Is operative revision associated with favorable clinical outcomes in arthrofibrosis following total hip arthroplasty (THA)? An initial retrospective, single-center data analysis of 42 cases

doi:10.21203/rs.3.rs-5198515/v1

Purpose:

Clinical outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA) have not been published to date. Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical outcome following surgical intervention for histologically verified endoprosthesis-associated arthrofibrosis of the hip after THA.

Methods:

This study enrolled 7983 THA revision procedures during the study period, in 51 cases arthrofibrosis has been histologically confirmed based on the synovial-like interface membrane (SLIM) criteria. For the final statistical analysis 42 cases (59.5 % women) with an average age of 63.6 years were included, achieving a follow-up rate of 82.6 % with a mean follow up of 70 months. Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). In addition to the complication and revision rates, the Harris Hip Score (HHS) and the EQ-5D-3L questionnaire were analysed for all cases at the time of follow-up.

For the risk analysis of a poor clinical outcome (HHS <55), the study cohort was divided into two different groups.

Results:

Open arthrolysis was performed in all cases (100 %), with a mobile component being replaced in 73.8 % of cases (n = 31) and only two cases requiring additional replacement of the femoral and acetabular components due to aseptic loosening.

The Harris Hip Score (HHS) had a mean value of 53.2 before revision surgery and increased significantly postoperatively to a mean value of 65.7 (p < 0.001). It is noteworthy that only 34.1 % of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37).

Complications occurred in seven cases (16.7 %,), with dislocation in 2 cases and persistent AF symptoms in 3 cases being the most common, accompanied by a revision rate of 14.3 % (n = 6). In three cases, a new open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4kg vs. 78.7kg, p = 0.086) and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55.

Conclusion:

The initial clinical results following surgical intervention for endoprosthesis-associated arthrofibrosis show a moderate to poor postoperative outcome with an acceptable complication rate. The type of surgical intervention does not appear to have any influence on a poor clinical outcome.

The arthrofibrosis after total knee arthroplasty (TKA) is a frequent and significant complication, with a prevalence ranging from 4–13%, leading to varying clinical outcomes[1]. A systematic review has demonstrated that the subjective patient reported outcomes (PROMs) significantly improve after surgical revision of endoprosthesis-associated arthrofibrosis in TKA [2]. However, it is important to note that this improvement is accompanied by a high revision rate, reaching up to 25%[2]. In comparison to other aseptic revision procedures, there is a tendency for a less favorable clinical outcome [3]. Although arthrofibrosis following TKA has been extensively examined in the literature, its pathogenesis remains incompletely understood.

Gehrke et al.[4] succeeded in histologically confirming arthrofibrosis following the primary implantation of total hip arthroplasty (THA), thereby providing the initial description of this condition in hip joints. In a review article, the ENDO clinic research group outlined potential therapeutic approaches, including both conservative and surgical interventions such as open arthrolysis or partial replacement of the THA[5]. Clinical outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after THA have not been published to date. Consequently, the objective of this study is first to present the clinical outcomes and second to identify risk factors for poor clinical outcome following surgical intervention for histologically verified endoprosthesis-associated arthrofibrosis of the hip after THA.

In a retrospective data analysis ranging from January 2011 to March 2020, a total of 7983 revision surgeries related to implanted total hip arthroplasty (THA) were enrolled. Inclusion criteria comprised the histological confirmation of arthrofibrosis according to the Synovial-Like Interface Membrane (SLIM) criteria from samples obtained during the revision. During histological examination, the peri-implant synovial membrane is categorised into seven distinct types of Synovial-Like Interface Membrane (SLIM) based on consensus classifications of periprosthetic interface membrane[6, 7]. Type V specifically identifies endoprosthetic-associated arthrofibrosis, further divisible into particle-induced and non-particle-induced arthrofibrosis based on pathogenesis[6, 7].

