HIP International最新文献

Background: The posterior horizontal dislocation distance (PHDD) is a 3-dimensional jump distance measurement that is relevant to the risk of dislocation. There are a number of dual-mobility (DM) constructs with varying designs available. The present study identifies design factors associated with increased PHDD and evaluates the PHDD of 3 DM implants.

Methods: 3 different computer-aided implant designs were virtually implanted within a 3-dimensional CT-derived pelvic model. Each design represented an analogue of a DM system (MDM, OR3O, and G7) according to specific variations in acetabular liner rim build-up and femoral head centre location. The effective head diameters and PHDD values were calculated for each size acetabular shell and DM design.

Results: The positive rim build-up design (MDM) showed higher PHDD values as compared to the other 2 hemispherical rim designs with no build-up, across all studied shell sizes. Specifically, the MDM design analogue had 16.4-29.0% greater PHDD values than the OR3O design analog and 15.2-30.5% greater PHDD values than the G7 design analogue The effect of a sfemoral head centre location relative to the liner head centre (OR3O) was negated by a larger effective head diameter to shell diameter ratio of the G7 design, resulting in similar PHDD values.

Conclusions: Design parameters affect the PHDD values of DM cups. The use of an elevated rim was associated with greater PHDD values. A medialised femoral head centre should also improve PHDD values, but the effect was nullified due to consecutive lower effective head diameters.

Introduction: Constrained acetabular liners (CALs) are predominantly used as a salvage procedure in patients with a severe risk for dislocation after total hip arthroplasty (THA). However, the constrained design of CALs bears the risk of impingement with subsequent loosening or failure of the integrity of the implant. We investigated the use and survival of CALs in primary and revision THA in the Dutch Arthroplasty Register (LROI).

Methods: Use of CAL in THAs was extracted from the LROI in the period 2007-2022. 423,773 primary THAs and 52,706 revision THAs have been registered, of which 29 CALs were implanted in primary THA and 236 CALs in revision THA. Patient characteristics and survival of the CAL placed in primary and revision THA were separately analysed.

Results: Of the CALs placed in primary THA, no revisions of the implant occurred during a median follow-up of 5.4 years (interquartile range [IQR] 4.0-12.4). The CALs in revision THA were most frequently used for cases with recurrent dislocation (183/236). Median follow-up was 4.8 (IQR 2.3-8.2) years. The re-revision rate was 10% (95% CI, 6.6-14) at 5-year follow-up and 12% (CI, 8.1-17) at 9-year follow-up. The most frequently registered reason for re-revision was dislocation (n = 19, 70%).

Conclusions: In the Netherlands there is a relatively low use of CALs in primary as well as revision THA. The survival rate of CALs is acceptable, with recurrent dislocation as the main reason for re-revision. The use of CALs should be reserved for specific cases with high risk for dislocation.

Background: Whether postoperative posterior pelvic tilt progression is an independent risk factor for cup revision after total hip arthroplasty (THA) with a conventional polyethylene (PE) liner is unclear. This long-term follow-up study assessed the association between posterior pelvic tilt and cup revision after THA using the porous-coated anatomic (PCA) total hip system.

Methods: This retrospective cohort study included 94 patients who underwent THA using the PCA total hip system and participated in postoperative follow-up for a mean of 25 years. The Japanese Orthopaedic Association (JOA) hip score was the clinical outcome, and prosthetic alignment and the change in pelvic tilt were measured as radiological outcomes. Prosthetic survival rates for revision as the endpoint were evaluated, and risk factors for cup revision were identified using a multivariate logistic regression analysis.

Results: The JOA hip score improved significantly (p < 0.001) after THA (before THA: 41 ± 6.3 points; after THA: 86 ± 8.9 points). The postoperative posterior pelvic tilt progressed 3.6 ± 3.2°. Survival rates of the cup and stem at 27 years postoperatively were 60.8% and 87.5%, respectively (p < 0.001). The main reason for revision (81% of all revisions) was aseptic loosening. Postoperative posterior pelvic tilt progression was an independent risk factor for cup revision (odds ratio, 1.53; 95% confidence interval, 1.06-2.20; p = 0.022).

