Hip & pelvis最新文献

Commonly referred to as frozen shoulder, adhesive capsulitis is an extensively studied and well-documented condition in the glenohumeral joint. However, adhesive capsulitis of the hip (ACH) remains a clinical enigma with limited research and understanding. Characterized by pain and a significant restriction in the range of motion, ACH, severely impacts patient quality of life. The current literature on ACH is sparse, with few studies addressing its pathophysiology, clinical presentation, diagnosis, and treatment. This review aims to consolidate existing knowledge on ACH to provide a comprehensive overview, drawing parallels with adhesive capsulitis of the shoulder (ACS). We explore the similarities and differences in pathophysiology between ACH and ACS, review the clinical manifestations of ACH, and discuss the diagnostic challenges faced by clinicians. Furthermore, we evaluate current conservative and surgical treatment strategies and their outcomes, highlighting the noted limitations in the available evidence. By clarifying this poorly studied condition, we aim to stimulate further research and ultimately improve the diagnosis, management, and prognosis of patients suffering from ACH.

Purpose: The study aimed to assess the impact of age and comorbidities on mortality in patients with femur neck fractures, focusing on those individuals aged over 90 years. The objective was to determine if chronological age alone defined frailty and if a dedicated hip fracture unit would improve patient outcomes.

Materials and methods: The retrospective study was conducted over 16 months (January 2017 to April 2018), and included patients undergoing hemiarthroplasty, categorized into Group 1 (aged <90 years) and Group 2 (aged 90 years and above). Detailed data were collected on demographics, mobility, co-morbidity, operative aspects, delays, and mortality. Statistical analysis employed IBM SPSS ver. 25.0, utilizing Mann-Whitney U, Fisher exact, and chi-squared tests with a significance level of <0.05.

Results: Of the 203 patients in our study cohort, 151 were in Group 1, and 52 in Group 2. A significant correlation between high American Society of Anesthesiologists (ASA) grade and mortality after one year (P=0.028) was revealed by logistic regression. Spearman test indicated a positive correlation (0.354) between Charlson comorbidity index scores and ASA grades. Compared to Group 1, Group 2 showed no significant decrease in survival at any studied time point.

Conclusion: Patients over 90 years did not represent a uniquely high-risk subset. Frailty was not defined solely by chronological age; a combination of comorbidities and biological age influenced survival rates. The study reinforced that treatment in dedicated hip fracture units and adherence to established guidelines, led to positive outcomes, and reduced mortality, irrespective of age groups.

Purpose: Preoperative biomarkers such as the neutrophil‑to‑lymphocyte ratio (NLR), lymphocyte‑to‑C‑reactive protein ratio (LCR), and albumin have been proposed to predict postoperative outcomes in various conditions. This study investigated their association with 3‑year mortality in elderly patients undergoing closed reduction and internal fixation with proximal femoral nail anti‑rotation (CRIF with PFNA) for unstable intertrochanteric femur fractures (UIFF).

Materials and methods: We retrospectively reviewed 306 patients aged ≥65 years who underwent CRIF with PFNA for UIFF between April 2012 and December 2020. Receiver operating characteristic curve analysis determined optimal cutoffs: LCR 0.441 (sensitivity 48.2%, specificity 78.4%), NLR 3.573 (sensitivity 83.2%, specificity 36.3%), and albumin 3.250 g/dL (sensitivity 52.0%, specificity 76.1%). Patients were dichotomized into low versus high groups for each marker. Univariate and multivariate Cox regression analyses assessed associations with 3‑year mortality.

Results: At 3 years postoperatively, 76 patients (30.4%) had died. Kaplan-Meier survival analysis revealed that patients with low LCR (<0.441) and low albumin (<3.250 g/dL) had significantly shorter survival compared to those with higher values. In contrast, stratification by NLR did not yield significant differences in survival. Multivariate Cox regression identified both low LCR and low albumin as independent predictors of increased 3‑year mortality (P<0.05), whereas NLR showed no prognostic significance.

Conclusion: Preoperative LCR and albumin levels are valuable prognostic biomarkers for 3‑year survival following CRIF with PFNA in elderly UIFF patients. Incorporating these parameters into preoperative risk assessment may improve clinical decision‑making and patient counseling, while NLR appears less predictive.

