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Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre. 手术治疗髋关节假体周围骨折的治疗策略和临床疗效:来自一个高流量中心的分析。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-06-11 DOI: 10.1177/11207000241256873
Fabio Mancino, Ben Wall, Thomas A Bucher, Gareth H Prosser, Piers J Yates, Christopher W Jones

Background: Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making.

Methods: This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. P-values <0.05 were considered significant.

Results: 282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions.

Conclusions: PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.

背景:全髋关节置换术(THA)后髋关节假体周围骨折(PPF)越来越普遍。其处理主要取决于骨折类型和植入物的稳定性。本研究旨在提供一个高产量中心手术治疗 PPF 的结果,以帮助指导未来的决策:这是一项回顾性研究,收集了 2008 年 1 月至 2021 年 1 月期间的前瞻性数据。研究收集了患者的人口统计学特征、植入物的具体细节和固定策略。收集的并发症包括感染、再次手术、再次骨折、再次修补。评估了 3 个月和 1 年的短期死亡率。P 值 结果:共发现 282 例经手术治疗的 PPF。52% 的病例以温哥华 B2 型为主。单纯翻修和翻修加额外固定是最常见的治疗方法,共 168 例(60%)。20%的病例出现了需要再次手术的并发症,其中以感染最为常见(8.5%)。3个月和1年的死亡率分别为7.8%和15.7%,其中B2型的死亡率明显较低。采用骨水泥柄治疗的B2型骨折的1年死亡率明显低于远端翻修:结论:PPF的并发症发生率较高。结论:PPF的并发症发生率较高,对于B2/B3型骨折,单纯翻修和翻修加额外固定仍是首选方法,但骨水泥翻修可获得相似的结果,且短期死亡率较低。考虑到高风险的老年和体弱患者,需要一个多学科团队来改善治疗效果并降低死亡率。
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引用次数: 0
Incidence of risk factors in developmental dysplasia of the hip: a retrospective study on 18,954 cases. 髋关节发育不良风险因素的发生率:对 18954 个病例的回顾性研究。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-20 DOI: 10.1177/11207000241248416
Gaetano Caruso, Edoardo Gambuti, Elisa Spadoni, Sara Filipponi, Achille Saracco, Francesca Artioli, Ambra Galla, Leo Massari

Background: DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH.

Aim: To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH.

Materials and methods: This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4).

Results: 18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (n = 10,629) were females and 44% (n = 8325) were males. According to Graf classification, 34.9% (n = 6621) were 1A, 52.7% (n = 9999) were 1B, 4.0% (n = 753) were 2A+, 2.5% (n = 478) were 2A-, 1.5% (n = 284) were 2B, 1% (n = 196) were 2C, 1.3% (n = 243) were 2D, 1% (n = 193) were 3 and 1.0% (n = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63-6.20) followed by a family history (OR 2.35; 95% CI, 2.08-2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21-3.42), oligohydramnios (OR 1.75; 95% CI, 1.44-2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27-1.60).

Conclusions: Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex.