Conclusions: When the PCA total hip system was used, the stem exhibited good longevity during a mean follow-up period of 25 years; however, the cup was vulnerable because of aseptic loosening. Postoperative posterior pelvic tilt progression was an independent risk factor for cup revision.

Introduction: The unnecessary over-ordering of routine pre-transfusion tests (blood typing, screening, and cross-matching) for surgical cases results in substantial avoidable costs and imposes an undue burden on transfusion services. This study specifically focuses on conducting a systematic review of the literature to assess the necessity of routine pre-transfusion tests before total hip arthroplasty (THA) and aims to provide a comprehensive summary of the outcomes associated with this practice.

Methods: A systematic review and meta-analysis were conducted to analyse the study's characteristics, assess the prevalence of over-ordering, defined as ordering more routine pre-transfusion tests than clinically necessary, examine transfusion rates, and evaluate potential cost savings to the healthcare system.

Results: The study included 12,178 patients. Pooled results revealed an 88.1% over-ordering pre-transfusion test rate (95% CI, 0.80-0.96; p < 0.001) among patients undergoing primary THA. The pooled prevalence of hospital transfusion rate was 11.9%, with a percentage of intraoperative transfusion of 0.4% (95% CI, 0.001-0.007; p = 0.007). There were statistically significant differences in preoperative haemoglobin (Hb) levels between patients not requiring 14.1 g/dl (95% CI, 13.2-14.9; p < 0.001) and those needing transfusion 11.9 g/dl (95% CI, 10.9-12.9; p < 0.001) (p < 0.001). The per-patient total cost savings ranged from 2.10 to 191.27 dollars.

Conclusions: Our findings indicate that routine pretransfusion testing for all patients undergoing primary THA may be unnecessary. We recommend restricting pre-transfusion test orders to patients with preoperative haemoglobin levels below 12 g/dl specifically in the context of unilateral primary THA, always considering individual patient and surgical risk factors. This focused approach has the potential to yield substantial cost savings for healthcare systems and transfusion services by mitigating the unnecessary over-ordering of pre-transfusion tests associated with these surgical procedures.

Background and purpose: Considering dissatisfaction rates of around 10% after total hip arthroplasty (THA), this study aimed to investigate the role of pain catastrophising (PC) on functional outcomes, pain, and quality of life following THA in a large prospective study. PC is the tendency to focus on and exaggerate painful stimuli combined with a decreased ability to deal with pain.

Patients and methods: A prospective comparative study was performed with 531 patients undergoing primary unilateral THA between 2019 and 2020. Patients were considered PC with a preoperative score ⩾30 on the PC Scale, resulting in 57 (11%) PC-patients. Patient-reported outcome measures (PROMs) were collected preoperatively, at 3 months, 1 year, and 2 years postoperatively and consisted of Hip disability and Osteoarthritis Outcome Score-Physical Function (HOOS-PS), Oxford Hip Score (OHS), pain (NRS), and quality of life (EQ-5D), including minimal clinical important differences (MCIDs) and patient acceptable symptom state (PASS), as well as length of stay and aseptic revisions.

Results: PC-patients reported inferior preoperative scores on all PROMs and had longer hospital stay (p = 0.02). Although PC-patients had more improvement in all scores and a higher proportion generally reached MCID, they still reported lower OHS, more pain, and lower EQ-5D at 2-year follow-up (all p < 0.03), and fewer PC-patients reached PASS for OHS and EQ-5D at final follow-up. No difference in aseptic revisions was seen (p = 0.95).

Conclusions: PC-patients had worse preoperative subjective function and more pain. Although they showed more improvement than non-PC patients at all outcomes, less patients reached PASS for OHS and EQ-5D at 2-year follow-up.

Background: Valgus osteotomy is a femoral head-preserving surgery to treat femoral neck non-union in young, active patients. The traditional approach, however, causes medialisation of the femoral shaft during valgus correction, which alters femoral anatomy and complicates conversion to total hip arthroplasty if head osteosynthesis fails. This study aims to outline a novel surgical technique, medial opening wedge valgus intertrochanteric osteotomy (VITO), and evaluate its clinical and radiographic outcomes, focusing on restoring hip biomechanics and improving union rates.

