Search Results (618)

Background and Objectives: Cerclage cable fixation with 2 mm multiple-braided cables for displaced acetabular fractures has shown good midterm functional and radiographic outcomes. We retrospectively evaluated the clinical and radiographic outcomes of cerclage cable fixations over ten years. Materials and Methods: We extracted data for patients who underwent cerclage cable fixation for acetabular fractures at a single institution from 2007 to 2012. We adopted this procedure for acetabulum fractures with posterior column fractures. Postoperative reduction quality, complications, reoperations, and Japanese Orthopedic Association (JOA) hip objective functional scores were analyzed. Postoperative reduction quality was classified using plain radiography and computed tomography. Results: We evaluated nine patients with a mean follow-up period of 14.1 ± 2.6 years (range: 10.8–18.1 years). The mean age was 47.1 ± 15.5 years old (range: 28–74 years); the mean injury severity score was 13.6 ± 4.7 (range: 9–22). The most frequent type of fracture was a both-column fracture. Anatomical reduction quality was achieved in five cases. Four patients had hip osteoarthritis at the last follow-up; among them, one patient had worsening hip arthritis > 5 years after surgery, and one patient developed osteoarthritis > 10 years after surgery. Their postoperative reduction quality was worse than their anatomical reduction quality, and both engaged in physical labor. None of the patients underwent revision total hip arthroplasty. The mean JOA hip score was 90.9 ± 7.9 (range: 74–100); seven patients scored >90 at the last follow-up. Conclusions: Cerclage cable fixation showed satisfactory postoperative reductions and favorable long-term clinical outcomes. Long-term follow-up might be necessary for patients whose postoperative reduction is not anatomical to detect late occurrence of hip osteoarthritis, even if osteoarthritis is not evident during short-term follow-up periods. Full article

Background/Objectives: In recent years, there has been a widespread focus on implementing technology in total hip arthroplasty (THA) to further improve precision and outcomes. This study aimed to identify recent trends in the utilization, clinical variables, and rate of adverse events for technology-assisted THA (TA-THA) and compare the outcomes to those of conventional THA. Methods: This retrospective cohort analysis of the ACS-NSQIP database queried data on THA patients (CPT 27130) from 2015 to 2020. Technology assistance was identified with CPT 20985, 0054T, and 0055T. Matched cohorts were created to compare clinical comorbidities and adverse events. Results: This analysis included 219,216 conventional THAs and 2258 cases utilizing TA-THA. The number and percentage of surgeries utilizing technology, as well as the average operative time, consistently rose from 2015 to 2019, with all declining in 2020. Length of stay decreased yearly from 2015 to 2019, with an increase in 2020. There were no significant differences in the incidence of adverse events by year. Matched cohort analysis demonstrated that TA-THA led to longer operative times (102.6 ± 35.6 vs. 91.6 ± 37.4 min, p < 0.001) and a shorter average length of stay (1.6 ± 1.4 vs. 2.0 ± 1.9 days, p < 0.001). Transfusion rates were higher in the TA-THA cohort (6.0% vs. 4.4%, p = 0.013). Conclusions: The usage of TA-THA increased from 2015 to 2019, with declines during 2020. TA-THA led to longer operative times, increased transfusion rates, and no difference in the incidence of adverse events compared to conventional arthroplasty. These findings demonstrate that TA-THA is growing in popularity without a significant improvement in short-term complication rates. Full article

Background: Recent advancements in hip arthroplasty aim to enhance the stability, longevity, and functionality of femoral implants. However, the distal fitting of femoral stems, often caused by metaphyseal–diaphyseal mismatch, remains a significant issue, particularly in patients with Dorr type A femora. Such mismatches can result in suboptimal implant performance, leading to potential complications. This study focuses on evaluating the anatomical compatibility of five representative single-tapered wedge mid–short stems with the mediolateral (ML) anatomy of the proximal femur in an East Asian population, where these mismatches are often more pronounced. Methods: A total of 742 patients from two hospitals, all of whom underwent unilateral primary total hip arthroplasty, were included in the study. The contralateral proximal femur was confirmed to have normal anatomy in each patient. Hip anteroposterior radiographs were used for measurements, which were standardized in conjunction with CT images. Key anatomical parameters were measured, including proximal and distal medial–lateral canal dimensions, vertical offset, and medial offset. Five femoral stem designs—Tri-lock^®, Taperloc^®, Anthology^®, Accolade II^®, and Fit^®—were evaluated. R programming was employed for a detailed fit analysis to match stem sizes with patient anatomy, categorizing the fit as proximal, simultaneous proximal–distal, or distal engagement. Results: Among the femoral stems analyzed, the Fit^® stem demonstrated the closest alignment with the regression line for ML widths in the study population (slope = 0.69; population ML slope = 0.38). This was followed by Accolade II^®, which had a slope of 0.83. In terms of offset options, the Accolade II^® offered the largest offset coverage, making it particularly suitable for this population. The fit analysis revealed that the Fit^® stem had the highest suitable fit rate (90.56%), followed by Accolade II^® (73.04%). Taperloc^®, Anthology^®, and Tri-lock^® had similar fit rates of approximately 59%. Overall, optimal results were obtained for 92.05% of the population in the automated fitting trial, regardless of the product type. Conclusions: When designing modern cementless femoral stems intended for press-fit fixation, it is crucial to account for the anatomical variations specific to the target population. In this study, Fit^® and Accolade II^® femoral components demonstrated superior compatibility with the femoral anatomy of the East Asian population, particularly in those with a higher incidence of Dorr type A femora. These stems, characterized by slimmer distal dimensions and high-offset options, appear to minimize metaphyseal–diaphyseal mismatch and associated complications. Full article