背景:DDH 是导致儿童残疾的最重要原因之一。新生儿期可通过奥托拉尼(Ortolani)和巴洛(Barlow)手法诊断出DDH不稳定。然而,临床检查虽然特异性很高,但与超声检查相比灵敏度较低。对于是否有必要对所有新生儿进行发育不良的普遍筛查,还是对有不稳定性临床表现或已知 DDH 危险因素的新生儿进行选择性筛查,目前还存在争议:这是一项横断面研究,对象是2000年1月至2019年12月期间在意大利费拉拉马里诺-奥托拉尼中心连续接受检查的婴儿。格拉夫分类法的前3种类型被认为是生理性的(1A、1B、2A+),而后6种是病理性的(2A-、2B、2C、2D、3、4):18954 名婴儿符合纳入标准,因此被认为符合研究条件。在这 18954 名婴儿中,56%(n = 10629)为女性,44%(n = 8325)为男性。根据格拉夫分类,34.9%(n = 6621)为 1A,52.7%(n = 9999)为 1B,4.0%(n = 753)为 2A+,2.5%(n = 478)为 2A-,1.5%(n = 284)为 2B,1%(n = 196)为 2C,1.3%(n = 243)为 2D,1%(n = 193)为 3,1.0%(n = 187)为 4。最重要的风险因素是女性(OR 5.36;95% CI,4.63-6.20),其次是家族史(OR 2.35;95% CI,2.08-2.65),然后是骨骼病变(OR 2.04;95% CI,1.21-3.42)、少水胎儿(OR 1.75;95% CI,1.44-2.13),最后是臀先露(OR 1.42:95% CI,1.27-1.60):根据我们的数据,家族史、肌肉骨骼疾病、少水胎儿和臀先露是导致 DDH 的主要风险因素,女性也是风险因素之一。
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引用次数: 0
Early surgery within 48 hours of admission for hip fracture did not improve 1-year mortality in Japan: a single-institution cohort study. 在日本,髋部骨折患者入院 48 小时内尽早手术并不能改善 1 年死亡率:一项单一机构队列研究。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-21 DOI: 10.1177/11207000241248836
Hiroki Iida, Yasuhiko Takegami, Yoshihito Sakai, Tsuyoshi Watanabe, Yusuke Osawa, Shiro Imagama

Introduction: Early surgery for hip fracture, within 48 hours of hospital admission, is effective in reducing mortality. However, the average preoperative waiting time for hip fractures in Japan is 4.5 days and the 1-year mortality rate after a hip fracture is 10% in Japan. This study aimed to investigate whether early surgery, within 48 hours, could reduce the 1-year mortality rate in patients with hip fractures in Japan.

Methods: This cohort study involved 402 consecutive patients with hip fractures who underwent surgical treatment between January 2013 and September 2019. The exclusion criteria were an age of <60 years and in-hospital injury. A total of 389 patients were included in this study. The patients were divided into two groups: those who underwent early surgery within 48 hours of admission (early group) and those who di not undergo early surgery (delayed group). We compared patient characteristics and treatment outcomes between the 2 groups.

Results: A comparison of patient characteristics revealed that the early group had lower hemoglobin levels (P=0.046), lower C-reactive protein levels (P = 0.031), lower numbers of patients with weekend hospitalization, lower numbers of patients with a history of using medications that may cause bleeding (P < 0.01), and who received general anaesthesia (P < 0.01). However, there were no significant differences with regard to the other variables between the 2 groups. A treatment outcome analysis showed that the early group had shorter waiting times for surgery (P < 0.01) and shorter stays in acute-care wards (P < 0.01). However there were no differences in the total hospital stay, Barthel index at discharge, home discharge rates, in-hospital mortality rates, and 1-year mortality.

Conclusion: Our findings indicate that early surgery did not reduce the 1-year mortality rate in older patients with hip fractures in Japan.

简介入院 48 小时内尽早进行髋部骨折手术可有效降低死亡率。然而,日本髋部骨折患者术前平均等待时间为 4.5 天,髋部骨折后 1 年的死亡率为 10%。本研究旨在探讨在 48 小时内尽早手术是否能降低日本髋部骨折患者的 1 年死亡率:这项队列研究涉及 402 名在 2013 年 1 月至 2019 年 9 月期间接受手术治疗的连续髋部骨折患者。排除标准为年龄不超过 50 岁:对患者特征进行比较后发现,早期手术组患者的血红蛋白水平较低(P=0.046),C反应蛋白水平较低(P=0.031),周末住院的患者人数较少,有可能导致出血的药物使用史的患者人数较少(P P P P 结论:我们的研究结果表明,早期手术并不会对髋部骨折患者的健康造成影响:我们的研究结果表明,早期手术并未降低日本老年髋部骨折患者的 1 年死亡率。
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引用次数: 0
Predictors and risk factors of pulmonary embolism after total hip arthroplasty: an NSQIP study. 全髋关节置换术后肺栓塞的预测因素和风险因素:NSQIP 研究。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-08-22 DOI: 10.1177/11207000241270205
Halil Bulut, Maria Jose Maestre, Daniel Tomey

Introduction: Pulmonary embolism (PE) is a well-known contributor to morbidity after total hip arthroplasty (THA). Considerable efforts have been invested in reducing PE occurrence through pharmacological and perioperative interventions. Nonetheless, the effectiveness of these strategies in reducing the incidence and overall mortality associated with pulmonary embolism events remains a matter of debate. Therefore, identifying risky patients has been gaining importance.

