Hip & pelvis最新文献

Pelvic ring injuries with rotational and translational instability are complex and often result from high-energy trauma, posing significant challenges in management. Internal fixation has emerged as the preferred approach, with traditional methods such as iliosacral screw fixation exhibiting drawbacks like implant-related morbidity and hardware complications. This paper presents a modified minimally invasive transiliac plating technique aimed at addressing these challenges. The surgical technique involves careful preoperative planning, precise patient positioning, and meticulous exposure of the posterior pelvic structures. Key steps include osteotomy of the posterior superior iliac spine (PSIS), formation of a subcutaneous tunnel, contouring and placement of the plate, and fixation with strategically positioned screws. Additionally, the modified technique incorporates the replacement of the osteotomized PSIS bony fragment, providing secondary stability and minimizing the risk of implant back out. This modification aims to enhance biomechanical stability, reduce implant-related morbidity, and ensure optimal functional outcomes. The technique's efficacy is supported by biomechanical principles and clinical studies, indicating its potential as a promising alternative in the management of unstable pelvic ring injuries. Overall, this modified approach offers improved patient comfort, reduced surgical risks, and enhanced long-term outcomes, contributing to advancements in pelvic ring fracture management.

We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.

Steroids are used in management of coronavirus disease 2019 (COVID-19) patients with severe illness and their use has been demonstrated to decrease mortality. Although life-saving, steroids are well documented as risk factors for osteonecrosis. Osteonecrosis of the hip can be debilitating and surgery may be required to improve the quality of life. With the increasing number of COVID-19 cases, osteonecrosis of the hip and other joints resulting from steroid use is expected to show a sharp rise in the coming years. In this review we discuss the association between steroids and osteonecrosis, indications for steroid therapy in COVID-19 patients, and incidence, diagnosis, and treatment of osteonecrosis secondary to steroids in COVID-19.

Purpose: Although the etiology of Legg-Calvé-Perthes disease (LCPD) is not well understood, based on a new theory, it may be caused by a decrease in the supply of blood to the femoral head. The objective of this study was to examine the effects of a decrease in bone mineral density (BMD) and an increase in thickness of articular cartilage on the supply of blood to the femoral head in this group of patients.

Materials and methods: This case study was based on a simulation analysis. Computed tomography scan images of a subject with Perthes disease were used to create a three-dimensional model of the hip joint on both the normal and Perthes sides. In addition, modeling of the blood vessels of the femoral head, including the foveolar and retinacular arteries, was performed during this study.

Results: Increased stress on all articular components (femoral head, acetabulum, articular cartilage, and blood vessels) was observed on the Perthes side compared to the normal side. On the Perthes side with normal articular cartilage thickness, stress on all components, particularly the femur, showed a significant increase compared to the normal side.

Conclusion: Increased deformation of the femoral head vessels was observed in patients with Perthes condition and when increased thickness of the articular cartilage was observed. A decrease in BMD can evidently increase the stress applied to the arteries of the femoral head, ultimately leading to death of the femoral head.

Purpose: For end stage arthritis of the hip joint, total hip arthroplasty (THA) is the treatment of choice. Dual mobility (DM) liner is an implant designed to provide enhanced stability. Long-term effects and implant survivability remain areas of active research despite modern advancements in increased jump distance and dislocation reductions. The aim of this study is to understand the current research landscape and emerging trends through a bibliometric analysis of DM THA.

Materials and methods: An analysis of THA DM publications from between 1982-2022 was conducted through an extensive review of Web of Science Core Collection literature. To identify key trends, contributions, and thematic areas of focus, data on publications, authors, institutions, and countries were extracted and analyzed.

Results: The bibliographic search identified 314 articles, with a notable increase in publications over the period of study. Globally, the leading contributors were France and the USA. The analysis highlighted the Journal of Arthroplasty as the most relevant journal. Research themes included mechanical complications, comparative outcomes, metallosis, and corrosion concerns.

Conclusion: This study provides a comprehensive DM THA research landscape overview highlighting postoperative outcome value. In an effort to guide future research, contributors, sources, and thematic trends were analyzed.

Purpose: Fractures of the posterior column and posterior wall acetabulum are the most common pelvic fractures. In this study, we aimed to test the design of a new acetabular plate that combines the spring plate's function and the plate's reconstruction. This design should ease fixation and reduce surgery time, but is biomechanically untested. We analyzed this plate using finite element analysis (FEA).