Background/Objectives: Tendinopathy of the gluteus medius and minimus tendons is a primary source of lateral hip pain, ranging from interstitial and partial-thickness tears to complete tears. Treatments include muscle transfers, Achilles tendon allograft procedures, and primary repairs with allografts. This study evaluated the one-year outcomes of gluteus medius and minimus reconstruction using an open double-row technique with a partial tensor fasciae latae transfer for severe Trendelenburg post-total hip arthroplasty. Methods: A prospective study involving eight patients who underwent surgery from April to December 2023 was conducted. The surgery involved an open technique with double-row suture reinforcement and tensor fasciae latae autograft. Outcomes were measured using strength, the Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF-12), Hip Outcome Tool (HOT), International Hip Outcome Tool (iHOT), and Visual Analog Scale (VAS). Follow-ups occurred at 1, 3, 6, 9, and 12 months postoperatively. Results: At an average follow-up of 7.17 months, significant improvements in both hip function and quality of life were observed. The SF-12 quality of life score increased from 27 preoperatively to 34 by month 12. Hip functionality, as measured by the HHS, showed a marked improvement from 48 to 94 points, particularly after six months. The HOT score for hip functionality rose by 23 points by the third month, reaching an average of 86 points. Similarly, the iHOT score increased from 20 to 83 points starting at month 3, reflecting substantial improvements in hip function. Statistically significant improvements were noted at as early as month 3 (p = 0.02), with highly significant gains by month 6 (p < 0.01), which remained stable through month 12 (p < 0.01). Conclusions: Reconstruction of the gluteus medius and minimus tendons using an open double-row technique with a partial tensor fasciae latae transfer significantly enhances hip function and quality of life. Over an average follow-up period of 7.17 months, patients experienced notable improvements. This technique is an effective option for treating lateral hip pain due to tendinopathy. Full article

Background/Objectives: Single-taper conical tapered stems (STCTSs) are possible options for femoral reconstruction in THA performed for primary osteoarthritis, but outcomes are poorly ascertained. A specific STCTS in THA performed for primary osteoarthritis was investigated and compared to a control group including all the other cementless stems, aiming to assess the following: (1) the survival rates of the two cohorts and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failures for stem failure, stem aseptic loosening, and periprosthetic fracture. Methods: A regional arthroplasty registry study evaluating a specific STCTS in THA performed for primary osteoarthritis was designed. A control group including all the other cementless stems was considered. Results: In total, 1773 STCTSs were compared to 37,944 cementless stems. The cumulative survivorship of the STCTS cohort was 95.6% at 10 years and 92.7% at 15 years, which was not different to the control group (p = 0.252). After age stratification, the hazard ratio for STCTS failure was not different to the control group. With stem revision as the endpoint, the STCTS cohort outperformed the control group (at 10 years, 98% versus 96.8%; p < 0.001). The STCTSs achieved better survival rates in females <65 years (p = 0.023). With stem aseptic loosening as the endpoint, the survival rates did not differ between the two cohorts (p = 0.085), as well as the adjusted hazard ratios (p = 0.264). With periprosthetic fracture as the endpoint, the survival rates were better for the STCTSs (p < 0.001). Conclusions: STCTSs in THA for primary osteoarthritis provided dependable long-term outcomes, not inferior to all the other cementless stems with various designs. Full article

