately 45% of orthopaedists who performed THA and TKA in New York City in 1992 completed the surveys. Although there were wide variations among surgeons, most surgeons required at least severe pain daily, rest pain several days per week, transfer pain either several days per week (THA) or daily (TKA), and destruction of most of the joint space on radiograph. Younger age, comorbidity, technical difficulties, and lack of motivation modified the decision against surgery, whereas the desire to be independent and return to work swayed the decision for surgery. Most surgeons rated that patients with severe pain, osteoarthritis, or rheumatoid arthritis would have a high likelihood of an excellent outcome, whereas those with comorbidity and certain technical factors would have only a moderate likelihood of an excellent outcome. In the U.S.-Canadian survey of THA, in which more than 90% of surgeons responded, Canadian surgeons tended to require more frequent pain and use of assistive devices for walking. Although there was a majority of opinion for several indications, there was no clear consensus among surgeons regarding the indications for THA and TKA. Possible explanations for this are that isolated indications are not as important as integrating and weighing several indications and that the patient's desire to proceed with THA or TKA is an important driving force in the decision to operate.

The Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT), the Task Force on Outcome Studies of The American Academy of Orthopaedic Surgeons, and The Hip Society reached a consensus on the nomenclature to be used for the evaluation of the results of total hip arthroplasty. The Task Force of The American Academy of Orthopaedic Surgeons, to assess the results of total hip arthroplasty from the perspective of the patient, subsequently developed a questionnaire that incorporated this nomenclature. The validity and reliability data regarding this questionnaire are reported in this study. Twenty-five patients participated in the reliability test. The non-response rate was five (0.5 per cent) of 941 possible responses. Test-retest reliability was determined by calculating the Spearman correlation coefficients for each question. The coefficients ranged from 0.41 to 1.0 over a mean test-retest interval of sixteen days. Most items had Spearman coefficients that were greater than 0.50, indicating good or excellent reliability. Validity was assessed, for the fifty-four patients who participated, by calculating the Spearman correlation coefficients for the items regarding pain in the affected hip, limitation of usual activities, capacity for walking without support, and the Sickness Impact Profile. The coefficients ranged from 0.11 (pain and limitation of activity) to 0.56 (Sickness Impact Profile and limitation of activity). These coefficients reflected modest associations, as anticipated, indicating that pain, function, and health status are related yet distinct concepts.(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of hip and knee arthroplasty based on the patients' own evaluations of their health, quality of life, and physical ability was assessed using a cross-sectional study design. The eligibility criteria were a diagnosis of primary arthrosis, primary operation, and total joint arthroplasty. Preoperative hip and knee patient groups were compared with similar groups who underwent arthroplasty 2 or 5 years previously. Subjective health outcome was assessed with the Nottingham health profile and a 15-dimensional, health-related quality of life measure. Patients' physical ability was assessed using a measure of activities of daily living. Major improvements were observed for pain, sleep, range of motion, and physical ability. However, after surgery, patients were less healthy than the general population of the same age. The health status of patients operated on 2 or 5 years ago was similar, suggesting that health gains persist for several years.

Measuring the success of major surgeries such as total hip and total knee replacement is important for both case selection and public policy. Patients, purchasers, and practitioners must choose among clinical scoring systems, health status measures, and patient satisfaction ratings to monitor performance and ensure appropriate use of costly procedures. The present study compares results from the Medical Outcomes Study Short Form 36 (SF-36) Health Status Survey and clinical scoring systems to direct patient ratings of success. Data come from a study of 128 total knee-replacement procedure and 211 total hip replacements. Analyses indicate that for both hip and knee patients, success is related closely to posttreatment physical function and bodily pain. Patient ratings of success also are related to the clinical scores used by physicians. Success is related less to change from pretreatment function for knee patients than for hip patients. Although patient ratings of success are generally consistent with other outcome measures, their relationship to patient expectations, satisfaction, and attributions need to be understood before they can become a useful tool for performance monitoring and case selection.

