HIP International最新文献

Introduction: There is increased awareness of socioeconomic disparities among total hip arthroplasty (THA) patients. Most studies contain small sample sizes and few control for confounding variables. This study aims to evaluate postoperative outcomes and survivorship after THA in patients of different races/ethnicities.

Methods: Patients who underwent a primary THA were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were stratified into 4 groups: White, Black, Hispanic, or Asian. Categorical variables and continuous variables were compared, and revision free survival was calculated using Kaplan Meier survival analysis. Multivariate Cox proportional hazard regression was used to calculate revision hazard ratios.

Results: In total, 203,443 White, 19,282 Black, 11,669 Hispanic, and 2179 Asian patients were identified. Length of stay, discharge disposition, postoperative anaemia, blood transfusions, 3-month re-admissions and emergency room visits, and 3- and 12-month periprosthetic joint infection rates were all higher in Black and Hispanic patients compared to White (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.014, p = 0.003, respectively); however, 12-month mortality rates were similar. Cox proportional hazard regression analysis demonstrated that Black patients had a lower risk of revision compared to White patients (HR 0.90; 95% CI, 0.82-0.98, p = 0.021). There were no significant differences in the cumulative revision event rate up to 10 years postoperatively.

Conclusions: Non-White patients are significantly more likely to have worse short-term outcomes and complications. However, overall rates of revision at 1 year are similar across these groups, with a slightly lower rate of revision in Black patients after controlling for confounding factors.

Background: Osteoarthritis is the most common indication for primary total hip replacement (THR) in Australia. Due to its pathogenesis, avascular necrosis (AVN) often occurs in younger patients. It is unclear whether AVN results in a higher revision rate when compared to osteoarthritis in this population. The aim of this study was to compare revision rates between these cohorts and identify any differences in cause for revision to better allow prognostication when consenting younger patients prior to surgery with the null hypothesis that no significant difference will be found.

Methods: Australian Orthopaedic Association National Joint Replacement Registry data from 1999 to 2022 was used to assess difference in revision rates between the patients aged <55 years undergoing THR with a primary diagnosis of either AVN or osteoarthritis. Revision rates and reasons for revision were compared between cohorts.

Results: There were 51,879 THR meeting the inclusion criteria available for analysis, of which 9.3% were implanted for AVN and 90.7% for osteoarthritis. Patients with AVN were younger and more likely to be male compared to patients with osteoarthritis. Rates of all cause revision were higher in patients undergoing surgery for AVN when adjusted for age, sex, body mass index, head-size, and American Society of Anesthesiologists score. AVN had a higher rate of revision for infection (HR 1.61 [95% CI, 1.23-2.11] p < 0.001) and dislocation/instability after 1 month (1 Month+: HR 1.84 [95% CI, 1.31, 2.58)] p < 0.001). Increased risk of revision in the AVN group was found to occur early, within the first 3 months. There was no significant difference in the rate of revision for periprosthetic fracture, or implant loosening between groups.

Conclusions: Younger patients undergoing THR for AVN have a higher revision rate and are more likely to be revised for early infection, when compared to patients who undergo THR for osteoarthritis.

Background: In cases of large, irreparable gluteus medius (GM) tears, gluteus maximus tendon transfer has emerged as a viable treatment option. The purpose of this study is to evaluate the short- to mid-term outcomes of gluteus maximus transfer as a treatment for irreparable GM tears in the native hip.

Methods: Data was reviewed for all patients with native hips who underwent gluteus maximus transfer between 2011 and 2021. Patient were eligible for inclusion in the study if they presented with a full thickness irreparable GM tear treated with a gluteus maximus transfer and had completed preoperative and minimum 2-year postoperative questionnaires; or had a documented endpoint (revision surgery) within the study's timeframe. The minimal clinically important difference (MCID) for the mentioned PROs was calculated and included in the analysis.