With the exception of revision osteosynthesis, conversion total hip arthroplasty (CTHA) following sliding hip screw (SHS) and cephalomedullary nail (CMN) failure in intertrochanteric fractures (ITF) is the most commonly used treatment option. This review determined the relative risk of medical and orthopedic complications, including periprosthetic femoral fractures (PFF), following CTHA in failed SHS and CMN fixation of ITF, as well as the Harris hip score (HHS). Major electronic databases were searched for studies and reports on CTHA after SHS and CMN fixation failures in ITF. To assess the risk of bias, the studies were analyzed using the Joanna Briggs Institute critical appraisal tool for cohort studies. Three studies pooled 327 cases and 353 cases of CTHA from failed CMN and SHS in ITF. The relative risk of medical and orthopedic complications and PFF in the SHS group as compared to the CMN group was 0.87 [0.39, 1.90], 1.64 [1.18, 2.29], and 1.92 [0.81, 4.56], respectively. The mean difference in HHS was -0.72 [-1.47, 0.02] between failed SHS and CMN groups. The included studies were of retrospective study design with a more than 20% loss of follow-up and a high risk of bias. There is 64% more risk of orthopedic complications with CTHA in SHS failures than CMN failures. There is no difference in relative risk of medical complications and PFF between CTHA in both SHS and CMN failure. After CTHA, the benefits in function are similar in both groups.

Purpose: Sacroiliac joint (SIJ) changes due to ankylosis may influence the fracture pattern of the posterior ilium, an essential component of the posterior ring. This study aimed to assess the association between SIJ ankylosis and posterior ilium fractures (PL) in pelvic ring injuries.

Materials and methods: A retrospective analysis was conducted on 272 patients diagnosed with pelvic ring injuries between January 2004 and October 2023. Patients were categorized into non-ankylosed (n=185) and ankylosed (n=87) SIJ cohorts. The prevalence of SIJ ankylosis in our study sample was 32.0% (87/272). Patient demographics, SIJ ankylosis, PL, and fracture classification using computed tomography were compared between the two groups. PL was defined as any type of posterior ring injury with fracture lines extending to the region posterior to the iliac pillar, with or without SIJ subluxation or dislocation. To determine the association between SIJ ankylosis and PL, a logistic regression analysis adjusted for age, body mass index, sex, and energy of injury mechanism was performed.

Results: Our results found that the ankylosed group had a higher PL ratio (47.1% vs. 31.4%, P=0.012), was older (64.9 years vs. 53.5 years, P<0.001), and included more males (58.6% vs. 37.8%, P=0.001) than the non-ankylosed group. Multivariate analysis revealed a significant association between SIJ ankylosis and PL (odds ratio 2.15, P=0.022).

Conclusion: This study determined that SIJ ankylosis is significantly associated with PL in pelvic ring injuries; transformed SIJ may contribute to changes in posterior ring fracture patterns.

Femoral head fracture malunions resulting in femoroacetabular impingement syndrome are rare complications after the occurrence of femoral head fractures. A 26-year-old female, with a motor vehicle accident history two years prior to our consultation, experienced multiple injuries, including a posterior right dislocation with a femoral head fracture. Although the fracture achieved a successful union with no evidence of osteoarthritis or avascular necrosis, the patient continued to experience hip pain and limited range of motion. We report on a case of femoral head fracture malunion that led to femoroacetabular impingement syndrome. In this case, arthroscopic labral repair, osteoplasty of the femoral head malunion, and capsular closure were performed. At three years post-surgery, the patient was asymptomatic and reported significant improvements in validated hip scores. Arthroscopic management of secondary femoroacetabular impingement is minimally invasive, safe, and beneficial in the treatment of femoral head malunion of the hip.

Purpose: Cementless femoral fixation has become widely adopted throughout the United States for primary total hip arthroplasty (THA). However, femoral fixation in conversion THA (convTHA) presents unique challenges, and optimal strategies have not been extensively studied. This study investigated differences in outcomes for cemented versus cementless femoral fixation in convTHA for patients with failed osteosynthesis after proximal femur fracture.

Materials and methods: Data was retrospectively collected for 75 patients who underwent convTHA after previous proximal femur fracture. Based on type of femoral fixation type at time of conversion, patients were sorted into two cohorts, cemented (n=19) or cementless (n=56). Demographic, surgical, and outcome variables, including revision and complication rates, were collected and compared between the cemented and cementless cohorts. Statistical analyses were performed using multivariate regression analyses.

Results: As compared to the cemented cohort, patients for whom cementless implants were chosen tended to be younger (P<0.01), male (P=0.03), and non-white (P<0.01). The cementless cohort had shorter surgical time (149.64 minutes vs. 197.16 minutes, P=0.01). No differences were noted in anesthesia type (P=0.93), surgical approach (P=0.84), or use of dual mobility implants (P=0.93). Multivariable logistic regression analysis revealed that there was no difference in length of stay (LOS), revision rate, complication rate, or discharge disposition between the cemented and cementless cohorts.

Conclusion: Our results revealed shorter operative times with cementless femoral fixation in convTHA, but no significant difference in LOS, discharge disposition, revision rate, or complication rate when compared with cemented fixation.