Background: GaitSmart (GS) is a sensor-based digital medical device that can be used with the integrated app vGym to provide a personalised rehabilitation programme for older people undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study aimed to determine whether the GS intervention used in the rehabilitation of older people undergoing THA or TKA is potentially cost-effective compared to the current standard of care (SoC). Methods: Decision-analytic modelling was conducted to estimate the cost-effectiveness over a seventeen-week time horizon from an NHS perspective. UK clinical and cost data from the GaitSmart randomised clinical trial was used to obtain the input parameters, and a sensitivity analysis was performed to address uncertainties. Results: Over a seventeen-week time horizon, GS incurred cost savings of GBP 450.56 and a 0.02 gain in quality-adjusted life years (QALYs) compared to the SoC. These results indicate that GS is the dominant intervention because the device demonstrated greater effectiveness and lower costs. Probabilistic sensitivity analyses confirm the robustness of our results. Conclusions: GS appears to offer short-term efficiency benefits and demonstrates cost-effectiveness for the improvement in gait in people undergoing THA or TKA, compared to the SoC. Full article

Background: Stem revisions in revision total hip arthroplasty (THA) with proximal bone stock loss may be dealt with utilizing modular, uncemented conical stems. During stem extraction, surgeons may resort to extended trochanteric osteotomy (ETO). However, ETO is associated with extensive blood loss and infections. This study compared the clinical outcomes, radiographic results and complications in THA revisions utilizing conical modular stem with and without ETO. Methods: Patients who underwent revision THA with or without ETO were assessed retrospectively. The minimal follow-up was 3 years. The functional evaluation included Harris Hip Score (HHS) and Short Form 36 (SF-36) as well as Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Numerical Rating Scale for pain assessment. The radiographic evaluation comprised bone defect assessment, osteotomy healing, stem migration and position, presence of radiolucent lines and stress shielding. Results: In total, 73 patients (80 hips) were included in the final analysis. The ETO group comprised 48 hips, and the no-ETO group comprised 32 hips. In the ETO group, pre-operative WOMAC scores were lower than in the no-ETO group (p = 0.012). No significant differences were found in terms of post-operative HHS, WOMAC, and NRS scores between groups, except worse results were found in the case of claw plate implantation. Patients in the no-ETO group exhibited better results in SF-36 than in the ETO-group. Osteotomy non-union was observed in four hips (9.5%). Stam varus/valgus position was within ±1.5 degrees (85.9%). Conclusions: ETO does not adversely impact outcomes in patients undergoing femoral stem revisions with modular conical stems. The invasive nature of these procedures prompts careful consideration in each case individually. Full article

Background: Owing to the risk of atypical femoral fractures, total hip arthroplasty presents unique challenges for patients with ipsilateral osteoarthritis and localized periosteal thickening in the femoral subtrochanteric region. Stem length selection is critical for minimizing stress concentration in the thickened cortex to avoid such fractures. Herein, we report the case of a 78-year-old woman with ipsilateral hip osteoarthritis and localized subtrochanteric periosteal thickening. Methods: Preoperative planning included a finite element analysis to assess the stress distribution across various stem lengths. A simulation was conducted to determine the optimal stem length to span the cortical thickening and reduce the risk of postoperative complications. Results: The finite element analysis indicated that a stem length of >150 mm was required to effectively reduce the stress at the site of cortical thickening. A 175 mm stem was selected for total hip arthroplasty, which provided a favorable stress distribution and avoided the risk of stress concentration. Conclusions: In cases of ipsilateral osteoarthritis with localized subtrochanteric periosteal thickening, finite element analysis can be valuable for preoperative planning to determine the optimal stem length, thereby reducing the risk of atypical femoral fractures. Further studies with multiple cases are recommended to validate these findings and improve surgical outcomes. Full article

The surgical treatment of geriatric acetabular fractures is becoming increasingly important due to a demographic change in age. While acetabular fractures used to occur more frequently in younger patients, they are currently more prevalent in geriatric patients. This change has also led to an increase in the frequency of anterior and combined anterior acetabular fractures. Surgery for geriatric acetabular fractures is very challenging, and surgeons need years of experience to be able to deal with the advantages and disadvantages of pelvic surgery. This is why a high level of surgical expertise is required. The aim of this article is to provide an insight into the topic of geriatric acetabular fractures with a critical narrative review of the current literature and a focus on minimally invasive surgical treatment using the modified Stoppa approach without patients’ own assessment. The modified Stoppa approach offers excellent visibility of the anterior structures of the acetabulum and can address the quadrilateral surface effectively. Pelvic surgery, in particular acetabular surgery, offers patients many advantages, such as rapid mobilization and the quick relief of pain symptoms. Total hip arthroplasty is currently being discussed as an alternative with good results for certain types of acetabular fractures in older patients, though it requires clarification of studies and recommendations. Full article

