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Introduction: Prosthetic joint infection (PJI) is a much-feared complication in total joint arthroplasty. Debridement, antibiotics, irrigation and implant retention (DAIR) is often the preferred treatment in acute PJIs, but with varying results. The primary aim of this study was to evaluate the outcome of a high quality DAIR procedure performed according to a consistently applied surgical protocol in early postoperative and acute haematogenous PJIs in hip and knee, and secondary to study risk factors associated with failure.

Methods: We performed a prospective multicentre study to evaluate the effect of a standardised protocol-based surgical management (DAIR) emphasising a thorough debridement, followed by 6 weeks of antimicrobial therapy. Empiric parenteral antimicrobial treatment was administered until the results of susceptibility tests were available. No suppressive antimicrobial therapy was given after the 6-week treatment-period. Primary outcome measure was infection control at the 2-year follow-up.

Results: A total of 99 patients from 8 Norwegian hospitals were found eligible and included in the study, and 82 patients were finally analysed. 69 of 82 patients (84% [CI, 76-92%]) were successfully treated with this treatment protocol. We found a reduced success rate when patients were treated with a DAIR procedure following an infected revision arthroplasty compared with an infected primary arthroplasty (11/17 (65 %) versus 58/65 (89 %), respectively (p = 0.02).

Conclusions: The success rate of a standardised DAIR procedure with a 6-week antimicrobial treatment was good in PJI following primary arthroplasties. The success rate following PJI in revision arthroplasty was poor, and other treatment options should be considered.

Background: Acetabular fractures are among the most challenging orthopaedic fractures, and a high total hip arthroplasty (THA) conversion rate has been reported in older patients with acetabular fractures. Bone quality is a poor prognostic factor after acetabular fracture fixation and has been assessed using computed tomography (CT). However, the relationship between Hounsfield unit (HU) values measured using CT and early acetabular fracture outcomes remains unknown. This study aimed to elucidate the effect of HUs on early acetabular fracture outcomes.

Methods: 50 consecutive patients who underwent open reduction and internal fixation for acetabular fractures were included. The mean follow-up duration was 24 months. 27 hips had elementary fractures and 23 had associated fractures. The reduction quality assessed using CT was as follows: anatomical, 13 hips; imperfect, 10 hips; and poor, 27 hips. Secondary hip osteoarthritis was observed in 5 patients (10%), and the surgery was converted to THA in 1 patient (2%). The HU values of the fifth vertebral body and the unaffected side of the femoral head were measured. The fracture type, radiological secondary hip osteoarthritis, conversion to THA, and postoperative displacement gap were recorded.

Results: The unaffected femoral head HU values in elementary fractures (250.5 ± 50.5) were significantly higher than those in associated fractures (221.5 ± 48) (p < 0.047). The HU values of the fifth vertebral body and the unaffected femoral head were significantly correlated with the postoperative residual displacement gap and were significantly lower in those with secondary osteoarthritis than in those without it. The cut-off value for predicting early osteoarthritic change after an acetabular fracture was approximately 180.

Conclusions: The HU values were correlated with the fracture type, postoperative displacement gap, and early osteoarthritic change after acetabular fractures and are clinically useful prognostic factors for early acetabular fracture outcomes.

Background: Patients with total hip arthroplasty (THA) under the age of 35 represent a small and heterogeneous group of 1% of all THA performed. This systematic review aims to analyse the diagnosis, implant type, complications, and long-term results in these patients.

Methods: A search was performed on PubMed, Scopus, and Cochrane Library up to 31 July 2023. We included observational prospective and retrospective studies published in the last 20 years, which evaluated diagnosis, implant types, long-term results, and return to sports in patients ⩽35 years who underwent THA. We excluded case reports, case series, and studies with <35 patients. We extracted age, diagnosis, surgical information, follow-up, complications, revision rate, implant survival, and clinical outcomes for each study. The methodology of the included studies was evaluated using the MINORS score.

Results: 18 studies with 1955 patients and 2383 THAs were included. Osteonecrosis (40.6%), posterior approach (81%), the uncemented press-fit implants (73.4%), metal-polyethylene bearings (31.3%) were the most frequently found items. All the clinical outcomes reported improvement from the preoperative to postoperative. The most frequent complication was aseptic loosening (4.3%). The survival rate was 92.4% at a mean follow-up of 10 years.

Conclusions: THA is a good option for specific hip diseases in the young, but aseptic loosening still is the major point of concern.

Introduction: The progressive nature of multiple sclerosis (MS) may adversely affect outcomes following total hip arthroplasty (THA). As patient-reported outcome measures (PROMs) in this specific group are not well defined, this study aimed to compare the clinical outcomes and the rates of achieving the minimal clinically important difference for improvement (MCID-I) and worsening (MCID-W) between patients with MS and those without MS undergoing THA.

