[Systematic evaluation of the painful hip]. / Evaluación sistemática de la cadera dolorosa.

The painful hip has been a topic of study that has evolved from the beginning of the last century to the present. The clinical approach is complex, and requires a systematization process associated with good questioning, clinical maneuvers with their corresponding interpretation, and complementary imaging studies. The understanding of hip pathology, especially in young adults, is highly simplified and sometimes underdiagnosed, therefore, not treated in a timely manner. The prevalence of painful hip is more common in males (49 to 55%) than in females (25 to 28%), and the causes may vary according to demographic characteristics and the history of each patient. Bryan Kelly, made a topographic and anatomical description of the approach to the painful hip according to the theory or system of the layers: I. Osteochondral layer; II. Inert layer; III. Contractile layer; and IV. Neuro-mechanical layer. This system helps us understand the anatomical site of pain and its clinicopathological correlation. The semiological approach to hip pain is the fundamental pillar for differential diagnosis. We can divide it according to its topography into anterior, lateral and posterior, as well as according to its chronology and characteristics. The physical examination should be carried out systematically, starting from a generalized inspection of gait and posture to the evaluation of specific signs for alterations in each layer, which evoke pain with specific postures and ranges of mobility, or weakness and alterations in the arc of mobility of the joint. Image evaluation is initially recommended with radiographic projections that evaluate different planes, both coronal, sagittal and axial, complemented with panoramic views, and eventually dynamic sagittal ones if necessary. Requesting specific studies such as tomography to evaluate bone structure and reserve, or simple MRI when there is suspicion of soft tissue affection, or failing that, arthroresonance for joint pathology, will depend on the clinical symptoms and radiographic findings.

La cadera dolorosa ha sido un tema de estudio que ha evolucionado desde principios del siglo pasado hasta la actualidad. El abordaje clínico es complejo y exige un proceso de sistematización asociado a un buen interrogatorio, maniobras clínicas con su interpretación correspondiente y estudios de imagen complementarios. El entendimiento de la patología de cadera, sobre todo en adulto joven, es altamente simplificado y en ocasiones infradiagnosticado, por lo tanto, no tratado en tiempo y forma. La prevalencia de cadera dolorosa es más frecuente en el sexo masculino (49 a 55%) que en el femenino (25 a 28%), y las causas pueden variar de acuerdo a características demográficas y a los antecedentes de cada paciente. Bryan Kelly realizó una descripción topográfica y anatómica del abordaje de la cadera dolorosa de acuerdo con la teoría o sistema de las capas: I. Capa osteocondral; II. Capa inerte; III. Capa contráctil; y IV. Capa neuromecánica. Este sistema nos ayuda a entender el sitio anatómico del dolor y su correlación clínico-patológica. El abordaje semiológico del dolor de cadera es el pilar fundamental para el diagnóstico diferencial. Podemos dividirlo de acuerdo con su topografía en anterior, lateral y posterior, así como de acuerdo a su cronología y características. La exploración física debe realizarse de manera sistemática, iniciando desde inspección generalizada, de la marcha y postura hasta la evaluación de signos específicos para alteraciones en cada capa, los cuales evocan dolor con posturas y arcos de movilidad específicos, o bien debilidad y alteraciones en el arco de movilidad de la articulación. La evaluación por imagen se recomienda inicialmente con proyecciones radiográficas que evaluen diferentes planos, tanto coronal, sagital y axial, complementado con panorámicas, y eventualmente sagitales dinámicas de ser necesarios. Solicitar estudios específicos como tomografía para evaluar estructura y reserva ósea, o bien, resonancia simple cuando hay sospecha de afección a tejidos blandos, o en su defecto, artrorresonancia para patología articular, dependerá de la clínica y los hallazgos radiográficos.

Role of Preoperative Information and Education of Patients Undergoing Total Hip Arthroplasty: A Narrative Review of the Literature.

Total hip arthroplasty (THA) is a common and highly effective surgical procedure used to relieve pain and improve function in patients with severe hip arthritis and other hip disorders. While the surgical techniques and implants used in THA have advanced significantly, the importance of preoperative information and education cannot be overstated. The aim of this narrative review is to explore the effect of preoperative information and education on the outcome of THA. Key components of preoperative education and information include detailed information about the operation itself, the preoperative preparation, the postoperative pain management and rehabilitation, the possibility of postoperative complications, psychosocial support, and answers to frequently asked questions. The results of the study have confirmed the contradictory findings found in the literature concerning the impact of preoperative education on THA clinical outcomes, including pain, anxiety, functionality, postoperative rehabilitation, duration of hospitalization, and rate of complications. While, theoretically, preoperative education should have a positive effect on clinical outcomes, a plethora of studies have failed to support this hypothesis. Thus, there is a great need for properly designed, prospective, randomized, and controlled studies that have sufficient power in order to fully elucidate the role of preoperative education and information on THA outcomes.