Subsequently, patients were excluded if a routine joint aspiration before the index operation, assessed according to the 2018 ICM criteria[8], revealed a possible (ICM Score 2–5) or definitive (ICM Score ≥ 6) periprosthetic infection[8]. This led to the inclusion of a total of 51 cases in the study with unspecific painful hip und no radiologic signs for loosening. For the final statistical analysis, 42 cases were considered, reflecting an 82.6% follow-up rate. The mean follow up was 70 months (SD 4.1, range 30–122 months)

Alongside basic demographic data (such as age, gender, pre-existing conditions, etc.), operation-associated data, including the surgical procedure, were collected. Additionally, prospective postoperative data (clinical examination results, postoperative complications) and patient-reported outcomes were obtained through a questionnaire. The questionnaire covered fundamental inquiries regarding further operative interventions, pain levels on a scale of 1–10, and patient-reported outcome measures (PROMs) utilizing the Harris Hip Score (HHS)[9] and the EQ-5D-3L questionnaire [10]. The study was approved by the local ethics committee (2020-10340-BO-ff).

Study population

The mean age of the study population was 63.6 years (SD 10.3), with an average BMI of 28.1 (SD 4.9). The majority were of the female gender (59.5%). (Table 1)

Table 1

Description of the metric variables - total collective
Variable	N	Mean	SDA	Min	Max
Age [years]	42	63.6	10.3	38	80
Height [cm]	42	171.4	9.0	155	191
Weight [kg]	42	82.6	16.6	50	130
BMI [kg/m²]	42	28.1	4.9	18	38
Flexion	39	96.2	14.0	40	120
Internal rotation	37	16.2	9.8	0	40
External rotation	37	22.3	10.8	0	50
Adduction	36	19.4	16.8	0	100
Abduction	36	24.9	8.8	10	45
BMI: Body Mass Index
N: Number of observations; Mean: Mean value; SDA: Standard Deviation; Min: Minimum value; Max: Maximum value

Before the index surgery, primary implantation of the THA occurred in 73.8%. In the remaining 26.8%, revision surgeries had already taken place, with the mainly undergoing only one revision after the primary implantation (n = 27; 64.3%). The indication for the index surgery was predominantly the clinical suspicion of arthrofibrosis in most cases (n = 35, 83%), unclear persistent pain symptoms in four cases (10%), and suspected loosening of the acetabular and/or stem components of the total hip arthroplasty (THA) in three cases (7%). (Table 2)

Table 2

Description of the categorical variables - total collective
Variable	Value	N	%
Gender	Female	25	59.5
	Male	17	40.5
Smoker	No	36	85.7
	Yes	6	14.3
Arterial hypertension	No	22	52.4
	Yes	20	47.6
CHD	No	40	95.2
	Yes	2	4.8
Heart failure	No	42	100.0
Ischemic stroke	No	42	100.0
Peripheral vascular disease	No	39	92.9
	Yes	3	7.1
Liver cirrhosis	No	42	100.0
HIV	Missing	1
	No	41	100.0
Hepatitis	No	39	92.9
	Yes	3	7.1
Solid organ transplant	No	42	100.0
COPD	No	40	95.2
	Yes	2	4.8
Diabetes mellitus	No	35	83.3
	Yes	7	16.7
Chronic renal failure	No	39	92.9
	Yes	3	7.1
Hemodialysis	No	42	100.0
RA	No	41	97.6
	Yes	1	2.4
Other autoimmune disease	No	41	97.6
	Yes	1	2.4
Bone marrow transplant	No	42	100.0
Charlson comorbidity score	0	23	54.8
	1	8	19.0
	2	7	16.7
	3	4	9.5
ASA Score	0	10	23.8
	1	22	52.4
	2	1	2.4
	3	9	21.4
Type of fixation (femoral implant)	Uncemented	38	90.5
	Cemented	4	9.5
Number of prior surgeries	1	27	64.3
	2	9	21.4
	3	5	11.9
	4	1	2.4
Prior septic history	No	36	85.7
	Yes	6	14.3
Leukocyteesterase test	Missing	17
	Negative	22	88.0
	+	3	12.0
Extension	Missing	3
	0	37	94.9
	5	1	2.6
	10	1	2.6
Type of surgery	Arthrolysis	9	21.4
	Partial replacement	31	73.8
	Complete replacement	2	4.8
SLIM Typ V	Not particle-induced	38	90.5
	Particle-induced	4	9.5
Indication diagnosis	Arthrofibrosis	35	83.0
	Persistent pain	4	10.0
	Loosening	3	7.0
CHD: chronic heart disease; HIV: human immunodeficiency virus; COPD: chronic obstructive pulmonary disease; RA: rheumatoid arthritis; ASA Score: American Society of Anesthesiologists Score; SLIM: Synovial-Like Interface Membrane
N: Number of observations; %: Percentage