Methods: We utilised data from the National Surgical Quality Improvement Program (NSQIP) participant usage file (PUF) database spanning the years 2016 to 2021. All preoperative parameters were analysed with chi-square afterwards, meaningful ones were run with logistic regression test.

Results: A study examined factors influencing pulmonary embolism (PE) prevalence in 235,393 total hip arthroplasty patients. Univariate analysis identified significant associations between PE and female gender, diabetes, smoking, dyspnea, CHF, COPD, hypertension (HT), bleeding disorders, disseminated cancer, steroid use, and functional health status. Multivariate analysis revealed male gender as protective, while COPD, hypertension, and disseminated cancer increased PE risk. Notably, smoking appeared protective. PE patients had higher return-to-operation rates (41.7% vs. 2.2%) but similar 30-day mortality (0.2% vs. 0.04%), though mortality's odds ratio was not significant.

Conclusions: Our findings suggest that certain patient characteristics, such as COPD and metastatic malignancy, significantly influence the likelihood of PE development.

简介:众所周知,肺栓塞(PE)是导致全髋关节置换术(THA)后发病率的一个因素。为了通过药物治疗和围手术期干预来减少肺栓塞的发生,人们付出了巨大的努力。然而,这些策略能否有效降低肺栓塞事件的发生率和总死亡率仍存在争议。因此,识别高危患者变得越来越重要:我们利用了国家外科质量改进计划(NSQIP)参与者使用文件(PUF)数据库中的数据,时间跨度为 2016 年至 2021 年。之后对所有术前参数进行了卡方分析,对有意义的参数进行了逻辑回归测试:研究调查了235393名全髋关节置换术患者肺栓塞(PE)发病率的影响因素。单变量分析发现,肺栓塞与女性性别、糖尿病、吸烟、呼吸困难、慢性心力衰竭、慢性阻塞性肺病、高血压(HT)、出血性疾病、播散性癌症、类固醇使用和功能健康状况之间存在明显关联。多变量分析显示,男性具有保护作用,而慢性阻塞性肺病、高血压和播散性癌症会增加 PE 风险。值得注意的是,吸烟具有保护作用。PE患者的手术返回率较高(41.7% vs. 2.2%),但30天死亡率相似(0.2% vs. 0.04%),尽管死亡率的几率比并不显著:我们的研究结果表明,某些患者特征(如慢性阻塞性肺病和转移性恶性肿瘤)会显著影响发生 PE 的可能性。
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引用次数: 0
The anterior femoral cortical window as an alternative to an extended trochanteric osteotomy in revision hip arthroplasty surgery: the evolution of the surgical technique and outcomes in 22 consecutive cases. 在翻修髋关节置换手术中,股骨皮质前窗可替代延长转子截骨术:手术技术的演变和 22 例连续病例的疗效。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-08-20 DOI: 10.1177/11207000241267704
David Morley, Michael C Wyatt, John van Dalen

Background: The anterior femoral cortical window is an attractive alternative to the extended trochanteric osteotomy when removing femoral cement in revision hip arthroplasty. CT-based additive manufacturing technology has now permitted the creation of patient-specific instrumented (PSI) jigs to facilitate this. The jig simplifies creation of the window, potentiating medullary exposure through an optimally-sized window and therefore cement removal. Between 2006 and 2021 this technique was used in 22 cases at a regional hospital in New Zealand (mean age 74; range 44 to 89 years). 16 cases were for aseptic loosening and 6 for infection. We describe the technique and our case series. Bone incorporation for the cortical window was assessed in all cases using CT imaging. Oxford scores were obtained at a minimum of 6 months after revision surgery. Of the 6 septic cases 5 went onto successful stage-2 procedures, the other to a Girdlestone procedure.

