HIP International最新文献

Introduction: Isolated femoral head and polyethylene liner exchange is commonly performed with varying surgical approaches used for the primary THA (pTHA) and the revision THA (rTHA). The purpose of this study is to investigate the prevalence and postoperative outcomes associated with concordance and discordance in isolated head-liner exchange.

Methods: A retrospective chart review from May 2016 to November 2023 was performed for all patients at 2 institutions who underwent isolated head-liner exchange. 175 patients had minimum 1-year follow-up with complete information regarding surgical approach and outcomes. 175 included were grouped based on their pTHA approach including posterior approach (PA), anterolateral (AL), and direct anterior (DA), and their subsequent rTHA approach. Demographics and postoperative outcomes were compared between groups. Chi-square tests were used to measure associations between surgical approaches and postoperative complications, with a p-value of <0.05 signifying statistical significance.

Results: Our study included 175 patients with isolated head-liner exchange, with a mean age of 68.5 ± 10.4 years. Of the 175 patients, 100 (57.1%) received primary THA via the posterior approach (PA), with 68.0% having concordant revisions. For the anterolateral (AL) and direct anterior (DA) primary approaches, 91.1% and 94.7% of revisions were concordant, respectively. Indication for revision differed by approach, particularly within the PA group, where instability favoured concordant revisions, and metallosis favoured discordant revisions. There was no significant difference in perioperative outcomes between concordant and discordant approaches, except the concordant group had more EBL, higher rates of transfusions, reoperations, and discharge to skilled nursing facilities (SNF).

Conclusions: In pTHA cohort, patients with PA approach were more likely to undergo head-liner exchange with a discordant approach via DA or AL. As no significant associations were found in any combination of discordant approaches with postoperative complications, surgeons should choose their head-liner approach without significant concern for discordance.

Background: Constrained liners (CLs) have been used in revision total hip arthroplasty (rTHA) with varying results. Relatively few studies have identified specific risk factors for failure. This study aimed to assess implant survivorship and complication rates, identify risk factors for constraint-related complications, and assess the effect of multiple factors present in a single case.

Methods: We conducted a retrospective analysis of 101 rTHAs for various aseptic indications and as second-stage procedures for periprosthetic joint infection (PJI) utilising 2 models of conventional single-articulation CLs. We excluded 8 cases in which the liners were removed early due to PJI and assessed the risk factors for constraint-related complications in the remaining 93 cases. The mean follow-up duration for complication-free cases was 6.5 years (range 4.7-10.5 years).

Results: The incidences of dislocation of a prosthetic head and loosening of the acetabular component were 19.8% and 5.0%, respectively. We also observed 8 cases where the locking ring of the liner was dislodged without dislocation (1 case required re-revision). The presence of factors related to impingement (cup retention, smaller internal diameter CLs, signs of probable impingement from the femoral side) was associated with higher rates of constraint-related complications. The presence of factors related to soft-tissue stabilisers did not increase the rate of complications. The simultaneous presence of multiple impingement-related risk factors resulted in worse outcomes.

Conclusions: CLs may be less effective for treating or preventing instability related to impingement. CLs should be used with caution or avoided when multiple impingement-related risk factors are present.

Background: Although the Burch-Schneider antiprotrusio cage (BS-APC) has been reported to be reliable, long-term data for this implant are scarce. We thus aimed to investigate survival and radiological results for revision total hip arthroplasty with the BS-APC in patients with major bone deficiency (55% AAOS defect grade 3, 39% grade 4) who had a minimum follow-up of 5 years (mean 10.2 years).

Methods: 144 revisions in 140 patients were performed due to aseptic loosening (n = 74), infection (n = 50), or other reasons (n = 20). Survival analysis was performed with death as a competing risk. Clinical follow-up was performed at 1, 2, and 5 years and every 5 years thereafter.

