Stéphane Poitras

Background: There is growing interest in identifying psychological factors associated with outcomes following total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, the available evidence is heterogeneous, and uncertainty remains regarding which psychological factors are most consistently associated with postoperative outcomes following arthroplasty. The aim of this study was to provide an overview of available evidence of association between psychological factors and function or health-related quality of life (HRQoL) after arthroplasty. Methods: An umbrella review was conducted, and 3 electronic databases were searched, and systematic reviews were included. We reported the risk of bias assessments of primary studies as reported in systematic reviews. Only high quality studies were included in qualitative synthesize. Results: A total of 25 systematic reviews, including data from 40,024 patients, were included. Two psychological vulnerability factors, including depression, and anxiety negatively affect postoperative function/HRQoL after THA or TKA. Our findings also indicated that distress, kinesiophobia, pain catastrophizing, and pessimism negatively impact postoperative function/HRQoL outcomes following TKA, though no reviews have addressed these factors for THA. Conversely, the psychological protective factors of patient expectations and mental well-being were found to positively influence function/HRQoL outcomes following both TKA. Conclusion: These findings may help clinicians target specific elements to enhance the management of patients and could potentially improve outcomes by addressing these factors through tailored interventions. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Hip fractures represent sentinel events in older adults’ lives that can lead to a loss of function and permanent disability. Our team developed an ev

Background: Although there has been increasing focus on patient-centered approaches in outcome evaluation, there is limited information on how well the existing patient-reported outcome measures (PROMs) used to assess function for hip or knee arthroplasty align with patients’ perspectives. Questions/purposes: (1) To what extent do currently used functional PROMs for hip or knee arthroplasty cover the functional activities that are important to patients at 2, 6, 13, and 26 weeks after surgery? (2) Which functional activities important to patients are either not covered or inadequately covered by PROMs? (3) Which activities not important to patients are covered by PROMs? Methods: We assessed functional key activity coverage and coverage gaps of 47 PROMs at four points. This analysis was based on 22 key activities identified by 953 patients who underwent primary elective hip or knee arthroplasty performed by eight surgeons. These patients were recruited from the Orthopedic Division at The Ottawa Hospital in Ottawa, Ontario, Canada, an academic-affiliated institution in an urban setting. From November 2023 to March 2024 and September 2024 to January 2025, a total of 615 patients who underwent hip arthroplasty and 555 who underwent knee arthroplasty were approached, and 503 and 450, respectively, completed the questionnaire. Patients who underwent hip arthroplasty had a mean ± SD age of 65 ± 11 years; 51.1% (257 of 503) were female, and the mean BMI was 28.3 ± 5.6 kg/m ² . Patients who underwent knee arthroplasty had a mean age of 68 ± 9 years; 51.3% (231 of 450) were female, and the mean BMI was 31.1 ± 6.4 kg/m ² . A functional activity was defined as key if at least 75% of patients rated it as important and at least 15% had difficulty doing it. Results: No PROM adequately addressed all key activities. Within the first 2 weeks after surgery, knee-specific, hip-specific, and combined hip and knee PROMs addressed 86%, 85%, and 79% of key activities, respectively, but this coverage declined for hip and knee PROMs at subsequent follow-up points to fewer than one-half by 26 weeks. The most commonly covered activities were going up and down stairs, rising from a chair, and putting on footwear. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) demonstrated the widest coverage among knee and hip PROMs, respectively, while the WOMAC provided the widest coverage for combined hip and knee PROMs. Several key functional activities were either inadequately covered or not covered by PROMs. Inadequate coverage often resulted from combining multiple activities into a single item, with the most frequent key activities inadequately addressed being “going up and down stairs” and “doing housework.” Five key activities, including washing lower body parts, putting on clothes, taking off clothes, carrying objects, and placing objects on the floor, were not covered by any PROMs. Furthermore, all PROMs included at least one non-key activity. Conclusion: Given the role of PROMs in evaluating treatment efficacy, their limited comprehensiveness could lead to inaccurate assessments of interventions, potentially contributing to the overuse or underuse of healthcare services. Moreover, including non-key activities in these measures may burden patients and increase the likelihood of nonresponses. To address these issues, future development of PROMs for hip and knee arthroplasty should prioritize engaging patients in the design process. Clinical Relevance: Our findings showed that the relationship between the length and coverage of current PROMs is often inverse. Selecting between longer and shorter PROMs requires weighing comprehensiveness against burden, with the most efficient PROMs maximizing coverage of key activities while minimizing non-key ones. Clinicians should consider choosing PROMs to specific phases of recovery after hip or knee arthroplasty rather than relying on a single tool across all time periods. This approach can enhance the relevance of follow-up assessments and better support individualized care decisions. The wide variety of available PROMs presents selection challenges, and stakeholders, including clinicians, patients, and decision-makers, should work toward consensus on a core set of outcome measures appropriate for various stages of recovery.

