HIP International最新文献

Background: In the setting of femoral neck fractures, hip arthroplasty and internal fixation are considered as treatment interventions depending on the patient's age and fracture characteristics. In this study, we utilised the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to evaluate the robustness of statistical outcomes reported in randomised controlled trials (RCTs) evaluating arthroplasty versus fixation in the treatment of femoral neck fractures.

Methods: Pubmed, Embase, and MEDLINE were queried from 2010 to present for RCTs reporting dichotomous outcomes where intervention arms were stratified as arthroplasty versus fixation for femoral neck fractures. The FI and rFI were calculated by outcome event reversals until the significance of the outcome was altered for significant and nonsignificant outcomes, respectively. FQ was calculated as the FI divided by the study sample size. Subgroup analysis was performed based on type of arthroplasty versus fixation and outcome type.

Results: 985 RCTs were screened with 9 studies included in the analysis comprising 30 total outcomes. The median FI across all outcomes was 5 (IQR 2-10.75) with an associated FQ of 0.039 (IQR 0.019-0.059). For 14 significant outcomes, the median FI was 4.5 (IQR 2.5-12.5) with an associated FQ of 0.045 (IQR 0.020-0.098). Across 16 nonsignificant outcomes, the median rFI was 5.5 (IQR 2.0-8.5) with an associated FQ of 0.039 (IQR 0.017-0.049). In 11/30 (36.67%) of study outcomes, the number of patients lost to follow-up was greater than or equal to the median FI. The studies evaluating hip hemiarthroplasty versus fixation were the most fragile with a median FQ of 0.018 (IQR 0.014-0.069) across 10 outcomes from 4 RCTs. The 4 studies evaluating total hip arthroplasty versus fixation were the least fragile with a median FQ of 0.049 (0.024-0.059) across 15 outcomes. 1 study evaluated either THA or HA versus fixation and reported 5 outcomes with a median FQ of 0.039 (IQR 0.039-0.044). The RCTs assessing arthroplasty versus fixation for non-displaced fractures were found to be more fragile (median FQ 0.016) compared to the RCTs looking at displaced fractures (median FQ 0.042). By outcome type, the median FI's were 4 (IQR 2-11), 6 (IQR 2-6), 16 (IQR 10-16), and 5 (IQR 3.5-6.5) for failure/reoperation, complications/adverse events, mortality, and "other", respectively.

Conclusions: The statistical findings reported in RCTs comparing arthroplasty to fixation for femoral neck fractures exhibit considerable fragility, suggesting that minor changes in patient follow-up or outcome occurrences could significantly impact results. To enhance the interpretation of comparative trials in orthopaedic trauma we advocate for the routine inclusion of FI and FQ alongside p-values.

Introduction: In the past decade, an increasing number of younger, active patients, including athletes, sought hip resurfacing (HR) arthroplasties. Some literature has suggested that hip resurfacing may allow faster recovery, better postoperative range of motion, and reduced risk for dislocation compared to total hip arthroplasty (THA). The purpose of the present systematic review was to study the variations in postoperative gait parameters among patients with hip osteoarthritis who have undergone hip resurfacing or THA.

Methods: According to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), a literature search was conducted in October 2022 for "hip resurfacing" OR "hip arthroplasty" AND "gait".

Results: 8 studies with 206 patients (273 hips) were included in the analysis. The mean age of patients ranged from 44.4 to 67 years. On average of all studies, 54.3% of the patients were male and 45.7% female. Among all patients undergoing HR and THA, there were comparable numbers of males in each group (range 58.3-82.1% and 60.0-88.9%, respectively). 6 studies indicated that hip resurfacing patients reached a greater average walking speed, average stride lengths, stance times, and ability to perform uphill walking. 3 studies showed similar outcomes in flat surface walking between hip resurfacing and total hip arthroplasty patients.

Conclusions: Little data are available to compare gait parameters in HR and THA. Some studies suggest that HR might have advantages in the gait and walking parameters like a greater average walking speed, average stride lengths, stance times, and ability to perform uphill walking, energy expenditure and better peak extension moment.

