Hip & pelvis最新文献

Pathological hip fractures are associated with substantial morbidity and functional decline. We report a rare case of localized dialysis-related amyloidosis involving both hip joints. A 48-year-old man undergoing long-term hemodialysis presented with atraumatic right hip pain. Radiographs and magnetic resonance imaging revealed a pathological subcapital fracture of the right femoral neck and extensive bilateral femoral neck osteolysis, with amyloid deposition showing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Given the severe bone erosion and impending fracture of the left femoral neck, bilateral total hip arthroplasty was performed. No evidence of systemic amyloidosis or plasma cell dyscrasia was identified. At one-year follow-up, the patient showed no postoperative complications and regained independent ambulation. This case represents the first reported Korean case of localized dialysis-related amyloidosis affecting both hip joints.

Purpose: Internal fixation of undisplaced intracapsular hip fractures is typically achieved using either cannulated screws (CS) or a 2-hole dynamic hip screw (DHS). However, there is a lack of consensus on which of these is more effective clinically. Whilst several biomechanical analyses of cadaveric hips show a higher construct stability of DHS fixation, there is a paucity of large clinical studies investigating patient outcomes.

Materials and methods: Data from 2,705 patients at a single institution, including 322 internal fixations, were analysed retrospectively. Propensity scores were calculated to mitigate for the impact of covariates such as age, sex, Charlson comorbidity index and Nottingham Hip Fracture Score, producing an eligible group of 255 patients.

Results: The CS group included 204 patients (mean age, 82.5±7.5 years; female, 90.7%), the DHS group included 51 patients (mean age, 82.4±8.0 years; female, 90.2%). There were no differences between groups after propensity matching. There were no significant differences in outcomes between CS and DHS groups for reoperation rate (CS 5.9% vs. DHS 5.9%, P>0.999), death <30 days (CS 5.9% vs. DHS 5.9%, P>0.999), length of stay (CS 11.5 days vs. DHS 14.0 days, P=0.294) and hours to surgery (CS 31:03 hours vs. DHS 29:23 hours, P=0.618). However, operation time was significantly shorter for CS (CS 39.0 minutes vs. DHS 44.0 minutes, P=0.013), an 11% reduction.

Conclusion: There is no difference in clinical outcomes between CS and DHS fixation of intracapsular hip fractures. However, in this cohort the operating time was approximately 5 minutes shorter in CS fixation.

For femoral reconstruction in revision total hip arthroplasty (rTHA), cementless, diaphyseal engaging femoral components are the most commonly-used implants. At present, there are no reviews that directly compare the design features of these implants. We performed a manual review of the designs of commercially available diaphyseal engaging femoral stems. We compiled and compared the design features of these implants. Clinical outcomes of modular and monoblock stems were also compared. We identified five modular and four monoblock stems in the manual review of commercial companies manufacturing these stems. Distal stem taper varied from 2° to 3.5°, and the number of splines varied from 8 to 16. The stems varied in their stem lengths, offsets, and surface finish. Although there are no clinically significant differences in the restoration of leg length between monoblock compared to modular stems. The modular stems appear to perform slightly better with respect to subsidence and restoration of leg length. A source of concern for modular stems are mechanical implant failures that occur almost exclusively at modular junctions. Current evidence does not support any difference in dislocation rate, intraoperative or postoperative fracture, aseptic loosening, re-revision rates, or clinical outcomes between monoblock and modular stems. With the knowledge of the distinct features of implants, surgeons must make choices associated with specific design characteristics that could be pivotal to the success of the operation. Our understanding of design differences will help us minimize chances of failure and choose patient-specific implants that will lead to a high rate of success.

Purpose: Japanese International Hip Outcome Tool 12 (iHOT12J) and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) have been used in patients with hip labral injuries. However, patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID) from iHOT12J and JHEQ have not been investigated. We analyzed PASS score and MCID between iHOT12J and JHEQ preoperatively and at 2 years postoperatively in patients underwent hip arthroscopy.

Materials and methods: PASS score and MCID were calculated using pre- and two years post hip arthroscopy iHOT12J and JHEQ data from 99 patients. Anchor-based method was used to calculate PASS, which involved dividing patients into two groups based on their JHEQ satisfaction visual analog scale as well as performing receiver operating characteristic (ROC) curve analyses. ROC curve and PASS score were computed using obtained values and Youden index, respectively. Value with the greatest sensitivity and specificity was target value. MCID was calculated with 0.5 standard deviation (SD) method by dividing the mean of iHOT12J and JHEQ values, obtained from pre- and at two years post-surgery, by 0.5.