Surgical Intervention

The surgery was performed in the lateral decubitus position. Following routine fourfold skin disinfection, sterile draping was applied. The posterior approach to the hip joint was performed routinely. If present, the previous posterior scar was totally excised. After subcutaneous preparation the capsule was incised. Intra-articular findings revealed significant scarring consistent with arthrofibrosis (Fig. 1a and b), necessitating extensive debridement and arthrolysis starting from the cranial acetabular rim including the posterior and caudal part of the joint. Subsequently, the prosthesis was dislocated, and the head removed. Further circumferential dissection was performed at the level of the stem entry, with tissue samples obtained for bacteriology. In most of the cases the psoas tendon was surrounded by scar tissue and debrided thoroughly, in cases of massive arthrofibrosis a tenotomie of the tendon was necessary. The femoral component was checked for loosening and if signs of loosening were present, explantation was performed followed by intramedullar debridement. Afterwards the debridement was completed in the ventral part of the joint. Then the acetabular component was checked for loosening and was exchanged if necessary. Depending on intraoperative findinds new implants were inserted and after reduction layered sutures were used for wound closure.

Statistical analysis

In the description of metric variables within the report, the following measures are utilised: count, mean, standard deviation, quartiles, extremes, and median. The distribution of categorical data is elucidated using absolute and relative frequencies.

To assess the distributional characteristics of a metric variable across independent groups, the Shapiro-Wilk test was initially employed to examine the normality assumption. If the null hypothesis of normality was not rejected (p-value ≥ 0.1), a comparison was conducted using the t-test for independent samples. In the event of rejecting the assumption of normality, the Mann-Whitney U test was applied.

For the comparison of frequency distributions of a categorical variable among independent groups, either the chi-square test or Fisher's exact test (in case of expected cell frequencies less than five) was employed. If the group size of either of the compared groups was less than five, no statistical test was conducted. All tests were two-tailed. The analysis is purely exploratory, and thus, p-values are interpreted purely descriptively.

Concerning the Harris Hip Score (HHS), the minimal clinically important difference (MCID) of 18 was employed for comparing preoperative and postoperative values. To identify risk factors for an unfavorable clinical outcome, the study population was stratified into two groups based on the Harris Hip Score. An HHS value of < 55 was categorised as poor, which is consistent with the literature.[11]

In all patients (n = 42), intraoperatively, histological evidence of endoprosthetic associated arthrofibrosis (Type V) according to SLIM criteria was observed. The majority were non-particle-induced (n = 38, 90.5%), with only 4 cases (9.5%) exhibiting particle-induced Type V. (Table 2)

In all cases, an open arthrolysis was performed (100%), with an additional exchange of mobile components such as the liner and the head in 73.8% (n = 31) of the cases. In only 2 cases, there was an additional replacement of the femoral and acetabular components due to aseptic loosening. (Table 2)

The Harris Hip Score (HHS) averaged 53.2 (SD 17.1) before the index operation and showed an average score of 65.7 (SD 22.1) postoperatively, with a minimum follow-up of 30 months (mean 70 months, SD 4.1, range 30–122 months, demonstrating a statistically significant difference (p < 0.001) (Fig. 2). This corresponds to an average increase in HHS from pre- to postoperative of 12.5 (SD 21.4) HHS points. Only 34.1% achieved the minimal clinical importance difference (MCID) of 18 HHS points after operative revision. The average pain intensity on the numeric rating scale (NRS) scale (1–10) was 3.6 (SD 2.8). The EQ-5D-VAS Score and -TTO Score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37), respectively. Regarding the Health Status (0-100), an average of 60.5 (SD 20.1) was reported. (Table 3)

