HIP International最新文献

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.

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).

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.

Purpose: To evaluate the effect of the stem length on femoral stress distribution, using thermoelastic stress analysis (TSA) to provide insights into optimal stem selection for conversion to total hip arthroplasty (cTHA) following femoral trochanteric fracture.

Methods: 6 simulated femurs were prepared via intramedullary nailing followed by implant removal to construct a post-explantation model. A screw hole was replicated 135 mm distal to the apex of the greater trochanter. Following femoral neck osteotomy, cTHA models were constructed using either a quadrangular taper collared standard or long stem. TSA was conducted under vertical loading, measuring the maximum change in the sum of principal stresses around the screw hole. The stress-reducing effects of both stems were compared using the Wilcoxon signed-rank test.

Results: Maximum stress around the screw hole decreased after stem insertion, with a greater reduction in the long stem group. The median maximum stress at the distal screw hole measured 11.2 and 8.42 MPa laterally and -14.6 and -12.3 MPa medially for the standard and long stem, respectively. The long stem significantly reduced stress in both regions.

Conclusions: Stem insertion alleviated stress concentration, with long stem offering greater relief. The long stem effectively redistributed stress, providing valuable insights for optimising stem selection and reducing postoperative fracture risk.

The Australian and New Zealand Hip Fracture Registry (ANZHFR) is a bi-national clinical quality registry established to enhance care and outcomes for older adults hospitalised with hip fractures. Since its inception in 2015, the ANZHFR has amassed data on over 120,000 hip fractures from 107 hospitals across Australia and New Zealand. This ongoing data collection adheres to an internationally agreed-upon minimum common dataset and incorporates indicators aligned with the Australian Commission on Safety and Quality in Health Care (ACSQHC) Hip Fracture Clinical Care Standard. These indicators reflect best-practice guidelines for hip fracture care. The registry tracks key processes and outcomes, including care at presentation, preoperative pain management, orthogeriatric involvement, timing of surgery, postoperative mobilisation, prevention of subsequent fractures, hospital discharge transitions, functional outcomes, quality of life at 120 days, and post-injury mortality. This manuscript serves as a foundational reference for all future publications using ANZHFR data, providing detailed insights into its structure, scope, and significance. Researchers and collaborators interested in utilising or contributing to the ANZHFR data are encouraged to contact the team at clinical@anzhfr.org.

Background: Safe surgical dislocation has revolutionised hip preservation surgery by allowing complete access to the proximal femur while minimising the risk of avascular necrosis. However, despite meticulous technique, intraoperative injury to the superior retinacular vessels (SRV), the primary blood supply to the femoral head, can still occur, potentially compromising outcomes.

Purpose: To identify, classify, and analyse intraoperative patterns and mechanisms of SRV injury during surgical hip dislocation procedures performed for complex hip deformities.

Methods: A prospective analysis of all cases with intraoperative lateral retinacular damage during hip preservation surgeries through surgical dislocation between 2005 and 2024 was performed. Patient demographics, preoperative diagnoses, intraoperative findings, and patterns of SRV damage were documented. Standard safe surgical dislocation with trochanteric flip osteotomy was performed in all cases, with vascular assessment using arterial Dopplers and intraosseous femoral head drilling.

Results: 14 patients (mean age 14 years; 7 males, 7 females) were included. Preoperative diagnoses included Perthes disease, stable and unstable slipped capital femoral epiphysis (SCFE), healed SCFE, chondrolysis, and pseudo-rheumatoid dysplasia. Patterns of SRV injury included stripping of the lateral retinaculum during internal rotation in 3 cases, spontaneous avulsion in unstable slips and dysplastic hips, ischemia following distal neck osteotomies, and iatrogenic avulsion following combined flap elevation and circumferential cam osteoplasty. Pre-existing vascular compromise was common in unstable and healed slips. Careful surgical technique, controlled reduction, and intraoperative vascular monitoring minimised further SRV damage.

Conclusions: This study represents the largest reported intraoperative series of SRV injuries during surgical hip dislocation. Internal rotation during reduction, osteotomy near the physeal scar, and extensive cam osteoplasty were major contributors to SRV injury. Awareness of vulnerable steps, meticulous surgical technique, and intraoperative assessment of femoral head perfusion are essential to preserve the femoral head's vascular integrity during complex hip preservation procedures.

Introduction: This study evaluated the accuracy of cup placement by the robotic arm-assisted system (Mako) in obese patients with developmental dysplasia of the hip (DDH).

Methods: This retrospective single-centre study included 923 consecutive hips with primary robotic arm-assisted total hip arthroplasty (THA). After propensity score-matching, 80 hips with DDH each were selected for the obese group and non-obese group. Postoperative cup orientation and positioning were assessed by superimposition of a 3-dimensional cup template, using postoperative computed tomography images with pelvic coordinates matching the preoperative planning.

Results: The absolute error of cup inclination and anteversion was comparable between the obese and non-obese groups (1.2 ± 1.0° vs. 1.2 ± 1.0° and 1.4 ± 1.0° vs. 1.6 ± 1.2°, respectively). The absolute error of the transverse, sagittal, and longitudinal axes between the obese and non-obese groups were 1.0 ± 0.9 mm vs. 1.4 ± 1.0 mm, 1.5 ± 1.0 mm vs. 1.3 ± 1.8 mm, and 1.4 ± 1.2 mm vs. 1.3 ± 0.9 mm (p = 0.02, p = 0.89, and p = 0.12, respectively). There was no significant difference in cup orientation or positioning in the obese group, regardless of body mass index.

Conclusions: Robotic arm-assisted THA enables accurate cup placement even in obese patients with DDH.

Background: With the increased rates of revision total hip (rTHA) and total knee arthroplasty (rTKA), the financial burden of these procedures is at risk of straining the healthcare system. Our study sought to create a model to evaluate the cost-effectiveness of rTKA and rTHA performed by high-volume (HV) and low-volume (LV) surgeons.

Methods: The database of rTKA and rTHA from April 2018 to March 2021 at our academic institution was retrospectively reviewed. Surgeons above the 90^th percentile in annual volume were classified as HV surgeons and the remainder were classified as LV surgeons. Previously published cost estimates were utilised for operative time, hospital length of stay (LOS), discharge disposition, 90-day readmission, and 1-year re-revision.

Results: A total of 442 rTKA were performed by 30 surgeons and 420 rTHA were performed by 32 surgeons. 3 surgeons were HV in each group with HV surgeons performing 213 (48.2%) rTKA and 215 (51.2%) rTHA in the study period. LV surgeons had longer operative times for both rTKA (167.1 vs. 145.8 minutes; p < 0.001) and rTHA (172.5 vs. 151.2 minutes; p < 0.001). Both groups had equivalent discharge disposition, 90-day readmission, and 1-year re-revision. HV surgeons had lower estimated mean costs for rTHA ($22,027.81 vs. $24,617.39) and rTKA ($20,343.23 vs. $18,554.67).

Conclusions: HV surgeons have a lower estimated mean cost for both rTHA and rTKA. Healthcare systems may benefit from having rTHA and rTKA procedures performed by HV surgeons who are able to perform these revision procedures for a lower cost without negatively impacting patient outcomes.