Results: PASS scores were 74.2 for iHOT12J and 62.0 for JHEQ. SD was 24.8% for iHOT12J and 19.4 for JHEQ. MCID was 12.4 for iHOT12J and 9.7 for JHEQ. Achievement rates of PASS and MCID were 73/99 (73.7%) for iHOT12J and 89/99 (89.9%) for JHEQ.

Conclusion: PASS score and MCID could serve as measurable benchmarks to define significance in patient-reported outcome measure values for clinical outcomes or variables of postoperative hip arthroscopy.

Despite contradictory results of various published data on the subject, the complications of total hip arthroplasty (THA) in femoral neck fracture (FNF) compared to those in osteoarthritis (OA) are yet to be further elucidated. We queried PubMed, Cochrane, and Google Scholar from inception until October 2024 for studies that compared the surgical outcomes of THA in the management of FNF and OA. We evaluated the overall complications, such as dislocations, prosthetic joint infection (PJI), intraoperative fractures, periprosthetic fractures (PPFx), mechanical loosening, venous thromboembolism (VTE), hematoma, leg length discrepancy (LLD), and revisions. In addition, surgical parameters such as the duration of surgery and the length of stay (LOS) were also assessed. Eleven studies were included in our meta-analysis. The use of THA in FNF is associated with high risks of overall complications (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.00-2.49, P=0.05), dislocations (OR 2.12, 95% CI 1.07-4.21, P=0.03), PJI (OR 1.75, 95% CI 1.50-2.05, P<0.00001), PPFx (OR 1.62, 95% CI 1.18-2.22, P=0.003), and intraoperative fractures (OR 3.82, 95% CI 1.59-9.19, P=0.003) in comparison to those in the OA group treated with THA. FNF patients had a long LOS (mean difference=3.34, 95% CI 0.69-5.99, P=0.01). There was no statistically significant difference observed in the risk of VTE, hematoma, LLD, mechanical loosening, the number of revisions, and the duration of surgery between the FNF and OA groups, which were treated with THA. There is an increased risk of complications in patients undergoing THA for FNF than in patients undergoing THA for OA.

Purpose: Hip fracture surgery is a high-stakes topic due to elevated mortality and high economic costs, making the identification of optimal treatment for displaced femoral neck fracture (FNF) pivotal. Our study aimed to evaluate and compare (1) surgery-associated parameters and (2) mortality rates following multiple screw fixation (MSF) or cementless bipolar hemiarthroplasty (BHA) in patients with displaced FNF using twenty years of data from a single tertiary referral center.

Materials and methods: Between January 2000 and January 2018, we analyzed 1,153 cases of displaced FNFs treated at our institution with either MSF or cementless BHA. We evaluated (1) surgery-associated parameters, (2) hospitalization duration, and (3) postoperative complications and mortality rates at one and five years following the surgical procedure.

Results: MSF showed a reduced waiting period preceding surgery, a shortened duration of the surgical procedure, but an extended period of hospitalization. There was an increase of estimated blood loss and postoperative transfusion with cementless BHA compared to that with MSF. Both the procedures did not differ in postoperative complications. The one-year and five-year mortality rates were also similar in both groups.

Conclusion: Since cementless BHA and MSF surgeries did not distinctly differ in mortality rates at one year and at five years, it is crucial that surgeons make personalized surgical decisions based on the individual characteristics of the patient. Surgeons should carefully weigh the advantages of MSF, which include shortened surgery time and low blood loss against the benefits (e.g., reduced hospitalization period) of cementless BHA.

Purpose: The main aim of this study is to compare the functional and radiological outcomes of the acetabular distraction technique and the cup-cage construct technique in the management of chronic pelvic discontinuity.

Materials and methods: In this prospective interventional study, 36 patients with chronic pelvic discontinuity were initially split into two equal groups and underwent surgery utilizing either the acetabular distraction technique or the cup-cage construct technique. The patients were followed up for 2 years to assess the functional and radiological outcomes of the techniques. Six patients were lost during follow-up (two of them died, four discontinue follow-up).

Results: The two groups did not differ significantly with regards to the clinical (Harris hip score) and radiological (stability of the construct, graft incorporation, and absence of loosening or migration) outcomes. Both the techniques displayed significant postsurgical improvements in both the Harris hip score and limb length discrepancy.

