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Fulltext Patient-reported Outcome Measures of Revision Total Hip Arthroplasty for Prosthetic Joint Infection is not Inferior to Aseptic Revision Total Hip Arthroplasty

Lim J, Pang HN, Tay K, Chia SL, Yeo SJ, Lo NN

Malays Orthop J, 2020 Nov;14(3):73-81.
PMID: 33403065 DOI: 10.5704/MOJ.2011.012

Introduction: This study aims to investigate whether patients undergoing two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) and one-stage revision THA for aseptic reasons have similar clinical outcomes and patient satisfaction during their post-operative follow-up. We hypothesise that the two-stage revision THA for PJI is associated with poorer outcomes as compared to aseptic revision THA.
Materials and Methods: We reviewed prospectively collected data in our tertiary hospital arthroplasty registry and identified patients who underwent revision THA between 2001 and 2014, with a minimum of two years follow-up. The study group (two-stage revision THA for PJI) consists of 23 patients and the control group (one-stage revision THA for aseptic reasons) consists of 231 patients. Patient demographics, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford Hip Score (OHS), Short Form-36 (SF-36) scores and patient reported satisfaction were evaluated. Student's t-test was used to compare continuous variables between the two groups. Statistical significance was defined as p <0.05.
Results: The pre-operative demographics and clinical scores were relatively similar between the two groups of patients. At two years, patients who underwent revision THA for PJI reported a better WOMAC Pain Score and OHS as compared to aseptic revision THA. A similar proportion of patients were satisfied with their results of surgery in both groups (p=0.093).
Conclusions: Although patients who underwent revision THA for PJI had poorer pre-operative functional scores (WOMAC function and SF-36 PF), at two years follow-up, these two groups of patients have comparable post-operative outcomes. Interestingly, patients who had revision THA for PJI reported a better clinical outcome in terms of OHS and WOMAC Pain score as compared to the aseptic group. We conclude that the revision THA for PJI is not inferior to aseptic revision THA in terms of patient satisfaction and clinical outcomes.
Fulltext Comparative demographics, ROM, and function after TKA in Chinese, Malays, and Indians

Siow WM, Chin PL, Chia SL, Lo NN, Yeo SJ

Clin Orthop Relat Res, 2013 May;471(5):1451-7.
PMID: 23299954 DOI: 10.1007/s11999-012-2776-7

There is marked racial disparity in TKA use rates, demographics, and outcomes between white and Afro-Caribbean Americans. Comparative studies of ethnicity in patients undergoing TKAs have been mostly in American populations with an underrepresentation of Asian groups. It is unclear whether these disparities exist in Chinese, Malays, and Indians.
Direct and indirect costs of osteoarthritis in Singapore: a comparative study among multiethnic Asian patients with osteoarthritis

Xie F, Thumboo J, Fong KY, Lo NN, Yeo SJ, Yang KY, et al.

J Rheumatol, 2007 Jan;34(1):165-71.
PMID: 17216684

OBJECTIVE:
To estimate and compare the direct and indirect costs of osteoarthritis (OA) in multiethnic Asian patients with OA in Singapore.

METHODS:
The study was a retrospective and cross-sectional design. Patients were stratified according to ethnicity and presence or absence of joint surgery. Direct costs were estimated from both a societal and a patient perspective using the Singapore General Hospital database; indirect costs were estimated using the human capital approach. All costs were expressed as mean costs per patient per annum in 2003 Singapore dollars.

RESULTS:
A total of 1179 patients (83.6% Chinese, 7.2% Malay, 3.5% Indian, 5.7% others) were included in estimating direct costs, of which 513 (43.5%) had total knee replacement (TKR) and 92 (7.8%) total hip replacement (THR), while 105 patients (71.4% Chinese, 14.3% Malay, 14.3% Indian) were included in estimating indirect costs. Direct costs to patients ranged from 1460 dollars to 7477 dollars for Chinese, 1362 dollars-7211 dollars for Malays, 1688 dollars-6226 dollars for Indians, and 1437 dollars-12,140 dollars for other ethnic patients; direct costs to society ranged from 3351 dollars to 15,799 dollars for Chinese, 2939 dollars-15,436 dollars for Malays, 3150 dollars-10,990 dollars for Indians, and 2597 dollars-17,879 dollars for other ethnic patients. In contrast, the indirect costs ranged from 1215 dollars to 3834 dollars for Chinese, 1138 dollars-6116 dollars for Malays, and 1371 dollars-5292 dollars for Indians. However, most ethnic variations were not statistically significant.

CONCLUSION:
The economic burden of OA to society and patients increased by 3-fold or more in the patients with TKR/THR compared to those without. The ethnic differences in health resources consumed were more apparent when the disease progressed.
Fulltext Long-Term Outcomes of Articular Surface Replacement (ASR) Implant in Hip Arthroplasty: A Single Institution Review

Yuen JC, Pang HN, Woo YL, Lo NN, Keng Jin DT, Chia SL, et al.

Cureus, 2023 Mar;15(3):e36029.
PMID: 36915400 DOI: 10.7759/cureus.36029

Various metal-on-metal (MoM) total hip replacements (THRs) have been found to have high short-term failure rates due to adverse responses to metal debris (ARMD). As a consequence, several low-performing THRs have been removed off the market. The purpose of this research was to look at the at least five-year outcomes of patients who had MoM hip arthroplasty at our institution. In one specialised centre between 2007 and 2008, 24 Articular Surface Replacement (ASRTM, DePuy, Warsaw, IN, USA) MoM THRs (in 24 patients, mean age: 56.4 years) were implanted. DePuy ASR hip prosthesis for osteoarthritis or hip fractures were employed in the THR system. All patients were summoned back for a clinical assessment, and imaging was done as needed. The average period of follow-up was 8.0 years (6.0-10 years). In all, eight instances (33.3%) were discovered to have pseudotumors, four hips (16.7%) were revised, and one (4.1%) was operated for ARMD. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Oxford ratings improved statistically significantly five years after surgery in all three areas of pain, disability, and stiffness; however, there was no statistically significant change in the 36-Item Short Form Survey (SF-36) (mental) score. MoM hip arthroplasty had a greater revision incidence at five years in our group, presumably owing to the adoption of a smaller femoral head size.