Results: The mean rectangular shaped window size was 8 × 1.5 cm and in each case, this provided adequate intramedullary access. On average at minimum 5 months post-surgery, 84% bone incorporation of the cortical window occurred on CT (40-100%). The functional outcome Oxford hip score was 37 (range 22-48) for 10 cases. There were 2 cases with femoral component subsidence which then stabilised.

Conclusions: This technique description and retrospective case series has shown the effectiveness of removing a distal femoral cement mantle in revision hip arthroplasty using an anterior femoral cortical window, recently optimised using a PSI jig. This technique is a straightforward alternative to a trochanteric osteotomy. Reliable bony integration of the cortical window occurred and functional outcomes were comparable with the mean score for revision hip procedures reported in the New Zealand Joint Registry.

背景:在翻修髋关节置换术中清除股骨骨水泥时,股骨皮质前窗是一种极具吸引力的替代方法。目前,基于 CT 的快速成型技术已能制造出患者特异性器械夹具 (PSI),以实现这一目的。该夹具简化了开窗过程,通过最佳尺寸的开窗使髓质暴露更充分,从而达到清除骨水泥的目的。2006 年至 2021 年间,新西兰一家地区医院在 22 个病例(平均年龄 74 岁;44 至 89 岁不等)中使用了这种技术。其中16例为无菌性松动,6例为感染。我们将介绍这项技术和我们的病例系列。所有病例均通过CT成像评估了皮质窗的骨结合情况。翻修手术后至少 6 个月进行牛津评分。在6例化脓性病例中,5例成功进行了第二阶段手术,另1例进行了Girdlestone手术:平均矩形窗口大小为 8 × 1.5 厘米,每个病例都能提供足够的髓内通道。手术后至少 5 个月,CT 显示皮质窗的平均骨结合率为 84%(40%-100%)。10例患者的牛津髋关节功能评分为37分(范围为22-48分)。有2例股骨组件下沉,但随后趋于稳定:该技术描述和回顾性病例系列显示了在翻修髋关节置换术中使用股骨皮质前窗去除股骨远端骨水泥套的有效性,最近使用PSI夹具对该技术进行了优化。该技术可直接替代股骨转子截骨术。皮质窗实现了可靠的骨整合,功能结果与新西兰关节登记处报告的翻修髋关节手术平均得分相当。
{"title":"The anterior femoral cortical window as an alternative to an extended trochanteric osteotomy in revision hip arthroplasty surgery: the evolution of the surgical technique and outcomes in 22 consecutive cases.","authors":"David Morley, Michael C Wyatt, John van Dalen","doi":"10.1177/11207000241267704","DOIUrl":"https://doi.org/10.1177/11207000241267704","url":null,"abstract":"<p><strong>Background: </strong>The anterior femoral cortical window is an attractive alternative to the extended trochanteric osteotomy when removing femoral cement in revision hip arthroplasty. CT-based additive manufacturing technology has now permitted the creation of patient-specific instrumented (PSI) jigs to facilitate this. The jig simplifies creation of the window, potentiating medullary exposure through an optimally-sized window and therefore cement removal. Between 2006 and 2021 this technique was used in 22 cases at a regional hospital in New Zealand (mean age 74; range 44 to 89 years). 16 cases were for aseptic loosening and 6 for infection. We describe the technique and our case series. Bone incorporation for the cortical window was assessed in all cases using CT imaging. Oxford scores were obtained at a minimum of 6 months after revision surgery. Of the 6 septic cases 5 went onto successful stage-2 procedures, the other to a Girdlestone procedure.</p><p><strong>Results: </strong>The mean rectangular shaped window size was 8 × 1.5 cm and in each case, this provided adequate intramedullary access. On average at minimum 5 months post-surgery, 84% bone incorporation of the cortical window occurred on CT (40-100%). The functional outcome Oxford hip score was 37 (range 22-48) for 10 cases. There were 2 cases with femoral component subsidence which then stabilised.</p><p><strong>Conclusions: </strong>This technique description and retrospective case series has shown the effectiveness of removing a distal femoral cement mantle in revision hip arthroplasty using an anterior femoral cortical window, recently optimised using a PSI jig. This technique is a straightforward alternative to a trochanteric osteotomy. Reliable bony integration of the cortical window occurred and functional outcomes were comparable with the mean score for revision hip procedures reported in the New Zealand Joint Registry.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimal retractor insertion point for nerve safety during total hip arthroplasty: an anatomical study on the femoral and sciatic nerves in relation to hip motion. 全髋关节置换术中保证神经安全的最佳牵引器插入点:股神经和坐骨神经与髋关节运动关系的解剖学研究。
IF 1.3 4区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-02-19 DOI: 10.1177/11207000241227399
Masakazu Okamoto, Yoshinobu Uchihara, Kenichiro Saito, Yusuke Inagaki, Pasuk Mahakkanukrauh, Yasuhito Tanaka

