HIP International最新文献

Background: The global demand for primary total hip arthroplasty (THA) and the corresponding demand for revision THA continue to rise. Revision THA in the face of severe acetabular bone loss is challenging, and the custom triflange acetabular component (CTAC) has emerged as a valuable option for the arthroplasty surgeon. Furthermore, dual mobility liners have been advocated as a promising strategy to reduce the risk of dislocation, a common complication in revision THA.

Methods: This retrospective study of prospectively collected data comprised 15 consecutive patients who underwent revision THA with 3D-printed CTACs and dual mobility liners between January 2020 and March 2023. All patients had either Paprosky type 3B defects or pelvic discontinuity. Functional outcomes were evaluated using the modified Harris Hip Score (mHHS) and pain via the Visual Analogue Scale (VAS). Implant survival and complications are reported.

Results: At a mean follow-up of 40 months, mean mHHS improved from 30.46 to 83.90 (p < 0.001), and VAS pain scores decreased from 7.0 to 1.9 (p < 0.001). All patients reported favourable outcomes, and no case was complicated by infection, implant loosening, component failure, or revision. Radiographs showed lateralisation of the centre of rotation by about 1 cm in one patient and Brooker class 1 heterotopic ossification in another. However, all patients demonstrated radiographically stable constructs with good osseointegration at final follow-up. Complications included 2 dislocations and 2 transient sciatic nerve palsies (13.3% each). The dislocations were addressed by closed reduction.

Conclusions: The CTAC is a powerful tool for managing extensive acetabular bone loss in revision THA. Our findings demonstrate promising outcomes with significant functional improvement, pain reduction, and implant stability.

Introduction: Lewinnek safe zone has guided optimal acetabular cup positioning for decades. This study aimed to provide new data on dislocation rates after total hip arthroplasty (THA), assess the effects of cup positioning, and evaluate how well the event of dislocation can be predicted.

Methods: A total of 1520 THAs performed at our hospital were included. The primary outcome was dislocation. Hips were divided into 20° × 20° areas with 5° intervals based on positioning, and crude dislocation rates were compared. Logistic regression models were used and the results reported using odds ratios with 95% confidence intervals. Predictive performances were assessed with R² and C-indexesResults:59 dislocations (48 posterior, 11 anterior) occurred, giving a dislocation rate of 3.9%. Neither a universal nor component-specific safe zone could be created. Cup brand was the most significant factor. Overall predicative values were 0.041-0.134 with R² values and 0.665-0.775 with C-index values.

Conclusions: Dislocation after THA cannot be explained by cup positioning alone. Risk profiles differ between acetabular cup systems, and even though cup design emerged as a key factor, its explanatory power remained modest. These findings emphasize the multifactorial nature of dislocation and the limitations of universal safe zones.

Objective: The purpose of this study was to investigate the relationship between the presence of perceived leg-length discrepancy (PLLD) and spatiotemporal gait parameters in the early postoperative period following total hip arthroplasty (THA).

Methods: A total of 63 patients (age 73.19 ± 9.00 years) who underwent primary unilateral THA were included in the study. PLLD was assessed using the Block test, and spatiotemporal gait parameters were measured 3 weeks postoperatively with the Walkway MW-1000 system. Statistical analysis was performed using analysis of covariance (ANCOVA), adjusting for confounders such as height, muscle strength, and postoperative structural leg-length discrepancy, to examine the independent association between PLLD and spatiotemporal gait parameters.

Results: ANCOVA analysis revealed significant differences between the PLLD group and the non-PLLD group. The PLLD group exhibited longer operative single support time, longer non-operative double support time, and wider step width than the non-PLLD group.

Conclusions: This study demonstrates the relationship between PLLD and spatiotemporal gait parameters. As such, it provides important insights for gait assessment and how this might be used in rehabilitation programmes following THA. Improving PLLD and gait symmetry may help to lower the risk of postoperative falls.

Introduction: Each surgical approach for primary THA has unique advantages. The direct lateral approach (DLA) offers increased visualisation of the gluteus medius and minimus tendons and, consequently, has been suggested to facilitate management of intraoperatively identified abductor tears. However, there remains a paucity of data exploring the frequency of abductor tears in patients undergoing primary THA via DLA. The purpose of this prospective study was to: (1) report the incidence of abductor tears in the DLA patients; and (2) identify risk factors for abductor tears in patients undergoing primary THA.

Methods: All patients undergoing primary THA for osteoarthritis via the DLA by 3 high-volume, fellowship-trained arthroplasty surgeons from September 2023 to March 2024 were enrolled. Data on patient demographics and preoperative functional outcome scores were collected. The location, size, and tissue quality for patients with an abductor tear intraoperatively was also recorded. Receiver operating characters (ROC) curve analysis was utilised to determine abductor tear risk factors.

