Femoral head and acetabular necrosis combined with hip subluxation in people with HIV: a case report and literature review.

INTRODUCTION: HIV is widely prevalent in all regions of the world. The use of antiretroviral drugs has dramatically reduced the mortality rate of HIV-related diseases, but correspondingly increased the incidence of chronic complications in HIV-positive people. Related studies have found that the incidence of osteonecrosis of the femoral head is higher in HIV-positive people, but the co-occurrence of femoral head necrosis, acetabular necrosis and hip joint dislocation in HIV-positive patients is rare. METHODS: We report a 50-year-old man with a 15-month history of progressively worsening right hip pain with movement restriction. According to the CT findings of the other hospital, the patient was admitted to the hospital with femoral head necrosis. After the admission, the relevant X-ray, CT and MRI examinations showed that the right femoral head collapsed and deformed, with the surrounding bone sclerosis, bone fragments, loose body of the joint, right hip subluxation, acetabular marginal osteogeny, and local microcystic degeneration. The left femoral head was in good shape, and cystic degeneration can be seen under the articular surface. The patient was finally diagnosed with femoral head necrosis and acetabular necrosis combined with hip subluxation. RESULTS: The pain of the patient was significantly relieved after the operation, and the patient was discharged from the hospital one week after the start of treatment to continue rehabilitation training. During the follow-up one month after the operation, the self-reported pain disappeared completely, and the limitation of activity was significantly improved.

Influence of hip prosthesis position on postoperative gait in symptomatic hip osteoarthritis secondary to hip dysplasia patients after primary total hip arthroplasty: a short-term follow-up study.

BACKGROUND: The aim of this study was to analyze the influence of the positioning of the components of total hip arthroplasty (THA) evaluated by the acetabular anteversion (AA) and femoral anteversion (FA) angle on postoperative gait in patients with symptomatic hip osteoarthritis secondary to hip dysplasia undergoing THA. METHODS: Between May 2023 and May 2024, patients with symptomatic hip osteoarthritis secondary to hip dysplasia (Crowe Type I and IV) who underwent THA were enrolled in the study. The AA angle and FA angle were measured by computer tomography (CT). Gait data were determined by using the Dynamic Right Gait & Posture analysis system. The relationship between FA, AA and gait data was analyzed by Pearson correlation test, subgroup Pearson correlation test, multiple linear regression. RESULTS: A total of 40 patients (45hips) were included in the study. Compared with preoperative, the patient's postoperative foot progression angle, foot contact angle, plantarflexion velocity, swing foot speed, gait velocity, cadence, stride length were significantly improved. Preoperative FA is significantly different from postoperative FA (P < 0.05), while the difference between preoperative and postoperative AA is not significant. BMI, Crowe Type, AA were related to change of cadence. The less the postoperative AA of patients, and the more the cadence in the postoperative gait of patients. CONCLUSION: Our study showed that THA could improve the gait function of patients with symptomatic hip osteoarthritis secondary to hip dysplasia. Adjusting AA lower could obtain a much more postoperative cadence.

Are some neutral liners more neutral than others? An ex vivo morphological analysis of acetabular liners classified as "neutral".

BACKGROUND AND PURPOSE:  In contemporary total hip replacement (THR), dislocation is one of the most common complications. At our institution, the cause of an increase in the dislocation rate was recently reported to be reduced head coverage of a newly introduced neutral liner. We therefore aimed to ascertain whether differences exist in articulating head coverage between the various neutral liners used in contemporary THR. A secondary aim was to utilize coverage measurements to develop a new liner coverage classification. METHODS:  The articulating head coverage of 25 modular neutral polyethylene liners used in 6 uncemented cup designs from 4 major manufacturers was evaluated. The measurements were performed in a metrology laboratory and a mathematical model was developed to calculate coverage of the articulating surfaces. Further, 1 "elevated rim" liner and 1 "face changing liner" were included to develop a new liner coverage classification. RESULTS:  The articulating head coverage among the studied liners ranged from 167.7° to 194.8°, corresponding to a variation of 27.1°. The variations with different cup and head sizes within each design were smaller (from 1.0° to 5.6°) than those between different designs. Each of the liner designs offered distinct coverage, even though they were all classified as neutral. Based on measurements, a set of descriptive parameters to discriminate different liners in terms of coverage was created. CONCLUSION:  We showed that all neutral liners are not equal - instead, they clearly varied in terms of their actual coverage design. We suggest our set of descriptive parameters called "hemispheric coverage index values" be used in discriminating the differences in liner coverage.