Methods: Between 2007 and 2022, this technique was used in 18 cases (mean age 39; range 16-51 years). There were 14 males and 4 females. Non-union was due to failed internal fixation in 10 cases, while in 8 cases was due to neglected fractures. Treatment outcomes were evaluated by assessing union, pre- and postoperative neck-shaft angle (NSA) correction and functional outcomes by the Harris Hip Score (HHS).

Results: 16 out of 18 patients were available for follow-up. The average duration of nonunion was 10.7 (range 1-60) months and the mean follow-up was 64 (range 24-140) months. All achieved successful union, with an average neck shaft angle correction of 16°. 3 patients were converted to total hip arthroplasty (THA) due to implant failure. Complications included 3 cases of avascular necrosis (AVN). Despite these complications, 62% of patients had excellent HHS, and 19% had good HHS. The mean improvement in HHS was 92 (postoperative) from 46 (preoperative).

Conclusions: The medial opening wedge VITO is an effective technique for restoring hip biomechanics and achieving high union rates in patients with femoral neck non-union. This technique preserves the proximal femoral anatomy, facilitating easier conversion to THA when necessary.

Background: Survival at 25 years' follow-up for total hip arthroplasty (THA) has been reported at 5%-77%, with hydroxyapatite (HA) coating, due to its osteo-conductive properties, used to enhance implant fixation and survival. The progressive increase in life expectancy raises doubts regarding HA-coated THA survival and THA revision surgery risk. The aim of our study was to retrospectively analyse survival for primary uncemented fully HA-coated THA after 28 years' follow-up.

Methods: Our cohort survival study of the JRI Furlong HA-coated system retrospectively included patients aged 18-75 years who had undergone THA between 1992 and 1998 at our centre and who were followed up according to clinical records by orthopaedic surgeons to 2022. Data on THA revision surgery and its causes, follow-up, and death were analysed using Kaplan-Meier survival and Cox regression modelling.

Results: The cohort included 196 patients (268 hips) followed up to a maximum of 27.5 years (mean 15.54 (SD 6.01) years) with 62 patients (88 hips) >25 years. THA revision surgery was performed in 7.5% of cases, occurring a mean of 11.1 years following primary surgery. Aseptic loosening accounted for 4.4% of these revisions, affecting both the acetabular component (2.2%) and the femoral stem (1.3%). THA survival at 15 years', 20 years', and 27.5 years' follow-up was 95.5%, 88.3%, and 79.3%, respectively. According to the log-rank and Cox regression analysis, no significant relationships were found.

Conclusions: Furlong HA-coated stem provides excellent long-term bone fixation for a long-term follow-up over 27.5 years with an aseptic loosening stem revision rate of 1.3%.

Introduction: A primary objective when performing a total hip arthroplasty (THA) is to restore hip biomechanics in accordance with a chosen surgical plan. The aim of this study was to assess the accuracy of a 3D-printed patient-specific guide for delivering a planned femoral osteotomy for both a posterior and an anterior approach.

Methodology: 40 patients (20 anterior and 20 posterior) scheduled for THA received a preoperative work-up allowing for patient-specific implant sizing and positioning. Following surgeon confirmation, a patient-specific guide was designed and printed, enabling the desired osteotomy to be executed. Achieved osteotomies were assessed using commercially available software platforms. Planning accuracy was also assessed using both the planning platform as well as more traditional 2D-templating techniques.

Results: The mean deviation between the planned and achieved osteotomy level was -0.6 mm (range -4.1-6.4 mm). 95% of the achieved osteotomy levels were within 3 mm of the plan for both the posterior and anterior approach groups. 70% of the Optimized Positioning System (OPS) planned femoral components were the exact size as planned versus 25% of the 2D-planned components. 98% of the OPS planned femoral components were within 1 size of plan versus 58% for the 2D-planned components. No sizing accuracy difference was observed between planning approaches (p = 0.70).

Conclusions: A patient-specific osteotomy guide can be a simple and accurate method to reproduce a planned femoral neck resection through an anterior or posterior approach. Further, 3D planning appears to more accurately predict femoral sizing in THA than more conventional 2D methods.