Strategic Surgical Intervention in a Rare Presentation of Hip-Spine Syndrome With Lumbosacral Malunion: A Case Report.

The hip and lumbar spine are closely related and can create similar patterns of pain and dysfunction. Furthermore, diagnosing and treating hip and spine conditions can be challenging due to the overlap of symptoms. This report describes the successful treatment of a 54-year-old male with hip-spine syndrome following multiple surgeries for spondylolytic spondylolisthesis. The patient presented with low back pain (LBP) and bilateral hip pain, with radiological findings indicating spinal deformity and hip joint synovitis. Two years after two-stage corrective surgery, including pedicle subtraction osteotomy (PSO), the hip synovitis resolved and the symptoms improved. This case emphasizes the need to consider hip-spine syndrome as a possible complication of lumbosacral spine fusion surgery and demonstrates the efficacy of two-stage corrective surgery with pedicle subtraction osteotomy in treating this condition.

Cemented Constrained Liners Used as an Articulating Hip Spacer for the Treatment of Chronic Prosthetic Joint Infection.

Background: Two-stage exchange arthroplasty remains the gold standard for treating chronic hip periprosthetic joint infections. However, controversy remains regarding the optimal spacer type, particularly among patients with increased dislocation risk. This study reports on the outcomes of articulating hip spacers utilizing a single constrained-liner design. Methods: All patients who underwent treatment for hip periprosthetic joint infection at a single institution were screened. Patients were included if they received an articulating spacer utilizing a constrained liner of a single manufacturer design. Indications for constrained liner, demographic variables, and surgical variables were recorded. Patients were assessed for dislocation and component loosening prior to the second stage or at the final follow-up if the second stage was not undertaken. Comparative analysis was performed. Results: Overall, 26 constrained liners were utilized in 25 patients. Indications for constrained liner included history of dislocation (n = 14), massive proximal femoral bone loss (n = 14), greater trochanteric deficiency (n = 12), and absent abductors (n = 7). Many patients had more than one indication. In total, 9 hips (34.6%) underwent a second stage at an average of 7.4 months, while 17 hips never underwent a second stage with an average follow-up of 27.6 months. One patient experienced failure of their constrained liner prior to the second stage due to pelvic discontinuity and massive acetabular bone loss. Conclusions: Utilization of a constrained liner as an articulating spacer is a viable option for patients at high risk of instability. Meticulous cement technique, appropriate component position, and implant selection are crucial in achieving successful outcomes.

Effects of lower limb vibration on hip pain and function after total hip arthroplasty: A randomized controlled trial.

BACKGROUND: A vibration roller is an effective tool for reducing muscle soreness and improving damaged muscle function. However, its efficacy in reducing hip pain and improving function after total hip arthroplasty is unclear. We investigated the effect of lower limb vibration using a vibration roller on postoperative hip pain and function after total hip arthroplasty in a randomized controlled clinical trial. METHODS: Thirty patients scheduled for total hip arthroplasty were randomly assigned to vibration and control groups. The patients in the vibration group performed lower limb vibration using a vibration roller. The patients in the control group performed sham therapy using a hot pack. Patients performed both interventions for 10 min daily on postoperative days 1-7, in addition to regular physical therapy. Primary outcome was hip pain intensity as measured using a visual analog scale. Secondary outcomes were pain-pressure threshold and serum creatine kinase and C-reactive protein levels. We also assessed physical functions, including the Harris Hip Score, range of motion of the hip joint, muscle strength, gait velocity, and timed up-and-go test. The effects of the interventions on outcome measurements in the groups were compared using a split-plot design variance analysis. RESULTS: After one week of the intervention and three weeks of follow-up, the vibration group showed statistically significant improvement in the exercise-induced hip pain, pain-pressure threshold of lateral thigh, and serum creatine kinase compared to the control group (p = 0.006, 0.003, and 0.012, respectively). No statistically significant differences were found between the groups regarding the physical functions. CONCLUSIONS: Lower limb vibration using a vibration roller after total hip arthroplasty was an effective intervention to reduce exercise-induced hip pain and improve serum creatine kinase, but there was no synergistic effect on the physical functions.

Development and validation of a prognostic scoring system for 1-year mortality in older patients with hip fractures.

