HIP International最新文献

Background: Total hip arthroplasty (THA) is a standard treatment for advanced hip disorders; however, conventional manual THA (M-THA) is potentially limited by suboptimal prosthesis positioning, a prolonged learning curve, and an elevated risk of complications. Robot-assisted THA (R-THA), with its enhanced accuracy in prosthesis alignment and intraoperative feedback capabilities, has been proposed to address these shortcomings. Nevertheless, the current literature on the differences in clinical outcomes between R-THA and M-THA remains inconsistent and fragmented, warranting a systematic review and meta-analysis. This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of R-THA versus M-THA regarding surgical accuracy, perioperative outcomes, and complications.

Methods: A comprehensive search was performed by 7 general databases prior to November 2024, and studies were collected if they were involved in the comparison between robot-assisted THA and manual THA in the surgical outcomes, including learning curve, operation time, prosthesis placement accuracy (cup anteversion and inclination), Harris Hip Score (HHS), and complications. The R 4.5.1 software was used to calculate the 95% confidence intervals with standardised mean differences and Cohen's d values for continuous variables, as well as odds ratios for binary variables. The methodological bias and potential heterogeneity sources of included studies were evaluated.

Results: A total of 37 studies were analysed in this study. Compared with M-THA, R-THA showed the better accuracy in prosthesis anteversion (OR 2.67; 95% CI, 1.15-6.19) and inclination angles (OR 2.71; 95% CI, 1.47-4.98), a shorter learning curve inflection point (18.48 vs. 63.53), a lower periprosthetic fracture rate (OR 0.54; 95% CI, 0.38-0.77) and a lower incidence of leg length-discrepancy (LLD) (MD -1.42; 95% CI, -2.19--0.66), but at the cost of a longer operation time (MD 18.16; 95% CI, 8.81-27.51). Moreover, there was no significant difference between the 2 groups in the other complications and HHS (MD -2.04; 95% CI, -6.84-2.76).

Conclusions: R-THA shortens the learning curve, improves implant positioning accuracy, and reduces LLD, although it is associated with longer operative time, while functional outcomes and complication rates remain largely comparable to M-THA.PROSPERO registration number: CRD42025636461.

Aims: The use of highly cross-linked polyethylene (XLPE) on the acetabulum has undoubtedly improved the wear rates and hence survivorship of total hip arthroplasty (THA). However, the importance of head tribology is not known. Oxidised zirconium (OxZr) was introduced to offer the lower wear rates of ceramic but the strength of metal. Whether OxZr heads have any purported benefits in terms of lowering wear is not known. This study therefore aims to compare wear rates of XLPE against metal and OxZr heads over a 10-year period.

Methods: A previous study has suggested we need a minimum 95 cases to show a statistically significant difference. Thus, in this 10-year retrospective analysis we included 95 subjects with a primary THA with a 28-mm OxZr and 131 patients with a 28-mm cobalt-chrome (CoCr) head, both against XLPE liners.Linear and volumetric wear rate comparisons were performed using a validated 2-dimensional stereoisometric analysis by an independent centre.

Results: There were no significant differences for any of the patient demographics between the 2 groups, with >60% women in both groups and normally distributed age. Cup inclination angle was also comparable between the 2 groups.While there was no difference in volumetric wear rates (p = 0.7377), the annual linear wear rate for OxZr was 0.030 mm (95% CI, 0.024-0.036) compared with 0.046 mm (95% CI, 0.038-0.054) for CoCr, a statistically significant difference (p = 0.0002)Conclusions:The widespread use of XLPE has revolutionised THA. This study is the first to show a statistically significantly lower wear rate with the use of OxZr. Whether this is enough to justify the cost differential and whether it translates to better implant survivorship is still to be determined. But if wear limiting wear rates is associated with decreasing revision rates, the use of ceramicised metal may be of clinical benefit.

Background: Hip fractures cause significant morbidity and mortality worldwide, a burden expected to rise with population ageing. Operative management remains the mainstay of treatment; however, a small number of patients receive non-operative treatment. The Australian and New Zealand Hip Fracture Registry (ANZHFR) began recording reasons for non-operative management in 2021. The study aimed to identify factors influencing the decision for non-operative management, compare outcomes between operative and non-operative treatment and compare palliative patients who died ⩽30 days to those who survived >30 days.

