HIP International最新文献

Purpose: To examine the effects of superior lateralisation of the centre of rotation and femoral offset shortening on the gluteus medius in developmental dysplasia of the hip (DDH), and the impact of biomechanical restoration by total hip arthroplasty (THA).

Methods: Horizontal (femoral, acetabular, and combined offset) and vertical (centre height, leg length) radiographic parameters, as well as gluteus medius radiodensity measured by computed tomography, were evaluated preoperatively and 1 year postoperatively in 100 hips (87 patients). Patients were grouped by whether radiodensity improved postoperatively. Correlations between parameter changes and radiodensity were analysed.

Results: In advanced osteoarthritis, radiodensity deterioration correlated with femoral offset shortening (p = 0.0011) and increased centre height (p < 0.0001). Postoperative radiodensity improvement correlated with increased combined offset (p = 0.0380) and leg lengthening (p = 0.0002). Multivariate analysis showed that the non-improvement group had a significantly smaller combined offset (p = 0.0399).

Conclusions: Gluteus medius fatty infiltration improved mainly with leg lengthening, but insufficient combined offset limited this recovery.

Purpose: Using a finite element (FE) model, we aimed to validate the efficacy of our new additional reduction screw technique to basicervical femoral neck fractures.

Methods: To investigate the biomechanical effects of an additional screw in an FE model of a femoral fracture, we recorded von Mises stress distributions. The fracture was simulated along the trochanteric line, with the additional screw positioned as inferior to the femoral neck as possible without invading the cortical bone. We compared models with and without the additional reduction screw to assess differences in external stress resistance.

Results: In the model without the additional screw, stress was distributed along the inferior neck of the fractured femoral head fragment. With the additional screw, stress in this region decreased, leading to better stress redistribution and improved structural integrity. The peak implant stress - particularly at junctions - was lower with the additional screw. Fracture fragment displacement around the femoral head centre was 61.9 mm without the additional screw and 9.5 mm with it.

Conclusions: In basicervical fractures, additional reduction screw fixation enhanced stress distribution across the bone at the fracture site - especially on the anteromedial cortex - reduced implant stress, and minimised fracture fragment movement during cephalomedullary nailing.

Purpose: Understanding the trajectory of recovery after hip arthroscopy is valuable to help manage expectations and recognise patients at risk for delayed recovery. The purpose of this study was to determine the recovery profile of function, pain, and activity level up to 2 years after hip arthroscopy.

Methods: Patients from a single centre's orthopaedic registry who underwent hip arthroscopy were identified. Function, pain, and activity level were measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), a numeric pain scale (NPS), and Tegner Activity Scale (TAS) up to 2 years postoperatively. Nonlinear growth models were used to estimate the effect of recovery time on each outcome.

Results: Of 92 patients identified, 64 (70%) were followed up to 2 years. There was significant improvement in all outcome measures at 2 years. The time to 50% recovery for PROMIS PF, PROMIS PI, and TAS was 11.0, 6.7, and 18.5 weeks, respectively. The time, in weeks, to full recovery of PROMIS PF, PROMIS PI, and TAS was estimated at 17.0, 37.4, and 28.8 respectively. NPS declined at a rate of -0.22 points per week, plateauing by 12 weeks.

Conclusions: Physical function and activity levels plateau at 4 and 7 months respectively, while pain recovery is more variable. These results can help guide discussions with patients regarding recovery after hip arthroscopy and provide benchmarks for identifying patients who could benefit from changes in postoperative protocol.

Background: Periacetabular osteotomy (PAO) is a well-established surgical treatment of symptomatic developmental dysplasia of the hip in young patients by improving the lateral centre-edge angle (LCEA) and the acetabular index (AI). Hence, the correction of the acetabular fragment is a hallmark of the PAO procedure.

Purpose: To evaluate the efficacy of fluoroscopy-guided visual estimation of the correction of the fragment during PAO.

Methods: 49 patients undergoing PAO were enrolled. The surgeons (3) were asked to visual assess the perioperative LCEA and AI. Perioperative assessments were compared with perioperative and postoperative measurements. Interobserver variation was assessed by regression analysis. Bland-Altman analysis was used to determine correlation between visual assessment and measurements.