Introduction: Femoral neck fractures pose significant health risks, particularly in the elderly population, leading to mortality, morbidity, and decreased quality of life. Surgery is the preferred treatment to restore function and alleviate pain, with options including total hip arthroplasty (THA) and hemiarthroplasty (HA). However, clinical guidelines for selecting surgical procedures remain heterogeneous, prompting the need for further investigation into treatment trends and influencing factors. Methods: Data from the NIS database spanning 2016–2019 were analyzed, focusing on patients diagnosed with intracapsular femoral neck fractures and undergoing THA or HA as primary in-hospital surgeries. Advanced statistical analyses using SPSS and MATLAB were conducted to identify trends and factors influencing surgical choices. Results: Comorbidity profiles varied significantly between HA and THA patients, with specific conditions such as Alzheimer’s disease showing higher prevalence in HA patients. Demographic differences included a higher proportion of females and Medicare-insured individuals in the HA group. Racial disparities were observed, with differences in surgical preferences among various ethnic groups. THA adoption gradually increased over the study period, indicating a shift in surgical priorities. Additionally, THA patients tended to be younger on average compared with HA patients. Conclusions: This study highlights evolving trends in surgical management for femoral neck fractures and identifies factors influencing treatment decisions in our cohort. Understanding these trends and disparities is crucial for optimizing patient care and informing future clinical guidelines. Further research should focus on assessing different surgical approaches’ long-term outcomes and cost-effectiveness. Full article

Background and Objectives: Navigation systems are designed to enhance surgical precision, improving patient outcomes and reducing the risk of implant misplacement. In this study, we have evaluated a novel orthopedic surgical platform that utilizes CT imaging with AI-based algorithms to automate several critical aspects of total hip arthroplasty. It contains three modules—preoperative planning, navigation during surgery, and follow-up analysis. The primary objective of the current study was to evaluate the precision of the navigation tool in cup placement, i.e., whether the information displayed for navigation correctly reflected the actual position of the implant. Materials and Methods: Surgery outcomes of 15 inter-rater measurements on human cadavers and 18 surgeries on patients who underwent total hip replacement using the navigation tool were analyzed. Results: In the inter-rater assessment, the mean errors were −0.31 ± 1.42° for anteversion, 1.06 ± 1.73° for inclination, and −0.94 ± 1.76 mm for cup position depth. In patients’ surgeries, the mean errors were −0.07 ± 2.72° for anteversion, −0.2 ± 0.86° for inclination, and 0.28 ± 0.78 mm for cup depth. Conclusions: The navigation tool offers intra-operative guidance on notable precision in cup placement, thereby effectively mitigating the risk of cup malpositioning outside the patient-specific safe zone. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is a disastrous complication after joint replacement procedures as the diagnosis remains a significant challenge. The objective of this study is to assess the accuracy and test the interdependency of the proposed compound serum biomarkers for the diagnosis of PJI after total hip arthroplasties (THA). Methods: From January 2019 to December 2023, 77 consecutive cases that underwent revision total hip arthroplasties (rTHA) were included in a single−retrospective, observational cohort study. A total of 32 arthroplasties were classified as having septic complications using the European Bone and Joint Infection Society (EBJIS) definition from 2021, while the other 45 cases were assigned as aseptic failures (AF). Results: In the univariate analysis between the two groups created, statistically significant differences (p < 0.005) were found for the following variables: time from primary arthroplasty to symptom onset (Time PA−SO), neutrophil count, Lymphocyte count, haematocrit level (HCT) and haemoglobin level (HGB), C−reactive protein (CRP), the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). The ROC curve analysis showed that the SII (sensitivity 90.6% and specificity 62.2%) and the NLR (sensitivity 84.4% and specificity 64.4%) are the most accurate biomarkers. The multivariate analysis confirmed that NLR > 2.63 (p = 0.006), PLR > 147 (p = 0.021), MLR > 0.31 (p = 0.028), SII > 605.31 (p = 0.002), SIRI > 83.34 (p = 0.024), and AISI > 834.86 (p = 0.011) are all closely related to PJI diagnosis independently. Conclusions: The proposed serum biomarkers can be correlated with PJI diagnosis with the reserve of relatively low specificities. Full article