Results: A total of 15 native hips were included in the study, with all having a minimum 2-year follow-up and 8 reaching a minimum 5-year follow-up. The study group was predominantly female (93.3%), with a mean age of 66.7 ± 3.1 years, 3 (20%) patients underwent the gluteus maximus transfer as a primary surgery while 12 (80%) underwent a revision surgery from a prior failed GM repair. Significant improvements were observed across all evaluated patient reported outcome measures with high patient satisfaction. Additionally, only 3 patients (20%) showed a residual Trendelenburg gait, with 80% of patients regaining a normal gait. These improvements were sustained from the 2-year to the 5-year timepoint. A high percentage of patients reached the calculated MCID.

Conclusions: Gluteus maximus transfer remains a salvage procedure for irreparable GM tears. This procedure demonstrated favourable short- to mid-term outcomes, high patient satisfaction rates, high rate of restoration of normal gait, and a substantial percentage of patients achieving clinically meaningful improvements in functional scores.

Background: The French Paradox (FP) technique, characterised by line-to-line cementing, has recently been applied to polished tapered stems with favourable results despite the thin cement mantle created. However, it contravenes the minimum 2-mm cement mantle described in the standard (STD) cementing technique.

Aim: This experimental study aimed to compare the FP and STD cementing techniques by comparing the cement mantle thickness, micromotion, and alignment of a polished tapered stem under clinically relevant loads.

Methods: Stems were implanted into 4 pairs of human cadaveric hips. Femurs within each pair were randomly allocated to receive either the STD or FP technique. 5 linear variable displacement transducers (LVDTs) were used to measure the real-time motion of the stem relative to the femur. The specimens were mounted onto a joint motion simulator and cyclically loaded with axial compression (0-1,600 N) and internal torsion (0-15 Nm).

Results: No significant differences were found in permanent migration, initial and long-term inducible motion, or stem alignment between techniques. The FP technique resulted in a thinner cement mantle (∆1.0 ± 0.2 mm). The mean permanent migration was below 20 μm, and inducible motions were below 100 μm for both techniques.

Conclusions: Both FP and STD cementing techniques resulted in well-fixed stems with low migration and inducible motion.

Purpose: This study examined whether cemented stems in total hip arthroplasty (THA) accelerate postoperative rehabilitation compared to cementless stems, even in patients with osteoporosis.

Methods: A retrospective analysis of 232 unilateral THAs included cemented (n = 84) and cementless (n = 148) groups. Propensity score matching yielded 53 matched pairs. Outcomes included rehabilitation milestones (initiation of T-cane walking, stable ambulation, and stair climbing), length of hospital stay, and clinical scores. Perioperative parameters, such as operative time, blood loss, and pain scores were also assessed.

Results: The cemented group achieved earlier initiation (4.2 ± 2.4 vs. 5.2 ± 2.6 days, respectively; p < 0.05) and stabilisation (5.3 ± 3.1 vs. 6.6 ± 3.4 days, p < 0.05) of T-cane walking compared to the cementless group. No significant differences were observed in stair-climbing time or length of hospital stay. Despite greater intraoperative blood loss in the cemented group, the estimated total and postoperative blood losses were comparable. Both groups showed similar improvements in clinical scores over 12 months.

Conclusions: Cemented stems facilitated earlier ambulation without compromising long-term outcomes, supporting their use in osteoporotic patients for early postoperative recovery.

Aim: The purpose of this study was to investigate differences in patient-reported outcome measures (PROMs) among patients who underwent THA in comparison to Birmingham hip resurfacing (BHR) for the treatment of osteoarthritis.

Methods: A prospective cohort of 1414 patients who underwent BHR (n = 707) or THA (n = 707) for the treatment of primary osteoarthritis in a single healthcare system between July 2015 and December 2017 were included and propensity score matched on age. Differences between groups in the Hip disability and Osteoarthritis Outcome Score (HOOS) pain subscale, HOOS-Physical Function Shortform (PS), and the University of California at Los Angeles (UCLA) activity score at 2 years follow-up were evaluated. Minimal clinically important differences (MCID) were based on previous studies.

Results: Of the total 622 patients (THA, n = 311; BHR, n = 311) who completed the 2-year follow-up, BHR patients reported less pain (2-year HOOS pain: BHR, 100; THA, 95; p < 0.001), higher function (2-year HOOS PS: BHR, 95.4; THA, 91.2; p < 0.001), and greater activity levels (2-year UCLA activity: BHR, 7.5; THA, 6; p < 0.001) compared to THA patients. After adjusting for demographic variables, no significant difference in estimated median HOOS pain scores was found between cohorts. BHR patients exhibited significantly higher median HOOS-PS scores (HOOS-PS score difference: 2.5, 95% CI, 0.38-5.4; p = 0.03) and higher median UCLA activity scores (UCLA activity score difference: 0.79, 95% CI, 0.33-1.24; p < 0.001) compared to THA patients. No differences were observed in the proportion of patients achieving MCID thresholds in all PROMs between groups.

Conclusion: BHR and THA have both been shown to significantly ameliorate pain and enhance functional capacity in patients with end-stage osteoarthritis. Interestingly, at the 2-year postoperative follow-up, BHR patients exhibited higher activity levels and improved physical function compared to those who underwent THA; however, the extent of this improvement may not reach clinical relevance.

Purpose: Total hip arthroplasty (THA) significantly enhances patients' quality of life. In the field of haematologic healthcare, hip replacement surgery is particularly relevant for those with conditions such as leukaemia, lymphoma, and myeloma. These patients often undergo extensive treatments, including chemotherapy and corticosteroids, which can lead to bone-related complications like avascular necrosis of the femoral head (ANFH). This systematic review explores the relationship between haematologic diseases and bone pathologies requiring THA.

Methods: Data were collected from observational retrospective studies on hip arthroplasty in patients with haematologic disorder. Independent reviewers searched the literature, extracting relevant data according to PRISMA guidelines. We analysed 820 papers and included 10 observational studies in the review. Demographics, pathology, treatment, clinical outcomes, complications, survivorship, and follow-up were analysed.

Results: The study included a total of 363 patients and 401 hips. The mean age of the patients was 39.5 years. The mean follow-up was 5 years. In the examined studies, most patients were diagnosed with acute lymphoid leukemia (5 out of 11 studies). Avascular necrosis of the femoral head was consistently recognised as the significant etiology for THA. All patients had received corticosteroid therapy in the past, and additional therapies included chemotherapy, radiation, and stem cell transplantation. The median period before surgery was 2.05 years. There were 29 complications that required surgical revision. Aseptic loosening was the cause of 41.95% revisions, impingement and instability for 22.58%, infection for 19.35%, and fracture for 9.67%. Minor causes include sinking and a fractured ceramic liner.

Conclusions: THA is a safe and valuable procedure in patients with an ANFH history of haematological diseases and immunosuppressive treatments. Although THA presents higher complication rates in these patients compared to the general population, it has demonstrated satisfactory success rates.

Revision total hip arthroplasty continues to increase rapidly, with formidable challenges in managing complex acetabular bone defects. Porous metal augments have emerged as an efficacious solution, offering superior mechanical stability, greater osseointegration potential and better biomechanical reconstruction compared to traditional methods like structural allografts and jumbo cups. These augments can address various defect patterns with configurations tailored to specific defect location and extent (e.g., roofing, flying buttress, column buttress, doming, and footing configurations). Key material advantages include high porosity, optimal pore diameter, good biocompatibility, enhanced coefficient of friction, and native elastic modulus similar to the trabecula. Clinical studies reported 10-year survivorship rates exceeding 90% for severe defects (Paprosky type III), with precise hip centre restoration and reduced complications. The newly introduced rim-point-column-oriented algorithm provides a practical framework for optimised reconstruction using porous metal augments by emphasising rim or 3-point fixation, column stabilisation and medial wall support. Combined strategies, such as acetabular distraction for pelvic discontinuity, further extend indications and improve outcomes. However, concerns persist regarding metal debris release at cup-augment interfaces and the inability to restore bone stock in young patients. Emerging innovations, including 3D-printed porous augments, show comparable efficacy with customised advantages. Porous metal augments represent a versatile and durable option for complex acetabular reconstruction, though lifelong surveillance through follow-up is warranted.

