HIP International最新文献

Introduction: The anatomical Lubinus SPII-stem is commonly used in hemi-arthroplasty for femoral neck fractures (FNF), combined with either the bipolar Variocup, the Unipolar Head (UH) and a newly introduced unipolar Modular Trauma Head (MTH). Similar constructs like the MTH are reported to have risk of corrosion and wear. This is the first publication evaluating the MTH.

Aim: To describe the revision rate of the SPII-stems/heads which were divided into 3 groups (Variocup, UH, MTH). The head types are compared by their rate of revision at 2 years, due to any cause and to dislocation. Revision and mortality rates up to 10 years are reported.

Methods: This observational cohort study based on prospectively registered data from the Swedish Arthroplasty Register included 33,059 patients with hemiarthroplasty 2005-2021 due to FNF. SPII-stems combined with Variocup (n = 7,281), UH (n = 23,980), MTH (n = 1,798) were included. The follow-up ended at 10 years for Variocup and UH, for MTH at 2 years. Kaplan-Meier survival analyses was used, with a 95% confidence interval (CI). Patients were censored at death or at the end of the study (31 December 2021).

Results: The 2-year revision rate regardless of cause was similar between the groups: after Variocup 3.5% (CI, 3.1-4.0), UH 3.1% (CI, 2.9-3.4), MTH 3.5% (CI, 2.6-4.5).At 10 years, the Variocup and UH had similar revision rates; 4.6% (CI, 4.0-5.2) and 5.0% (CI, 4.4-5.6).For revision due to dislocation at 2 years Variocup 2.3% (CI, 1.9-2.7) had an inferior outcome compared to UH 1.5% (CI, 1.3-1.7). The MTH had an intermediate outcome, 1.7% (CI, 1.0-2.3). Variocup had a higher dislocation related revision rate, until the 10th year.The 2-year-mortality was 36% (CI, 35-37) after Variocup, 43% (CI, 42-43) after UH and 44% (CI, 41-47) after MTH.

Conclusions: The hemi-heads have comparable revision rates within 2 and 10 years. The new MTH performs similar to the standard UH. The bipolar Variocup is associated with more revisions due to dislocation.

Background: Recently, surgeons introduced a minimally invasive modification on the classic posterolateral approach (PLA) in total hip arthroplasty (THA): the direct superior approach (DSA). We investigated the association between surgeon's experience and the risk of early revision of the DSA in primary THA, using data from the Dutch Arthroplasty Register (LROI).

Methods: We retrieved all primary THAs performed using the DSA in 4 hospitals between 2016 and 2022 (n = 1551). Procedures were sorted in 5 groups using the date of operation and number of previous procedures per surgeon: 1-25; 26-50; 51-75; 76-100; >100. Subsequently, data from different surgeons were pooled together and the risk of revision was calculated via a multilevel time-to-event analysis.

Results: The overall revision rate was 1.5% after a mean follow-up of 2 years. Patients from the 1-25 group had comparable risks of revision compared to patients in the >100 group (hazard ratio [HR] 1.0 [CI, 0.3-3.2]). The risk for patients in groups 26-50, 51-75 and 75-100 was also not statistically different from the >100 group (resp. HR 1.5 [CI, 0.5-5.0], 1.8 [CI, 0.5-6.4] and 0.5 [CI, 0.1-4.0]). Main reasons of revision were dislocation (0.5%) and infection (0.4%).

Conclusions: We did not identify an association between the surgeon's experience and the early risk of revision for the DSA in primary THA in the Netherlands. The DSA seems safe in the early adoption phases with a low risk of revision due to dislocation and revision for all other causes.

Objectives: The current study sought to investigate whether physical function and activity were associated with hip structural analysis (HSA) parameters on the non-fracture side of patients with hip fractures.

Methods: Participants were patients with unilateral hip fracture treated by surgery. HSA of the proximal femur was conducted based on dual-energy x-ray absorptiometry data. HSA parameters in the narrow neck region included cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (SM), and buckling ratio (BR). Hierarchical multiple regression analysis was conducted to identify predictors of HSA.