Life expectancy and overall function of amputated patients have improved significantly over the last few decades; for this reason, amputees are more exposed to primary or secondary degenerative disease of the hip, requiring total hip arthroplasty (THA) surgery. However, during training, not all the surgeons acquire adequate skills to manage these patients, and only a few studies and case reports describe technical pearls and outcomes of THA in patients with ipsilateral lower limb amputation, either above or below the knee. The objective of this narrative review is to present current evidence and surgical tips for performing THA in ipsilateral amputated patients, with a focus on the differences between patients with above- (AKA) and below-knee amputation (BKA). We reviewed manuscripts in major scientific databases, cross-referencing to retrieve adjunctive manuscripts, and summarized all relevant cases. We found 17 manuscripts, spanning 70 years of literature, collecting a total of 39 patients who underwent THA on an ipsilateral amputated limb: 13 AKA, 23 BKA, and 3 through-knee-amputation (TKA). The cohort primarily consists of patients with post-traumatic hip arthritis, often associated with sequelae such as fractures to other bones, soft tissue compromise and heterotopic calcifications. Managing with amputated patients requires careful planning, which includes the study of the residual bone, muscle anatomy, and the level of femoral amputation, as these factors present significant surgical challenges, especially in patients without a knee joint. In dealing with the post-traumatic and multi-comorbidity patients, rehabilitation goals should be considered prior to surgery and should drive the surgical strategy. We found that BKA patients typically have high functional demands, necessitating precise positioning of the components and an aggressive post-operative physiotherapy regimen to avoid unsatisfactory outcomes. AKA patients, on the other hand, often present with altered anatomy, and typically require more surgical instruments and expertise to achieve intraoperative dislocation of the hip joint. Full article

Background: This study reports the long-term survivorship of primary total hip arthroplasty (THA) for protrusio acetabuli. Methods: Patients undergoing THA utilising cement and bone graft acetabular reconstruction for protrusio acetabuli in a university teaching hospital during the period 2003 to 2014 were included. Kaplan–Meier survival estimates were calculated with 95% confidence intervals (CI) up to 15 years following surgery. PROMs were collected pre- and post-operatively for hip-specific function (Oxford Hip Score [OHS]) and health-related quality of life (HRQoL) using the EQ-5D-3L. Results: 129 consecutive THAs (96 patients) performed for protrusio acetabuli were identified (median age 69, IQR 61–75; female 115 [89.1%]; 38 [29.5%] inflammatory arthritis) with a mean follow-up of 15.7 years (range: 10.1–20.1 years). At the final follow-up, fifty-six (43.4%) patients had died and there were eleven (8.5%) reoperations, of which eight (6.2%) involved the revision of the acetabular component. The fifteen-year Kaplan–Meier any-reoperation survival estimate was 91.3% (95% CI 85.9–97.0). When considering all-cause acetabular revision only, the 15-year survival estimate was 93.1% (95% CI 88.2–98.3). The median pre-operative OHS improved significantly from baseline to 1 year post-THA, beyond the minimal important change (mean difference 28, 95% CI 25–30, p < 0.001). Similarly, there were clinically relevant improvements in HRQoL at 1 year post surgery (mean difference 0.10, 95% CI 0.06–0.15, p < 0.001). Conclusions: This study demonstrates that primary cemented THA utilising acetabular bone graft for reconstruction in patients with protrusio acetabuli was associated with 15-year survival rates of 93.1% and clinically relevant improvements in hip-specific function and HRQoL. Full article

Background/Objectives: Geriatric hip fracture patients have an increased risk of malnutrition. Proper nutritional supply in the perioperative period is very important for their recovery. Oral nutritional supplements (ONSs) are recommended in geriatric hip fracture patients to improve dietary intake and prevent complications. This study aimed to evaluate the efficacy of postoperative ONSs after total hip arthroplasty in geriatric hip fracture patients. Methods: A retrospective study of elderly patients who underwent total hip arthroplasty for hip fracture was conducted. Data from patients who received ONSs postoperatively until hospital discharge (ONS group, n = 69) were compared with patients who did not receive ONSs (control group, n = 168). Laboratory test results, including serum protein and albumin levels, length of hospital stay, and the incidence of postoperative medical complications of the two groups, were analyzed. Results: Preoperative serum protein and albumin levels were significantly higher in the control group (p = 0.002 and p = 0.010, respectively). However, the degree of decline for both protein and albumin levels was significantly less in the ONS group (p < 0.001 for both). Serum albumin levels were significantly higher in the ONS group at postoperative two-week follow-up (p = 0.006). The length of hospital stay was shorter in the ONS group (p < 0.001). The incidence of postoperative delirium was significantly higher in the control group (p = 0.007). Conclusions: In geriatric hip fracture patients, postoperative ONSs can improve postoperative nutritional status, shorten the length of hospital stay, and reduce the incidence of postoperative delirium. Full article