Background: Different methods can help to optimise sagittal cup orientation in total hip arthroplasty (THA) based on individual spinopelvic characteristics. This study aimed to: (1) assess how often combined sagittal index (CSI) and hip-spine-classification targets were achieved post THA; (2) compare anteversion/inclination between cups in-/outside optimal CSI zone; and (3) determine association with outcome.

Methods: This is a multicentre, prospective, case-cohort study of 435 primary THA for osteoarthritis (53% females; age: 65 ± 12 years; follow-up: 2.4 ± 0.6 years) (58% lateral, 29% anterior, 13% posterior approach). No robotics or dual-mobility were used. Patients underwent spinopelvic radiographs to measure parameters including lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), pelvic femoral angle (PFA), and ante-inclination (AI) on lateral spinopelvic radiographs. Unbalanced spine was defined as PI - LL ⩾ 10° (PI: pelvic incidence; LL: lumbar lordosis), stiffness as ∆LL < 20°. Optimal cup orientation was based on CSI targets: 205-245° for balanced spine (n = 327), or 215-235° for unbalanced spine (n = 108), hip-spine classification targets (±5°), and conventional inclination/anteversion (40/20° ± 10°) target. Patient-reported outcome was measured using Oxford Hip Score (OHS).

Results: CSI targets were achieved in 60% (n = 261/435), whilst 44% had cup position within hip-spine classification targets (n = 125/284). Anteversion was higher among cups within CSI targets (26° ± 8° vs. 22° ± 10°; p < 0.001). Overall dislocation rate was 0.9% (n = 4/435), without difference whether CSI targets were achieved (0.4% vs. 1.7%; p = 0.178). Postoperative OHS was better among those within CSI targets (42 ± 8 vs. 40 ± 9; p = 0.003) or within hip-spine-classification targets (p = 0.028), but not according to conventional orientation (p = 0.384).

Conclusions: Awareness of adverse spinopelvic characteristics and using sagittal characteristics (especially CSI) can help surgeons to achieve optimal cup orientation, improving outcome and reducing dislocation risk post-THA.

Introduction: The RM Pressfit vitamys is an uncemented, titanium particle-coated, isoelastic monoblock cup made of vitamin E blended highly cross-linked polyethylene. We addressed the following questions: (1) What are the clinical and (2) radiographic outcomes 10 years after implantation? (3) What is the revision rate?

Methods: In this prospective observational study in a tertiary care centre we investigated all consecutive cases of total hip replacement with the RM Pressfit vitamys cup between September 2009 and November 2011. It was implanted in 162 hips, 49.4% in women. The mean age was 67.2 years (standard deviation [SD] 9.5), and the mean BMI was 27.3 kg/m² (SD 4.7). In 153 cases (94.4%), primary or secondary osteoarthritis was the diagnosis. We evaluated preoperative and follow-up data at 6 weeks, 1, 5, and 10 years. A modified Harris Hip Score (mHHS), pain and satisfaction on a visual analogue scale (VAS), radiographic evaluation, complications and revision rate were investigated.

Results: At the 10-year follow-up (mean 120.5 months, SD 1.4, range 118-126), 99 hips were available for clinical and radiographic evaluation. (1) The mean mHHS was 94.8 (SD 9.9), rest pain 0.2 (SD 0.6), load pain 0.5 (SD 1.5), and satisfaction 9.5 (SD 1.1). The mean improvement as compared to preoperatively was +33.7 (SD 16.8), -3.3 (SD 2.7), -6.0 (SD 2.4) and +5.7 (SD 2.5), respectively. (2) In the radiographic evaluation, no loose cups, no acetabular lucent lines, or acetabular osteolysis were seen. (3) 2 cups were revised, both due to malpositioning. The 10-year cumulative revision rate was 2.0% (95%CI, 0.0-4.2%). The implant survival rate with aseptic loosening as endpoint was 100%. No adverse events were reported.

Conclusions: At the 10-year follow-up, the RM Pressfit vitamys cup still had promising results with good clinical and radiographic outcomes and a low revision rate.