Results: Except for the adjustment variables, age, gender and BMI, other variables were extracted. Hierarchical multiple regression analysis (standardised partial regression coefficients) identified movement control during one-leg standing on the non-fractured side (0.15) as factors associated with CSA. Hierarchical multiple regression analysis (standardised partial regression coefficients) identified hand grip (0.12, 0.23) as factors associated with CSMI and SM, respectively. Hierarchical multiple regression analysis (standardised partial regression coefficients) identified presence of steroid (0.23) and cerebrovascular disease (0.19) as factors associated with BR. The coefficients of determination adjusted for degrees of freedom (R²) were 0.545, 0.331, 0.401, and 0.148 for CSA, CSMI, SM, and BR, respectively.

Conclusions: Our results indicate that movement control during 1-leg standing and muscle strength may be important for maintaining and improving bone strength.

Introduction: Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD.

Patients and methods: A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II-V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes.

Results: 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II-V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males.

Conclusions: Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients.

Introduction: As the volume of technology-assisted total hip arthroplasty (THA) increases, there is a need to characterise the outcomes of robotic-assisted (RA) and computer-navigated (CN) THA. The goal of this study was to assess outcomes and opioid consumption following CN-THA and RA-THA compared to conventionally-instrumented (CON) THA.

Methods: The Premier Database was queried for all patients who underwent primary, elective THA from 2015-2020. Patients were divided into 3 groups: CN, RA, or CON-THA. Yearly usage trends were assessed. Univariate and multivariate analyses were performed to assess the 90-day risk of postoperative complications. Opioid consumption was reported in morphine milligram equivalents (MME) for postoperative days (POD) 0 and 1.

Results: Overall, 474,707 elective THAs were identified (95.7% CON, 2.1% CN, 2.2% RA. After accounting for confounders, CN-THA patients were at decreased risk for periprosthetic joint infection (PJI) (aOR: 0.55, p < 0.001) and dislocation (aOR 0.45, p < 0.001), but increased risk for blood transfusion (aOR 1.97, <0.001) compared to CON-THA. RA-THA patients were at decreased risk of dislocation (aOR:0.66, p < 0.001) but increased risk for transfusion (aOR 1.20, p < 0.001), prosthesis breakage (aOR 3.88, p < 0.001), and periprosthetic fracture (aOR 1.72, p < 0.001). Opioid consumption for CN-THA patients was lower on POD1 and lower for RA-THA patients POD0 and 2 compared to CON-THA.

Discussion: CN-THA was associated with reduced rates of PJI and dislocation, but increased rates of blood transfusion while RA-THA was associated with decreased rates of dislocation, but increased rates of blood transfusion, prosthesis complications, and periprosthetic fracture compared to CON-THA. Technology-assisted THA was associated with lower postoperative opioid consumption.

Introduction: Dislocation is a potentially devastating complication severely affecting outcomes post total hip arthroplasty (THR). We aimed to assess the efficacy and safety of closed reduction of a dislocated THR within the Emergency Department (ED).

Methods: A prospective multi-centre study was conducted over a 1-year period from November 2020 to December 2021 within 10 hospitals based in the East of England. Collected data included patient demographics, agent used for sedation, hospital length of stay, implant type and discharge destination. Patients were analysed according to whether successful reduction was performed in the ED or not. The primary outcome was length of stay, with secondary outcomes including discharge destination and pain post-procedure.

Results: We studied 99 patients with an average age of 77.02 years, with 39 (39%) patients being male. 11 patients had revision hip replacements and 88 patients had primary THRs. 57 (57.6%) underwent closed reduction in the Emergency department, of which 44 (77.2%) were successful. Successful closed reduction was significantly associated with lower patient age (p = 0.02), lower American society of Anesthesiologists (ASA) score (p < 0.01) and use of propofol (p < 0.01). Patients who underwent successful ED closed reduction had a lower hospital stay than those that did not (1 vs. 3 days, p < 0.01), however there was no significant difference in discharge destination.

Conclusions: When adopted, success following closed reduction is increased in younger patients with less comorbidities following use of propofol sedation. Following sedation, patients have a significantly shorter hospital stay. Increasing uptake of closed reduction of THR dislocation within the ED in suitable patients with evidence-based best practice protocols will maximise patient outcomes whilst allowing efficient resource utilisation.

Background: Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS).

Methods: A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test.

Results: Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD -1.13, I² = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29-19.10 mm.

Conclusions: A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm.