HIP International最新文献

Aim: The primary aim of this study was to describe the prevalence of MRI findings in football players with and without hip and/or groin pain (HGP).

Methods: We described the prevalence of extra-articular findings (including gluteal, hamstring, iliopsoas, rectus femoris; pubic) and intra-articular (including labral, cartilage, bone marrow oedema, subchondral and paralabral cysts, ligamentum teres) findings on MRI for 215 eligible hips with HGP (132 participants) and 68 eligible asymptomatic hips (34 participants). Imaging of the hip joint included radiographs and a non-contrast 3.0 Tesla MRI, performed at a single imaging centre.

Results: There was no difference between groups for prevalence of any extra-articular or intra-articular findings. Pubic (75-85%), labral (70-78%) and chondral (54-60%) findings were most common. ⅓ of hips demonstrated all 3 findings regardless of symptoms (33.5% in HGP group and 35.5% in control group). 96.7% of HGP participants and 95.6% of control participants had at least 1 finding.

Conclusions: Our study found that prevalence of extra- and intra-articular hip MRI findings did not differ between football players with and without HGP. Football players with and without pain were likely to have multiple imaging findings in 1 hip. A thorough history and clinical examination should be used to contextualise any imaging findings.

Background: Excessive traction stress on the femoral nerve during total hip arthroplasty (THA) may cause femoral nerve palsy. This study aimed to evaluate the tension changes on the femoral nerve during the surgical processes in the modified Watson-Jones approach using spring devices.

Methods: We examined 11 lower extremities from 7 fresh cadavers. The femoral nerve was identified in the ilioinguinal approach and partially replaced with a tension spring (free length, 18.7 mm). Then, a modified Watson-Jones approach was employed in the lateral decubitus position. To assess the tension on the femoral nerve, the spring length was measured in the following settings: (1) limb in neutral position with no retractor after capsule incision; (2) hip joint completely dislocated with extension, adduction, and external rotation after femoral head resection; (3) femur elevated using retractors to expose the cutting surface; and (4) return to a neutral position. The differences in spring lengths were compared.

Results: Median spring lengths in the first, second, third, and fourth settings were 19.1 mm, 21.0 mm, 23.6 mm, and 18.8 mm, respectively. Significant differences were found between the first and second and the second and third settings, but not between the first and fourth settings. The extension of the springs from the first to the third setting was more than 1.7-fold higher than that from the first to the second setting for all but one spring.

Conclusions: The changes in spring length indicated that the femoral nerve tension progressively increased by more than 70% from hip dislocation to femur elevation with retractors. We directly demonstrated that tension on the femoral nerve increased in the modified Watson-Jones approach. These findings may contribute to recommendations regarding the surgical procedure.

Purpose: With an ageing population, the number of total hip arthroplasty (THA) performed in osteoporotic patients is increasing. Cemented stems are often chosen for osteoporotic bone owing to their lower fracture risk. However, how bone quality influences stress distribution after cemented stem insertion remains unclear. This study compared femoral stress distribution between normal and osteoporotic femora using thermoelastic stress analysis (TSA).

Materials and methods: 6 composite femora were used: 3 normal adult male models (#3403) and 3 osteoporotic models (#3503). C-stem AMT cemented stems were implanted with a standardised technique. TSA was conducted before and after stem insertion under physiological loading (normal: 100-1900 N; osteoporotic: 100-1000 N). Stress distribution was analysed by Gruen zones and compared using linear mixed models.

Results: In the normal models, stress uniformly decreased after stem insertion with a distal shift of peak stress. In the osteoporotic models, proximal stress decreased markedly, while distal stress (zones 4L, 4M) increased, demonstrating a more pronounced distal shift.

Conclusions: Bone quality strongly affects load transfer after cemented stem insertion. Osteoporotic bone demonstrated proximal stress loss and distal concentration, possibly underlying atypical periprosthetic femoral fractures. TSA provides useful insights for implant design and surgical planning in osteoporotic THA.

Introduction: Loosening of hip implants causes severe pain and disability. Revision surgery, the standard treatment, carries high risks, especially for frail patients. Therefore, a less-invasive treatment option is needed for patients with incapacitating pain. We evaluated the safety and efficacy of percutaneous periprosthetic cement injection (PPCI) to restabilise loosened hip implants.