Exploring the Relationship between Cerebral Palsy and Hip Dysplasia: Insights from the National Inpatient Sample.

Background and Objective: Cerebral palsy (CP) significantly impacts quality of life globally. Hip dysplasia (HD) is a common musculoskeletal issue in CP patients. This study investigates the prevalence, risk factors, and impact of HD on CP patients using a large national database. Materials and Methods: Data from the National Inpatient Sample (NIS) database (2016-2019) were used, identifying CP and HD diagnoses through ICD-10 codes. Baseline characteristics were tabulated. Univariate and multivariate logistic regression analyses examined predictors of HD development in CP patients, presenting data as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Among 3,951,040 pediatric patients, 28,880 had CP (27,466 without HD, and 1414 with HD), and 3,922,160 did not have CP. CP significantly increased the likelihood of developing HD in univariate (OR = 35.03, 95% CI [33.01, 37.17], p < 0.0001) and multivariate (OR = 26.61, 95% CI [24.94, 28.40], p < 0.0001) analyses. Among patients with CP, race was significantly associated with HD, with ORs below 1 for all racial categories compared to Whites. Females had nearly twice the odds of HD compared to males (OR = 1.96, 95% CI [1.86, 2.05], p < 0.0001). Age was significantly associated with HD, with each additional year increasing the odds (OR = 1.03, 95% CI [1.026, 1.034], p < 0.0001). Individuals in the high 51st-75th income quartile had a 17% increase in the odds of HD (OR = 1.17, 95% CI [1.09, 1.25], p < 0.0001) compared to the low 1st-25th income quartile. Conclusions: This study reinforces the strong association between CP and HD, highlighting the need for further research and prospective studies to validate these findings.

[Total hip arthroplasty with supracondylar shortening osteotomy in Crowe 4 inveterate hip dislocation: case report and surgical technique]. / Artroplastía total de cadera con osteotomía de acortamiento supracondílea en luxación inveterada de cadera Crowe 4: caso clínico y técnica quirúrgica.

Structural deformities of the acetabulum secondary to developmental dysplasia of the hip (DDH) are one of the most common causes requiring total hip arthroplasty (THA), whether in conjunction with femoral osteotomy in cases of Crowe dislocation 4. Several techniques have been described, studied, and compared, but there is no superiority of one technique over another. Currently, most hip surgeons perform a subtrochanteric osteotomy. With a follow-up of 10 years, good results have been obtained, so there is a need to present a therapeutic alternative with potential benefits, mainly in restoring the center of rotation of the hip, preserving the proximal bone component, and reducing complications. Therefore, this study aims to describe the surgical technique of CTA in conjunction with supracondylar shortening osteotomy in a 29-year-old female patient, using an uncemented acetabular cup, a short uncemented stem with ceramic-polyethylene bearing, and distal fixation with a 4-hole plate LC-LCP, with the goal of restoring the natural biomechanics of the hip.

