HIP International最新文献

Revision total hip arthroplasty continues to increase rapidly, with formidable challenges in managing complex acetabular bone defects. Porous metal augments have emerged as an efficacious solution, offering superior mechanical stability, greater osseointegration potential and better biomechanical reconstruction compared to traditional methods like structural allografts and jumbo cups. These augments can address various defect patterns with configurations tailored to specific defect location and extent (e.g., roofing, flying buttress, column buttress, doming, and footing configurations). Key material advantages include high porosity, optimal pore diameter, good biocompatibility, enhanced coefficient of friction, and native elastic modulus similar to the trabecula. Clinical studies reported 10-year survivorship rates exceeding 90% for severe defects (Paprosky type III), with precise hip centre restoration and reduced complications. The newly introduced rim-point-column-oriented algorithm provides a practical framework for optimised reconstruction using porous metal augments by emphasising rim or 3-point fixation, column stabilisation and medial wall support. Combined strategies, such as acetabular distraction for pelvic discontinuity, further extend indications and improve outcomes. However, concerns persist regarding metal debris release at cup-augment interfaces and the inability to restore bone stock in young patients. Emerging innovations, including 3D-printed porous augments, show comparable efficacy with customised advantages. Porous metal augments represent a versatile and durable option for complex acetabular reconstruction, though lifelong surveillance through follow-up is warranted.

Background: Total hip arthroplasty (THA) is an effective treatment for advanced hip osteoarthritis, particularly in complex cases such as Crowe Type 3 and 4 developmental dysplasia of the hip (DDH). This study aimed to compare radiological and early clinical outcomes of conventional (cTHA) and robotic (rTHA) THA in patients with Crowe Type 3 and 4 DDH.

Methods: Patients who underwent cTHA or rTHA were retrospectively analysed. Preoperative and postoperative clinical parameters, including range of motion (ROM), visual analogue scale (VAS) pain scores, modified Harris Hip Score (mHHS), and leg-length discrepancy, were evaluated. Radiological assessments included implant positioning (acetabular inclination and anteversion, femoral anteversion) using x-ray and CT imaging. Operative durations for cTHA and rTHA were also compared.

Results: A total of 45 patients (52 hips) were included. Both groups showed significant improvements in clinical and radiological outcomes. Postoperative VAS pain scores were lower in the rTHA group (1.35 ± 1.00 vs. 2.41 ± 1.14 for cTHA), and mHHS was higher (92.34 ± 5.68 vs. 79.68 ± 5.92 for cTHA). ROM and radiological parameters, such as acetabular inclination (37.11 ± 3.37° for rTHA vs. 41.13 ± 6.49° for cTHA) and anteversion (17.59 ± 1.78° for rTHA vs. 21.87 ± 1.71° for cTHA), were more precise in rTHA. Operative time was longer for rTHA (117.06 ± 8.16 vs. 79.71 ± 6.79 minutes).

Conclusions: Robotic THA achieved better implant positioning and superior early clinical outcomes compared to conventional THA in complex DDH cases, despite longer surgical times.

Background: Nerve injury is a major complication of total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH), and its incidence is influenced by the type of surgical approach used. The aim of this study was to compare the recently developed direct anterior approach (DAA) and the classic posterior approach (PA) regarding the characteristics of nerve injuries in Crowe IV DDH patients.

Methods: A total of 149 Crowe IV DDH patients who underwent THA were retrospectively included and divided into 2 groups based on surgical approach (DAA: 68 patients and PA: 81 patients). Postoperatively, the nerve injury was evaluated both clinically and electrophysiologically. The incidence, severity and prognosis of nerve injuries and involved nerves were compared and analysed.

Results: The overall incidence of nerve injury was 30.88% (21/68) for the DAA and 29.63% (24/81) for the PA (p = 0.868). The incidence of motor nerve injury (12.35%, 10/81) was higher with the PA than with the DAA (2.94%, 2/68, p = 0.036). The sciatic nerve was more commonly injured when the PA was performed (overall incidence: 27.16% vs. 8.82%, p = 0.004). In contrast, nerve injuries with the DAA mainly affected the femoral nerve (overall incidence: 25.00% vs. 11.11%, p = 0.026). The independent risk factors for symptomatic nerve injury were previous surgical history (OR 7.075) and body mass index (OR 1.598) for the DAA and previous surgical history (OR 9.143), surgical time (OR 1.029) and amount of limb lengthening (OR 1.104) for the PA.

Conclusions: Patients undergoing THA due to osteoarthritis secondary to Crowe IV DDH can be operated on with a DAA. However, there is an increased incidence of femoral nerve injury when compared to the posterior approach. To prevent symptomatic nerve injury, the DAA should not be used in obese patients and might require more extensive intraoperative soft-tissue release.

Background: Dual-taper modular stems have been linked to implant failure due to aseptic lymphocytic vasculitis-associated lesions (ALVAL), yet data on revision outcomes remain limited. This study assessed the survival rate of modular stems revised for ALVAL and compared outcomes with a non-revised control group.

Methods: A retrospective analysis of 233 total hip arthroplasties (THA) with ABGII dual-taper modular stems (2007-2011) was conducted, with follow-up until 2024. 39 THA (16.7%) underwent revision for ALVAL, confirmed by intraoperative histology. The control group included unrevised patients with ⩾1-year follow-up. Pre-revision assessments included Harris Hip Score (HHS), radiographs, MARS-MRI, and cobalt/chromium ion levels. Revision was indicated for disabling pain, cobalt >5 µg/L, or progressive effusion/pseudotumours. Outcomes included HHS, complications, and Kaplan-Meier survival analysis.

