Original ArticlesComparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates
Abstract
Functional measures (fast self-paced walk test, stair climb, and timed up and go) and a self-report measure of function (Lower Extremity Activity Profile) were assessed in 1,805 total hip (761) and knee (1044) arthroplasty candidates (1,063 women, 742 men) preoperatively. Women represented 59% of the study subjects and showed greater disability than men (P [le ] .001) in the physical performance and self-report measures. Although the hip arthroplasty group perceived greater functional disability and less satisfaction, the impact of osteoarthritis on the hip and knee was similar in terms of walking and stair performance. Overall, there was low-to-moderate correlation between the self-report and physical performance measures (r = .21[ndash ].50).
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Sex-related differences in PROMs prior to the outcome: comparison of preoperative PROMIS physical function scores in female vs. male patients undergoing shoulder arthroplasty
2023, JSES InternationalPatient-reported outcome measures (PROMs) are increasingly used to evaluate outcomes in patients undergoing shoulder arthroplasty. The Patient-Reported Outcome Measures Information System (PROMIS) is popular due to low cost and question burden. Females have been reported to have lower postoperative PROMIS scores after shoulder surgery, but studies have not focused on a dedicated cohort of shoulder arthroplasty patients or examined upstream differences in preoperative scores. This study aimed to characterize sex differences in baseline PROMIS scores among anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) patients.
Data were collected over a 9-month period. Demographics, Charlson Comorbidity Index (CCI), smoking status, BMI, American Shoulder and Elbow Surgeons (ASES) scores, PROMIS Pain, Physical Function (PF), Upper Extremity, Depression, and Anxiety scores, as well as Single Assessment Numeric Evaluation (SANE) scores were collected. Student t-tests were performed to determine correlation with baseline PROMs. A minimal clinically important difference (MCID) of 4 was used to determine if a PROMIS score difference between groups was clinically important. Significance was set as P < .05.
A total of 88 females (34 TSAs 54 rTSA) and 99 males (35 TSA, 64 rTSA) were enrolled. Only sex showed a correlation with preoperative PROMIS score. In rTSA patients, females had significantly lower preoperative PROMIS PF scores (P < .05). Among females undergoing TSA vs. rTSA, lower preoperative PROMIS PF scores were found in rTSA (P < .05). These differences exceeded the MCID of 4. The same difference was not found in men undergoing TSA vs. rTSA.
Preoperative sex-based differences in PROMIS scores are underappreciated in the shoulder arthroplasty literature. This is the largest study to date focusing on sex-based differences among a dedicated cohort of TSA and rTSA patients, showing a difference in baseline PROMIS scores between males and females above the MCID. These findings suggest that PROMIS scores are affected by sex-based baseline differences in rTSA patients. Further study should investigate sex-based differences in baseline scores to determine their effects on ultimate outcome.
Functional characteristics associated with hip abductor torque in severe hip osteoarthritis
2021, Musculoskeletal Science and PracticeHip abductor weakness due to the progression of hip osteoarthritis (OA) commonly causes poor functional mobility. The hip abductor strength has also been identified as a clinically relevant factor for successful functional outcomes after total hip arthroplasty.
This study aimed to examine the functional characteristics related to hip abductor torque in patients with hip OA.
A cross-sectional survey study.
One hundred and eight female patients with severe unilateral hip OA participated in this study. Hip abductor torque and pain were measured. The muscle cross-sectional area (CSA) and skeletal muscle density (SMD) of the gluteal muscles were also measured using computed tomography. To identify the hip parameters associated with hip abductor torque, multiple regression analysis was performed. The healthy model included the CSA and SMD of gluteus maximus, gluteus medius, and gluteus minimus; range of motion in hip abduction; age; and body mass index. The affected model included hip pain in addition to the healthy model.
In the affected limb, multiple regression analysis identified pain and angle of hip abduction as factors that determine hip abductor torque (Adjusted R2 = 0.39). In contrast, our analysis identified CSA and SMD of the gluteus medius and SMD of the gluteus minimus as the significant variables related to hip abductor torque in the healthy limb (Adjusted R2 = 0.40).
The findings of this study indicated that it is necessary to consider that hip pain may inhibit muscle exertion and contraction while training to improve the hip abductor torque in the affected limb.
The reliability and validity of the animated activity questionnaire in the Turkish population with knee and hip osteoarthritis
2021, Egyptian RheumatologistActivity limitation is one of the most common causes of disability in people with knee and hip osteoarthritis (OA). The present study aimed to determine the reliability and validity of the Turkish adaptation of Animated Activity Questionnaire (AAQ) in patients with hip and knee OA.