Methods: All patients treated with PPCIs of hip implants between 2004 and 2020 were retrospectively included (median follow-up 24 months, IQR 11-51). Cement was injected in the periprosthetic space of the loosened hip implant under fluoroscopy. Patient characteristics and the Charlson Comorbidity Index (CCI) were measured. Pain reduction was measured by the Harris Hip pain-subscore and adverse events were recorded.

Results: 34 patients were included (mean age 83 years, median CCI 6 points). 10 patients had a second PPCI after 12 months (median, IQR 7-27). 2 patients needed revision surgery. 30 patients had pain reduction and 4 had no pain reduction. Adverse events included femoral fissure during needle placement (n = 1) and progressive migration of a loosened acetabular cup (despite the cement injection; n = 2).

Conclusions: PPCIs for loosened hip implants is feasible in frail patients with pain reduction in the majority of patients and has limited adverse events.

Methods: 56 patients with severe acetabular bone defects with or without pelvic discontinuity were included. In the TCA group 31 patients and 25 in the 3D group with a minimum follow-up of 2 years were included. The main indication for revision surgery with acetabular bone defect was aseptic loosening in both groups.

Results: The mean follow-up was 57.21 ± 28.81 months. Implant survival rates were 90.32% in the TCA group and 100% in the 3D (P = 0.24). Functional outcomes improved in both groups based on the Merle D'Aubigné & Postel score, with greater improvement in the 3D group (9.24 ± 3.23 vs. 6.55 ± 2.59 points, P = 0.001). Pain levels improved equally in both groups. Surgical time was shorter in the 3D group (108 ± 34.5 vs. 129 ± 43.4 minutes, P = 0.047).There were no significant differences in reoperation rate, transfusion need, hospital stay, or mortality.

Conclusions: Tantalum metal cups and augments and custom-made 3D-printed trabecular titanium implants demonstrated an excellent survival rate in the management of severe acetabular bone defects. The group of patients operated on with custom 3D-printed implants had better postoperative functional outcomes and a shorter surgical time.

Background: Periprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA) that has major clinical and financial implications. Despite CDCR being the accepted gold standard for chronic PJI, serious complications, such as extensive bone loss and protracted rehabilitation, have led to the investigation of PTCR as an alternative treatment strategy for chronic PJI.

Methods: According to the PICOS framework, a systematic review and meta-analysis were performed to assess the clinical efficacy of partial 2-stage exchange in chronic PJI with a stable femoral component. There were no time or language limits during the search for relevant articles in PubMed, Embase, Scopus, and Cochrane Library databases. Data extraction and quality assessment were performed according to the MINORS criteria by 2 independent reviewers. Statistical analysis, including heterogeneity and sensitivity analyses, was performed using R Studio software with the appropriate meta-analytical packages.

Results: 13 studies, including 239 patients, were analysed. When the data were pooled, MDCT showed an 88% rate of complete eradication with homogeneity (I² = 0%). Secondary traits included 12% re-operations, 8% deaths, and 1% fractures. Infectious and systemic complications were observed in 13% and 3% of patients, respectively. Implant stability was present in 89% of cases, with significant functional improvement, with a mean Harris Hip Score of 37.77 at the final follow-up. Treatment failure, defined as infection recurrence or the need for chronic antibiotic suppression, was observed in 14% of cases, and sensitivity analysis excluding zero-event studies showed a 17% failure rate.

Conclusions: Partial 2-stage exchange results in favorable eradication of infection, may reduce bone stock loss, and optimises functional outcomes. However, concerns remain regarding its efficacy against resistant strains and proper patient selection criteria. Well-designed comparative studies with longer follow-up periods are needed to establish treatment algorithms and confirm long-term clinical results.PROSPERO registration number CRD42024599183.

Introduction: Failed internal fixation of proximal femoral fractures is associated with significant morbidity, mortality, and financial burden. Conversion total hip arthroplasty (THA) is a technically demanding salvage procedure associated with high risks of periprosthetic joint infection and instability.

Methods: Independent searches of MEDLINE, EMBASE, and the Cochrane library were performed for studies published from 1990 onwards regarding conversion THA in adults following failed proximal femur fixation. Following screening, 34 studies were included in this review.

Results: Predictors of failure include female sex, smoking, and tip-apex distance >25 mm. Preoperative screening for occult, extra-articular infection is vital, as pathogens often reside near hardware rather than within the joint. CT, ultrasound, and SPECT-CT are essential for assessing bone stock and identifying fluid collections. Dual-mobility cups effectively reduce dislocation rates to 0-3%. Functional scores improve significantly, though 10-year survivorship is approximately 86%.

