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Patients with end-stage osteoarthritis are recommended to engage in physical activity (PA) to reduce pain and improve function but may avoid PA due to joint pain. Our goal was to investigate patient-reported outcomes and objective mobility metrics (step counts) in total hip arthroplasty (THA) patients as a function of pre-operative PA levels. In total, 1647 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation that underwent THA and were included in analysis. The entire cohort's step count was divided into quartiles to categorize patients with low, moderate, and high baseline PA. Outcomes including pain, EQ-5D-5L, HOOS JR, and step counts were compared according to activity group by ANOVA. Pre-operative pain scores were lowest, with smallest improvements, in the high-baseline PA group. Low-PA patients demonstrated the greatest improvements in EQ-5D-5L, while changes in EQ-VAS, HOOS JR, and satisfaction were similar between groups. Low- and moderate-PA patients increased physical activity by six weeks, reaching 180% and 114% of pre-operative steps; high-PA patients did not return to full step counts until one-year post-operation. Patients who perform high levels of PA undergoing THA report lower levels of pain and higher function pre-operatively but may appreciate less improvement in PA up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations prior to surgery. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA. [ABSTRACT FROM AUTHOR]

Advances in algorithms developed from sensor-based technology data allow for the passive collection of qualitative gait metrics beyond step counts. The purpose of this study was to evaluate pre- and post-operative gait quality data to assess recovery following primary total knee arthroplasty. This was a multicenter, prospective cohort study. From 6 weeks pre-operative through to 24 weeks post-operative, 686 patients used a digital care management application to collect gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-samples t-test. Recovery was operationally defined as when the respective weekly average gait metric was no longer statistically different than pre-operative. Walking speed and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-operative (p < 0.0001). Walking speed recovered at 21 weeks (1.00 m/s, p = 0.063) and double support percentage recovered at week 24 (32%, p = 0.089). Asymmetry percentage was recovered at 13 weeks (14.0%, p = 0.23) and was consistently superior to pre-operative values at week 19 (11.1% vs. 12.5%, p < 0.001). Step length did not recover during the 24-week period (0.60 m vs. 0.59 m, p = 0.004); however, this difference is not likely clinically relevant. The data suggests that gait quality metrics are most negatively affected two weeks post-operatively, recover within the first 24-weeks following TKA, and follow a slower trajectory compared to previously reported step count recoveries. The ability to capture new objective measures of recovery is evident. As more gait quality data is accrued, physicians may be able to use passively collected gait quality data to help direct post-operative recovery using sensor-based care pathways. [ABSTRACT FROM AUTHOR]

In total hip arthroplasty (THA), proximal femoral neck stem modularity (PFNSM) has theoretical advantages over nonmodular stems, including the ability to more closely reconstruct anatomy and improve stability. However, risks of metallosis and breakage at the junction must be considered. In this study, we compared the head centers of a modular neck system with that of its nonmodular counterpart. Of 463 primary THAs with a modular stem, 261 (56%) had a head center equivalent to that of its nonmodular counterpart, and an additional 132 (29%) had a head center within 4 mm in length and 2 mm of offset. Thus, only 70 stems (15%) had a head center that was more than 4 mm in length and more than 2 mm in offset different from the nonmodular stem. Only 12 stems had a verted neck. These findings suggest that, in a majority of primary THAs, use of a modular stem results in head center positions also achievable with a nonmodular stem. Given the risks of modularity, PFNSM should be used with caution. We recommend PFNSM in cases that cannot be reconstructed with the nonmodular option.

Controversy exists concerning pin placement for supracondylar humerus fractures in children. Both crossed pin and lateral only pin configurations have shown good results; however, prospective studies are lacking. We present a prospective, surgeon-randomized study comparing crossed pin (group A, n = 20) versus preferential lateral only pin (group B, n = 20) fixation for displaced supracondylar humerus fractures. There was no difference in Baumann's angle (P>0.75), the humerotrochlear angle (P>0.85), or final elbow range of motion (P>0.25). Both groups had stable reductions and clinically normal alignment. The only complication in both groups was a transient ulnar nerve irritation, despite no intraoperative evidence of nerve violation with a nerve stimulator. One patient in each group required modification of the operative plan. In group B, one patient had a medial pin inserted because of medial comminution extending proximally limiting available lateral pin placement. In group A, the surgeon elected to use lateral pins only because of an obviously subluxating ulnar nerve. In conclusion, we recommend orthopedic surgeons treating unstable pediatric supracondylar humerus fractures be facile with both medial and lateral pin placement.