Methods: A retrospective cohort study was conducted using ANZHFR data between 01 January 2021 and 31 December 2022, including patients aged ⩾50 years with a hip fracture. Patients were categorised as: operative or non-operative, the latter sub-categorised; palliative, not clinically indicated, or other. Demographic, clinical and fracture characteristics, length of stay, discharge destination and mortality at 30, 120 and 365 days were compared. A sub-analysis of the palliative group compared those who survived >30 days with those who died ⩽30 days.

Results: Of 31,423 hip fracture patients, 30,734 (97.8%) underwent surgery, and 689 (2.2%) were managed non-operatively (438 palliative, 127 surgery not clinically indicated, 124 other). Palliative patients were older, frailer, less mobile, more likely to live in residential aged care, and to have dementia. Men and patients treated in Tasmania were more likely to receive palliative care. Non-displaced valgus impacted fractures were more common among the not clinically indicated group. 30-day mortality was highest in the palliated group (87.2%) and lowest in the operative group (7.3%). Age was the only factor associated with survival >30 days among palliated patients.

Conclusions: This is the first registry-based analysis of non-operative hip fracture management by reason. It identified distinct demographic, clinical and geographical patterns that influenced non-operative care. The palliative cohort had the highest mortality; however, a small proportion of patients survived.

Background: The optimal threshold to blood transfusion in patients after hip fracture surgery is unclear. This study leveraged regression discontinuity to quantify blood transfusion practices across haemoglobin thresholds of 7.0, 8.0, and 10.0 g/dL.

Methods: This study used the enhanced claims-based Premier Inc. database and included inpatients, aged 50+, with an ICD-10 code for hip fracture and hip surgery, and at least one haemoglobin following surgery. For each patient-day following surgery, we determined the lowest haemoglobin level and whether blood transfusion was administered. Regression discontinuity (RD) models with local linear regression were used to calculate risk differences, mean differences, and 95% confidence intervals (CIs) for blood transfusion use.

Results: There were 320,194 patient-days (among 93,111 patients) included in analyses. Transfusion occurred on 29,425 patient-days (9.2%). The median haemoglobin on patient-days with a transfusion was 7.0 (interquartile range [IQR] 6.7-7.6) g/dL and the median haemoglobin on patient-days without a transfusion was 9.3 (IQR 8.4-10.4) g/dL. There was a statistically significant increase in transfusion use crossing a haemoglobin threshold of 7.0 g/dL (19.0; 95% CI, 13.5-22.5 absolute percentage points) and a small, statistically significant increase in transfusion use crossing an 8.0 g/dL haemoglobin threshold. (3.2; 95% CI, 0.9-6.2 absolute percentage points). There was no discontinuity in transfusion use across a haemoglobin concentration threshold of 10.0 g/dL (-0.2; 95% CI -0.7-0.3 absolute percentage points).

Conclusions: After hip fracture surgery, transfusion based on a haemoglobin threshold of 7.0 g/dL was more common than at guideline recommended 8.0 g/dL or at the liberal threshold of 10 g/dL.

Background: We present a rare, previously unreported case of total hip arthroplasty (THA) implantation in a patient with an ankylosed hip and pelvic-femoral synostosis who sustained a subtrochanteric fracture.

Case: A 70-year-old woman had previously undergone right-sided infectious coxitis treatment, leading to hip ankylosis and pelvic-femoral synostosis. The patient had experienced no hip joint movement from her 20s for over 50 years due to bone fusion at 2 levels. Walking was feasible with compensation, given the ankylosis at an "ideal position" of 15° of flexion, 10° of abduction, and neutral rotation. The patient sustained a subtrochanteric fracture at the age of 70. Given the ankylosis and pelvic-femoral synostosis in the proximal femur fragment, an ideal solution was sought for the surgical management of this case.

Methods: Synostosis was resected, total hip replacement was performed using revision arthroplasty components, solving both the problem of the ankylosed hip and that of the subtrochanteric fracture.