Las deformidades estructurales del acetábulo como secuelas de displasia en el desarrollo de la cadera es una de las patologías más frecuentes que ameritan como tratamiento la cirugía de artroplastía total de cadera (ATC) asociada o no a osteotomía femoral en casos de luxación inveterada clasificada como Crowe 4. Múltiples técnicas han sido descritas, estudiadas y comparadas; sin embargo, no existe superioridad de una sobre otra. Actualmente, la osteotomía realizada por la mayoría de los cirujanos de cadera es subtrocantérica, se han reportado buenos resultados a 10 años de seguimiento. La necesidad de presentar una alternativa terapéutica con posibles beneficios, principalmente en la restitución del centro de rotación de la cadera, preservación de componente óseo proximal y disminución de las complicaciones, es meritoria en el campo quirúrgico. Por lo tanto, este estudio se propone describir la técnica quirúrgica de ATC asociada a osteotomía de acortamiento supracondílea en un paciente femenino de 29 años, con uso de copa acetabular no cementada, vástago corto no cementado con par de fricción cerámica-polietileno y fijación distal con placa LC-LCP de cuatro orificios, con el objetivo de restaurar la biomecánica natural de la cadera.

Factors Associated with Patient Satisfaction After Periacetabular Osteotomy.

BACKGROUND: The periacetabular osteotomy (PAO) was developed to treat acetabular dysplasia and avoid the progression of osteoarthritis. Prior research has correlated demographic and radiographic variables with postoperative patient outcomes but with limited focus on patient expectations and correlation with satisfaction. The purpose of this study was to determine whether any such associations exist with the PAO. METHODS: An anonymous, de-identified satisfaction survey was applied to patients undergoing a PAO between April 2017 and April 2019. Forty patients (26 females) who underwent PAOs were included in the final analysis. The average age of the cohort was 22.0 ± 5.1 years of age. All patients had a minimum of 12 months of follow-up from the date of surgery. Patient demographics, diagnosis, and complications were recorded. Radiographs were then analyzed to determine pre- and postoperative lateral center edge angle (LCEA) and Tönnis roof angle, and correlations between satisfaction and radiographic analyses were performed. Statistical analysis included non-parametric Spearman's correlation and receiver operator characteristic. Statistical significance was set at p < 0.05. RESULTS: Thirty (75%) patients were satisfied with their outcome. There were no statistically significant associations between patient age or sex and postoperative satisfaction (p > 0.05). The average LCEA was 10.9° ± 6.9° preoperatively and 26.0° ± 4.2° postoperatively with an average change of 15.1° ± 5.6°. The average Tönnis angle was 18.8° ± 3.3° preoperatively, decreasing to 11.6° ± 3.2° postoperatively with an average change of -7.2° ± 3.2°. Interobserver reliability was high, ranging from r = 0.782, p < 0.001 for postoperative Tönnis angle to r = 0.958, p < 0.001 for preoperative LCEA. Preoperative LCEA correlated positively with satisfaction, r = 0.351, p = 0.027. Logistic regression demonstrated that for every increasing degree of preoperative LCEA, odds of postoperative satisfaction increased by 1.13 (95% CI: 1.01 to 1.27), p = 0.034. CONCLUSION: This study suggests that postoperative patient satisfaction after PAO may be associated with preoperative patient demographics such as LCEA. It also suggests that more dysplastic hips may have lower rates of postoperative satisfaction than patients with less severe deformity. These associations warrant further study, which may yield prognostic value for future surgery.

Previous lumbar spine fusion increases the risk of dislocation following total hip arthroplasty in patients with hip-spine syndrome: a systematic review and meta-analysis.