Background: Femoral head fractures are a specific type of hip fracture that typically result from high-energy trauma. Surgical intervention is generally required for most displaced femoral head fractures. The anterior-based approach, particularly the Smith-Petersen approach (SPA), is a commonly recommended surgical approach for fixation in these cases. However, the fracture fragments of the femoral head usually occur at the anteromedial region. As a result, the medial hip approach (MHA) might serve as an alternative and suitable option for femoral head fractures and intra-articular pathology.

Purpose: This study aimed to determine and compare the visualisation area of the femoral head between the modified-medial hip approach (MHA) and the Smith-Petersen approach (SPA).

Methods: 14 fresh frozen cadavers were included in the study, with each hip being approached using both the modified MHA and SPA techniques. Measurements of area and localisation were performed to ideally simulate the intraoperative visualisation perspective of the surgeon for each approach.

Results: The findings demonstrated that the modified-MHA approach provided superior exposure of the medial and posterior aspects of the femoral head compared to the SPA.

Conclusions: The MHA may be considered as a viable alternative for the treatment of femoral head fractures and intra-articular pathologies.

Background and purpose: Considering dissatisfaction rates of around 10% after total hip arthroplasty (THA), this study aimed to investigate the role of pain catastrophising (PC) on functional outcomes, pain, and quality of life following THA in a large prospective study. PC is the tendency to focus on and exaggerate painful stimuli combined with a decreased ability to deal with pain.

Patients and methods: A prospective comparative study was performed with 531 patients undergoing primary unilateral THA between 2019 and 2020. Patients were considered PC with a preoperative score ⩾30 on the PC Scale, resulting in 57 (11%) PC-patients. Patient-reported outcome measures (PROMs) were collected preoperatively, at 3 months, 1 year, and 2 years postoperatively and consisted of Hip disability and Osteoarthritis Outcome Score-Physical Function (HOOS-PS), Oxford Hip Score (OHS), pain (NRS), and quality of life (EQ-5D), including minimal clinical important differences (MCIDs) and patient acceptable symptom state (PASS), as well as length of stay and aseptic revisions.

Results: PC-patients reported inferior preoperative scores on all PROMs and had longer hospital stay (p = 0.02). Although PC-patients had more improvement in all scores and a higher proportion generally reached MCID, they still reported lower OHS, more pain, and lower EQ-5D at 2-year follow-up (all p < 0.03), and fewer PC-patients reached PASS for OHS and EQ-5D at final follow-up. No difference in aseptic revisions was seen (p = 0.95).

Conclusions: PC-patients had worse preoperative subjective function and more pain. Although they showed more improvement than non-PC patients at all outcomes, less patients reached PASS for OHS and EQ-5D at 2-year follow-up.

Aims: Total hip arthroplasty (THA) combined with a shortening osteotomy of the femur has proved to be an effective treatment for patients with developmental dysplasia of the hip (DDH). Advances in surgical technique and implant design have led to the introduction of customised THA, without the inconvenience of femoral shortening osteotomy, as an alternative option.The purpose of this retrospective study was to determine if customised THA without femoral shortening osteotomy improves the functional outcome and long-term survivorship in total hip arthroplasty for DDH.

Methods: We carried out a retrospective analysis of 77 hips in 62 patients with DDH of all Crowe types who had been treated by customised THA without shortening osteotomy and who had a minimum of 20 years follow-up. Clinical evaluation was undertaken using the Harris Hip Score (HHS) at 6 weeks postoperatively and at final follow-up. Kaplan-Meier survivorship analysis was carried out with femoral revision due to aseptic loosening as the endpoint.

Results: The average HHS score at the 6 weeks postoperative assessment (86 ± 13) showed a significant improvement from the preoperative assessment (49 ± 22 points) as did the final follow-up examination (82 ± 12). The mean postoperative leg-length discrepancy was 7 ± 11 mm (-20-80 mm). 5 transient (6%) nerve palsies (1 sciatic and 4 femoral) were identified. The stem was revised in 12 hips (16%), 9(12%) for aseptic loosening at 4, 16, 70, 96, 165, 176, 177, 191 and 235 months, 2 (3%) for fracture and 1 (1%) for late infection.The Kaplan-Meier survivorship analysis at 20-year follow-up was 88% (95% confidence interval [0.81-0.96]). 7 patients (9 hips) were lost to follow-up (12%). 10 patients (11 hips) died during the study period (14%) but according to their general physician, none had undergone revision hip surgery.