Background Understanding what matters most to patients can help clinicians plan healthcare more responsive to patients’ needs after orthopedic surgery. However, there is still little understanding of which activities patients undergoing hip or knee arthroplasty prioritize at different time points after surgery. Purpose This study aimed to explore key functional activities from patients’ perspectives at different timepoints during the first six months after hip or knee arthroplasty. Methods A cross-sectional study was conducted at The Ottawa Hospital in Ottawa, Canada. Patients who underwent hip or knee arthroplasty due to osteoarthritis (OA) were recruited. A validated self-report questionnaire based on the activity and participation components of the International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis was used. Results A total of 953 patients participated, including 503 hip arthroplasty patients and 450 knee arthroplasty patients. Patients identified 23 key functional activities and 26 non-key functional activities within 2 weeks, at six, 13, and 26 weeks post-arthroplasty. Patients highlighted different key activities across various stages following hip or knee arthroplasty, with a decline in the number of key activities over time. During the acute recovery phase, patients focused on simpler activities such as walking short distances and self-care, progressing to more advanced activities like squatting and walking long distances as recovery advanced. The findings revealed similar key activities between patients undergoing hip and knee arthroplasty. Conclusion The study identified how patients’ perspective on key activities changed over different recovery stages following hip or knee arthroplasty. Understanding what matters most to patients enables clinicians to assess outcomes more accurately as well as adapt interventions that align with patients’ needs in order to optimize time to recovery.

Aims: We aimed to determine if a home-based hip exercise programme, designed to use strength and flexibility exercises to modify pelvic positioning, is superior to usual care in reducing pain and improving function and quality of life in patients with symptomatic femoroacetabular impingement (FAI).Methods: This was a single-blind parallel-group randomized controlled trial. Eligible participants were aged ≥ 16 years and diagnosed with symptomatic cam FAI. A sample size of 94 was needed to detect a clinically important difference. Participants were randomly allocated to: 1) an eight-week home-based exercise programme focused on posterior pelvic tilt supervised by a physiotherapist every two weeks in addition to usual care; and 2) usual care. The primary outcome measure was function (patient-reported 33-Item International Hip Outcome Tool (iHOT-33)) and secondary outcome measures were quality of life (EuroQol five-dimension five-level questionnaire (EQ-5D-5L)), and pain (visual analogue scale (VAS)) at baseline, nine weeks, and six months. The Mann-Whitney U test was used to test between-group differences in scores using a two-tailed level of significance of p < 0.05.Results: A total of 95 participants were recruited (48 intervention, 47 control), 55 were males (57.9%), the mean age was 32 years (SD 8.5), and both groups were similar at baseline. There were no statistically significant differences in the primary outcome measure between groups at nine weeks and six months for function (nine weeks: p = 0.394, 95% CI -15.5 to 6.5; six months: p = 0.526, 95% CI -8.8 to 13.7). There were no statistically significant differences in the secondary outcome measures between groups: pain (nine weeks: p = 0.153, 95% CI -0.4 to 2.4; six months: p = 0.743, 95% CI -1.1 to 1.7), and quality of life (quality of life VAS nine weeks: p = 0.877, 95% CI -10.0 to 6.0; six months: p = 0.269, 95% CI -15.0 to 5.0; index value nine weeks: p = 0.815, 95% CI -0.067 to 0.052; six months: p = 0.217, 95% CI -0.099 to 0.020).Conclusion: Our results demonstrated no statistical differences in pain, function, and quality of life for participants following an eight-week home-based exercised programme supervised by a physiotherapist compared to usual care.Cite this article: Bone Jt Open 2025;6(9):1138–1145.

