HIP International最新文献

Background: Diagnosis and management of developmental dysplasia of hip (DDH) in underdeveloped regions is frequently delayed, potentially impacting final outcomes. This prospective study was conducted with the aim of answering the question, "Do children <3 years at index surgery for DDH have better outcome at 5-year follow-up in comparison to children >3 years at index surgery?"

Methods: Between 2016 and 2021, all walking-age children with DDH were prospectively enrolled in the study. The study cohort was divided into 2groups: Group 1 ⩽3 years of age, and Group 2 included children >3 years old. Intraoperative decisions determined the need for addition of femoral or pelvic osteotomy to the open reduction (OR). Follow-up assessment and group comparison included acetabular-index (AI), proximal femoral growth disturbances (PFGD), and outcomes based on Severin's criteria. Subgroup analysis also compared re-dislocated hips with stable hips post-surgery. Children with follow-ups <3 years were excluded.

Results: 45 hips in 38 children analysed (31 in Group 1 and 14 in Group 2). Group 1 had higher pre-op AI (p = 0.0489). More hips in Group 2 underwent OR with femoral osteotomy (p = 0.0016). Re-dislocation occurred in 6 (19%) in Group 1 and 2 (14%) in Group 2. Subgroup analysis revealed higher index postoperative AI in re-dislocated hips (p = 0.0001). At the final follow-up, AI was similar between Groups 1 and 2 (p = 0.27). Overall, satisfactory outcomes were comparable between Groups 1 and 2 (p = 0.21). PFGD changes were significantly higher in Group 2 (p = 0.028) and in re-dislocated hips (p = 0.004). Satisfactory outcomes were found in 89% of non-re-dislocated hips and 75% of re-dislocated hips.

Conclusions: At an average follow-up of 5 years, children above and below 3 years at index procedure for DDH show similar outcomes but older ones need femoral osteotomy more frequently. Osteonecrosis risk rises with increasing age at index surgery and after re-operations, but its impact is not clear in mid-term.

Purpose: To assess clinical and radiographic outcomes of anterior acetabular wall reconstruction and cup revision in patients with anterior acetabular wall defects and associated iliopsoas tendinopathy (IPT) following total hip arthroplasty (THA).

Methods: 7 patients with IPT (defined as groin pain that increased with active hip flexion) and pre-revision computed tomography (CT) scans showing anterior acetabular wall defects and cup-iliopsoas impingement were included. During cup revision, an autologous biconvex iliac crest graft was harvested and placed over the anterior acetabular wall defect before press-fitting a revision cup. Cup inclination and anteversion, axial and sagittal cup overhang, and iliopsoas muscle strength (0-5) were evaluated pre- and post-revision. Forgotten joint score (FJS; 0-100), Oxford hip score (OHS; 0-48), hip pain (0-10), satisfaction (0-10), graft osseointegration and resorption were evaluated post-revision.

Results: Pre-revision cup inclination was 43.7 ± 9.4°, anteversion was 30.4 ± 10.5°, axial overhang was 6.6 ± 7.9 mm, and sagittal overhang was 14.2 ± 4.8 mm. Immediate post-revision cup anteversion was 33.0 ± 7.9°, inclination was 45.3 ± 5.1°, while there was no axial or sagittal overhang. At 60.3 ± 5.6 (52-70) months follow-up, 6 of 7 patients were available for assessment (1 patient had died). Iliopsoas muscle strength increased from 3.9 ± 0.7 to 4.6 ± 0.9, FJS was 77.5 ± 32.8, OHS was 40.3 ± 12.8, hip pain on VAS was 0.2 ± 0.4 at rest and 2.3 ± 2.6 during activities. Patient satisfaction with surgery was 8.3 ± 2.3, but 1 patient was dissatisfied and reported persistent hip pain. Last follow-up CT scans were available for 4 of 7 patients, with 3 showing osseointegrated grafts and no graft resorption.

Conclusions: Anterior acetabular wall reconstruction and cup revision resulted in satisfactory clinical outcomes at a minimum follow-up of 4 years in 5 of 7 cases. Most patients fully recovered their iliopsoas muscle strength, had minimal to no pain, excellent FJS, and an osseointegrated acetabular wall graft.

Purpose: Considering the low survival rate for the numerous hip-preserving procedures developed for treating early-stage osteonecrosis of the femoral head (ONFH), this study aimed to evaluate short-term clinical outcomes following avascular necrosis (AVN) CAGE implantation.

Methods: 58 hips with early-stage ONFH (44 with Association Research Circulation Osseous [ARCO] stage 2 and 14 with stage 3A) treated with the AVN CAGE between August 2018 and December 2021 were included. The survival rates were analysed using radiographic progression and conversion to subsequent total hip arthroplasty (THA) as endpoints.

Results: The mean follow-up period was 22.2 ± 8.2 months. 11 hips progressed to ARCO stage 3B/4, and 6 underwent THA. The estimated 2-year radiographic survival rates were 89.1% and 59.0% for patients with ARCO stages 2 and 3A, respectively. The estimated 2-year radiographic survival rates were 92.9% and 76.3% for Japanese Investigation Committee type B/C1 and C2, respectively. The overall estimated 2-year THA-free survival rate was 88.9%. Advanced disease stage and a large necrotic area were independent risk factors for radiographic progression.

Conclusions: AVN CAGE combined with standard core decompression was a promising hip-preserving option for patients with no signs of collapse, small necrotic areas, or medially located necrotic locations.

Introduction: Surgeons allocate an indication(s) for revision surgery on NJR Minimum Data Set forms in the immediate perioperative period, when results from intraoperative histology and microbiology samples are not available. We evaluated to what extent the postoperative diagnostics obtained for patients undergoing metal-on-metal hip arthroplasty (MoMHA) revision surgery align with the indication for revision listed in the NJR.

Methods: NJR data for MoMHA revision patients (2004-2015) at a single centre were linked to hospital records of microbiology and histology testing for prosthetic joint infection (PJI) and adverse reaction to metal debris (ARMD). The Musculoskeletal Infection Society and Mirra classifications were used as "gold standards' to classify PJI and ARMD respectively and to assess the diagnostic accuracy of the clinician selected revision indication recorded on MDS forms.

Results: Of 301 cases, 5.6% (n = 17) and 3.7% (n = 11) were revised for PJI and ARMD respectively. In a further 6.6% (n = 20, PJI) and 15.6% (n = 47, ARMD) the indication for revision selected at the time of surgery did not corroborate with the test results from intraoperative samples. Diagnostic accuracy analysis revealed sensitivity and specificity of indication for surgery at the time of revision for PJI of 35.5% (95% CI, 19.2-54.6) and 97.8% (CI, 54.6-95.2) respectively, and for ARMD of 7.41% (CI, 2.06-17.9) and 97.2% (CI, 94.3-98.9) respectively.

Conclusions: We observed that the results of histology and microbiology analyses of intraoperative samples may provide evidence to support alternative diagnoses in 20% of cases. This indicates a need for a change in the work-up of these cases to allow a more accurate prediction of the indication for revision. Alternatively, if there was evidence of a difference in outcome for patients where the indication may be changed when such data becomes available, the feasibility of a facility to add additional information from samples taken intraoperatively when it becomes available should be explored.

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.