Conclusion: Both acetabular distraction and the cup-cage construct techniques may be used to treat pelvic discontinuity without any significant difference in the clinical outcomes, as measured by Harris hip score, and in the radiological outcomes. Acetabular distraction appears to be more effective in treating discontinuity as a secondary outcome of neglected acetabular fracture.

Purpose: The alignment of the femoral with the acetabular components significantly influences the mechanics of the hip joint, especially in total hip arthroplasty (THA). Combined anteversion (CA) is a combination of femoral neck anteversion and acetabular anteversion (AA). CA is emerging as a significant factor that influences optimal THA outcomes. Our study aims to assess the impact of CA on postoperative functional outcomes in an Indian cohort where unique lifestyle demands may influence the anteversion characteristics.

Materials and methods: A retrospective study was conducted on 88 patients undergoing THA. Inclusion criteria included patients with unilateral THA due to femoral neck fractures or osteonecrosis of the femoral head. Computed tomography scans were used to identify and measure postoperative CA. We assessed the functional outcomes following THA at 7 days, 6 weeks, 3 months, 6 months, and 1 year, using the Harris hip score (HHS).

Results: Our findings indicate that the CA values ranged from 25.5° to 93.9°, with a mean of 59.3°±15.7°. Patients with CA between 40° and 70° exhibited significantly improved functional outcomes, with an improvement in the mean HHS from 67.57 at day 7, to 94.26 at 3 months, to 97.50 at 1 year (P<0.001). In contrast, CA below 40° or above 70° was associated with poor outcomes, which includes a high risk of dislocation in the group with >70° CA.

Conclusion: Our study concludes that achieving a CA within the range of 40° to 70° is pivotal for optimal functional outcomes and for minimum complications in THA.

Purpose: Osteochondroplasty and femoral neck osteotomy can be used in conjunction with surgical hip dislocation (SHD) for added benefit to patients with sequelae of Perthes disease. The aim of the current systematic review was to provide a critical analysis of the literature and present the outcomes of SHD with relative femoral neck lengthening in sequelae of Perthes disease.

Materials and methods: Electronic database searches with relevant keywords were conducted in PubMed and Embase. This review included studies which described relative femoral neck lengthening outcomes on sequelae of Perthes disease. A study required a minimum postoperative follow-up period of one year for inclusion in this review.

Results: Seven retrospective studies with 244 patients were included in the review. Five studies reported objective improvement in functional scores. Approximately 9% (12/137) of patients reported complications and the overall pooled proportion of patients requiring subsequent total hip arthroplasty was 8% (95% confidence interval with a range of 4% to 11%).

Conclusion: Used in conjunction with relative femoral neck lengthening SHD has opened a new treatment means for the correction of deformities resulting from sequelae of Perthes disease. Notable improvements in clinical and functional outcomes can be expected after this procedure. Low rates of postoperative complications and future conversions to total hip arthroplasty were also noted. The results of the review are limited by the non-uniform inclusion of study participants in terms of preoperative grading as well as any occurrence of prior, concomitant or subsequent surgical procedures.

Purpose: Primary cam and pincer type morphology of the hip can lead to femoroacetabular impingement and osteoarthritis. This study aimed to assess and compare magnetic resonance imaging (MRI)-based radiological parameters of hip morphology between young male semi-professional soccer players and non-athlete controls.

Materials and methods: This observational cross-sectional study included a retrospective review of MRI scans of young male soccer players and an age- and sex-matched control group obtained from a hospital radiology database. Lateral center edge angle, acetabular version, alpha angle, collodiaphyseal angle, and femoral head coverage ratio were recorded and compared between groups.

Results: Bilateral hip MRI scans of 30 young male soccer players and 30 non-athletes were analyzed. The mean age of participants was 24.88±5.10 years (range, 15-34 years). In the non-athlete control group, anteversion was higher in both hips (P=0.02 for right hip and P=0.05 for left hip) and reached statistical significance for the right hip. The collodiaphyseal angle was higher in the soccer-player group (P=0.01 for the right hip and P=0.03 for the left hip). The femoral head coverage ratio was significantly higher in the control group (P=0.02 for the right hip and P=0.01 for the left hip). No significant difference was observed in lateral center edge angle or alpha angle between groups.

Conclusion: Differences in collodiaphyseal angle, acetabular anteversion, and femoral head coverage ratio indicate partial variation in femoroacetabular morphology between groups; however, no evidence showed a higher incidence of cam or pincer morphology in soccer players.