Table 3

Description of the clinical outcome
Variable	N	Mean	SDA	Min	Max
EQ-5D-TTO	42	0.221	0.37	0	1
EQ-5D-VAS	42	0.226	0.245	0.02	0.9
Health Status (0-100)	40	60.5	20.1	10	100
Pain (NRS, 0–10)	41	3.6	2.8	0	8
Preoperative HHS	41	53.2	17.1	10	100
Postoperative HHS	41	65.7	22.1	26	100
HHS change	41	12.5	21.4	-35	62
TTO: time trade-off; VAS: visual analogue scale; NRS: numeric rating scale; HHS: Harris Hip Score
N: Number of observations; Mean: Mean value; SDA: Standard Deviation; Min: Minimum value; Max: Maximum value

Complication and Revision Rate

Complications occurred in seven cases (16.7%). These included two dislocations, one hematoma, three cases of persistent postoperative pain with restricted movement leading to a subsequent revision, and one case of wound healing problems. In both dislocation cases, a partial exchange was performed during the index operation. In the three cases with persistent postoperative pain, one case was treated with a partial exchange, while in the other two cases, only arthrolysis was conducted. Additionally, a revision rate of 14.3% (n = 6) was observed. The reasons for revision included wound healing problems, dislocation, hematoma, and three cases c of repeat open arthrolysis due to persistent complaints.

Risk Factors for Poor Clinical Outcome Postoperatively

Poor clinical outcome, as defined by Singh et al.[11], was characterized by a Harris Hip Score (HHS) < 55. In this analysis, 41 out of 42 cases were considered. Among these, 14 cases exhibited a postoperative Harris Hip Score < 55 (34.1%), while 27 cases had a score ≥ 55 (65.9%).

In the group with an outcome of < 55, a higher BMI (p = 0.019) was observed at 30.1 (n = 14 cases) compared to a BMI of 26.7 in the group with an outcome ≥ 55. This difference in BMI was reflected in the distribution of body weight (p = 0.086), confirming weights of 88.4 kg versus 78.7 kg. A lower HHS preoperatively was associated with poor clinical outcome postoperatively (p = 0.022). (Table 4)

Table 4

Description of the metric variables as a dependence of the postoperative Harris Hip Score
Variable	HHS postop.	N	Mean	SDA	Min	Max	p¹⁾
Age [yrs]	< 55	14	64.7	10.9	38	79	0.457
	≥ 55	27	63.2	10.3	45	80
Height [cm]	< 55	14	170.9	9.1	155	187	0.858
	≥ 55	27	171.5	9.3	160	191
Weight [kg]	< 55	14	88.4	18.6	54	130	0.086
	≥ 55	27	78.7	14.3	50	103
BMI [kg/m2]	< 55	14	30.1	5.0	20	38	0.019
	≥ 55	27	26.7	4.4	18	37
Flexion	< 55	14	97.1	11.2	75	120	0.854
	≥ 55	25	95.6	15.6	40	120
Internal Rotation	< 55	13	19.2	11.0	0	40	0.116
	≥ 55	24	14.6	9.0	5	40
External Rotation	< 55	13	26.2	10.6	5	50	0.048
	≥ 55	24	20.2	10.5	0	50
Adduction	< 55	13	17.3	9.5	0	30	0.798
	≥ 55	23	20.7	19.8	10	100
Abduction	< 55	13	23.8	8.2	15	45	0.638
	≥ 55	23	25.4	9.3	10	45
Preoperative HHS	< 55	14	44.4	12.5	22	67	0.022
	≥ 55	27	57.9	17.5	10	100
¹⁾p-value of the Mann-Whitney-U test
HHS: Harris Hip Score; BMI: Body Mass Index
N: Number of observations; Mean: Mean value; SDA: Standard Deviation; Min: Minimum value; Max: Maximum value

Furthermore, it was demonstrated that better preoperative external rotation (p = 0.048) and non-smoking status (p = 0.079) were associated with a poorer outcome. (Table 5)