BACKGROUND: With life expectancy on the rise, there has been an increase in patients with concomitant degenerative hip and spine pathology, defined as hip-spine syndrome (HSS). Patients affected by HSS may require both total hip arthroplasty (THA) and lumbar spinal fusion (LSF), although there is a paucity of data regarding how the sequential timing of these procedures may influence clinical outcomes. This study aims to compare complications and spinopelvic parameters in patients with HSS who underwent either LSF first or THA first. METHODS: A systematic search of PubMed and Scopus was conducted for randomized and nonrandomized studies investigating complications and spinopelvic parameters in patients with HSS who had undergone THA and LSF. The Methodological Index for Non-Randomized Studies (MINORS) tool was utilized to assess the risk of bias in included studies. Relevant outcomes were pooled for meta-analysis. RESULTS: Eleven articles were included in this study. There was a significantly higher THA dislocation rate in patients who had undergone LSF first compared to those who had THA first (OR: 3.17, 95% CI 1.23-8.15, P = 0.02). No significant difference was found in terms of THA aseptic loosening (OR: 0.86; 95% CI 0.32-2.32, p = 0.77) and revision rate (OR: 1.18, 95% CI: 0.53-2.62) between these two groups. Individuals who received THA only showed a significantly lower risk of hip dislocation (OR: 0.14, 95% CI: 0.08-0.25, P < 0.00001) and THA revision (OR: 0.22, 95% CI: 0.14-0.36, P < 0.00001) compared to patients with a previous LSF. CONCLUSIONS: In HSS patients who underwent both LSF and THA, those who received LSF first displayed an increased risk of hip dislocation after subsequent THA. Additionally, the relative risks of dislocation and revision rate appeared significantly lower in patients who had undergone THA only when compared to THA patients with a history of previous LSF. Due to the impact of LSF on spinopelvic biomechanics, caution must be exercised when performing THA in individuals with instrumented spines. PROSPERO ID: CRD42023412447. LEVEL OF EVIDENCE: LL.

Association of osteotomy, age, and component fixation with the outcomes of total hip arthroplasty in patients with hip dysplasia: a Dutch population-based registry study.

BACKGROUND AND PURPOSE:  Hip dysplasia can present challenges for total hip arthroplasty (THA) due to anatomic abnormalities. We aimed to assess the association of age, sex, osteotomies prior to THA, and fixation method on 5- and 10-year revision-free implant survival and patient-reported outcome measures (PROMs) of THAs in patients with hip dysplasia. METHODS: Using Dutch Arthroplasty Register data, we studied hip dysplasia patients receiving primary THAs in 2007-2021 (n = 7,465). THAs were categorized by age, pelvic osteotomy prior to THA (yes/no), and fixation (cemented, uncemented, hybrid, reverse hybrid). Kaplan-Meier and multivariable Cox models were used to determine 5- and 10-year revision-free implant survival and adjusted hazard ratios including 95% confidence intervals (CIs). Reasons for revision and PROMs were compared within the categories. RESULTS:  We found a 10-year revision-free implant survival of 94.9% (CI 94.3-95.5). Patients younger than 50 years had a 10-year implant survival of 93.3% (CI 91.9-94.7), Patients with prior pelvic osteotomy had a 10-year implant survival of 92.0% (CI 89.8-94.2). Fixation method and sex were not associated with implant survival. Patients with a prior pelvic osteotomy had more revisions due to cup loosening and reported lower PROM scores than patients without earlier osteotomy. CONCLUSION:  5- and 10-year revision-free implant survival rates of THA for hip dysplasia are 96.4% and 94.9%. Age and prior osteotomies were associated with decreased implant survival rates in patients with hip dysplasia, while fixation method was not. Prior osteotomies were also associated with reduced PROM scores.

Traumatic native hip dislocation in the absence of acetabular or femoral fracture in adults: a retrospective study reporting clinical and radiological outcomes from a major trauma centre in the United Kingdom.

INTRODUCTION: Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD. PATIENTS AND METHODS: A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II-V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes. RESULTS: 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II-V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males. CONCLUSIONS: Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients.

Combined Irreducible Femoral Head Fracture-Dislocation and Ipsilateral Segmental Femur Fracture: A Case Report.

CASE: A 48-year-old man presented to a Level 1 trauma center after a motor vehicle crash with a right irreducible posterior hip dislocation and ipsilateral fractures of the femoral head and segmental femur shaft. This injury was managed with open reduction and internal fixation and antegrade intramedullary nailing. CONCLUSION: This is the first report of a combined irreducible femoral head fracture-dislocation and a segmental femur fracture, a rare injury that requires a stepwise approach to operative management of each injury. Surgeons must recognize the clinical and radiographic findings associated with irreducible hip dislocations in the setting of ipsilateral fractures to the femoral head and shaft.