Femoroacetabular impingement (FAI) is caused by aberrant anatomy involving the proximal femur with or without the acetabulum resulting in mechanical impingement. FAI's effects can be devastating in the young. In recent studies, significant associations have been found between skeletal immaturity, FAI, and sports involvement. Hip arthroscopy for FAI has been demonstrated to produce good results. We opted to update the review and meta-analysis to further narrow the research gap in the literature by including recently published studies and a comprehensive review of the arthroscopic approach for FAI. Prior to January 1, 2024, PubMed, Embase, and Google Scholar databases were searched for the studies with data on surgical procedures and patient-related outcomes for arthroscopic FAI. RevMan 5.2 was utilized to calculate the pooled mean differences with a 95% confidence interval to compare reported postoperative and preoperative patients' outcomes. In total, 24 studies of adolescent subjects with a mean age of less than 20 years, including 1,619 patients and 1,767 hips, were included. Eleven studies included acetabuloplasty and femoroplasty as major treatments. When preoperative and postoperative outcomes were compared, statistically significant changes were seen in the mHHS (modified Harris hip score), HOS-ADL (Hip Outcome Score-Activities of Daily Living), HOS-SSS (Hip Outcome Score-Sports-Specific Subscale), i-HOT (International Hip Outcome Tool 12 questions), NAHS (Nonarthritic Hip Score), and the visual analog scale. Numbness, neuropraxia and infections were seen in only 12 patients. This meta-analysis demonstrated overall improvements in hip pain, quality of life, and hip function along with few complications.

Purpose: Total hip arthroplasty (THA) is the only definitive treatment for rapidly destructive coxarthrosis (RDC). THA for RDC has significantly higher perioperative blood loss with a greater requirement for transfusion than non-RDC primary THAs. Given the rarity of the disease, this study aimed to investigate perioperative and long-term outcomes of cementless THA for RDC that developed from osteonecrosis of the femoral head (ONFH).

Materials and methods: Each of 26 RDC patients was matched to a patient with typical advanced-stage ONFH for comparison, according to age, sex, American Society of Anesthesiologists classification, and the type of implant used. As a primary outcome, perioperative blood loss was calculated as the sum of compensated and uncompensated blood loss.

Results: The RDC group had a significantly larger amount of total perioperative blood loss in comparison to the group with typical ONFH (791.5 mL vs. 511.2 mL, P=0.034), which was primarily attributable to compensated blood loss (496.1 mL vs. 141.5 mL, P=0.024), as uncompensated blood loss was not significantly different (P=0.152). Intraoperative transfusion volume was significantly higher in the RDC group (234.6 mL vs. 46.2 mL, P=0.007), while the difference in postoperative transfusion was marginally significant (P=0.092).

Conclusion: THA for RDC was accompanied by a higher perioperative blood loss, attributable mainly to a significant difference in the amount of intraoperative transfusion, in a matched comparison with patients with typical advanced-stage ONFH. However, extended operation time and prolonged hospitalization along with a large volume of transfusion did not translate into inferior long-term outcomes.

Purpose: Hip arthroscopy is commonly performed on an outpatient basis; however, many are still performed in hospital operating rooms (HOR) over ambulatory surgery centers (ASC). Therefore, this study aimed to compare patient demographics and complications between hip arthroscopies performed in HOR and ASC.

Materials and methods: This was a retrospective cohort study (level III evidence) of 832 patients who underwent hip arthroscopy between 2014-2022 at a multi-hospital academic health system. Nine hundred four hip arthroscopies were performed, 72 of which were staged bilateral. Demographics, procedure details, and complications were recorded from the electronic medical record. Clinical environments were compared by using chi-squared tests with adjusted residuals (ARs), Welch's t-tests, and binary logistic regression.

Results: Eight hundred eighty-one cases were performed in HOR while 23 cases were conducted at ASC. Patients with at least one medical comorbidity (91.4% vs. 65.2%, AR=4.3) or who required 3 or more suture anchors (31.7% vs. 4.3%, AR=2.8) were more likely to undergo surgery in HOR. Femoroplasty (87.0% vs. 57.8%, AR=-2.8) and capsular repair (69.6% vs. 47.6%, AR=-2.1) had increased likelihood of being performed at ASC. There were no differences found in returns to the operating room or readmissions. Postoperative emergency department (ED) visits were more common in patients treated at HORs (3.0% vs. 0.0%, AR=-2.7).

Conclusion: ASCs and HORs both provided safe operating environments. ED visits were higher in patients treated at HORs during the 90-day postoperative period, often due to their comorbidities rather than as a direct sequela from surgery.