Table 5

Description of the categorical variables as a dependence of the postoperative Harris Hip Score
Variable	Harris Hip Score
	< 55		≥ 55
	n	%	n	%	p¹⁾
Gender
female	10	40.0	15	60.0	0.323²⁾
male	4	25.0	12	75.0
Smoker			6	100	0.079
no	14	40.0	21	60.0
yes
Arterial hypertension
no	6	28.6	15	71.4	0.440²⁾
yes	8	40.0	12	60.0
CHD
no	13	33.3	26	66.7	1.000
yes	1	50.0	1	50.0
Peripheral vascular disease
no	12	31.6	26	68.4	0.265
yes	2	66.7	1	33.3
Hepatitis
no	13	34.2	25	65.8	1.000
yes	1	33.3	2	66.7
COPD
no	13	33.3	26	66.7	1.000
yes	1	50.0	1	50.0
Diabetes mellitus
no	12	34.3	23	65.7	1.000
yes	2	33.3	4	66.7
Chronic renal failure
no	12	31.6	26	68.4	0.265
yes	2	66.7	1	33.3
RA
no	14	35.0	26	65.0	1.000
yes			1	100
Other autoimmune disease
no	13	32.5	27	67.5	0.341
yes	1	100
Charlson comorbidity score
0	5	21.7	18	78.3	0.101
1	3	42.9	4	57.1
2	5	71.4	2	28.6
3	1	25.0	3	75.0
ASA Score
0	3	30.0	7	70.0	0.828
1	7	31.8	15	68.2
3	4	44.4	5	55.6
Type of fixation (femoral implant)
uncemented	13	35.1	24	64.9	1.000
cemented	1	25.0	3	75.0
Number of prior surgeries
1	6	23.1	20	76.9	0.131
2	5	55.6	4	44.4
3	3	60.0	2	40.0
4			1	100
Prior septic history
no	10	28.6	25	71.4	0.157
yes	4	66.7	2	33.3
Leukocyte esterase test
missing	6		11
negativ	6	28.6	15	71.4	0.249
+	2	66.7	1	33.3
Extension
missing			2
0	14	37.8	23	62.2	1.000
5			1	100
10			1	100
Type of Surgery
Arthrolysis	3	33.3	6	66.7	0.858
Partial replacement	11	36.7	19	63.3
Complete replacement			2	100
*The percentages refer to the proportion of the column within the row (row total = 100%).
1) p-value of Fisher's exact test
2) p-value of the chi-square test
HHS: Harris Hip Score; CHD: chronic heart disease; HIV: human immunodeficiency virus; COPD: chronic obstructive pulmonary disease; RA: rheumatoid arthritis; ASA Score: American Society of Anesthesiologists Score; SLIM: Synovial-Like Interface Membrane
N: Number of observations; %: Percentage

One of the key findings of this study was that despite improvement in the Harris Hip Score (HHS) postoperatively, only 34.1% achieved the Minimum Clinical Significance Difference (MCID) of 18 HHS points following surgical revision. This outcome was corroborated by the EQ-5D-VAS Score and -TTO Score, averaging 0.226 (SD 0.245) and 0.221 (SD 0.37), respectively. After revision for endoprosthesis-associated arthrofibrosis, a complication rate of 16.7% and a revision rate of 14.3% were recorded, with arthrofibrosis emerging as the most persistent issue necessitating revision. Secondly, a higher BMI or body weight and a lower preoperative HHS were identified as risk factors for an unfavourable clinical outcome, defined as HHS < 55[11]. Additionally, preoperative improvement in external rotation and non-smoking status were associated with a poorer clinical outcome.

Following the initial description of prosthetic-associated arthrofibrosis of the hip by Gehrke et al. [4], these are the first outcomes after surgical intervention in histologically confirmed arthrofibrosis. The potential therapeutic implications and challenges of hip arthrofibrosis have been outlined by Linke et al. [5]. The findings of this study support the assumption [5] and are in line with the experiences of arthrofibrosis after total knee arthroplasty (TKA) [1], suggesting that surgical intervention is associated with a moderate clinical outcome. Currently, there is a lack of published data related to the hip. For the knee, we know that arthrofibrosis after TKA has a relatively high incidence of up to 13%, accompanied by a high complication rate [1, 2, 12]. Cohen et al. [12] demonstrated in a systematic review (485 patients) that after surgery for arthrofibrosis after TKA, there was an average improvement in the Knee Society Score (KSS) of 30.0 points. However, it is not reported how many of these achieved the minimal clinically significant difference (MCID) of 9 points [12, 13]. A high complication rate for persistent stiffness after TKA [12] has been described, up to 49% [14].

