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Cale A. Jacobs, Christian P. Christensen and Michael E. Berend

Over the past 10–15 years, many aspects of total hip arthroplasty (THA) have changed. First and foremost, the patients themselves have changed. Since 1990, the age group that has demonstrated the greatest increase in THA was patients between the ages of 45 and 64. As younger, healthier patients are having surgery, a greater emphasis is being placed on postoperative function, activity, and exercise. The rationale for increased postoperative activity is 2-fold: the obvious cardiovascular benefits of exercise and greater patient desire to return to recreational sporting activities. The purpose of this review is to discuss how recent changes in surgical technique, implant design, and pre- and postoperative rehabilitation have affected postoperative athletic activity for THA patients. Although these topics have been addressed often in the orthopedic literature, to our knowledge no published articles have summarized this information for a targeted audience of rehabilitation specialists.

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Kate N. Jochimsen, Margaret R. Pelton, Carl G. Mattacola, Laura J. Huston, Emily K. Reinke, Kurt P. Spindler, Christian Lattermann and Cale A. Jacobs

Background: Pain catastrophizing predicts poor outcomes following orthopedic procedures for patients with chronic conditions; however, limited research has focused on acute injuries. This study aimed to quantify the progression of Pain Catastrophizing Scale (PCS) scores from injury to 6-months post–anterior cruciate ligament reconstruction (ACLR) and determine if preoperative or 6-month PCS scores were related with self-reported pain or function 6 months post-ACLR. The authors hypothesized PCS scores would minimally fluctuate and would be related with worse outcomes 6-months post-ACLR. Methods: All 48 participants (27 male/21 female; aged 22.7 [4.6] y, body mass index 24 [3.3]) included in this secondary analysis of a randomized control trial sustained an ACL injury during sports activity. Participants completed the PCS and Pain Visual Analog Scale (VAS) at 5 time points: within 7 days of injury (INITIAL), day of surgery, 2 weeks postoperative (2W), 6 weeks postoperative (6W), and 6 months postoperative (6M). They completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6M. Wilcoxon signed-rank tests and Spearman rank-order correlations were used for analysis. Results: PCS scores were not fixed (INITIAL: 11.6 [10.8], day of surgery: 2.5 [3.7], 2W: 8.0 [7.8], 6W: 3.7 [6], 6M: 0.8 [2.3]). They fluctuated in response to injury and ACLR similar to Pain VAS scores. Preoperative PCS scores were not related with 6M outcomes; however, 6M PCS scores were significantly related with 6M Pain VAS and KOOS subscales. Conclusions: PCS scores fluctuated in response to injury and ACLR. Preoperative PCS scores were not related with 6M outcomes; however, 6M PCS scores correlated with pain and function at 6M. High pain catastrophizing appears to be a natural response immediately following acute ACL injury and ACLR, but may not be indicative of a poor postoperative result. PCS scores 6-months following ACLR may provide useful information regarding self-reported pain and function.