Background: Nerve injury is one of the most serious complications of total hip arthroplasty (THA). It is suspected to be a result from nerve compression or direct injury caused by an acetabular retractor. The anatomical relationship between the acetabular rim and the femoral and sciatic nerves, including hip motion, has not been investigated. This study aimed to identify the optimal position for retractor insertion during THA to prevent nerve damage.

Methods: A total of 28 hip joints from 14 freshly frozen cadavers were used. Using an anterolateral approach, each cadaver was immobilised in the lateral decubitus position and deployed to measure the distance between the nerves and the acetabular rim, while the hip joint was changed to the extension, neutral, and flexion positions.

Results: Three femoral nerves were closest to the anterior margin of the acetabulum at 90° and 120° of extension and farthest away at 30° of flexion. The sciatic nerve was closest to the posterior margin of the acetabulum at 90° and 120° of flexion and farthest away at 30° and 150° of extension compared with the other points.

Conclusions: To prevent nerve damage during THA, we suggest that the retractor be inserted at the points where the nerves are the farthest away, such as at 30° and 150°. The femoral and sciatic nerves vary in their movements depending on the hip position. Therefore, the safe insertion of a retractor is recommended for hip flexion of the femoral nerve and extension of the sciatic nerve. Additionally, it is important to carefully insert the retractor along the acetabular margin without penetrating the joint capsule. Overall, this study provides valuable insights into the anatomical location and movement of the femoral and sciatic nerves in relation to hip motion and can help inform surgical techniques for safer THA.

背景:神经损伤是全髋关节置换术(THA)最严重的并发症之一:神经损伤是全髋关节置换术(THA)最严重的并发症之一。它被怀疑是神经受压或髋臼牵引器直接损伤所致。髋臼边缘与股神经和坐骨神经之间的解剖关系,包括髋关节的运动,尚未得到研究。本研究旨在确定在全髋关节置换术中插入牵引器的最佳位置,以防止神经损伤:方法:共使用了来自 14 具新鲜冷冻尸体的 28 个髋关节。采用前外侧入路,将每具尸体固定在侧卧位,并在髋关节变为伸直、中立和屈曲位时展开,测量神经与髋臼边缘之间的距离:结果:在伸展90°和120°时,三条股神经最靠近髋臼前缘,而在屈曲30°时距离最远。与其他点相比,坐骨神经在屈曲 90°和 120°时最靠近髋臼后缘,在伸展 30°和 150°时最远离髋臼后缘:为防止在 THA 期间损伤神经,我们建议将牵开器插入神经距离最远的点,如 30° 和 150°。股神经和坐骨神经的运动因髋关节位置而异。因此,建议在股神经屈髋和坐骨神经伸展时安全插入牵开器。此外,沿着髋臼边缘小心插入牵开器而不穿透关节囊也很重要。总之,该研究为了解股神经和坐骨神经的解剖位置和运动与髋关节运动的关系提供了宝贵的见解,有助于为更安全的 THA 提供手术技术信息。
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引用次数: 0
Revision rate following unipolar versus bipolar hemiarthroplasty. 单极与双极半关节成形术后的翻修率。
IF 1.3 4区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-14 DOI: 10.1177/11207000241235394
David Kugelman, Joseph X Robin, Benjamin C Schaffler, Roy Davidovitch, Kenneth Egol, Ran Schwarzkopf

