HIP International最新文献

Background: Gluteus maximus (GMax) tenotomy is a well described technique to improve femoral and/or acetabular exposure during the Kocher Langenbeck approach. Branches of the first femoral perforator artery (1FPA) are frequently encountered and may be injured during the tenotomy, causing bleeding and obscuration of surgical field. The understanding of vascular anatomy around GMax insertion is poor. This study aims to identify the origin, size, course, and consistency of these vessels, and a safe technique for GMax tenotomy.

Methods: 100 eligible computed-tomography angiograms (CTA) of the lower-limbs were identified between January 2019 and July 2021 with 200 limbs studied. The gluteal tuberosity (GTu) was set as the origin of GMax tendon insertion. CTAs were reconstructed in multiplanar reformats, including 3D reconstructions. The 1FPA and its branches were mapped, their anatomical course, size, and relationship with GTu and posterior femoral cortex were recorded.

Results: Average age of cohort was 66.5years. Out of 200 limbs, 2 anatomical arterial variants of the 1FPA were identified near the gluteal tubercle. 23 limbs (11.5%) had a proximal (high) take-off of the 1FPA. 177 (88.5%) had a long ascending vessel originating from the 1FPA. The courses of both arteries are consistent. The average luminal size of these vessels was 2.1 mm. In terms of vertical distance, 12 (6%) limbs had an artery within 15 mm from the GTu, the assumed top of GMax tendon insertion. All 200 vessels were seen within 10 mm of the posterior cortex. The combination of these findings make up the "safe-zone" of GMax tenotomy.

Conclusions: This is the first to detail the origin, course, and size of the ascending artery in relation to GMax tendon. The "Safe zone" of GMax tenotomy is a 15-mm partial release, at least 10 mm off the posterior femoral cortex.

Introduction: Same-day discharge (SDD) has gained increasing importance in orthopaedic surgery, particularly for hip and knee procedures. Despite initial concerns about the lack of extended hospital care, growing evidence demonstrates its benefits, including reduced in-hospital infections and significant financial and psychosocial advantages for patients and healthcare systems. This study examines the adoption and outcomes of SDD in total hip arthroplasty (THA).

Method: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2016 to 2021 was conducted to identify trends, predictors, and outcomes of SDD in THA.

Results: In this study, a multicentre database analysis was performed on 235,393 patients, including 25,388 who were discharged on the same day following total hip arthroplasty. Patients undergoing same-day discharge THA were generally younger, with females comprising 48.3% of SDD cases compared to 55.6% in hospitalised patients. Operative times were shorter for SDD patients (83.9 minutes vs. 92.3 minutes). Postoperatively, SDD patients experienced significantly lower rates of 30-day readmissions (1.7% vs. 3.5%), procedure-related readmissions (1.0% vs. 2.1%), reoperations (1.1% vs. 1.9%), and mortality (0.02% vs. 0.04%). Predictors of unplanned readmissions in the SDD group included age >65 years (OR 2.0), hypertension (OR 1.6), chronic steroid use (OR 2.2), and severe COPD (OR 2.0), while gender, emergent surgery indication, and smoking were not significant predictors. The adoption of SDD increased markedly, rising from 1.5% in 2016 to 25.6% in 2021.

Conclusions: Same-day discharge is a safe and effective option for appropriately selected THA patients, offering reduced readmission and reoperation rates, shorter operative times, and increased healthcare efficiency. This trend highlights a paradigm shift in perioperative care, improving patient outcomes and satisfaction.

Background: The relationship between total hip arthroplasty (THA) surgeon volume and outcomes is informative in this era of health care value optimisation. The purpose of this study was to evaluate outcomes based on modern-day surgeon practice volumes.

Methods: The SPARCS database was queried for patients undergoing primary THA from 2010 to 2020. Annual case volume thresholds were 30 and 150, differentiating high-volume (HV), intermediate-volume (IV), and low-volume (LV) groups. Perioperative outcomes and all-cause cumulative revision rates were evaluated.

Results: There were 88,411, 142,201, and 53,276 in the HV, IV, and LV groups, respectively. HV surgeons had significantly lower 3-month prosthetic joint infection (PJI) rates (0.5 vs. 0.8 vs. 1.0%, p < 0.001). While controlling for confounders, multivariate regression revealed increased odds of PJI for IV (1.5) and LV (1.87) and increased all-cause revision hazard ratio for IV (1.1) and LV (1.3). Cumulative revision rates were lower for HV at 1 and 2 years, but rates converged with IV group at 9 years.

Conclusions: HV surgeons have the most favourable short-term outcomes. However, in the long-term the difference in all-cause revision event rates becomes less apparent.

Background: There have been few reports of long stem cemented revision arthroplasty in the treatment of periprosthetic fractures (PPFs). The purpose of this study was to retrospectively compare the clinical and radiological outcomes between osteosynthesis and long stem cemented revision arthroplasty for PPFs.