Results: The subtrochanteric fracture united, and sufficient motion was achieved after THA.

Conclusions: THA led to adequate fracture healing, relief of chronic lumbosacral pain and significant improvements in function, proving to be a promising solution for challenging complex hip cases, offering significant improvements in quality of life when combined with careful surgical technique, thorough planning, and attentive postoperative care.

Aims: This retrospective multicentre study, involving 38 UK hospital trusts, aimed to characterise the demographic features, inpatient management, and referral patterns of patients with prosthetic hip dislocations. The primary focus was to identify factors influencing a definitive management plan following acute total hip arthroplasty (THA) dislocation, and to assess differences in the management of primary versus revision THA dislocations.

Methods: Data from 645 patients who sustained acute prosthetic hip dislocations between 01 January 2019 and 31 July 2019, were collected from electronic medical records. Patients were divided into Primary and Revision THA groups. Statistical analyses were used to explore demographic patterns, comparative analyses, and factors influencing referral decisions, with significance set at p < 0.05.

Results: The mean age of patients was 76.2 years, with a predominance of females (65.7%) and posterior dislocations (72.7%). Of the patients, 37.8% underwent reduction in the Emergency Department (ED), with a success rate of 69.7%, while 72.9% required reduction in theatre, achieving a success rate of 90.6%. Inpatient mortality was 1.2%. Only 32.5% of patients had a definitive management plan following their dislocation. Primary THA patients (n = 504) were predominantly female (69.6%) compared to Revision THA patients (n = 141, 48.9%, p < 0.001). Anterior dislocations were more common in the Revision THA group (26.2% vs. 17.3%, p = 0.017). The primary THA group had a higher success rate in closed reduction (92.9% vs. 82.9%, p = 0.002). Revision THA patients were more likely to have a definitive management plan (52.9% vs. 26.9%, p < 0.001).

Conclusions: This study highlights significant variability in the management of THA dislocations, particularly in the lack of standardised protocols for inpatient management and onward referral to revision arthroplasty surgeons. Standardisation of care pathways is needed to optimise outcomes for patients with prosthetic hip dislocations.

Background: Subtrochanteric femoral fractures (SFF) are challenging to manage due to their complex anatomy and high complication rates. Various surgical techniques, including locking compression plate fixation (LCPF) and intramedullary nailing (IMN), have been used, but there is no consensus on the optimal treatment method.

Objective: To compare perioperative outcomes, radiological parameters, and functional recovery between LCPF and IMN in patients with SFF.

Methods: A comprehensive search was conducted on PubMed, Scopus, Cochrane Library, and Google Scholar from inception through March 2025. 5 studies comprising 341 patients (185 LCPF and 156 IMN) met the inclusion criteria. Primary outcomes included intraoperative blood loss, operative time, hip flexion, varus malalignment, time to full weight-bearing, hospital stay, malunion, nonunion, postoperative complications, and Harris Hip Score (HHS).

Results: IMN showed significantly lower blood loss (MD: 147.53 mL; p < 0.001), shorter hospital stay (MD: 4.73 days; p < 0.001), and better HHS (MD: -4.49 points; p = 0.02) compared with LCPF. LCPF was associated with shorter operative time (MD: 11.93 minutes; p = 0.03). No significant differences were observed in hip flexion, varus malalignment, nonunion, or overall complication rates.

Conclusions: Both LCPF and IMN provide acceptable outcomes in the management of SFF. However, IMN offers significant advantages in reducing intraoperative blood loss, shortening hospital stay, and enhancing early functional recovery. These findings suggest that IMN may be the preferable option, particularly in patients at higher risk for perioperative morbidity. Further large-scale, prospective randomised studies are warranted to validate these conclusions and establish definitive treatment guidelines.

Introduction: The functionality of the hip joint is primarily determined by the anatomical relationship between acetabulum and femur. Impairment of this relationship can lead to diseases such as femoroacetabular impingement and hip osteoarthritis. In patients undergoing total hip arthroplasty, accurate placement of the acetabular and femoral components in accordance with native 3-dimensional anatomy (3D) is crucial for obtaining prosthesis stability and survival, also for preventing postoperative complications such as wear, dislocation and osteolysis. Therefore, 3D determination of native anatomical features of the hip joint is highly important.