Introduction: There has been much debate on use of bipolar or unipolar femoral heads in hemiarthroplasty for the treatment of femoral neck fractures. The outcome of these implants should be studied in the America Joint Replacement Registry (AJRR).

Methods: All primary femoral neck fractures treated with hemiarthroplasty between January 2012 and June 2020 were searched in the AJRR. All cause-revision of unipolar and bipolar hemiarthroplasty and reasons for revision were assessed for these patients until June of 2023.

Results: There were no differences in number and reason for all cause revisions between unipolar and bipolar hemiarthroplasty (p= 0.41). Bipolar hemiarthroplasty had more revisons at 6 months postoperatively (p= 0.0281), but unipolar hemiarthroplasty had more revisions between 2 and 3 years (p= 0.0003), and after 3-years (p= 0.0085), as analysed with a Cox model. Patients with older age (HR = 0.999; 95% CI, 0.998-0.999; p= 0.0006) and higher Charlson Comorbidity Index (HR = 0.996; 95% CI, 0.992- 0.999; p= 0.0192) had a significant increase in revision risk.

Conclusions: We suggest that surgeons should consider using bipolar prosthesis when performing hemiarthroplasty for femoral neck fracture in patients expected to live >2 years post injury.

导言:关于在半关节成形术中使用双极或单极股骨头治疗股骨颈骨折的问题一直争论不休。美国关节置换登记处(AJRR)应对这些植入物的效果进行研究:方法:在美国关节置换登记处检索了2012年1月至2020年6月期间所有采用半关节置换术治疗的原发性股骨颈骨折。结果:截至 2023 年 6 月,对这些患者的单极和双极半关节成形术的所有翻修原因和翻修原因进行了评估:结果:单极和双极半关节成形术的所有原因翻修次数和原因均无差异(P = 0.41)。根据Cox模型分析,双极半关节成形术术后6个月的翻修率更高(p = 0.0281),但单极半关节成形术术后2至3年的翻修率更高(p = 0.0003),3年后的翻修率更高(p = 0.0085)。年龄较大(HR = 0.999; 95% CI, 0.998-0.999; p = 0.0006)和Charlson合并症指数较高(HR = 0.996; 95% CI, 0.992- 0.999; p = 0.0192)的患者翻修风险显著增加:我们建议外科医生在为预计伤后存活时间超过2年的股骨颈骨折患者实施半关节置换术时,应考虑使用双极假体。
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引用次数: 0
Does-dual mobility still offer improved stability in smaller cup sizes? A computer modelling comparison of stability with 22-mm versus 28-mm inner heads in dual-mobility versus single-bearing constructs. 双活动度是否仍能提高较小罩杯的稳定性?通过计算机建模比较双活动度与单承托结构中 22 毫米与 28 毫米内杯头的稳定性。
IF 1.3 4区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-02-19 DOI: 10.1177/11207000231220031
Amit Atrey, Alessandro Navacchia, Sarah E Ward, David Rister, Jacqueline Brillantes, Alexandra Stavrakis, Amir Khoshbin

Purpose: Dislocation remains 1 of the leading causes of revision after primary total hip arthroplasty (THA) and there is clear evidence the dual-mobility (DM) is used more frequently to minimise this. But in smaller cups, whether the use of DM with smaller 22-mm heads imparts any increased stability compared to standard bearing is unknown; especially when those smaller cups now allow for large single-bearing (SB) heads.