Results: Of the 346 patients included in the analysis, 63 (18.2%) had an abductor tear. There was no difference in BMI, laterality, and preoperative functional outcome scores between groups. However, patients with an abductor tear were more likely to be older (70.1 ± 7.9 versus 65.0 ± 9.5 years, p < 0.001), Women (68.3% vs. 31.7%, p = 0.027), and have a higher age-adjusted Charlson comorbidity index score (4.0 ± 1.7 vs. 3.3 ± 1.9, p = 0.002). Using ROC curve analysis, patients 68 years of age or older were 2.99 times more likely to have a tear identified. Of all tears, 87.3% of tears were at the anterior aspect of the greater trochanter with a mean size of 26.6 ± 12.1 by 12.9 ± 11.5 mm.

Conclusions: In the present study, the incidence of abductor tears in patients undergoing primary THA via the DLA was 18.2%. Future studies are needed to compare the implications of abductor tears encountered in primary THA.

Background: Reorientation of the acetabulum through a periacetabular osteotomy is 1 of the increasingly popular treatment modalities for hip dysplasia. The purpose of this study is to assess the timing of recovery, return to previous activities, driving and painless full weight-bearing for non-athlete patients undergoing a periacetabular osteotomy for borderline or true hip dysplasia.

Methods: Patients who underwent a periacetabular osteotomy between 2018 and 2022 were eligible for enrollment. Patients with at least 2 years of follow-up, with complete radiological and clinical data were included. The following parameters were evaluated on pelvic radiographs: lateral centre-edge angle, anterior centre-edge angle, acetabular inclination angle, extrusion index, anterior wall index, and joint space width at the narrowest point.

Results: A total of 40 patients were included. 4 patients were male (10%), average age was 24 years. Patients regained their preoperative activity levels in an average of 4.5 months (range 2-12 months). The average time for patients to walk without pain while bearing full weight was 3.4 months (range 2-5 months). Mean preoperative lateral centre-edge angle improved from 8.7° to 35.0°, while their mean preoperative anterior centre-edge angle increased from 11.6° to 33.1°. All clinical scores improved significantly when compared to their preoperative values.

Conclusions: Radiographic parameters and functional outcomes improve with periacetabular osteotomy. Non-athletic, moderately active patients returned to their pre-surgery activity levels on average 4.5 months after surgery and were able to walk without pain after an average of 3.4 months. A progressively narrowing preoperative joint space translates into longer pain-free full weight-bearing times.

Purpose: To develop and compare machine learning-based risk prediction models to identify patients at risk for short-term adverse outcomes (overnight admission, early complication, or readmission) after hip arthroscopy and to determine key predictive demographic and clinical factors.

Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database were used to develop and compare risk prediction models aiming to: (1) identify patients likely to experience short-term adverse outcomes including overnight admission, early complication, or readmission; and (2) determine the most predictive demographic and clinical factors contributing to adverse outcomes following hip arthroscopy. Predictive models were developed using support vector machine, random forest, logistic regression, gradient boosting, and extreme gradient boosting methods.

Results: A total of 1478 eligible patients were included (56.4% female, mean age 40.0 ± 14.9 years), of whom 214 (14.5%) experienced a short-term adverse event. Compared to patients with an uncomplicated outpatient surgical course, those experiencing a short-term adverse event exhibited higher rates of diabetes mellitus, hypertension requiring medication, COPD, bleeding disorder, wound class ⩾2, ASA class ⩾3, lower preoperative haematocrit, and longer operative times. Logistic regression produced the optimal model for predicting short-term adverse events (AUC = 0.763), with operative time, preoperative haematocrit, ASA class, surgical procedure (CPT code), and age identified as the strongest predictive features.

Concusions: These findings demonstrate the value of ML and may assist in predicting surgical outcomes, guiding clinical decision-making, and managing patient expectations regarding their postoperative course.

Background: Residual deformities after Perthes disease, such as high-rising greater trochanter (HGT) and reduced femoral offset (FO), may compromise abductor function and influence long-term hip function.

Purpose: To determine the prevalence of HGT and abnormal FO in young adults with healed unilateral Perthes disease and evaluate their associations with the Stulberg classification and hip function.

Methods: In this cross-sectional follow-up study, 180 individuals (mean age 28.2 years, 72% male) previously diagnosed with unilateral Perthes disease were examined with radiographs and clinical tests. Articulo-trochanteric distance (ATD) and FO were measured on calibrated pelvic radiographs. Femoral head shape was classified using a modified 3-group Stulberg classification. Hip function was evaluated using the Trendelenburg test, passive hip abduction range of motion, and the Copenhagen Hip and Groin Outcome Score (HAGOS).

Results: ATD was significantly lower in Perthes hips compared to contralateral hips (7.7 mm [SD 9.6] vs. 20.7 mm [SD 6.2], p < 0.001). HGT was present in 70 individuals (39%), and a positive Trendelenburg test was observed in 12 Perthes hips (7%). Risk factors for a positive test included hip pain, aspherical femoral head, and surgical treatment. Mean FO was lower in Perthes hips (34.2 mm vs. 39.7 mm, p < 0.001), as was hip abduction (25.5° vs. 29.7°). ATD and FO were significantly associated with the modified Stulberg classification, particularly between Stulberg 1 and Stulberg 3 hips (p < 0.001). No significant associations were found between ATD, FO, and hip function parameters, nor between HGT and HAGOS scores in spherical hips.