Discussion: Conversion THA provides substantial functional recovery but carries a 7-fold higher infection risk than primary THA. Success requires meticulous screening tailored to previous hardware sites and selecting femoral fixation based on bone quality and cortical defects. Specialised implants are essential for optimising long-term outcomes in this high-risk population.

Objectives: The benefits and risks of the minimally invasive direct superior approach (DSA) compared with the posterior approach (PA) in primary total hip arthroplasty (THA) remain uncertain.

Methods: We performed a systematic review and meta-analysis comparing DSA and PA in primary THA. Outcomes included perioperative parameters, radiological and functional results, and postoperative complications. Statistical analysis was performed using Review Manager, with heterogeneity assessed using I². Subgroup analyses were restricted to randomised controlled trials (RCTs).

Results: 11 studies comprising 5217 patients were included, with 1259 undergoing DSA. DSA was associated with a shorter hospital stay (MD -0.67 days; p < 0.00001), reduced blood loss (MD -66.09 mL; p = 0.007), and increased Harris Hip Scores (HHS) within 3 months (MD 1.00; p = 0.03). No significant differences were observed in operating time, radiological outcomes, Oxford Hip Score, Western Ontario and McMaster Universities Osteoarthritis Score, 12-month HHS, or postoperative complications. Subgroup analysis revealed differences between RCTs and observational studies in length of stay (p < 0.0004), leg-length discrepancy (p = 0.07), and operating time (p = 0.04).

Conclusions: DSA appears to be a safe, effective alternative to PA, providing less blood loss, shorter hospitalisation, and faster early recovery without compromising mid-term outcomes.

Introduction: Manual measurement of leg length (LL) and offset can be tedious. This study developed an automated algorithm for measuring LL and offset from pre- and postoperative AP pelvis radiographs in a large cohort of THA patients.

Methods: Using a deep learning model trained on 1100 total AP pelvis radiographs, an algorithm was developed to calculate LL and offset. Algorithm measurements were compared with manual measurements by 4 raters on a sample of 100 pre- and postoperative image pairs. Inter- and intra-rater consistency was calculated using the intraclass correlation coefficient (ICC). The algorithm was applied to calculate the pre- and postoperative LL and offset discrepancies and the change in LL and offset bilaterally in a cohort of 15,951 image pairs.

Results: ICC values between the algorithm and human raters ranged from 0.83 to 0.88 for offset measurements and 0.92 to 0.97 for LL measurements. Human raters demonstrated good-to-excellent inter-rater ICC and uniformly excellent intra-rater ICC. Entire database measurements demonstrated shorter LLs for arthritic joints versus the contralateral leg preoperatively and reduced LL discrepancy post-arthroplasty.

Conclusions: We present a deep learning algorithm for calculating LL and offset using AP pelvis radiographs. This tool can support population-level studies and may assist operative management.

Introduction: We aimed to delineate the histological characteristics of the hip joint's capsule of patients undergoing hip arthroplasty (HA) for primary osteoarthritis (OA) versus femoral neck fracture (FNF).

Methods: 86 patients were included: 39 with OA and 47 with FNF. A 2×2 cm capsular sample was harvested near the transverse ligament. Sections (4 µm thick) were stained with haematoxylin and eosin. Outcomes included capsular thickness (mm), fibrosis percentage, vascularization grade, inflammatory infiltrate, and cartilaginous metaplasia.

Results: Inflammatory infiltrates were present in 25.6% of OA cases and 12.8% of FNF (p = 0.127). Superficial degenerative changes were more common in OA (48.7%) than FNF (10.6%) (p < 0.01). Cartilaginous metaplasia was higher in OA (35.9%) versus FNF (6.4%) (p = 0.01). Vascular density showed no significant difference (p = 0.104). Severe fibrosis was more frequent in OA (46.2%) than FNF (8.5%) (p < 0.01). Mean capsular thickness was greater in OA (5 mm; IQR 4.3-7.1) than FNF (3.1 mm; IQR 2-4) (p < 0.01).

Conclusions: The hip capsule in OA showed greater thickness, fibrosis, and cartilage metaplasia. These structural differences may influence joint stability and could partly explain differing postoperative outcomes between elective THA for OA and urgent THA for FNF.