Conclusions: Customised THA with 3-dimensional planning and a custom-made femoral stem may improve functional outcomes and long-term survivorship after THA for DDH.

Introduction: Few studies have evaluated nonpharmacologic interventions, including preoperative psychotherapy, in patients who have depression. We studied whether psychotherapy visits prior to total hip arthroplasty (THA) in patients with depression were associated with lower: (1) readmissions; and (2) implant complications in patients who have depression.

Methods: A nationwide database was queried from 2010 to 2021. Patients who had depression were 1:1 propensity score matched based on those who had (n = 16,143) and did not have (n = 16,140) preoperative psychotherapy visits within 3 months of primary THA. These depression patients were 1:5 ratio-matched to a control cohort of patients without comorbid depression (n = 80,627). A 90-day and 2-year follow-up surveillance period was used to evaluate readmissions and implant complications, respectively. Logistic regression models computed the odds ratios (OR) of psychotherapy on readmissions and implant complications. Patients without comorbid depression served as the reference cohort. p-Values less than 0.001 were significant.

Results: Of patients who had depression, a stepwise increase in odds of readmissions occurred for patients who had psychotherapy (6.2 vs. 5.0%, OR 1.25; p < 0.0001) and did not have psychotherapy (6.7 vs. 5.0%, OR 1.36; p < 0.0001) compared to patients who did not have depression. Compared to patients who did not have depression, patients who had depression and did not have psychotherapy experienced greater odds of aseptic loosening (1.7 vs. 0.7%, OR 2.31; p < 0.0001), periprosthetic fractures (0.5 versus 0.2%, OR 2.44; p < 0.0001), dislocations (3.7 vs. 1.6%, OR 2.39; p < 0.0001), periprosthetic joint infections (PJIs) (3.1 vs. 1.7%, OR 1.93; p < 0.0001), and all-cause THA revisions (3.6 vs. 1.5%, OR 2.44; p < 0.0001).

Discussion: Preoperative psychotherapy may provide a modifiable benefit among patients who had depression for 2-year implant complications. This intervention may aid arthroplasty surgeons in optimising patients potentially at higher risk for adverse events.

Objectives: Total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA) offer promising therapeutic solutions to physically active patients with hip osteoarthritis (OA). The impact of physical activity on long-term implant integrity in this population remains unknown. This systematic review compares the impact of physical activity and sports participation on implant integrity in THA versus RHA.

Methods: A comprehensive search of Medline, Embase (both via Ovid), Scopus, and CINAHL was conducted from inception to May 2023 following the Cochrane Handbook for Systematic Reviews of Interventions. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Implant integrity was measured either radiographically, via serum metal ion levels or revision rates.

Results: A total of 16 studies with 4676 patients (THA: 3146; RHA: 1530) met the inclusion criteria. The median age at surgery was 60 years (range 49 to 86) in THA and 54 (range 49-61) years in RHA. At a median follow-up of 7.1 (range 4.8-13.1) years in THA and 10 (range 2.8-11.7) years in RHA, 3 studies out of 12, including 65.7% of the patients who underwent THA, and 2 studies out of 5, including 30.1% of the patients who underwent RHA, demonstrated that increased physical activity was associated with poor implant survivorship.

Conclusions: Patients undergoing THA or RHA should be counselled to participate in moderate physical activity and may benefit from avoiding sports that exert an excessive load on their implants. On average, the quality of the studies was moderate. The outcome measures used to quantify physical activity and implant integrity are heterogenous.

Background: The posterior horizontal dislocation distance (PHDD) is a 3-dimensional jump distance measurement that is relevant to the risk of dislocation. There are a number of dual-mobility (DM) constructs with varying designs available. The present study identifies design factors associated with increased PHDD and evaluates the PHDD of 3 DM implants.

Methods: 3 different computer-aided implant designs were virtually implanted within a 3-dimensional CT-derived pelvic model. Each design represented an analogue of a DM system (MDM, OR3O, and G7) according to specific variations in acetabular liner rim build-up and femoral head centre location. The effective head diameters and PHDD values were calculated for each size acetabular shell and DM design.

