HIP International最新文献

Background: Even in cases of bilateral osteonecrosis of the femoral head (ONFH), only one side often collapses and the contralateral side is often asymptomatic at the time of initial diagnosis. This study aimed to evaluate the presence of asymptomatic ONFH based on the radiographic necrotic area on the symptomatic side.

Methods: The study included 89 hips of patients with ONFH who were divided into two groups: unilateral ONFH and bilateral ONFH groups, with a minimum follow-up of 3 years. The extent of the necrotic area in the anteroposterior (ANA) and lateral (LNA) radiographic hip joint views on the symptomatic side in the groups was assessed using plain radiography. The most effective cut-off value was extracted from the receiver operating characteristic (ROC) curve of the radiographic necrosis area of symptomatic ONFH in the absence of contralateral ONFH.

Results: The unilateral ONFH and bilateral ONFH groups included 36 and 53 patients, respectively. There was a significant difference in ANA and LNA between the unilateral ONFH and bilateral ONFH groups (ANA: 66.5 ± 16.3% vs. 77.2 ± 16.4%, p < 0.01; LNA: 62.2 ± 17.7% vs. 72.9 ± 17.6%, p <0.01). Multivariate analysis revealed that only LNA of the symptomatic side was a predictor of contralateral ONFH (odds ratio 1.052, 95% confidence interval 1.01-1.12, p = 0.028). A cut-off value of 67% of the LNA was extracted from the ROC curve analysis. The 4-year survival rates with the collapse progression as the endpoint were 30.6% in LNA ⩾67% and 80.0% in LNA <67% (p <0.01 and p <0.01, respectively).

Conclusions: The LNA of ONFH on the symptomatic side is a useful indicator of the presence and prognosis of contralateral ONFH. The findings of this study provide useful information for planning treatment strategies and predicting the prognosis of patients with ONFH.

Introduction: Previous reports have shown that addressing gluteus medius (GM) tears during total hip replacement (THA) provides favourable clinical outcomes compared to cases without GM repair. However, there is limited discussion in the literature regarding the relationship between the direct anterior approach (DAA) or posterior approach (PA) and patient-reported outcomes (PROs) when performing GM repair. The purpose of this study was to evaluate and compare minimum 2-year patient-reported outcomes and survivorship between patients undergoing GM repair during DAA THA versus PA THA.

Methods: Data from patients undergoing THA between April 2010 and December 2022 was retrospectively reviewed. Included patients had preoperative and 2-year follow-up data for the following PROs: modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score for Joint Replacement HOOS-JR), Forgotten Joint Score (FJS), visual analogue scale (VAS) and patient satisfaction or a documented endpoint (revision surgery). Patients were divided by the approach used during the THA, DAA or PA, and then matched in a 1:1 ratio based on age, sex, BMI, follow-up time, and the thickness of the GM tear (<50% thickness, >50% thickness, full thickness).

Results: 26 hips in the DAA cohort were matched with 26 hips in the PA cohort. There were no significant differences in demographics, the composition and distribution of GM tears, and the use of robotic assistance between the cohorts. Both cohorts demonstrated significant improvement across all PROs (p < 0.01) while also yielding comparable postoperative PROs (p > 0.05), Forgotten Joint Score (FJS, p = 0.72), patient satisfaction (p = 0.56), rates of achieving clinically relevant thresholds (p > 0.05), and rates of revision surgery (p > 0.05).

Conclusions: Patients undergoing THA with concomitant GM repair via either the DAA or PA demonstrated favourable functional outcomes, with a high percentage achieving clinically-relevant thresholds. Both approaches resulted in comparable levels of clinical improvement and short-term survivorship.

Aims: Hip resurfacing arthroplasty offers a femoral bone preserving procedure that allows high function activities. Understanding what happens to the bone inside the head component in resurfacing has always been limited by metal artefact. The development of ceramic resurfacing has allowed much better visualisation into well-functioning resurfacings. Our aim was to investigate postoperative MRI imaging of ceramic hip resurfacing.

Methods: All participants underwent ceramic hip resurfacing using the ReCerf implant (MatOrtho Ltd). All procedures were performed by a single surgeon through an extended posterior approach. Patients underwent MRI at various time frames postoperatively ranging from 4 to 56 months postoperative. Secondary objectives included patient-reported outcomes and complications.

Results: We identified 12 cases involving 9 patients, comprising 6 females and 3 males, with an average age of 46.8 years at the time of resurfacing. The mean follow-up period was 37 (range 13-56) months. The overall findings from the MRI imaging were: 18% (2/11) demonstrated features of avascular necrosis, 27% (3/11) had evidence of femoral neck thinning, no patients had excessive cement mantles. The average Oxford Hip Score prior to the procedure was 24, which increased to 43 following the procedure.

Conclusions: This study represents the first known investigation of ceramic hip resurfacings utilising postoperative MRI imaging. The findings indicate that the residual anatomy of the femoral head and neck can be effectively visualised and interpreted.The application of MRI imaging offers valuable insights into the successes and potential complications associated with this new generation of hip resurfacing procedures.

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.