Results: 77 patients died during follow-up, 25 within the first 5 years. 12 BS-APCs were re-revised for infection (n = 5), aseptic loosening (n = 5), or instability (n = 2). The cumulative incidence for aseptic re-revision of BS-APCs was 4.3% at 10 years (95% CI, 1.8-10.1%), and the cumulative risk of death was 73.3% (95% CI, 62.4-83.2%). Radiological changes occurred in 26 of 87 radiologically examined hips, of which 8 cases were revised.

Conclusions: We found excellent mid- and long-term survival of the BS-APC in acetabular revision with major bone deficiencies, in accordance with or superior to most literature reports, which might be explained by strict adherence to surgical technique.

Background: The association between primary total hip arthroplasty (THA) approaches and short-term mortality rates remained unexplored. This study aimed to compare short-term mortality rates between the direct anterior (DAA), posterolateral (PL), anterolateral (AL) and direct lateral (DL) approaches and determine associated factors.

Methods: A registry study was conducted using data from 2007 to 2023 of the Dutch Arthroplasty Register. 30- and 90-day mortality were compared between approaches using the chi-square test and the logistic regression analysis to adjust for confounders (age, sex, patient's physical status [ASA] classification, fixation method, body mass index [BMI] and smoking status). Multivariate regression models were used to determine factors associated with short-term mortality. Sensitivity analyses for time periods (2007-2012, 2013-2017, 2018-2023) were performed.

Results: The study comprised 379,108 patients (mean age 69.9 ± 9.5, male 33.8%). The AL, PL and DL approaches demonstrated a significantly larger likelihood for 30-day mortality compared to the DAA after adjusting for confounders (DAA: reference; AL: OR 2.32 [1.52-3.57], p < 0.001; PL: OR 1.79 [1.36-2.36], p < 0.001; DL: OR 2.78 [1.69-4.57], p < 0 .001). In ASA I-II patients, likelihood for 90-day mortality for the AL, PL and DL approaches was significantly higher than the DAA approach (DAA: reference; AL: OR 2.293, p < 0.001; PL: OR 1.963, p < 0.001; DL: OR 2.016, p < 0.001). In ASA III-IV patients, differences were not significant, except when comparing the DL to the DAA approach (OR 1.484, p = 0.011). Increased age, male sex, surgical approach and cemented fixation were significantly associated with 30- and 90-day mortality.

Conclusions: Findings were suggestive that the DAA provides a reduced likelihood for short-term mortality compared to the PL, AL and DL, after adjusting for confounding factors. Differences in mortality rate were more substantial in healthy patients and remained similar irrespective of time periods. Increased age, male sex, surgical approach, and cemented fixation increased likelihood on short-term mortality.

Background: 10 years after changing our institution's total hip arthroplasty (THA) preoperative antibiotic prophylactic protocol by adding gram-negative (GN) coverage, this study aimed to assess the impact of adding GN specific coverage (GNSC) prior to THA on periprosthetic joint infection (PJI) rates.

Methods: This was a retrospective case-control study of 14,598 patients who underwent primary, elective THA between July 2012 and January 2022, with minimum 1-year follow-up. All patients were under perioperative antibiotic protocol that included GNSC with either weight-based gentamicin or aztreonam (+GNSC) and were compared to a historical control group of patients for which the antibiotic prophylactic protocol did not include GNSC (-GNSC). PJI and nephrotoxicity rates, as well as the severity of nephrotoxicity according to the RIFLE criteria, were compared between the study populations and 4122 controls.

Results: Proportions of GN-related PJIs among culture-positive (13.70 vs. 26.53%, p = 0.076) and all PJIs (10.64 vs. 26.53%, p = 0.014) were lower for +GNSC patients, while the proportion of PJIs caused by a gram-positive bacteria were similar between groups (87.67 vs. 83.67%, p = 0.532). While the +GNSC group have significantly higher rates of nephrotoxicity (2.87 vs. 1.78%, p = 0.003), the rates of kidney injury (0.39 vs. 0.39%, p = 0.998) and kidney failure (0.17 vs. 0.16%, p = 0.567), which are the two more severe forms of nephrotoxicity, were comparable between the groups.