Methods: This study retrospectively evaluated 29 femurs who underwent surgical treatment for PPF following total or bipolar hip arthroplasty. The mean duration of clinical follow-up was 5.0 (range 2-12) years. Surgical options included osteosynthesis only in 7 femurs (Group O) and long stem cemented revision arthroplasty in 22 femurs (Group R).

Results: Repeat surgeries due to implant failure were performed in 2 (29%) and 1 (5%) in groups O and R, respectively. In the walking component of the mean Merle d'Aubigné clinical score at the last follow-up, there were significant differences between the groups. Mean time to independent cane walking was 24.0 (13.1-42.3) weeks and 7.2 (2.0-15.6) weeks in groups O and R, respectively (p < 0.05). Bone union rates were 71% and 95% in groups O and R, respectively (p = 0.14). Where bone union was successfully achieved, the mean time to bone union was 12.2 (6.1-22.2) months in group O and 6.6 (1.7-12.5) months in group R (p < 0.05).

Conclusions: The time to independent cane walking and bone union was significantly shorter for long stem cemented revision arthroplasty. This procedure offers considerable advantages for patients, despite the difficulty of the procedure for surgeons.

Objective: This study aimed to evaluate the efficacy of interdisciplinary nursing care based on the concept of enhanced recovery after surgery (ERAS) during the perioperative period of geriatric hip arthroplasty.

Methods: A prospective, single-centre, randomised, evaluator-blinded, case-control study was conducted involving 80 patients diagnosed with femoral neck fractures who underwent total hip arthroplasty from October 2021 to May 2023. Patients were randomly assigned to a control or experimental group (40 patients each). Clinical and surgery-related data were collected and compared between the 2 groups. Critical assessments included the Harris Hip Score (HHS), Barthel Index (BI), Berg Balance Scale (BBS), Numeric Rating Scale (NRS) for pain, Beck Anxiety Inventory (BAI), and Caprini thrombosis risk scale.

Results: No significant differences between the 2 groups in baseline characteristics such as age, gender, BMI, surgery time, and complication rates (p > 0.05). The experimental group had shorter durations for catheter removal and postoperative ambulation (p < 0.05). Preoperative HHS and BI scores were similar in both groups, but at 1 week, 1 month, and 6 months postoperatively, the experimental group showed significantly higher HHS, BI, and BBS scores (p < 0.05). Anxiety levels (BAI) and thrombosis risk scores were comparable at all time points, except for significantly lower Caprini thrombosis and NRS pain scores in the experimental group at 1 month (p < 0.05).

Conclusions: Interdisciplinary nursing care based on the ERAS concept improves joint function recovery and self-care abilities and shortens mobilisation time in geriatric hip arthroplasty patients, promoting enhanced overall recovery.

Background: There is a limited literature available describing the various diagnostic modalities and treatment options for the management of subspine impingement (SSI). We developed a study to evaluate the clinical improvement at 1 year and 5 years, with iHOT 33 and HOS hip scores.

Questions: (1) Do patients with subspine compression improve with arthroscopic treatment clinically at short-term follow-up (1 year); (2) Is the improvement maintained in the mid-term (5 years)?

Methods: 43 young patients (21-65 years) with subspine compression (prominent anterior inferior iliac spine) treated arthroscopically between January 2010 and December 2021 were included. Patients completed the iHOT33, HOS-SPORT and HOS-ADL questionnaires before surgery, 1 year and 5 years follow-up. We evaluated pre- and postoperative differences at 1 year and at 5 years. Minimum clinically significant difference (MCID) and the substantial clinical benefit (SCB) were used to establish clinical improvement.

Results: Mean age was 37.38 years and 66% were males. Almost 75% and 70% of our patients exceed the MCID and the SCB respectively in all the questionnaires after 1 year follow-up. However, at 5 years follow-up, nearly 70% and 65% of the patients exceeded MCID and SCB respectively, therefore producing a slight worsening in the medium term.

Conclusions: We demonstrate that arthroscopic treatment of subspine impingement is effective. However, larger sample size and longer follow-up period are necessary to analyse long-term results to demonstrate this treatment as the "gold standard".

Background: The shuck test is a subjective method used intraoperatively to measure soft tissue tension during total hip arthroplasty (THA). This study aimed to introduce and quantify the shuck length vector magnitude in patients undergoing robotic arm-assisted THA, and identify factors affecting its value.

Methods: This prospective cohort study analysed 95 primary THAs performed on 87 patients. Surgical data and intraoperative soft tissue tension measurements were recorded using the Mako robotic arm-assisted system. An exploratory analysis of factors affecting the shuck length vector magnitude was performed.

Results: The mean shuck length vector magnitude was 8.7 mm. Shuck length vector magnitude was significantly higher in males as compared to females (p = 0.017). A strong inverse correlation was found between increased hip offset and hip length on shuck length vector magnitude (p < 0.001 and p = 0.004, respectively). Shuck length vector magnitude was not affected by femoral head size (p = 0.674) and arthritis severity (p = 0.141).