Methods: A total of 100 adults were randomly selected. Right femur and acetabulum were segmented using MIMICS program. 2D and 3D measurements of femoral anteversion according to posterior condylar and transepicondylar axis, acetabular anteversion, acetabular inclination and combined anteversion were determined. The differences between gender groups and the correlations of two- and three-dimensional measurement results were evaluated.

Results: According to 2D and 3D measurements, statistically significant differences were observed between gender groups in all parameters except for 2D acetabular inclination. A very strong correlation was observed between 3D femoral anteversion measurements performed using the posterior condylar axis and transepicondylar axis. Our findings revealed statistically significant differences between 2D and 3D measurements in most parameters, which have clinical relevance.

Conclusions: A very strong correlation between femoral anteversion measurements obtained using the transepicondylar and posterior condylar axes supports the intraoperative use of the transepicondylar axis reliably. We believe the data obtained from our study will contribute to understand the 3-dimensional native anatomy of the hip joint.

Introduction: Robotic-arm assisted systems are being increasingly used for primary total hip arthroplasties (THAs). However, their use in the surgically more complex revision THAs (rTHAs) has remained limited. This case series describes the surgical techniques used in 5 cases of robotic-arm assisted rTHA and discusses the advantages and disadvantages of robotic-arm assisted systems.

Methods: 5 rTHAs were performed using a robotic-arm assisted system with CT-based planning and robotic-guided acetabular reconstruction. Clinical data, intraoperative details, and postoperative findings were retrospectively reviewed.

Discussion: Robotic-arm assisted rTHA offers detailed preoperative planning, including simulation of acetabular cup positioning, range of motion, and identification of osteophytic impingement risks. The flexibility of selecting reliable registration points is essential in cases with acetabular bone defects. Real-time calculations of hip length, offset, and bone void locations allow for tailored reconstruction without the need for intraoperative radiography.

Conclusions: This case series demonstrates that robotic-arm assisted rTHA provides valuable surgical guidance, particularly in preoperative planning and intraoperative precision. Its use in complex revisions shows promise in optimising outcomes.

Introduction: Oxidised zirconium-on-polyethylene (OxZroP) total hip arthroplasty prostheses are increasing in popularity as an alternative to other bearing types. The surface characteristics and wear properties of OxZroP result in less metal and polyethylene wear which may be protective against microbiological seeding of the synovial joint space. The purpose of this study was to compare the rates of infection and inflammatory diagnoses between THAs using OxZroP heads with ceramic-on-polyethylene (CoP) and metal-on-polyethylene (MoP) designs.

Methods: This study queried the Premier PINC AI Healthcare Database (PHD) (Premier Inc.) for all primary total hip arthroplasties from 2017 to 2022. Infection-related ICD10 codes were collected at 30 days, 3, 6, 12 months and 2 years postoperatively. Positive results were noted to be either PJI-related diagnosis codes, or the combination of an arthroplasty-related code with infection-related procedure codes. The rates of infection/inflammatory reaction were reported.

Results: OxZroP THA bearings demonstrated a decreased rate of prosthetic joint infection or inflammatory reaction diagnoses, at up to 2 years post-surgery, compared to MoP bearings an effect that was maintained when cross-referenced with imaging procedure codes. When compared to CoP hips OxZroP demonstrated lower odds reduction of infection or inflammatory reaction with diagnosis codes at up to 6 months, however, showed equal odds to CoP at later timepoints.

Conclusions: OxZroP bearings for primary total hip arthroplasty demonstrated a reduced odds ratio of prosthetic joint infection and inflammatory-related diagnoses than ceramic-on-polyethylene bearings before 6 months and maintained lower odds than metal-on-polyethylene bearings at up to 2 years. Further studies are needed to obtain longer-term follow-up and understand the mechanism for this observed reduction in prosthetic joint infection and inflammatory-related diagnoses.