Methods: 3 primary cup sizes (48 mm, 50 mm, 52 mm) were chosen a priori for modelling. Head sizes trialled for the standard bearing (SB) constructs group were 28-0 mm, 32-0 mm and 36-0 mm against neutral polyethylene liners. In the modular sub-hemispheric DM constructs the inner head sizes for the DM constructs were altered where appropriate (22-0 mm vs. 28-0 mm). Cup position, stem offset, and stem size were standardised.

Results: Both DM constructs outperformed all SB constructs because of a statistically significant jump distance increase (p < 0.001). However, there was no difference in range of motion (ROM) or jump distances between the 22-mm and 28-mm DM inner heads.The ROM angle before impingement between the DM (with 22-mm or 28-mm heads) and SB (with different head sizes where appropriate) showed no statistically significant difference. However, DM constructs presented significantly larger jump distances than SB constructs for both provocative dislocation tests across all 3 cup sizes.Of interest, for 50-mm and 52-mm cup sizes (for which this particular DM construct design can accommodate both 22-mm and 28-mm inner heads), there were no differences in ROM or jump distance between 22-mm versus 28-mm inner heads.

Conclusions: In this computer-modelling study, DM constructs are advantageous over SB constructs for improving jump distances in clinically provocative positions, but not range of motion angles. Inner head diameter of DM has no effect on stability.

目的:脱位仍是初次全髋关节置换术(THA)后翻修的主要原因之一,有明显证据表明,双活动度(DM)的使用频率更高,可最大限度地减少脱位。但在较小的髋臼杯中,与标准轴承相比,使用较小的 22 毫米头的 DM 是否会增加稳定性,目前尚不清楚;尤其是在较小的髋臼杯现在允许使用较大的单轴承(SB)头的情况下。方法:事先选择 3 种主要髋臼杯尺寸(48 毫米、50 毫米、52 毫米)进行建模。在标准轴承(SB)结构组中,针对中性聚乙烯内衬试用的头颅尺寸分别为 28-0毫米、32-0 毫米和 36-0毫米。在模块化次半球DM结构中,DM结构的内侧头尺寸酌情改变(22-0毫米与28-0毫米)。髋臼杯位置、茎杆偏移量和茎杆尺寸均已标准化:结果:两种 DM 构型都优于所有 SB 构型,因为在统计意义上,两者的跳跃距离都有显著增加(p 结论:DM 构型和 SB 构型的跳跃距离都有显著增加:在这项计算机建模研究中,DM结构比SB结构更有利于提高临床刺激体位的跳跃距离,但对运动角度范围没有影响。DM 头的内径对稳定性没有影响。
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引用次数: 0
"Stuck in the middle": the missing lumbosacral link in total hip arthroplasty. "卡在中间":全髋关节置换术中缺失的腰骶部环节。
IF 1.3 4区 医学 Q1 Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-12 DOI: 10.1177/11207000231223706
Christopher M Scanlon, Thomas Christensen, Thomas Bieganowski, Weston Buehring, Morteza Meftah, Matthew S Hepinstall

Introduction: Spinopelvic mobility drives functional acetabular position, influencing dislocation risk after total hip arthroplasty (THA). Patients have been described as "stuck sitting" or "stuck standing" based on pelvic tilt (PT). We hypothesised that some patients are "stuck in the middle," meaning their PT changes minimally from sitting to standing - increasing their risk of dislocation.

Methods: We reviewed 195 patients with standing and sitting whole body radiographs prior to THA. Standing anterior pelvic plane tilt (APPT) and standing and sitting sacral slope (SS) were measured and used to calculate sitting APPT. Normal standing and sitting were defined as APPT >-10° and <-20°, respectively. Spinal stiffness was classified as <10° change in sacral slope between sitting and standing. Patients were categorised as: (A) able to fully sit and stand; (B) "stuck sitting" - able to fully sit; unable to fully stand; (C) "stuck standing" - able to fully stand; unable to fully sit; or (D) "stuck in the middle" - unable to sit or stand fully.