Conclusions: This study demonstrates that it is possible to quantify soft tissue tension using the shuck test during robotic-assisted THA. Restoring hip offset is crucial for optimising joint stability. Future research should establish a threshold for acceptable shuck length vector magnitude and correlate this with dislocation rates and patient reported outcomes.

Purpose: To determine: (1) the prevalence of articular noise in primary ceramic-on-ceramic (CoC) total hip arthroplasty (THA) using 2 different designs of short uncemented stems; (2) risk factors for noise; and (3) the impact of noise on quality of life (QoL), at a minimum follow-up of 5 years.

Methods: 70 patients (81 hips) that underwent primary CoC THA with either SMS or Minimax stems (Medacta, Switzerland) between 01 February 2015 and 31 December 2017 were retrospectively reviewed. Clinical assessment included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and a questionnaire on articular noise. Regression analyses were performed to find associations with articular noise.

Results: 64 patients (74 hips; 40 SMS, 34 Minimax) were available for clinical assessment at ⩾5 years. There were no significant differences between the SMS and Minimax groups in terms of postoperative WOMAC (93.5 ± 6.7 vs. 90.9 ± 11.8, p = 0.746) and mHHS (94.9 ± 12.7 vs. 95.7 ± 9.7, p = 0.641). The prevalence of articular noise was 23% (9 hips) in the SMS group and 24% (8 hips) in the Minimax group (p = 1.000). Regression analyses revealed that presence of noise was associated with preoperative WOMAC (OR 1.05; 95% CI, 1.01-1.10; p = 0.023), and tended to be associated with age (OR 0.96; 95%CI, 0.91-1.00; p = 0.060), cup diameter of 58-60 mm (OR 4.43; 95% CI, 0.86-23.44; p = 0.070), and head diameter of 36 mm (OR, 5.29; 95% CI, 0.86-38.10; p = 0.080). Impact of noise on QoL was low for both groups (1.0 ± 1.4 vs. 1.3 ± 2.2, p = 0.862).

Conclusions: The present study on primary CoC THA reported an overall prevalence of articular noise of 24% for 2 designs of short stems. Clinical outcomes and satisfaction rates were high for most patients, with noise having little impact on QoL and no noise-related clinical complications being observed. Risk factors for articular noise may be better preoperative WOMAC, younger age, and larger femoral head and cup diameter.

Objectives: To investigate the impact of preoperative virtual simulation planning on intraoperative parameters, postoperative complications, and functional recovery in acetabular fracture surgery, thereby aiding in clinical decision-making regarding the most effective approach.

Methods: We conducted a systematic search of articles in PubMed, Embase, Cochrane Library, and Web of Science databases up to July 14, 2023. All clinical studies comparing preoperative virtual simulation planning with conventional surgical treatment were included.

Results: 16 studies involving 593 patients were included. Among these studies, 6 were randomised controlled trials (RCTs), 1 was a prospective study, and 9 were retrospective studies. Compared to conventional surgery, preoperative virtual simulation planning-assisted surgery significantly reduced intraoperative time (weighted mean differences [WMD] -48.87; 95% CI, -61.15--36.59; p < 0.001), internal fixation time (WMD -29.83; 95% CI, -37.46--22.20; p < 0.001), intraoperative blood loss (WMD -259.95; 95% CI, -354.15--165.75; p < 0.001), and fluoroscopy frequency (WMD -4.56; 95% CI, -5.39--3.73; p < 0.001), as well as the incidence of postoperative complications (OR 0.34; 95% CI, 0.18-0.65; p = 0.001). There was no significant difference in fracture reduction quality between the preoperative virtual simulation planning group and the conventional group (OR 0.98; 95% CI, 0.75-1.29; p = 0.900), but the former had a higher rate of anatomical reduction (OR 3.00; 95% CI, 1.90-4.72; p < 0.001). There was no significant difference in hip joint function scores between the 2 groups (OR 1.01; 95% CI, 0.72-1.41; p = 0.974). However, the preoperative virtual simulation planning group had a higher proportion of patients with excellent scores (OR 2.32; 95% CI, 1.35-3.99; p = 0.002) and a lower proportion of patients with poor scores (OR 0.52; 95% CI, 0.14-1.92; p = 0.327).

Conclusions: Compared to conventional surgery, preoperative virtual simulation planning is more effective in the treatment of acetabular fractures, resulting in shorter intraoperative and internal fixation times, reduced intraoperative blood loss, and lower fluoroscopy frequency. Moreover, in the follow-up period, the preoperative virtual simulation planning group exhibits a lower incidence of postoperative complications and superior fracture site recovery, resulting in better overall prognostic outcomes.Prospero registration:https://www.crd.york.ac.uk/PROSPERO/ (registration number: RD42023447807).