Purpose Involving patients in developing patient-reported outcome measures (PROMs) is essential for accurately capturing their perspectives. However, understanding how patients were involved in developing PROMs used after hip or knee arthroplasty is limited. This scoping review aimed to evaluate whether patients were involved in the development of these PROMs and how they were involved. Methods Two independent reviewers documented patient involvement in item development and comprehensibility testing for 50 PROMs used after hip or knee arthroplasty. Trends in patient involvement over time were analyzed using binary logistic regression. Results There was no documentation of patient involvement in a collaborative role during the PROM development processes. Regarding the consultative role, of these 26 PROMs, they contributed to item development in 13 PROMs (26%) and comprehensibility testing in four PROMs (8%) and both item development and comprehensibility testing in nine PROMs (18%). Patients who underwent arthroplasty were involved in one or both phases in ten PROMs (20%), while patients with other lower extremity conditions were involved in 16 PROMs (32%). Patients who underwent arthroplasty contributed to both phases in five PROMs: Oxford Knee Score-Activity and Participation Questionnaire, Patient’s Knee Implant Performance Questionnaire, Patient-Reported Outcomes Measurement Information System R-Plus-Osteoarthritis of the Knee, Oxford Arthroplasty Early Recovery Score and Oxford Arthroplasty Early Change Score. In addition, our analysis revealed no significant change in patient involvement in a consultative role during either item development or comprehensibility evaluation over time since 1982, when the first PROM included in this review was developed (p = 0.21). Conclusions Almost half of PROMs used after arthroplasty did not involve patients in their development, highlighting the need to address this gap in development of PROMs. There is also a need to analyze PROMs to ensure they accurately reflect the outcomes that matter to patients.

Rational: One of the important considerations to select the appropriate outcome measures is determining if the tool is relevant to patients. Despite the availability of various performance‐based tests to objectively assess function, it is unknown which performance‐based tests best capture important aspects of function after hip or knee arthroplasty.Aims and Objectives: Our systematic review aimed to identify the existing performance‐based tests used in hip or knee arthroplasty and link the activity component of each test to the modified International Classification of Functioning, Disability and Health (ICF) core set for osteoarthritis (OA).Method: We searched four databases from inception until April 2024. A performance‐based test was included if an individual performs one or more activities, evaluated by an assessor and resulted in a numerical value. Two reviewers independently screened and extracted data and assessed the included performance‐based tests.Results: From 449 studies included in this review, we identified 28 performance‐based tests which covered 15 categories of OA core set activity and participation. The categories of d4500:walking short distances, d4104:standing and d4103:sitting were the most frequently used, employed in 14, 10 and 10 performance‐based tests, respectively. However, 34 categories of activity and participation were not found in any performance‐based tests. A‐test (‘A’ like Activity or Assessment) had the widest coverage covering 10 out of 49 core set categories. Four performance tests covered four activity and participation categories, one covered three categories, 10 covered two categories and 12 covered one category.Conclusion: Our ICF‐based content analysis revealed that the existing performance‐based tests covered certain OA core set activity and participation categories, but overlooked multiple categories. This analysis can serve as a guide for researchers and clinicians in selecting suitable performance‐based tests or a battery of tests to assess function following hip or knee arthroplasty.