Background: Total hip arthroplasty (THA) is an effective treatment for advanced hip osteoarthritis, particularly in complex cases such as Crowe Type 3 and 4 developmental dysplasia of the hip (DDH). This study aimed to compare radiological and early clinical outcomes of conventional (cTHA) and robotic (rTHA) THA in patients with Crowe Type 3 and 4 DDH.

Methods: Patients who underwent cTHA or rTHA were retrospectively analysed. Preoperative and postoperative clinical parameters, including range of motion (ROM), visual analogue scale (VAS) pain scores, modified Harris Hip Score (mHHS), and leg-length discrepancy, were evaluated. Radiological assessments included implant positioning (acetabular inclination and anteversion, femoral anteversion) using x-ray and CT imaging. Operative durations for cTHA and rTHA were also compared.

Results: A total of 45 patients (52 hips) were included. Both groups showed significant improvements in clinical and radiological outcomes. Postoperative VAS pain scores were lower in the rTHA group (1.35 ± 1.00 vs. 2.41 ± 1.14 for cTHA), and mHHS was higher (92.34 ± 5.68 vs. 79.68 ± 5.92 for cTHA). ROM and radiological parameters, such as acetabular inclination (37.11 ± 3.37° for rTHA vs. 41.13 ± 6.49° for cTHA) and anteversion (17.59 ± 1.78° for rTHA vs. 21.87 ± 1.71° for cTHA), were more precise in rTHA. Operative time was longer for rTHA (117.06 ± 8.16 vs. 79.71 ± 6.79 minutes).

Conclusions: Robotic THA achieved better implant positioning and superior early clinical outcomes compared to conventional THA in complex DDH cases, despite longer surgical times.

Background: Nerve injury is a major complication of total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH), and its incidence is influenced by the type of surgical approach used. The aim of this study was to compare the recently developed direct anterior approach (DAA) and the classic posterior approach (PA) regarding the characteristics of nerve injuries in Crowe IV DDH patients.

Methods: A total of 149 Crowe IV DDH patients who underwent THA were retrospectively included and divided into 2 groups based on surgical approach (DAA: 68 patients and PA: 81 patients). Postoperatively, the nerve injury was evaluated both clinically and electrophysiologically. The incidence, severity and prognosis of nerve injuries and involved nerves were compared and analysed.

Results: The overall incidence of nerve injury was 30.88% (21/68) for the DAA and 29.63% (24/81) for the PA (p = 0.868). The incidence of motor nerve injury (12.35%, 10/81) was higher with the PA than with the DAA (2.94%, 2/68, p = 0.036). The sciatic nerve was more commonly injured when the PA was performed (overall incidence: 27.16% vs. 8.82%, p = 0.004). In contrast, nerve injuries with the DAA mainly affected the femoral nerve (overall incidence: 25.00% vs. 11.11%, p = 0.026). The independent risk factors for symptomatic nerve injury were previous surgical history (OR 7.075) and body mass index (OR 1.598) for the DAA and previous surgical history (OR 9.143), surgical time (OR 1.029) and amount of limb lengthening (OR 1.104) for the PA.

Conclusions: Patients undergoing THA due to osteoarthritis secondary to Crowe IV DDH can be operated on with a DAA. However, there is an increased incidence of femoral nerve injury when compared to the posterior approach. To prevent symptomatic nerve injury, the DAA should not be used in obese patients and might require more extensive intraoperative soft-tissue release.