Posttraumatic Anterior Hip Dislocation with Ipsilateral Comminuted Intertrochanteric Fracture: A Rare Case Report.

Hip joint is a ball and socket type of joint and its anatomic features makes it very stable. However, Incidence of hip dislocation has increased recently due to high energy trauma like road traffic accident, fall from height etc. It is usually associated with fracture of femoral head, neck, shaft and acetabular wall. Association of ipsilateral intertrochantric fracture is exceedingly rare and only a few case reports are available in the literature. We are presenting a rare case report of neglected anterior hip dislocation with ipsilateral comminuted intertrochanteric fracture managed with hemiarthroplasty using long cemented distal press-fit revision stem. A 66-year-old male presented to our outpatient department with history of fall from a tree 22 days back with pain in right hip and inability to bear weight on right lower limb. Radiographs were suggestive of anterior hip dislocation with fracture of ipsilateral comminuted intertrochanteric fracture of right side. Anterior hip dislocation with ipsilateral intertrochanteric fracture is a very rare entity, and only a few case reports are available in the literature. Management includes early open reduction and fixation to achieve optimal outcomes, but doing primary arthroplasty is also a viable option especially in neglected cases as there is high chances of avascular necrosis and secondary osteoarthritis of the hip joint later on.

RésuméL'articulation de la hanche est une articulation de type rotule et ses caractéristiques anatomiques la rendent très stable. Cependant, l'incidence de luxation de la hanche a récemment augmenté en raison de traumatismes à haute énergie comme un accident de la route, une chute de hauteur, etc. Elle est généralement associée à une fracture de la tête fémorale, du col, de la diaphyse et de la paroi acétabulaire. L'association de fractures intertrochantriques homolatérales est extrêmement rare et seuls quelques rapports de cas sont disponibles dans la littérature. Nous présentons un rapport de cas rare de luxation antérieure négligée de la hanche avec fracture intertrochantérienne comminutive ipsilatérale gérée par hémiarthroplastie utilisant une longue tige de révision distale cimentée à ajustement serré. Un homme de 66 ans s'est présenté à notre service ambulatoire avec des antécédents de chute d'un arbre il y a 22 jours avec des douleurs à la hanche droite et une incapacité à supporter le poids sur le membre inférieur droit. Les radiographies évoquaient une luxation antérieure de la hanche avec une fracture intertrochantérienne comminutive homolatérale du côté droit. La luxation antérieure de hanche avec fracture intertrochantérienne homolatérale est une entité très rare et seuls quelques rapports de cas sont disponibles dans la littérature. La prise en charge comprend une réduction ouverte et une fixation précoces pour obtenir des résultats optimaux, mais la réalisation d'une arthroplastie primaire est également une option viable, en particulier dans les cas négligés, car il existe un risque élevé de nécrose avasculaire et d'arthrose secondaire de l'articulation de la hanche par la suite.

Clinical treatment of traumatic hip dislocation in children: a single-centre retrospective study.

This study aimed to analyse the treatment and outcomes of traumatic hip dislocation (THD) in children. Clinical data of children with THD were collected at our clinical centre from 1 June 2012 to 1 January 2023. Demographic data, injury mechanism, type of dislocation, combined injuries, reduction time, reduction method, and radiographs were analysed. The Merle d'Aubigné-Postel hip score was used to evaluate hip function and complications at the final follow-up. A total of 19 children with THD were enrolled, including 12 male and seven female patients, with an average age of 8.28 ± 0.99 years. Posterior dislocation was the main type of dislocation (89.47%). Fifteen patients (78.95%) had experienced high-energy injuries and traffic accidents were the main causes of injury (47.37%). Closed reduction was performed as soon as possible, and open reduction was performed if necessary. The hip scores of 18 patients (94.74%) were excellent. One patient had osteonecrosis of the femoral head, with a hip function score of 10 (moderate). High-energy injuries, such as traffic accidents, have gradually become the main cause of injury. The prognosis for THD in children is generally good.