Conclusions: Reduced ATD and FO were prevalent in young adults with previous PD and were associated with the modified Stulberg classification but not with hip function.

Clinical trials registration: ClinicalTrials.gov (NCT03995960).

Objectives: This study explored the impact of altitude on hip fracture types, focusing on the prevalence of intracapsular and extracapsular fractures in patients from high-altitude and low-altitude regions in Turkey.

Method: A retrospective analysis of 767 hip fracture cases was performed, involving patients aged 50 years and older treated between 2018 and 2023. Patients were categorised into high-altitude (Erzurum and Kars) and low-altitude (Izmir) groups. Fracture types and demographic variables were analysedResults:High-altitude patients demonstrated a significantly higher incidence of extracapsular fractures (50.5%) than low-altitude patients (38.5%; p = 0.001). Male patients were more prevalent in high-altitude regions (39.9%) than low-altitude areas (30.8%; p = 0.01). There were no statistically significant differences in age or BMI between the groups.

Conclusions: The findings suggest that high-altitude environments may increase the risk of extracapsular fractures. These results will guide the need to consider environmental and geographic factors in hip fracture prevention and treatment strategies. Future research should focus on the physiological mechanisms underlying these differences.

Background: Femoroacetabular impingement syndrome (FAIS) is a common hip disorder that can lead to joint degeneration and osteoarthritis. Posterolateral (PL) cam lesions, characterised by an α angle >60° on anteroposterior (AP) pelvis and Dunn views, present significant surgical challenges due to their anatomical location and proximity to critical vascular structures. Effective surgical intervention relies on achieving optimal postoperative resection, yet clear radiographic thresholds for surgical success remain undefined.

Objective: This study aimed to investigate the relationship between postoperative α angle measurements on pelvis AP radiographs and clinical outcomes in patients undergoing hip arthroscopy for PL cam lesions. Additionally, it seeks to determine an optimal postoperative α angle threshold that correlates with improved patient-reported outcomes at 2 years.

Methods: A retrospective analysis was performed on a cohort of 117 patients (121 hips) who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) between the years 2013 and 2022, with a minimum follow-up period of 2 years. Preoperative and postoperative α angles were measured on the pelvis AP and Dunn views. Clinical outcomes were assessed using the Hip Outcome Score-Activities of Daily Living (HOS-ADL), the modified Harris Hip Score (mHHS), and the Non-Arthritic Hip Score (NAHS). Receiver operating characteristic (ROC) curve analysis was used to establish an α angle cutoff associated with better functional recovery.

Results: Patients with a postoperative α angle below 55° demonstrated significantly better functional outcomes across all scoring systems. ROC analysis confirmed that α < 55° was a strong predictor of achieving a patient-acceptable symptomatic state (PASS), with an area under the curve (AUC) of 0.849 for mHHS, 0.741 for NAHS, and 0.721 for HOS-ADL (p < 0.001). Sensitivity and specificity values varied across scoring systems, with PASS-NAHS showing a sensitivity of 88.0% and specificity of 52.6%, PASS-HOS-ADL demonstrating a sensitivity of 88.0% and specificity of 52.6%, and PASS-mHHS revealing a sensitivity of 87.6% and specificity of 75%. Multivariate logistic regression further confirmed that a postoperative α angle below 55° was independently associated with improved hip function, reinforcing its significance as a key threshold for surgical success.

Conclusion: A postoperative pelvis AP α angle of less than 55° appears to be a key threshold for optimal recovery in patients with PL cam lesions. These findings highlight the importance of adequate resection during hip arthroscopy to enhance functional outcomes. Further research with larger patient cohorts and advanced imaging techniques may help refine postoperative evaluation criteria.

Background: Minimally-invasive percutaneous treatment has become the most popular and effective method for the treatment of acetabular fractures. The aim of this study was to investigate the safety and efficacy of minimally-invasive percutaneous treatment of adult acetabular fractures with the titanium elastic nail system.

Methods: 12 patients with acetabular fractures were referred to us from March 2020 to June 2020, including 8 males and 4 females. The life-threatening shock and severe combined injury were treated first. The acetabular fractures (anterior and double-column fractures) were all treated with closed reduction and minimally-invasive elastic titanium nail intramedullary fixation. Intraoperative C-arm and O-arm fluoroscopy were used to determine the reduction of fractures and the location of elastic titanium nail in the bone channel. Postoperative CT was used to measure and evaluate the reduction of fracture and the position of elastic titanium nail.

Results: Through closed reduction and minimally-invasive incision, the acetabular fractures could be safely fixed by placing elastic titanium nail in the osseous medullary cavity channels of acetabulum. The placement time of each elastic titanium nail was 15-45 minutes, with an average of 19.6 minutes. The frequency of fluoroscopy imaging of each elastic titanium nail was 4-16 times, with an average of 8 times. Postoperative wounds of the patients were all healed in the first stage, without any occurrence of complications such as nerve, blood vessel and important tissue structure injury. The patients recovered quickly after the operation and could perform functional exercises in the early stage.

Conclusions: Elastic intramedullary nail system can be used for the minimally-invasive treatment of adult acetabular fractures, with less blood loss, less cost, and fewer incision complications. This is a promising new technique.