The outcome of elective hip arthroplasty in 11 mentally impaired patients was compared with a cohort of 244 mentally competent patients. The impaired patients had a diagnosis of cerebral palsy, schizophrenia, or Down's syndrome, and were unable to give their own surgical consent. Major complications requiring additional surgery occurred in 5 of the mentally impaired patients. Three patients sustained fractures of the femur below the stem and were treated with plating, 1 developed a deep infection requiring prosthesis removal, and 1 developed a thoracic decubiti with bone involvement requiring debridement and rotation flap coverage. Three of these patients also developed urinary tract infections. Of the other 6 mentally impaired patients, 3 developed urinary tract infections, and 1 had a deep venous thrombosis. Functional independence was improved after surgery in the mentally impaired patients. However, the average cost of hospitalization, length of stay, and complication rate were significantly higher (p < 0.05) than those of the mentally competent patients.

Four to 12 years after primary treatment of femoral neck fracture with hemiarthroplasty in a group of Finnish patients and secondary total hip arthroplasty as a salvage procedure for healing complication after primary osteosynthesis in a group of Swedish patients, function was classified and the Nottingham Health Profile questionnaire was applied. The two groups were comparable with regard to age, sex, and social status. The patients with secondary total hip arthroplasty used walking aids to a lesser extent than the patients with hemiarthroplasty and experienced less problems in several aspects of life. Walking ability was considered unchanged, compared to prefracture, to a larger extent in the secondary total hip arthroplasty group. Thus, secondary total hip arthroplasty in patients with healing complication following primary osteosynthesis gives better long-term functional capacity than that obtained with a primary hemiarthroplasty.

The impact of total hip arthroplasty on psychological functioning was examined in 51 patients; 25 females and 26 males with a mean age of 65 years (range 42-81 years). Assessments of psychological well-being and distress were made with the Mental Health Inventory. Life satisfaction, self-rated health, and pain ratings were also obtained. Assessments were made prior to surgery, immediately after surgery, and at a 2 month follow-up. The operation produced significant improvements in psychological well-being (P < 0.001), psychological distress (P < 0.001), life satisfaction (P < 0.01), self-rated health (P < 0.001), and pain (P < 0.001). It is concluded that the changes in medical and functional status following hip arthroplasty documented in previous research are accompanied by substantial improvements in psychological state, and that the inclusion of psychological factors in hip arthroplasty research will provide a more comprehensive assessment of outcome.

A case-matched study was performed to assess the social effects of surgical complications of operative fixation of fractures of the proximal femur. Fifty-two patients aged over sixty-five, half with deep wound infection, the remainder with serious early mechanical problems requiring revision surgery to correct these, had their hospital fatality, length of stay, mobility and social dependency at admission and on discharge compared with patients free from such complications. Deep wound infection was associated with a high fatality and in the survivors a prolonged period in hospital, a marked decline in mobility and without exception a great increase in social dependency; patients having revision surgery had a longer hospital admission, considerable alteration in social circumstances but a little decline in mobility and no significant increase in fatality when compared with matched cases.

Objective: To test the reliability of the Danish version of the Nottingham Health Profile., Design: Test-retest reliability with an interval of four weeks between administrations of the measure., Setting: Copenhagen., Participants: Seventy patients suffering from osteoarthrosis, living at home and awaiting hip-replacement operation. The patients' ages ranged from 37 to 90 years, with a median of 72 years., Outcome Measure: The Danish version of the Nottingham Health Profile, a measure of perceived health status, widely used in Europe. The measure consists of six sections; pain, physical mobility, energy level, sleep, social isolation, and emotional reactions., Results: The respondents scored highly on the measure, particularly on the pain, physical mobility, and energy sections. No major differences in scores associated with age or sex were found. The test-retest correlation coefficients obtained for the six sections were high (ranging from 0.76 to 0.86) and comparable with those found in Sweden and the UK. The test-retest correlation for the whole measure was 0.93., Conclusion: The Danish version of the Nottingham Health Profile has been shown to be reliable and to be acceptable and relevant to patients with chronic disability. Should the formal tests of validity currently in progress prove satisfactory, Danish clinicians and researchers will have a valuable tool available for gaining insight into the impact of illness and its treatment on patients.