Can acetabular dysplasia be measured on axial CT? A measurement for trauma surgeons.

BACKGROUND: Acetabular dysplasia has been theorized as a risk factor instability amongst common acetabular fractures, such as posterior wall (PW) fractures. However, common radiographic measurements often cannot be acquired in trauma patients. We evaluated axial computed tomography (CT) scans to identify novel, easily-obtained measurements that correlate with acetabular dysplasia for use in surgical indications and planning. METHODS: Patients with known acetabular dysplasia undergoing elective periacetabular osteotomy were selected. A different group of patients without pelvic ring or acetabular fractures from an institutional trauma registry were selected as a comparison group. Standard indices of dysplasia were collected, such as center-edge angle (CEA). Acetabular geometric measurements were taken at three axial levels: 0 - cranial CT slice at the dome; 1 - cranial CT where the dome is an incomplete circle; 2 - cranial CT with femoral head visible. Distances between levels were also calculated: Levels 0-1 (Dome Height; DH), Levels 1-2 (Head Height; HH), and Dome-Head Difference (DH - HH = DHD). RESULTS: DH, HH, and DHD were all significantly correlated with CEA, Tonnis angle, and Sharp's angle in dysplastic hips. All dysplastic hips had DH ≤ 2.5 mm and HH ≥ 1.25 mm. DHD ≤ 0 mm was most specific (93.6 % sensitive, 77.3 % specific) for predicting dysplasia. CONCLUSION: DH ≤ 2.5 mm, HH ≥ 1.25 mm, and DHD ≤ 0 mm were independently associated with dysplasia on axial CT scans. These measurements may be quickly and easily used by trauma surgeons to assess a trauma-based axial CT scan for acetabular dysplasia.

How Strong Is the Ligamentum Teres of the Hip? A Biomechanical Analysis.

BACKGROUND: Intraarticular hip pain represents a substantial clinical challenge, with recent studies implicating lesions in the ligamentum teres as potential contributors. Even more so, damage to the ligamentum teres is particularly prevalent among young patients undergoing joint-preserving interventions. Although several studies have investigated the biomechanical attributes of the ligamentum teres, inconsistencies in reported findings and reliance on cadaveric or animal models have raised concerns regarding the extrapolation of results to clinical practice. Furthermore, there is a lack of research examining ligamentum teres biomechanics specifically within the relevant patient cohort-individuals who benefit from joint-preserving surgical interventions. QUESTIONS/PURPOSES: We sought (1) to determine the biomechanical properties (ultimate load to failure, tensile strength, stiffness, and elastic modulus) of fresh-frozen ligaments from patients undergoing surgical hip dislocation, and (2) to identify patient-specific factors that are associated with them. METHODS: This was an institutional review board-approved study on intraoperatively harvested ligamentum teres from 74 consecutive patients undergoing surgical hip dislocation for joint preservation (August 2021 to September 2022). After the exclusion of patients with previous surgery, posttraumatic deformities, avascular necrosis, slipped capital femoral epiphysis, and Perthes disease, 31 ligaments from 31 patients were analyzed. The mean age of the study group was 27 ± 8 years, and 61% (19) of participants were male. The main indication for surgery was femoroacetabular impingement. Standardized AP pelvic and axial radiographs and CT scans were performed in all patients for better radiological description of the population and to identify associated radiological factors. The ligament was thoroughly transected at its origin on the fossa acetabuli and at the insertion area on the fovea capitis and stored at -20°C until utilization. Specimens were mounted to a materials testing machine via custom clamps that minimized slippage and the likelihood of failure at the clamp. Force-displacement and stress-strain curves were generated. Ultimate failure load (N), tensile strength (MPa), stiffness (N/mm), and elastic modulus (MPa) were determined. Using a multivariate regression analysis and a subgroup analysis, we tested demographic, degenerative, and radiographic factors as potential associated factors. RESULTS: The ligamentum teres demonstrated an ultimate load to failure of 126 ± 92 N, and the tensile strength was 1 ± 1 MPa. The ligaments exhibited a stiffness of 24 ± 15 N/mm and an elastic modulus of 7 ± 5 MPa. After controlling for potential confounding variables like age, fossa/fovea degeneration, and acetabular/femoral morphologies, we found that female sex was an independent factor for higher tensile strength, stiffness, and elastic modulus. Excessive femoral version was independently associated with lower load to failure (HR 122 [95% CI 47 to 197]) and stiffness (HR 15 [95% CI 2 to 27]). Damage to the acetabular fossa was associated with reduced load to failure (HR -93 [95% CI -159 to -27]). CONCLUSION: Overall, the ligamentum teres is a relatively weak ligament. Sex, degeneration, and excessive femoral version are influencing factors on strength of the ligamentum teres. The ligamentum teres exhibits lower strength compared with other joint-stabilizing ligaments, which calls into question its overall contribution to hip stability. CLINICAL RELEVANCE: Young patients undergoing hip-preserving surgery are the population at risk for ligamentum teres lesions. Baseline values for load to failure, tensile strength, elastic modulus, and stiffness are needed to better understand those lesions in this cohort of interest.