In the examined cohort, a moderate complication rate (16.7%) and revision rate (14.3%) were observed during the mid-term follow-up period, averaging 70 months. These findings closely align with the results of Deere et al. [15], who reported a revision rate of 23.7% for all revised hip replacements within the initial 15 years in the context of aseptic hip revision based on the National Joint Registry (England, Wales, Northern Ireland, the Isle of Man, and the States of Guernsey). [15]

The outcome following aseptic revision in total hip arthroplasty (THA) is lower compared to primary THA [16–18], with a long-term follow-up showing an average Harris Hip Score (HHS) of 86. and 96.6, respectively [17]. In this study, the HHS was significantly lower postoperatively, although in comparison to Koutalos et al. [17], the preoperative HHS was at the same level of 53.2. As it has been demonstrated that a higher preoperative HHS correlates with a higher postoperative HHS [19], this suggests, from our perspective, that the entitiy or co-entitiy of arthrofibrosis could have a decisive impact on the poor clinical outcome (HHS and EQ-5D-3L). A correlation between arthrofibrosis and periprosthetic infection has not yet been proven [20].

Regarding the risk factors for a poor clinical outcome with a Harris Hip Score (HHS) [9] of < 55, as described by Singh et al. [11], a higher BMI and a lower preoperative HHS were associated with an unfavorable postoperative outcome. Unfortunately, there are no clinical comparative data available to strengthen these data. However, a higher BMI fundamentally represents an increased risk, particularly being identified as a risk factor for the development of arthrofibrosis [1]. Favorable factors such as non-smoking status or good preoperative external rotation are clinically inexplicable and need to be critically reexamined in a larger study population. However, it should be emphasised that the type of surgical procedure, involving debridement, partial, or complete exchange of the components seems to have no impact on the outcome.

Nevertheless, the presented results must be interpreted considering the limitations. The retrospective study design and the small sample size (n = 42) are limiting factors, albeit explained by the rarity of the entitiy. Furthermore, it should be acknowledged that while there are indications of the independent entity of endoprosthesic-associated arthrofibrosis after total hip arthropalsty, a pure co-entity cannot be ruled out.

The initial clinical results following surgical intervention for endoprosthesis-associated arthrofibrosis show a moderate to poor postoperative outcome with an acceptable complication rate. The type of surgical intervention does not seem to have any influence on a poor clinical outcome.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local Ethics Committee of Ärztekammer Hamburg (2020-10340-BO-ff).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