Two hundred knee and hip OA patients aged 18–80 were assessed using the AAQ. Internal consistency and test–retest measurements were performed to determine reliability. A subgroup of 40 patients completed the AAQ again after seven days to determine test–retest reliability. In order to validate Turkish version of the AAQ, all patients completed the AAQ, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS) and Hip Disability and Osteoarthritis Outcome Score-Physical Function Short form (HOOS-PS). Another subgroup of 136 patients performed the timed up and go (TUG) test, the 30-second chair stand test (CST), and the stair climbing test (SCT).
The Cronbach alpha value of the AAQ was 0.94, demonstrating high internal consistency. The test–retest score of the AAQ was 0.97, which was also high. The AAQ exhibited negative and moderate correlation with the WOMAC, KOOS-PS and HOOS-PS (0.59, −0.60, and −0.49, respectively). Stronger and high correlations were determined between the AAQ and TUG, CST, SCT tests (-0.74, 0.62, and −0.58, respectively).
The study findings suggest that the AAQ is a reliable and valid tool for evaluating activity limitations in Turkish knee and hip OA patients.
The Influence of Lateral and Posterior Total Hip Arthroplasty Approaches on Muscle Activation and Joint Mechanics During Gait
2020, Journal of ArthroplastyLateral and posterior total hip arthroplasty (THA) approaches disrupt muscle function, which could impact gait. The objectives of this study were to compare muscle activation and joint mechanics during gait, and isometric strength between participants after lateral and posterior THA approaches and healthy adults.
Participants 1 year post-THA from either lateral (n = 21) or posterior (n = 21) approaches, and healthy adults (n = 21) ambulated at self-selected speeds. Surface electromyography, optical motion capture, and force plates measured muscle activation and joint mechanics during gait. A dynamometer measured isometric torque. Gait characteristics and isometric torque were compared using analysis of variance and effect sizes (d).
Lateral THA group had higher gluteus medius amplitudes during gait compared to the healthy group (P < .01, d = −0.97). Posterior THA group had higher gluteus maximus amplitudes during loading response (P = .02, d = −0.94) and higher hamstring amplitudes during midstance (P = .02, d = 0.45-1.31) than the healthy group. Both THA groups had decreased hip flexion and adduction angle excursions during gait (d = 0.89-1.14), but increased medial rotation angle excursions (d = −1.06 to −0.91), compared to the healthy group. Lateral THA group had lower isometric hip abduction torque than the healthy group (P = .03, d = 0.74). There was no pelvic drop in the THA groups.
There were few differences in gait and isometric torque between lateral and posterior THA groups. The elevated muscle activation amplitudes in the lateral and posterior THA groups compared to healthy adults were likely due to muscle weakness. Despite these findings, there was no evidence of pelvic drop.
Gender Differences for Hip and Knee Arthroplasty: Complications and Healthcare Utilization
2019, Journal of ArthroplastyThe influence of patient gender on complications and healthcare utilization remains unexplored. The purpose of the present study was to determine if patient gender significantly affected outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Retrospective cohort study of THA and TKA patients was performed using the Nationwide Inpatient Sample from 2002 to 2011. Only patients who underwent elective procedures and those with complete perioperative data were included. Multivariate logistic regression was used to compare the rates of adverse events between male and female cohorts while controlling for baseline characteristics.
A total of 6,123,637 patients were included in the study (31.2% THA and 68.8% TKA). The cohort was 61.1% female. While males had a lower rate of any adverse event (odds ratio [OR] = 0.8, P < .001), urinary tract infection (OR = 0.4, P < .001), deep vein thrombosis/pulmonary embolism (OR = 0.9, P < .001), and blood transfusion (OR = 0.5, P < .001), male gender was associated with statistically significant increases in the rates of death (OR = 1.6, P < .001), acute kidney injury (OR = 1.6, P < .001), cardiac arrest (OR = 1.7, P < .001), myocardial infarction (OR = 1.6, P < .001), pneumonia (OR = 1.1, P < .001), sepsis (OR = 1.6, P < .001), surgical site infection (OR = 1.4, P < .001), and wound dehiscence (OR = 1.4, P < .001).
Males had increased rates of many individual adverse events. Females had higher rates of urinary tract infection, which translated to an overall higher rate of adverse events in females because of the rarity of the other individual adverse events.
Responsiveness of Isokinetic Dynamometry in Patients with Osteoarthritis after Knee and Hip Arthroplasty: A Prospective Repeated-Measures Cohort Study
2024, Healthcare (Switzerland)