Results: The positive rim build-up design (MDM) showed higher PHDD values as compared to the other 2 hemispherical rim designs with no build-up, across all studied shell sizes. Specifically, the MDM design analogue had 16.4-29.0% greater PHDD values than the OR3O design analog and 15.2-30.5% greater PHDD values than the G7 design analogue The effect of a sfemoral head centre location relative to the liner head centre (OR3O) was negated by a larger effective head diameter to shell diameter ratio of the G7 design, resulting in similar PHDD values.

Conclusions: Design parameters affect the PHDD values of DM cups. The use of an elevated rim was associated with greater PHDD values. A medialised femoral head centre should also improve PHDD values, but the effect was nullified due to consecutive lower effective head diameters.

Background: A population-based study delineating the epidemiologic, clinical, and treatment characteristics of femoral neck fractures (FNFs) in elderly patients has not yet been conducted in Turkey. In this nationwide study, the epidemiologic, clinical, and treatment characteristics of patients aged ⩾65 years with FNFs who underwent osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA) were examined.

Methods: Patients aged ⩾65 years with FNFs were identified in this retrospective, nationwide study. Then, the patients who underwent osteosynthesis or total/hemiarthroplasty from 2016 to 2021 were included. All the outcome variables were collected from patient medical records stored in the e-health database of the Republic of Turkey Ministry of Health.

Results: A total of 83,789 FNFs treated surgically were analysed. Osteosynthesis was performed on 21,130 FNFs (25.2%), HA on 56,378 FNFs (67.3%), and THA on 6281 FNFs (7.5%). From 2016 to 2021, the overall revision rates for THA and HA were 14.6% (914/5367 patients) and 5.9% (3301/53,077 patients), respectively. The rate of revision prosthetic surgery was significantly higher after THA than after HA (p < 0.001). Mortality rates at 1 year were 25% (n = 5293) for osteosynthesis, 14.7% (n = 924) for THA, and 71.1% (n = 40,109) for HA (p = 0.001). The multivariate model of 1-year postoperative mortality revealed 7 independent predictors: male sex (odds ratio [OR] 1.694; 95% confidence interval [CI], 1.640-1.751), use of a cemented femoral stem (OR 1.182; 95% CI, 1.117-1.250), acute myocardial infarction (AMI) (OR 1.317; 95% CI, 1.240-1.400), cerebrovascular accident (CVA) (OR 1.379; 95% CI, 1.333-1.425), chronic liver disease (CLD) (OR 2.188; 95% CI, 1.802-2.489), diabetes mellitus (DM) (OR, 1.160; 95% CI, 1.122-1.200), and age >81.50 years (OR 2.654; 95% CI, 2.569-2.742).

Conclusions: Our study suggested that a hemiarthroplasty is the most common treatment modality for FNF followed by osteosynthesis (25.2%) and THA (7.5%) in Turkey. Revision rates after THA for FNF are concerning. The 1-year mortality rates are highest after HA, followed by osteosynthesis and THA. Male sex, cemented fixation, CVA, CLD, liver failure, DM, and age >81.50 are the independent predictive factors for postoperative 1-year mortality in this specific group of patients.

Introduction: When operating in lateral decubitus apparent operative inclination (AOI) is the angle between the handle of the acetabular cup introducer and the theatre floor. A digital inclinometer has demonstrated optimal control of AOI. This study aims to compare the deviation from a target AOI with a novel autoclavable ball-in-cage mechanical alignment guide (MAG) as compared to a digital inclinometer.

Methods: 90 primary total hip arthroplasty cases performed in lateral decubitus using a posterior approach were included. The ball-in-cage mechanical alignment guide on a standard Pinnacle cup introducer handle was used to achieve the target AOI of 35° ± 2.5°. Final AOI was measured with a digital inclinometer. These readings were compared to a published historical series of 90 patients using a digital inclinometer.

Results: The ball-in-cage MAG mean inclination was 35.0° (range 32.5-37.4°), with 100% falling within target. This compared to a mean inclination of 34.0° (range 27.5-37.5°), with the digital inclinometer where 87.8% fell within target. However, the range of postoperative radiographic inclination for the ball-in-cage MAG was 23.4-53.9° with 31.1% being outside a ±5° target.

Conclusions: These results indicate that this simple autoclavable ball-in-cage MAG consistently achieves an intraoperative AOI within target range. In isolation this does not guarantee a postoperative radiographic inclination within target range.