Conclusions: The addition of gentamicin or aztreonam prior to THA reduces the incidence of GN-related PJIs. Increased nephrotoxicity rates were limited to the mildest form, usually associated with reversibility and favourable outcomes.

Objective: Does the use of staples or sutures for wound closure have a lower surgical site infection rate in patients receiving primary total hip arthroplasty (THA)?

Design: Prospective, randomised controlled multicentre trial.

Methods: 535 patients undergoing THA were included and randomised into 2 groups: 268 wounds were closed with staples, and 267 with sutures. Primary outcome was surgical site infection (SSI). Secondary outcomes were prosthetic joint infection (PJI), other wound complications (dehiscence, necrosis and prolonged drainage) and duration of admittance. Follow-up occurred at 2, 6, and 12 weeks, and at 1 year.

Results: There were no significant demographic differences between the 2 groups. SSI occurred more frequently when wounds were closed with staples (4% compared to 1% with sutures; OR 2.8; CI, 0.885-0.952; p = 0.057). SSI was treated with oral antibiotics. The staples group showed significantly more wound complications (17% compared to 5%; OR 3.943, CI 2.073-7.498; p = 0.000). Wound discharge was significantly prolonged in the staples group (n = 40, compared to n = 12 in the sutures group; OR 3.728; CI, 1.909-7.281; p = 0.000). There was no significant difference in PJI (p = 0.364).

Conclusions: In this large RCT comparing staples with sutures after THA, the use of staples is associated with a nearly 3 times greater risk of SSI (OR 2.8; p = 0.057). Staples significantly prolong wound discharge. The use of sutures for wound closure after THA is advised.Trial registration: Staples Or Sutures trial (S.O.S. trial) http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3946, NTR3946.

Background: The presence of radiolucent lines (RLLs) around total hip replacement (THR) stems correlates with stem failure. However, the zone this occurs in is significant. The widely adopted Gruen Zone classification has disadvantages and is unlikely to be reflective of uncemented biomechanics. We propose a simpler system for describing these changes and introduce its relevance clinically.

Methods: In a single-centre retrospective study CORAIL THR stems implanted between 2010 and 2013 were analysed. On postoperative radiographs 2 parallel "SKY" lines divided the stem bone interface into 3 zones A, B and C. 1 year and 5 years postoperative radiographs were reviewed by 5 surgeons for the presence and location of RLLs. The revision rates of the UK's National Joint Registry were correlated with the presence of RLLs.

Results: 1113 stems were included.331 (29.7%) had RLLs, 273 (24.5%) in zone A only, 50 (4.5%) in zones A and B and 8 (0.7%) in all 3 zones A, B and C. In absence of RRLs in zone A, no RLLs were identified in the other zones. 73% RRLs appeared in the first postoperative year, the remaining at 5 years follow-up.1.8% (20 of 1113) stems were revised. The revision rate for stems with RLLs in zone A alone was 2.9%, with RLLs in zone A and B it was 12% and with RLLs in all 3 zones it was 12.5%.The odds of revision were 4.7 times higher (p = 0.007) with RLLs in Zone A and 6.6 times higher (p < 0.001) with RLLs in Zones B and C compared to those without.

Conclusions: The SKY lines can be used to classify RLLs and predict the risk of revision for the CORAIL stem. Stems with RLLs progressing beyond the first SKY line from zone A into Zone B-C should be considered higher risk for revision and hence followed-up closely for signs of failure. Absence of RLLs or RLLs in Zone A only can be discharged to patient-initiated follow-up.

Purpose: Studies on short-stem total hip arthroplasty (THA) in young patients with developmental dysplasia of the hip (DDH) are limited, with no studies on long-term outcomes. Our study aimed to investigate whether the Mayo conservative hip stem demonstrates favourable mid- to long-term outcomes in these patients.

Methods: This retrospective study included 42 patients (50 joints) with DDH aged <55 years who underwent THA using the Mayo conservative hip stem and excluded those with a follow-up period <5 years. Radiographic evaluation involved comparison of the immediate postoperative anteroposterior images with those at the final follow-up. Clinical evaluations utilised the Japanese Orthopaedic Association (JOA) hip score and major postoperative complications, including revision surgery.