Methods: We conducted a retrospective analysis of 375 THAs, including 75 MS patients and 300 propensity-matched non-MS patients (4:1), performed between 2016 and 2022. Collected PROMs included Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Mental and Physical, PROMIS Physical Function short form 10-a (PF-10a), and Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS). Preoperative and postoperative PROMs and MCID-I/MCID-W rates were compared.

Results: A total of 375 THAs, including 75 MS and 300 matched non-MS patients, were analysed. MS patients had higher 90-day postoperative complication rates (9.3% vs. 2.3%, p = 0.012) and infection rates (4.0% vs. 0.3%, p = 0.006). The rates of achieving MCID-I and MCID-W were similar for PROMIS Global Mental, PROMIS Global Physical, and HOOS-PS, but MS patients had a higher rate of experiencing MCID-W for PROMIS PF-10a compared to non-MS patients (16.7% vs. 6.5%, p = 0.022). Additionally, MS patients had a longer mean hospital stay (2.4 vs. 1.9 days, p = 0.005) and lower rates of being discharged home (82.7% vs. 94.3%, p < 0.001).

Conclusions: The present study found that MS patients experience similar rates of MCID-I and MCID-W in most PROMs but have a higher rate of MCID-W for PROMIS PF-10a and increased postoperative complications. These findings highlight the need for careful consideration of postoperative risks despite potential improvements. Further research is needed to explore the impact of MS progression on PROMs and perioperative outcomes.

Background: The growing adoption of robotic-assistance during total hip arthroplasty (THA) has provided novel means through which a patient's anatomy and dynamic spinopelvic relationship can be incorporated into surgical planning. However, the impact of enhanced technologies on intraoperative decision-making and changes to component positioning has not yet been described.

Methods: A multicentre, prospective study included 105 patients (52% women) patients who underwent robotic-assisted THA with the integration of software that incorporates a patient's pelvic tilt (PT) and virtual range-of-motion (VROM) for impingement modeling. The primary outcome of the study was the percentage of patients who underwent changes to the preoperative plan for cup position after incorporating the data from the software.

Results: Utilising the intraoperative VROM information, the preoperative plan for cup position was changed from the default (40° inclination and 20° anteversion) in 82/105 (78%) cases. When stratifying by spinopelvic mobility, 64% were considered normal (change ⩾ 10° and ⩽30°), 27% were stiff (change < 10°), and 9% were hypermobile (change > 30°). For all cohorts, the majority of cases (78%) deviated from the 40° inclination and 20° version target. When evaluating the proportion of cases within the Lewinnek and Callanan safe zones based on spinopelvic mobility, 19% of cases within the normal group were planned outside of both zones compared to 39% of stiff cases and 10% of hypermobile cases.

Conclusions: Utilising the latest version of robotic-assisted THA software, the preoperative plan for cup position was changed in the vast majority (78%) of patients, causing substantial deviations from traditional, generic cup targets.

Background and purpose: Metaphyseal-stabilised short stems rely on sufficient metaphyseal fixation and are inserted by following the medial cortex. This type of stem is used extensively in our institution, and we observed on occasion unintended implant positioning with an increased distance between the implant and the medial cortex. A bony structure within the proximal femur which was first described in 1874 and named the calcar femorale, coincides with this phenomenon.The aim of this study was to investigate the impact of the calcar femorale on the position of a metaphyseal-stabilised short stem.

Patients and methods: The frequency of cases with an increased distance between medial cortex and the implanted short stem was analysed in 52 consecutive patients. Additionally, we performed an anatomical CT study with 60 cadaveric femora to obtain more detailed information on the anatomy of the calcar femorale. Detailed measurements regarding the calcar femorale and its relationship to the proximal femur were obtained. From this, we derived implications for the implantation of a short stem prosthesis.

Results: In 50% of all cases, we found an increased gap between the stem and the medial cortex. An increased gap did not significantly affect stem size, position, or subsidence rate, but in cases with an increased gap we found fewer stems with a radiologically optimum fit. The calcar could be identified in all 60 cadavers. The calcar femorale angle showed a high correlation with the mechanical antetorsion (0.87, p = 0.02) and the functional antetorsion (0.86, p = 0.05) of the femur.

Conclusions: The calcar femorale is a consistent anatomical structure which may be the cause for an increased gap medial to the short stem in 50% of our cases. It limits the intramedullary space and influences both stem size and orientation. The CF angle which correlates with femoral antetorsion may influence the anteversion of the stem.

Introduction: Dynamic interaction of cam and pincer deformities can result in pathological contact forces in femoroacetabular impingement (FAI) syndrome. Similar deformities were noted during acetabular fracture reconstruction. We hypothesise that the prevalence of FAI deformity is higher in patients sustaining acetabular fractures than in a control group.

Methods: This retrospective radiographic study compared the parameters that define FAI deformity in 100 patients consecutively admitted to a trauma unit with an acetabular fracture and a control group of 100 patients with lateral compression pelvic fracture without acetabular injury. Both underwent identical clinical imaging. Centre-edge angles (CEA) and alpha angles were used to define patients with pincer, cam, or mixed FAI deformity.

