Hip & pelvis最新文献

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.

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.