None

Author Contribution

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Christian Lausmann, Navid Memarnia and Philip Linke. The first draft of the manuscript was written by Christian Lausmann, Navid Memarnia and Philip Linke and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Tibbo ME, Limberg AK, Salib CG, Ahmed AT, van Wijnen AJ, Berry DJ, Abdel MP (2019) Acquired Idiopathic Stiffness After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 101:1320–1330. 10.2106/JBJS.18.01217
Cohen JS, Gu A, Kapani N, Asadourian PA, Stake S, Quan T, Malahias MA, Sculco PK (2021) Efficacy of Arthroscopic Arthrolysis in the Treatment of Arthrofibrosis: A Systematic Review. J Knee Surg 34:1349–1354. 10.1055/s-0040-1709182
Cheuy VA, Foran JRH, Paxton RJ, Bade MJ, Zeni JA, Stevens-Lapsley JE (2017) Arthrofibrosis Associated With Total Knee Arthroplasty. J Arthroplasty 32:2604–2611. 10.1016/j.arth.2017.02.005
Gehrke T, Althaus L, Linke P, Salber J, Krenn V, Citak M (2022) Arthrofibrosis following primary total hip arthroplasty: a distinct clinical entity. Arch Orthop Trauma Surg 142:511–515. 10.1007/s00402-021-03922-z
Linke P, Lausmann C, Gehrke T, Citak M (2022) [Arthrofibrosis of the hip joint: Diagnostic and therapeutic challenge]. Unfallchirurgie (Heidelb) 125:868–871. 10.1007/s00113-022-01240-6
Krenn V, Morawietz L, Perino G, Kienapfel H, Ascherl R, Hassenpflug GJ, Thomsen M, Thomas P, Huber M, Kendoff D, Baumhoer D, Krukemeyer MG, Natu S, Boettner F, Zustin J, Kolbel B, Ruther W, Kretzer JP, Tiemann A, Trampuz A, Frommelt L, Tichilow R, Soder S, Muller S, Parvizi J, Illgner U, Gehrke T (2014) Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract 210:779–786. 10.1016/j.prp.2014.09.017
Morawietz L, Classen RA, Schroder JH, Dynybil C, Perka C, Skwara A, Neidel J, Gehrke T, Frommelt L, Hansen T, Otto M, Barden B, Aigner T, Stiehl P, Schubert T, Meyer-Scholten C, Konig A, Strobel P, Rader CP, Kirschner S, Lintner F, Ruther W, Bos I, Hendrich C, Kriegsmann J, Krenn V (2006) Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 59:591–597. 10.1136/jcp.2005.027458
Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N (2018) The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty 33:1309–1314e1302. 10.1016/j.arth.2018.02.078
Soderman P, Malchau H, Herberts P (2001) Outcome of total hip replacement: a comparison of different measurement methods. Clin Orthop Relat Res 163–172. 10.1097/00003086-200109000-00019
EuroQol G (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16:199–208 DOI 10.1016/0168–8510(90)90421-9
Singh JA, Schleck C, Harmsen S, Lewallen D (2016) Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord 17:256. 10.1186/s12891-016-1106-8
Cohen JS, Gu A, Lopez NS, Park MS, Fehring KA, Sculco PK (2018) Efficacy of Revision Surgery for the Treatment of Stiffness After Total Knee Arthroplasty: A Systematic Review. J Arthroplasty 33:3049–3055. 10.1016/j.arth.2018.04.036
Lizaur-Utrilla A, Gonzalez-Parreno S, Martinez-Mendez D, Miralles-Munoz FA, Lopez-Prats FA (2020) Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sports Traumatol Arthrosc 28:1473–1478. 10.1007/s00167-019-05543-x
Kim GK, Mortazavi SM, Parvizi J, Purtill JJ (2012) Revision for stiffness following TKA: a predictable procedure? Knee 19:332–334. 10.1016/j.knee.2011.06.016
Deere K, Whitehouse MR, Kunutsor SK, Sayers A, Mason J, Blom AW (2022) How long do revised and multiply revised hip replacements last? A retrospective observational study of the National Joint Registry. Lancet Rheumatol 4:e468–e479. 10.1016/S2665-9913(22)00097 – 2
Espehaug B, Havelin LI, Engesaeter LB, Langeland N, Vollset SE (1998) Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop Relat Res :135–148
Koutalos AA, Varitimidis S, Malizos KN, Karachalios T (2023) Revision total hip arthroplasty for aseptic loosening compared with primary total hip arthroplasty for osteoarthritis: long-term clinical, functional and quality of life outcome data. Hip Int 33:889–898. 10.1177/11207000221115354
Patil N, Lee K, Huddleston JI, Harris AH, Goodman SB (2010) Aseptic versus septic revision total knee arthroplasty: patient satisfaction, outcome and quality of life improvement. Knee 17:200–203. 10.1016/j.knee.2009.09.001
Ramadanov N, Ostojic M, Lazaru P, Liu K, Hable R, Marinova-Kichikova P, Dimitrov D, Becker R (2023) Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials. J Clin Med 12. 10.3390/jcm12185895
Lara-Taranchenko Y, Moreira T, Sandiford NA, Guerra-Farfan E, Gehrke T, Citak M (2024) Unexpected positive cultures in patients with arthrofibrosis following total hip and total knee arthroplasty. Int Orthop 48:345–350. 10.1007/s00264-023-05990-9

No competing interests reported.

Is operative revision associated with favorable clinical outcomes in arthrofibrosis following total hip arthroplasty (THA)? An initial retrospective, single-center data analysis of 42 cases

Status:

Version 1

Abstract

Figures

Introduction

Methods

Study population

Surgical Intervention

Statistical analysis

Results

Complication and Revision Rate

Risk Factors for Poor Clinical Outcome Postoperatively

Discussion

Conclusion

Declarations

Author Contribution

References

Additional Declarations

Status:

Version 1