Results: There were significantly more patients with FAI deformity in the acetabular fracture group than in the control group (71% vs. 18%, p < 0.0001). There were considerably more fractures involving both anterior and posterior acetabular columns in patients with 'pincer' sockets (p = 0.02, OR = 2.95, 95% CI, 1.12-7.78).

Conclusions: There is a high prevalence of cam and pincer deformities in patients with acetabular fractures, particularly bi-column fractures.

Background: Appropriate selection of surgical approach for associated fractures of the acetabulum that involves both columns is still elusive. Therefore, present study aimed to assess the quality of life of complex acetabulum fracture managed with combined anterior and posterior approach (dual approach) as well as the association of postoperative reduction and patient reported outcomes.

Material and methods: This retrospective study was performed on 42 associated acetabular fracture patients with involvement of both columns, who were treated with a dual approach including combined anterior modified ilio-inguinal approach in combination with posterior Kocher-Langenbeck (K-L) approach in a single anaesthetic session having minimum two years follow-up. Postoperative reduction and radiological outcomes were assessed using Matta criteria. Functional outcome was assessed by a score system developed by Merle d'Aubigné-Postel. Patient-reported outcomes were assessed using the 36-Item Short Form Survey (SF-36).

Results: The mean age of participants was 47.9 ± 11.95 years and mean follow-up period was 2.8 ± 0.49 years. Anatomical reduction was achieved in 32 (76.19%) cases in postoperative period. 8 (19.04%) cases had congruent and 2 (4.76%) had incongruent reduction. Radiological and functional outcome was excellent/good n = 35 (83.33%) cases. Patient-reported outcome on domains physical function and role physical showed a significant improvement between 6 to 24 months period (p < 0.001).

Conclusions: The dual approach for complex acetabulum fracture with mid-term follow-up showed good to excellent radiological and functional outcomes. A significant improvement in patient-reported outcomes on Physical function and Role physical domains of SF-36 was also seen over the follow-up period.

Introduction: Iliopsoas tendinitis after total hip arthroplasty (THA) has become more prevalent with the increased use of large-diameter femoral heads impinging on native surrounding tissues. Anatomically contoured heads (ACH) are soft-tissue-friendly femoral heads created to minimise this issue. This retrospective study assesses iliopsoas tendinitis prevalence and re-operations in primary THAs with ACH, while determining the minimal clinically important difference (MCID) achievement and improvement with 5 patient-reported outcome measures (PROMs).

Methods: We conducted a retrospective analysis of 53 ACHs from January 2020 to July 2023. Patients who completed Hip Injury and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF SF-10a), PROMIS Global Health (GH)-Mental, or PROMIS GH-Physical, and pain score questionnaires were identified. PROM scores were collected preoperatively and at 3-month and 1-year postoperative intervals. Comparisons using chi-square and ANOVA tests were applied.

Results: The rates of achieving MCID and improvement within the first year were (69.2 vs. 76.9%) for PROMIS GH-Physical, (38.5 vs. 46.2%) for PROMIS GH-Mental, (71.4 vs. 92.9%) for HOOS-PS, (80.0 vs. 80.0%) for PROMIS PF SF-10a, and (74.0 vs. 91.7%) for pain scores. PROM scores at 3 months and 1 year significantly varied across all categories, except for PROMIS GH-Mental. No patients had iliopsoas tendinitis, dislocations, or re-operations.

Discussion: ACH implants may alleviate anterior hip pain, while maintaining comparable strength and bio-compatibility to conventional femoral heads. This study underscores the early safety and potential of ACH implants in reducing iliopsoas tendinitis and impingement.

Background: The Food and Drug Administration (FDA) maintains the Manufacturer and User Facility Device Experience (MAUDE) database for reporting adverse events associated with medical devices, including emerging technologies, such as robotic-assisted total hip arthroplasty (THA). Aim of this study was to evaluate the variation of adverse events associated with robotics in THA.

Methods: Medical device reports (MDRs) within the MAUDE database were identified between 2017 and 2021. For MDR identification the product class "orthopaedic stereotaxic equipment" and terms associated with THA were used. Individual adverse events were identified and organised by type and consequences, such as patient injury, surgical delay, or conversion to the manual technique.

Results: 521 MDRs constituting 546 discrete events were found. The most common reported complication was intraoperative hardware failure (304/546, 55.7%), among which the most common failure was a broken impaction handle/platform (110, 20.1%). Inaccurate cup placement was the second most common reported complication (63, 11.5%). Abandoning the robot occurred in 13.0% (71/521) of reports. A surgical delay was noted in 28% (146/521) of reports, with an average delay of 17.9 (range 1-60) minutes.

Conclusions: Identifying complications that may occur with robotics in THA is an important first step in preventing adverse events and surgical delays. Database analysis provide an overview of the range of complications.