Materials and methods: This observational study compares seven pelvic models: normal pelvis, posterior wall acetabular fracture, posterior column fracture, these two fractures combined, and the three fracture models fixed with the new acetabular plate. The evaluation was based on the analysis of deformation and stress distribution in each pelvic model under a force of 1,000 N directed at 45° from the sagittal and coronal planes.

Results: In the normal pelvis, the greatest deformity was found on the ischial tuberosity (up to 3.91 mm and stress distribution tend to be homogenous. The new acetabular plate normalized the deformity and stress distribution to resemble the normal pelvis with highest stress on the ischial tuberosity and inferior side of the acetabulum. The largest deformation was in the middle of the plate and in the screw.

Conclusion: The novel plate can normalize stress and deformity in a fractured pelvis and may provide a solution for combining the posterior column and posterior wall of the acetabulum.

Trochanteric fractures of the femur pose an increasing burden for elderly people. The standard treatment for these types of fractures includes cephalomedullary nailing, which can be augmented with cement. Although many studies have reported on the stability of this augmented construct, few studies have examined its clinical benefit and safety. Therefore, the objective of this meta-analysis is to examine the perioperative complications and postoperative mortality associated with cement-augmented nails in the management of intertrochanteric and pertrochanteric fractures of the hip. A search of PubMed, Cochrane, and Google Scholar (pages 1-20) until January 2024 was conducted. Analysis of the outcomes included perioperative complications and postoperative mortality. Seven studies were included in this meta-analysis. Fewer perioperative complications were observed when using a cemented femoral nail (P=0.002), although there was no difference in postoperative mortality (P=0.30). This meta-analysis is the first to assess the safety of a cement-augmented femoral nail in management of intertrochanteric and pertrochanteric fractures. The results showed a reduced rate of perioperative complications, which may be attributed to a more a solid construct, which reduced the duration of postoperative immobilization as well as use of a proper augmentation technique, resulting in a reduced rate of cement-associated complications.

Purpose: Total hip arthroplasty (THA), a commonly performed surgical procedure for management of end-stage osteoarthritis, is considered minimally invasive and the popularity of the direct anterior approach (DAA) is increasing. The objective of this study is to analyze the current literature on DAA THA through conduct of a comprehensive bibliometric analysis.

Materials and methods: A comprehensive search of the Web of Science Core Collection was conducted for identification of articles published between 1993 and 2022. Specific keywords associated with hip replacement and the anterior approach were used as an attempt to identify articles published in scientific journals.

Results: As a result of the analysis, 743 articles were linked to DAA THA. The highest number of annual publications was reported for 2021, with 120 articles, followed by 2022 with 113 articles, 2020 with 104 articles, and 2018 with 69 articles. The United States led in contributions with 34.1% in production. The Medical University of Innsbruck contributed the highest number of studies with 263 articles, followed by the University of Ottawa with 229. The Journal of Arthroplasty emerged as the most influential journal with 903 articles and 4,571 citations. Keywords including "dislocation," "posterior approach," and "revision" were used frequently in 2015-2020, along with the increasing emphasis on perioperative complications and comparing different approaches.

Conclusion: The findings of this analysis provide helpful insights into the current attitude regarding DAA THA research, highlighting emerging trends and guiding the direction of future research. The increasing scientific production reflects growing interest in DAA THA.

Purpose: The purpose of the study is to examine the efficacy of intravenous injections of tranexamic acid (TXA) in reducing perioperative blood loss in patients scheduled for open reduction and internal fixation for pelvic fractures (Tile B and C). A study population with greater homogeneity was selected to minimize confounding variables related to fracture and fixation methods that may reflect an accurate result.

Materials and methods: A prospective randomized controlled trial including 100 patients who received either 15 mg/kg of TXA added to 40 mL saline twice separated by 3 hours interval or a similar volume of normal saline (~50 mL twice in same manner) intravenously. Measurement of hemoglobin was performed preoperatively and postoperatively. Blood loss in drain, blood units transfused, and complications were recorded.

Results: The mean decrease in hematocrit levels (preoperatively and postoperatively) was 3.2% in the trial group versus 3.7% in the control group (P>0.05). Mean total blood loss was 1,106 and 1,340 mL (trial vs. control group [P<0.05]). The mean operative time was 122.5 and 130.3 minutes (trial vs. control group [P>0.05]). Mean collected blood from the drain was 155 and 170 mL (trial vs. control group [P>0.05]). The transfusion rate was 28% and 76% while the mean for transfused units was 0.72 and 1.1 units (trial vs. control group [P<0.05]). There were no venous thromboembolic events.

Conclusion: Intravenous injection of TXA in pelvic fractures was effective in reducing blood loss and the rates of blood transfusion. There were no associated thromboembolic complications.