Results: The mean age of the patients was 48.8 years, with a median follow-up of 11 years. According to the Crowe classification, 35, 11, and 4 cases were classified as Types I, II, and III, respectively. According to the Dorr classification, 29 and 21 cases were classified as Types A and B, respectively. Radiographically, spot welds were observed in 98% of joints in zones 2 or 6, whereas stress shielding was evident in 94% (zone 1) and 54% (zone 7) of the joints. Stem sinking ⩾3 mm was observed in 2 joints. No periprosthetic femoral fractures, dislocations, or infections were observed.

Conclusions: The Mayo conservative stem in young patients with DDH resulted in favourable mid- to long-term outcomes, including stability and bone preservation. The stem is an effective treatment strategy for these patients.

Background: The objective of this study was to determine the effect of bone marrow aspirate concentrate (BMAC) on long-term patient outcomes when used as an adjuvant to acetabular repair of the labrum.

Methods: A systematic review and meta-analysis were completed following PRISMA 2020 guidelines. Included in the analysis were controlled studies which assessed functional outcomes via the International Hip Outcome Tool-33 (iHOT-33) 12 or 24 months after acetabular repair with BMAC adjunct. 4 studies totaling 315 participants were analysed.

Results: Pooled effect sizes for iHOT-33 scores were not significantly different between control and treatment groups at 12 (p = 0.14, Cohen's D ≏ 0.79) or 24 months (p = 0.30, Cohen's D ≏ 0.56).

Conclusions: Non-significant trends in favour of BMAC augmentation were found in this study. However, the trends reported are promising and warrant further investigation with further randomised controlled trials.

Background: To report the association between os acetabuli and relevant radiologic measurements in a series of surgically treated hip preservation patients.

Methods: We retrospectively reviewed 654 hips who underwent preservation surgery between 2012 and 2019, identifying 50 cases with os acetabuli (7.64%). We included 300 hips (277 patients) with radiographs and CT-scans obtained during preoperative assessment, after which the cohort was divided into two groups (with and without os acetabuli). Mean age of the study population was 35 (interquartile range [IQR] 28-42) years old, with 192 (62%) being males. 2 observers measured demographic and radiologic variables. A mixed-effects logistic regression tested the ability of radiologic measurements to predict the presence of os acetabuli.

Results: No between-group differences were found in terms of sex (156/250 vs. 36/50 males, p = 0.197), alpha angle (64 ± 13° vs. 65 ± 14°, p = 0.372), Tönnis angle (8 ± 7° vs. 7 ± 7°, p = 0.152), neck-shaft angle (132 ± 6° vs. 131 ± 5°, p = 0.199) and CT-acetabular version (16 ± 7° vs. 15 ± 6°, p = 0.221). Significant differences were found in terms of age (34 ± 9 vs. 39 ± 7 years, p = 0.002), lateral centre-edge angle (LCEA) (31 ± 9° vs. 34 ± 7°, p = 0.045), anterior wall index (AWI) (0.45 [IQR 0.37-0.54] vs 0.5 [IQR 0.39-0.6], p = 0.046), CT-femoral version (17 ± 5° vs. 8 ± 4°, p < 0.001), cross-over sign (96/250 vs. 28/50, p = 0.032) and baseline diagnosis (184/250 vs. 44/50 FAIs, p = 0.043), with the os acetabuli-group being older, with more FAI diagnosis/cross-over sign, and with higher LCEA, higher AWI, and a lower femoral version. After adjusting for confounders, only CT-femoral version (odds ratio 0.32; 95% CI. 0.14-0.73, p < 0.007) was associated with presence of os acetabuli.

Conclusions: Presence of acetabular rim fragments was significantly associated with a lower femoral version. Above 20° of femoral version, the likelihood of os acetabuli was almost zero. Treatment of os acetabuli (i.e., fixation vs. removal) should be adjusted for the underlying diagnosis.