Results: Revisions for ALVAL (39 THA, 16.7%) were primarily due to groin pain (64.1%), MRI effusion (79.5%), and elevated cobalt levels (46.2%). The median time to revision was 4 years postoperatively, with a mean time to revision of 2.4 years. Of 21 unipolar revisions 10 hips (27.1%) had a had a dislocation, bipolar revisions (18 hips) had none (p <0.001).At 5, 10, and 15 years, overall revision-free survival was 88.8%, 80.3%, and 75.2%, respectively, while survival free from revision specifically due to ALVAL, confirmed by histological findings, was 91.4%, 83.7%, and 83.1%. 3 hips were re-revised for periprosthetic fractures. After ALVAL revision the HHS improved from 77.6 to 87.7 (p <0.001) but remained lower than in the non-revised controls (p = 0.002). 25.6% of the revised patients had persistent pain.

Conclusions: ALVAL-related revisions led to improvement in the HHS but did not reach the levels of non-revied control. Revision with dual-mobility cups reduced the dislocation risk.

Purpose: The long-term success of total hip arthroplasty (THA) is dependent on support from the periprosthetic bone bed. We present a randomised study using 18F-fluoride Positron Emission Tomography/Computerised Tomography (F-PET/CT) to analyse bone metabolism in periprosthetic bone adjacent to femoral stems following THA surgery. To compare bone metabolism to cemented Exeter and uncemented SP-CL stems, patients with hip osteoarthritis were randomly assigned for THA with either cemented or uncemented femoral components. The results were analysed with F-PET/CT.

Patients and methods: In 28 patients (28 cases) with hip osteoarthritis, a THA was performed. The patients received either an uncemented or a cemented femoral stem. The contralateral healthy femur was used as reference for normal bone metabolism. Patients' clinical scores, radiography and F-PET/CT were analysed at 4, 16 and 36 weeks postoperatively. PET results were analysed and presented in 13 regions of interest (ROI) adjacent to the whole stem-bone interface.

Results: Clinical results were good in all patients, and no major complications were recorded. At radiography, all stems were stable. PET analyses after 4 weeks showed that bone mineralising activity was significantly higher around the SP-CL stems, both compared to the Exeter group and to the contralateral healthy reference femur group. The SP-CL also had prolonged raised activity compared to the Exeter group.

Conclusions: A detailed analysis of bone formation patterns on the implant surface shows that early healing is associated with higher mineral deposition using the uncemented SP-CL stem.

Clinical trial registration: The study was registered at ClinicalTrials.gov (identifier NCT02320682).

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 most cost-effective intravenous antibiotic prophylaxis for preventing prosthetic joint infection (PJI) in total hip arthroplasty (THA) has been a matter of debate. The aim of this study was to compare the cost differential between cefazolin and vancomycin as prophylactic options with a particular focus on costs associated with PJI management.

Methods: Using previously published data on PJI rates associated with cefazolin and vancomycin, we modelled the cost of each prophylactic option. This model included unit prices for each drug obtained from our hospital's pharmacy service, as well as the labor costs associated with the hour-long period required for vancomycin administration. Cost of PJI accounted for the price of a 2-stage septic THA revision procedure. National projections were obtained to account for future THA volume.

Results: The average per-patient cost associated with cefazolin PJI prophylaxis was $1025.59, accounting for a PJI rate of 0.75%. The average per-patient cost associated with vancomycin PJI prophylaxis was $2710.82, accounting for a 1.47% PJI rate. The annual cost difference could amount to $2.4 billion by 2040 given projections of THA incidence.

Conclusions: The per-patient cost associated with vancomycin PJI prophylaxis is 164% higher than that associated with cefazolin due to increased cost of primary treatment, labor costs associated with prolonged infusion time, and most importantly differential PJI rates (number needed to treat = 1.39). In an era of value-based care, the use of cefazolin has been consistently shown to be the gold standard for THA PJI prophylaxis and is associated with significant cost advantages.

Background: Evaluation of patients with hip arthritis for total hip arthroplasty (THA) may be confounded by concomitant low back pain (LBP).

Purpose: To study the prevalence and outcome of LBP in THA patients. To evaluate the outcome of THA in patients with dysfunctional low back pain (DLBP).

Methods: In patients undergoing THA, low back pain was assessed with the Roland Morris Disability Questionnaire (RMDQ) and Numerical Pain Rating Scale (NPRS) scores preoperatively and 1 year postoperatively. Patients were categorised as suffering from DLBP if their RMDQ score was >4. Hip function was assessed using the modified Harris Hip Score (mHHS).

Results: 26 of 79 (33%) patients had DLBP before THA. At 1 year follow-up, 19 of them either no longer suffered from DLBP (RMDQ ⩽ 4) or at least had improvement in their RMDQ scores ⩾ 5 suggesting discerning clinical improvement. The mean NPRS scores for LBP at one year also improved (1.5 vs. 0.7, p < 0.01). The mean mHHS at 1 year in patients without DLBP was significantly higher than those with DLBP (85.15 vs. 75.81, p = 0.003) implying that patients without DLBP had better hip outcomes following THA.

Conclusions: DLBP improves considerably after THA. The outcome of THA may be adversely affected by the presence of DLBP.

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.