Development of an aid to detect adults acetabular hip dysplasia (the ALPHA alert): A mixed methods study.

OBJECTIVES: To identify the signs and symptoms that people living with acetabular hip dysplasia (AHD) describe and to provide an aid for translating the findings into practice. METHODS: A three-phased mixed methods study. Phase 1 employed an open-question online survey that enabled people with AHD (aged ≥16 years) to describe features associated with their condition. Responses were thematically analysed. A Phase 2 survey used these themes to establish how common those features were. Phase 3 created a mnemonic that prompts clinicians to suspect AHD. RESULTS: Ninety-eight respondents completed Phase 1 and sixty-two completed Phase 2. From the responses, five themes were identified: Demographic and Diagnostic Profile; Characteristics of Posture and Gait; Pain; Childhood Hip and Family History; and Hip Joint Characteristics. Within these themes, 19 common signs and symptoms were reported, represented by the ALPHA mnemonic. ALPHA describes a young age at onset of problems (Age), a limp (Limp), progressing pain (Pain), a history of childhood and family hip anomalies (History) as well as hip joint hypermobility and instability (Articulation). CONCLUSION: The findings extend current understanding of AHD indicators. ALPHA alerts clinicians to suspect a diagnosis of AHD. ALPHA may facilitate timelier referral of patients for diagnostic X-Ray and appropriate treatment. Future studies should evaluate its clinical utility.

Importance of hip capsular repair in total hip arthroplasty (THA) via the posterior lateral approach: a five year retrospective cohort study.

PURPOSE: This study aims to assess the impact of repairing the hip joint capsule during posterior-lateral approach total hip arthroplasty (THA) on postoperative hip joint function and late dislocation incidence. METHODS: A retrospective cohort study included 413 patients, divided into experimental (hip joint capsule repair, n = 204) and control (hip joint capsule excision, n = 209) groups. Patients were followed for five years, evaluating postoperative hip range of motion (ROM), dislocation rate, VAS and HHS scores, inflammatory and coagulation markers, hospitalization, blood loss, and body composition. Statistical analysis included the Student's t-test, Chi-square test, and logistic regression for dislocation risk factors. RESULTS: Joint capsule repair improved postoperative hip flexion and extension within six months and at two years postoperatively, internal and external rotation within three months, and abduction and adduction throughout the entire follow-up period (P < 0.05). Capsular repair also reduced early and late dislocation rates (P < 0.05). Significant differences in HHS and VAS scores, inflammatory and coagulation indicators, hospitalization, blood loss, and body composition were noted (P < 0.05). Multivariate logistic regression indicated hip joint repair, rheumatoid arthritis, epilepsy, and sarcopenia as dislocation risk factors (P < 0.05). CONCLUSIONS: Capsular repair during posterior-lateral THA improves postoperative hip function and mobility while reducing dislocation rates, blood loss, pain, inflammation, and economic burden. Patients with rheumatoid arthritis, epilepsy, or sarcopenia require individualized planning and enhanced postoperative care to minimize complications.