Results: 84 patients could sit and stand normally (A), 22 patients were stuck sitting (B), 76 patients were stuck standing (C), and 13 patients were stuck in the middle (D). While 111 patients (56.9%) were considered stuck, only 58 patients (29.7%) met criteria for spinal stiffness.

Discussion: We identified a subset of patients with stiff spines and abnormal PT in both sitting and standing, including 37.1% of patients who would be classified as "stuck sitting" based only on standing radiographs. Placing acetabular components in less than anatomic anteversion in these patients may increase posterior dislocation risk.

简介:脊柱骨盆的活动度会影响髋臼的功能位置,从而影响全髋关节置换术(THA)后的脱位风险。根据骨盆倾斜度(PT),患者被描述为 "坐姿卡住 "或 "站姿卡住"。我们假设一些患者 "卡在中间",即从坐姿到站姿,他们的骨盆倾斜度变化很小,这增加了他们脱位的风险:我们对 195 名患者在接受全髋关节置换术前的站立和坐位全身X光片进行了复查。我们测量了站立时骨盆前平面倾斜(APPT)以及站立和坐位时的骶骨斜度(SS),并将其用于计算坐位时的APPT。正常站姿和坐姿的定义是 APPT >-10° 和 结果:84名患者可以正常坐立(A),22名患者坐姿受限(B),76名患者站姿受限(C),13名患者站姿受限(D)。虽然有 111 名患者(56.9%)被认为脊柱僵硬,但只有 58 名患者(29.7%)符合脊柱僵硬的标准:讨论:我们发现了一部分患者脊柱僵硬,坐姿和站姿的PT均异常,其中37.1%的患者仅根据站姿X光片就被归类为 "坐姿卡住"。将髋臼组件置于这些患者的解剖内翻位可能会增加后脱位风险。
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引用次数: 0
Extra-articular hip resection with maintenance of pelvic continuity in malignant tumours of the proximal femur with articular invasion. 股骨近端恶性肿瘤伴关节侵犯时的关节外髋关节切除术与骨盆连续性的保持。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-07-01 Epub Date: 2024-05-08 DOI: 10.1177/11207000241249135
Guillaume-Anthony Odri, Cédric Yatim, Diane Ji Yun Yoon, Pierre-Alban Bouche, Mathieu Severyns, Pascal Bizot

Introduction: Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection.

Technique: We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease.

Conclusions: Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.

导言:盆骨或股骨近端恶性肿瘤侵犯髋关节时,可能需要进行髋关节外切除术。当肿瘤位于股骨近端时,可以通过髋臼周围截骨术对髋臼进行整体切除,但这会造成骨盆环的不连续性,导致重建困难和功能减退。最近介绍的几种技术试图通过保留后柱或双柱来尽可能保留骨盆骨,以方便重建和改善功能。然而,这些技术仍然需要复杂的重建,并可能需要进行骨盆内剥离:我们在此介绍一种针对侵犯关节的股骨近端肿瘤的关节外髋关节切除技术,该技术通过保留髋臼的两根支柱和四边形骨板来保持骨盆的连续性,无需骨盆内剥离,适用于髋臼内侧壁足够厚的患者。我们的初步评估包括干骨研究和成像分析。该技术首先在一个尸体骨盆(包括两个髋关节)上进行了测试,随后在一名因继发于帕吉特氏病的骨肉瘤而导致股骨颈病理性骨折的患者身上进行了测试:进一步的临床应用对于评估该实验技术的整体有效性、安全性和对患者功能的影响至关重要。
{"title":"Extra-articular hip resection with maintenance of pelvic continuity in malignant tumours of the proximal femur with articular invasion.","authors":"Guillaume-Anthony Odri, Cédric Yatim, Diane Ji Yun Yoon, Pierre-Alban Bouche, Mathieu Severyns, Pascal Bizot","doi":"10.1177/11207000241249135","DOIUrl":"10.1177/11207000241249135","url":null,"abstract":"<p><strong>Introduction: </strong>Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection.</p><p><strong>Technique: </strong>We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease.</p><p><strong>Conclusions: </strong>Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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HIP International
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