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Which Functional Assessments Predict Long-term Wear After Total Hip Arthroplasty?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There is a paucity of literature concerning functional assessment at long-term followup of THAs in general and in young patients specifically. Functional data may be useful in determining differences in the performance of various implants and surgical techniques in THA.

Questions/purposes

The purposes of this study were to evaluate a group of young patients who were still active 10 years after THA to determine (1) which functional tests and (2) which patient-reported outcome assessments predicted long-term THA function, as measured by acetabular UHMWPE wear, and (3) whether medical comorbidities influenced patient performance on activity tests and patient outcome questionnaires.

Methods

Fifty patients (58 hips) 50 years and younger at the time of THA were followed clinically and radiographically for a minimum of 10 years. All patients wore step activity monitors for up to 21 days, performed 6-minute walk (6-MW) tests, and every patient had minimum 10-year radiographs and sequential radiographs evaluated for wear using edge detection techniques. Mean age and BMI at surgery were 39 years and 29 kg/m2, respectively.

Results

Patients who walked more as determined by step activity monitor (average daily steps) had more linear acetabular UHMWPE wear per year and more volumetric wear per year. The 6-MW, University of California Los Angeles (UCLA), and Tegner Lysholm scores did not correlate with acetabular wear. Mean 6-MW distance was 335 m and pedometer data averaged 1.56 million steps per year. Average UCLA and Tegner Lysholm scores were 6 and 3, respectively. Mean linear wear rate was 0.266 mm/year; mean volumetric wear rate was 82.6 mm3/year. The number of comorbid medical conditions had a detrimental effect on our activity parameters and outcomes questionnaires, but the relationships were not statistically significant.

Conclusions

Of functional tools measured, only pedometer data correlated with THA polyethylene wear. Obtaining pedometer data should be considered when trying to distinguish differences in various hip arthroplasty designs and techniques over the long term.

Level of evidence

Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Douglas R. Pedersen PhD, and Alison Klaassen MA, for their contributions to the study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Iowa Health Care, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01029 JPP, Iowa City, IA, 52242, USA

    Ryan K. Takenaga MA, MD, John J. Callaghan MD, Nicholas A. Bedard BS, Steve S. Liu MD & Yubo Gao PhD

  2. VA Medical Center, Iowa City, IA, USA

    John J. Callaghan MD

Authors
  1. Ryan K. Takenaga MA, MD
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  2. John J. Callaghan MD
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  3. Nicholas A. Bedard BS
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  4. Steve S. Liu MD
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  5. Yubo Gao PhD
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Corresponding author

Correspondence to John J. Callaghan MD.

Additional information

One author (JJC) certifies that he has or may receive payments or benefits, in any one year, an amount in excess of USD1,000,000, from a commercial entity (DePuy Orthopaedics Inc, Warsaw, IN, USA) not directly related to this work. In addition, the same author (JJC) certifies that he has or may receive payments or benefits, in any one year, an amount less than USD10,000, from a commercial entity (Lippincott, Williams & Wilkins, Philadelphia, PA, USA) not directly related to this work. One author (JJC) certifies that he is a consultant for DePuy (DePuy Orthopaedics Inc, Warsaw, IN, USA). Each author (RKT, NAB, SSL, and YG) certifies that he or she, or a member of their immediate family, has no commercial associations (eg consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

The authors acknowledge the Bierbaum Research Fund for funding resident research in hip arthroplasty.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

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Takenaga, R.K., Callaghan, J.J., Bedard, N.A. et al. Which Functional Assessments Predict Long-term Wear After Total Hip Arthroplasty?. Clin Orthop Relat Res 471, 2586–2594 (2013). https://doi.org/10.1007/s11999-013-2968-9

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