About 6,000 patients undergo total hip replacement in Norway each year. 2.2% of them are women of fertile age, and 14% of them need hip replacement because of inflammatory rheumatic disease. Female patients may wish to know about possible consequences of hip arthroplasty on sexual activity or pregnancy and delivery. An inquiry on these issues was carried out among Norwegian orthopaedic surgeons and obstetricians. The results of the inquiry and a review of the literature can be summarized as follows: Uncomplicated total hip replacement does not preclude normal delivery nor interfere with sexual activity. Some restrictions as regards sexual activity may be advisable during the first three months after hip arthroplasty. Patients with widespread joint or muscle involvement due to inflammatory arthritis need individual counselling. As a rule, pre- and postoperative information to female patients undergoing total hip replacement should take up the possible consequences for sexual activity and reproduction.

Data on disease severity, co-morbidity, and process of care were obtained from the medical records of 356 patients without rheumatoid arthritis undergoing a first unilateral total hip replacement at four teaching hospitals in California and Massachusetts. Socio-demographic characteristics, functional status prior and subsequent to hospitalization, and improvement in health status were measured with a patient questionnaire 12 months after discharge. Completed questionnaires were received from 284 patients, a response rate of 79.8%. The questionnaire was acceptable to patients, reliable, and had good construct validity. The data indicate substantial benefits from hip arthroplasty. As expected, pre-surgical functioning was a strong predictor of outcomes 1 year after surgery. Controlling for pre-surgical functioning, age was not related to outcomes.

Short measures of health status are used increasingly in health services research, yet their sensitivities to clinical change have not been compared with longer, established instruments. In this study, 5 health status measures were administered preoperatively and 3 months postoperatively to 54 patients undergoing total hip arthroplasty. These instruments included the Sickness Impact Profile (SIP)--an established, long measure--and 4 short forms: the SF-36, Functional Status Questionnaire, shortened Arthritis Impact Measurement Scales, and Modified Health Assessment Questionnaire. Scores for physical, psychological, and global dimensions were constructed by aggregating subscales. Sensitivity to change, or responsiveness, was expressed with the standardized response mean (SRM), calculated as the mean change in score divided by the standard deviation of the change in score. The sampling distribution of the SRM was estimated with a jackknife procedure. Preoperative scores were moderately to highly correlated across instruments. The physical and global dimension SRMs of the brief health status measures ranged from 0.85 to 1.27 and were as large as or larger than the corresponding SIP SRMs. The SIP had the highest SRM on the psychological dimension. None of the instruments was significantly more sensitive than the others at the critical value (P = 0.005) adjusted for multiple comparisons. The brief health status measures were equally or more responsive than the SIP after total hip arthroplasty in the physical and global dimensions. Much larger samples are required to demonstrate statistically significant differences in SRMs among instruments.

Social and psychological status of 40 female patients was studied, 1-3 years after total hip replacement by Mittelmeier method. The evaluation included standard tests of high reliability degree for medical purpose, like life goals ranking by Pleszewski and the semantic differential method by Osgood, Suci and Tannenbaum. Also a questionnaire was applied to analyse the situation and the subjective feelings of the patients after the surgery. The performed studies assure the positive aspect of operation and help in creating further life perspectives. The obtained output of the analysis was referred to the clinical results of the performed hip operation. Regarding the very good and good clinical results, the psychological and social feelings of the patients were connected and identified with psychological and environmental factors rather than with the very clinical result of the operation.

From 1973 to 1976, McKee-Farrar total hip arthroplasties were performed in the Orthopaedics Department at the Centre of Pulmology. In the present study, only patients with a complete record of radiological changes at the bone/implant or bone/cement interface were evaluated. A series of 81 patients with 100 total hip prostheses in situ according to the Mayo Clinic hip score and 36 patients who had undergone 36 revision operations were studied. The design of the metal cup with metal studs at the outer surface has a favourable effect on the stability of the implant/cement combination: loosening at the implant/cement interface did not occur in any of these cases and there were few cement fractures. In spite of the metal-to-metal combination, abrasion is slight and there is no danger of metallosis.