Reliability and Accuracy of Ultrasound Measurement of Hip Displacement in Children with Cerebral Palsy.

OBJECTIVE: Hip migration percentage (MP) measured on anteroposterior pelvis radiographs is the gold standard to assess the severity of hip displacement in children with cerebral palsy (CP). Repeated exposure of these children to ionizing radiation under a hip surveillance program is undesirable. Recently, a semi-automatic approach to measure MPUS on ultrasound (US) images was validated in a phantom study. This pilot in vivo study applied the previous phantom method and aimed to determine the reliability and accuracy of the MPUS. METHODS: Thirty-four children (23 boys and 11 girls) aged 8.9 ± 3.1 y old and diagnosed with CP were recruited. A total of 59 hips were scanned once, while 43 of these were scanned twice to evaluate the test-retest reliability. Two raters (R1 and R2) manually measured MPUS; procedures included selecting images of interest, cropping a region of interest and removing soft tissues on hip US images. Custom software was developed to measure MP automatically after the manual pre-image processing. RESULTS: The intra-class correlation coefficients (ICC2,1) for the test-retest (R1), intra-rater (R1) and inter-rater (R1 vs R2) reliabilities were 0.90, 0.94 and 0.82, respectively. The standard error of measurement of MPUS for all three evaluations was ≤3.0%. The mean absolute difference between MPUS and MPX-ray and the percentage of MPUS within clinical acceptance error of 10% for R1 and R2 were (R1: 6.2% ± 4.9%, 84.7%) and (R2: 7.6% ± 6.1%, 73.7%), respectively. CONCLUSION: This study demonstrated that US scans were repeatable and MPUS could be measured reliably and accurately.

Dual Mobility Versus Fixed Bearing Implants in Primary Total Hip Arthroplasty in Patients Under 55 Years of Age.

INTRODUCTION: Prosthetic dislocation after total hip arthroplasty (THA) is one of the most common causes of revision THA. Dual-mobility (DM) bearings were introduced to mitigate complications; however, there is minimal data on their performance in younger patients. This study compared results of patients who were under 55 years of age undergoing primary THA with DM or fixed-bearing (FB) implants. METHODS: A retrospective review of patients younger than 55 years who underwent primary THA with at least 2 years of follow-up between June 2011 and August 2019 was performed. Patients were stratified into two cohorts based on the implant they received (DM vs. FB). Primary outcomes were 90-day all-cause readmission, dislocation, all-cause revision, 90-day readmission and revision due to dislocation, and implant component survivorship. Demographic differences were assessed using chi-squared and independent samples t-tests. Outcomes were compared using multivariate linear and logistic regressions to control for confounding variables. RESULTS: A total of 803 patients were included (DM = 73, FB = 730). The DM and FB cohorts had similar rates of 90- day all-cause readmission (6.8% vs. 3.2%; p = 0.243) and 90-day readmission due to dislocation (4.1% vs. 0.8%; p = 0.653). At a mean follow-up of 4.42 ± 1.91 years, dislocation (4.1% vs. 1.1%; p = 0.723) and all-cause revision (5.5% vs. 4.9%; p = 0.497) rates between the DM and FB cohorts were similar. Kaplan Meier analysis yielded no significant differences in survivorship between groups for all-cause revision (95.1% vs. 94.5%; p = 0.923), revision due to dislocation (100% vs. 98.9%; p = 0.370), and acetabular component revision (97.3% vs. 98.6%; p = 0.418). CONCLUSION: Dual mobility implants demonstrate similar dislocation rates and implant survivorship compared to FB in patients less than 55 years of age. Larger trials with long-term follow-up may be required to further elucidate the effects of DM bearings compared to FB inserts in younger patients undergoing primary THA.