Results: Mean correction of the LCEA was 11.1° (-4-23.5°) and the average AI correction was -10.7° (-20- 4°). The interobserver agreement was high for LCEA (R² = 0.83) and acceptable for AI (R² = 0.60). Visual estimation significantly overestimated the correction of the LCEA angle by 1.5° (95% CI, 1.0-1.9) and significantly overestimated AI by 0.31° (95% CI, 0.22-0.39) compared with the postoperative result. Retrospective measurements on the perioperative x-rays showed that this would have led to a significant underestimation of the correction of LCEA of 1.4° (95% CI 1.0-1.9) and overestimation of AI by 2.7° (95% CI, 1.9-3.5).

Conclusions: Perioperative visual estimation is on average sufficient for assessing the postoperative correction of LCEA and AI in PAO. Outliers are however observed.

Background: Short stems have been developed to conserve bone stock, especially in the younger population undergoing total hip arthroplasty (THA). They demonstrated functional outcomes comparable to conventional stems. The purpose of this study was to compare the incidence of acute periprosthetic femoral fractures (PPFx) during posterior and lateral THA, between stems of the same manufacturer (Taperloc Microplasty (stem A) versus Taperloc complete (stem B)).

Methods: Institution's database was searched for all primary THA performed between August 2016 and August 2023. Preoperative x-rays were analysed to characterize the proximal femoral geometry, specifically the canal bone ratio (CBR) and canal flare index (CFI). Data analysis was performed to identify risk factors for PPFx.

Results: 2107 femoral stems (stem A: 1727, stem B: 380) were implanted. 53% were women. The average age was 70 ± 11 years. PPFx rate was 0.94%, with 20 PPF (stem A: 17, stem B: 3). There was no significant difference in PPFx rates between the 2 stems (0.98% vs. 0.79%, p > 0.72) The multivariate regression analysis demonstrated that stem length, CBR, CFI, age and gender were not risk factors for PPFx.

Conclusions: Taperloc Microplasty and complete stems had similar rates of PPFx, and stem length was not a risk factor for a PPFx during uncemented THA.

Purpose: This study aims to develop machine learning models to predict perioperative biochemical abnormalities in femoral neck fracture patients, optimising treatment strategies and enhancing outcomes.

Methods: A retrospective analysis was performed on a local clinical registry dataset, which included patients undergoing femoral neck fracture surgery from 2023 to 2024. The study focused on analysing preoperative and postoperative potassium, haemoglobin, and albumin concentrations. 6 ML algorithms were developed for prediction. Model interpretability was revealed using the control variable method, and robustness was enhanced through external data validation.

Results: A total of 220 patients who completed the questionnaire and clinical tests were included in the study. Additionally, external data validation was performed on 15 patients beyond the initial cohort. Among the 6 ML algorithms used to predict biochemical indicators in patients with femoral neck fractures, SVR achieved the best performance in predicting preoperative potassium concentration K*, with an R² of 0.792 and an MAE of 0.335 mmol/L. Additionally, XGBoost showed good performance in predicting K, HGB*, HGB, ALB*, and ALB, with particularly excellent results in predicting HGB, achieving an R² of 0.943 and an MAE of only 0.478 g/L [* preoperative concentration].

Conclusions: This study developed several ML-based predictive models that effectively assess changes in perioperative biochemical parameters in patients with femoral neck fractures. The interpretability heatmap clearly indicated the clinical features most influential on each biochemical parameter, such as the close relationship between K* and creatinine, which aligns with kidney regulation mechanisms and existing physiological knowledge. External data validation further demonstrated the model's robustness, suggesting that the model is applicable not only to the existing dataset but also to a broader clinical population. Overall, the proposed model provides an effective tool for perioperative management, with promising potential for clinical practice to help optimise treatment strategies and improve patient outcomes and quality of life.

Background: Preoperative templating in Total Hip Arthroplasty (THA) is an essential tool in arthroplasty surgery. This study investigates the efficacy of CT-based templating in robotic total hip arthroplasty (rTHA) compared to traditional 2D digital x-ray templating and evaluates intra-observer variability among 3 arthroplasty consultants.

Methods: A total of 37 patients scheduled for primary hybrid rTHA using the Mako robot (Stryker) were included in the study. Independent, 2D digital templating (Materialise Orthoview) was performed by 3 experienced orthopaedic arthroplasty consultants, and the results were compared with a CT templating system (Stryker) and the postoperative implant size after CT based rTHA. Intra-observer reliability among the surgeons was determined using Fleiss' Kappa, individual surgeons were compared to the CT-templating system and the postoperative implant using Cohen's Kappa.

Results: Intra-observer reliability among surgeons was low, with significant variability and no variable showing strong agreement. 2D digital templating demonstrated poor predictive value for the post-operative implant size. There was considerable variance between surgeons and their agreement with the CT demonstrated superior predictive values for the postoperative implants as compared to the 2D digital templating technique.

Conclusions: This study suggests that the predictive value of the CT templating system was superior to that of surgeon based 2D digital templating for CT templating based rTHA.

Background: Although the Burch-Schneider antiprotrusio cage (BS-APC) has been reported to be reliable, long-term data for this implant are scarce. We thus aimed to investigate survival and radiological results for revision total hip arthroplasty with the BS-APC in patients with major bone deficiency (55% AAOS defect grade 3, 39% grade 4) who had a minimum follow-up of 5 years (mean 10.2 years).

Methods: 144 revisions in 140 patients were performed due to aseptic loosening (n = 74), infection (n = 50), or other reasons (n = 20). Survival analysis was performed with death as a competing risk. Clinical follow-up was performed at 1, 2, and 5 years and every 5 years thereafter.

Results: 77 patients died during follow-up, 25 within the first 5 years. 12 BS-APCs were re-revised for infection (n = 5), aseptic loosening (n = 5), or instability (n = 2). The cumulative incidence for aseptic re-revision of BS-APCs was 4.3% at 10 years (95% CI, 1.8-10.1%), and the cumulative risk of death was 73.3% (95% CI, 62.4-83.2%). Radiological changes occurred in 26 of 87 radiologically examined hips, of which 8 cases were revised.

Conclusions: We found excellent mid- and long-term survival of the BS-APC in acetabular revision with major bone deficiencies, in accordance with or superior to most literature reports, which might be explained by strict adherence to surgical technique.

Background: Most of the current evidence for short femoral stems in total hip arthroplasty (THA) is related to uncemented fixation. This study aims to summarise the existing evidence on the use of short cemented stems in THA, with a focus on overall implant survival, clinical outcomes, radiographic findings, and complication rates.

Methods and materials: A systematic literature review was conducted following the PRISMA guidelines. 12 articles met the inclusion criteria. The risk of bias was assessed through the Methodological Index for Non-Randomized Studies (MINORS) score.

Results: With a total of 5294 total hip replacement performed, the mean follow-up was 13.5 years. The most reported complications were dislocation, periprosthetic fracture, and infections; several studies reported varus and valgus stem malalignment. All the included studies demonstrated improved clinical outcomes.

Conclusions: Short cemented stems are a reliable option for Dorr type A femurs, as well as for hypoplastic and small femurs. Their advantages include preservation of metaphyseal bone, easier insertion, and easier removal in case of revision. Varus and valgus stem-position should be studied as risk factors for failure. Despite small follow-up available, and considering different stem type and length, cemented short stems implants are a safe and effective option for THA.

Introduction: Due to demographic shifts and an increasing proportion of older adults at higher fracture risk, the overall burden of proximal femur fractures has risen significantly in recent years, placing a burden on patients and healthcare systems. Despite extensive research on hip fracture epidemiology and treatment, the specific influences of femoral and acetabular parameters on fracture localisation remain underexplored. This study evaluates the impact of these parameters on proximal femur fracture localisation.

Materials and methods: This retrospective cohort study analysed data from 400 patients with proximal femur fractures, including medial and lateral femoral neck fractures (FNFs), pertrochanteric, and subtrochanteric fractures, treated at a university hospital between 2010 and 2022. Radiographic measurements of femoral head size and other morphological parameters were conducted using pre-operative pelvic radiographs. Statistical analyses included multivariate logistic regression.

Results: A larger head-radius vertical (HRV) was associated with an increased risk of lateral FNFs (OR 1.11; p = 0.007). A lower Femoral Head Protrusion Index (FHEI) significantly increased the risk of lateral (OR 0.87; p < 0.001), pertrochanteric (OR 0.88; p < 0.001), and subtrochanteric fractures (OR 0.86; p < 0.001). Femur canal width was associated with a higher risk of pertrochanteric fractures (OR 1.17; p = 0.001), and a smaller lateral centre edge angle (LCEA) correlated with higher risks of lateral (OR 0.92; p = 0.021) and pertrochanteric fractures (OR 0.92; p = 0.018). Additionally, a higher body mass index (BMI) was significantly associated with subtrochanteric fractures (or 1.07; p = 0.020).

Conclusions: The study identified key variables associated with proximal femur fracture localisation. Morphological parameters such as HRV, FHEI, canal width, and LCEA, as well as BMI for subtrochanteric fractures, significantly influence fracture localisation, highlighting their importance for personalised risk assessment and preventive strategies.