BACKGROUND: Hip fractures in older people result in increased mortality. OBJECTIVE: We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively. DESIGN: Retrospective study. SETTING: Multicenter. PARTICIPANTS: Patients aged ≥65 years with hip fractures who underwent surgery between 2011 and 2021 were enrolled. METHODS: The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively. RESULTS: We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively. CONCLUSIONS: We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients.

The efficacy of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials.

PURPOSE: The purpose of this study was to assess the efficacy of aspirin versus low-molecular-weight heparin (LMWH) in preventing venous thromboembolism (VTE) following hip and knee arthroplasty. METHODS: PubMed/Medline, Embase, Cochrane Library and Google Scholar databases were searched from inception till June 2024 for original trials investigating the outcomes of aspirin versus LMWH in hip and knee arthroplasty. The primary outcome was VTE. Secondary outcomes included minor and major bleeding events, and postoperative mortality within 90 days. This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 7 randomized controlled trials with 12,134 participants were included. The mean ages for the aspirin and LMWH cohorts were 66.6 (57.6-69.0) years and 66.8 (57.9-68.9) years, respectively. There was no statistically significant difference in the overall risk of VTE between the aspirin and the LMWH cohorts (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.48-1.89; p: 0.877). A subanalysis based on the specific VTE entity (pulmonary embolism [PE] or deep venous thrombosis) showed a significantly higher PE risk for patients receiving aspirin than the LMWH cohort (OR: 1.79; 95% CI: 1.11-2.89; p: 0.017). There was no difference in minor (OR: 0.64; 95% CI: 0.40-1.04; p: 0.072) and major bleeding (OR: 0.77; 95% CI: 0.40-1.47; p: 0.424) episodes across both groups. Furthermore, subanalysis among the total knee arthroplasty group showed that the aspirin cohort was significantly more likely to suffer VTEs than their LMWH counterparts (OR: 1.55; 95% CI: 1.21-1.98; p < 0.001). CONCLUSION: This study demonstrated a significantly higher risk of PE among patients receiving aspirin compared to LMWH following hip or knee arthroplasty for osteoarthritis. Aspirin was associated with a significantly higher overall VTE risk among patients undergoing knee arthroplasty, in particular. This might suggest the inferiority of aspirin compared to LMWH in preventing VTE following such procedures. LEVEL OF EVIDENCE: Level I.

Femoral version and its clinical relevance in adult hip preservation surgery for developmental dysplasia of the hip.

Femoral version (FV) is more widely adopted with the definition as the angle between the long axis of the femoral neck and the tangent line of the posterior femoral condyles on the axial plane, and the normal range between 5 and 20°. FV can be measured by imaging and functional tests. Cross-sectional CT including both the hip and the knee is the typically used imaging technique, yet variation exists according to the different landmarks used. As MRI investigations are routinely performed preoperatively, and protocols can be easily adopted to include version measurement, they are frequently used as an alternative to CT and offers several advantages. Abnormal FV has adverse effects on the biomechanics and musculoskeletal health of the whole lower limb. It affects the lever arm of muscles and the forces that the hip and patellofemoral joints suffer, and can lead to disorders such as osteoarthritis and impingement. In adult hip preservation surgery for developmental dysplasia of the hip (DDH), abnormal FV is sometimes accompanied by other morphological abnormities of the hip, a more severe DDH, and can help predict postoperative range of motion (ROM), and postoperative impingement. Currently, the most frequently used surgical technique for abnormal FV is femoral derotational osteotomy. Many controversies are left to be solved, including the specific origin of FV, the indication for femoral derotational osteotomy, especially in patients with combined DDH and abnormal FV, and the explicit compensation mechanism of abnormal FV by tibial torsion.

Rates and risk factors for failure of reduction in closed reduction in developmental dysplasia of the hip: a systematic review and meta-analysis.

Objective: In developmental dysplasia of the hip (DDH), concentric reduction of dislocated hips cannot be achieved by closed reduction in many cases, and open reduction is required ('failure of reduction'). The incidence of cases requiring open reduction and the significance of risk factors for unsuccessful reduction remain unclear. We investigated the overall rate and the risk factors for failed closed reduction in DDH. Methods: We followed the Cochrane recommendations in our systematic review and meta-analysis. We performed a systematic search in three medical databases to identify all studies reporting on pediatric patients with hip dislocation in DDH on 2 July 2022. Eligible studies reported on the rate of failure in children younger than 36 months. We calculated odds ratios (ORs) with 95% CIs from two-by-two tables (event rate in risk group, event rate in non-risk group). Results: We identified 13 316 studies and included 62 studies (5281 hips) for failure rate and 34 studies (3810 hips) for risk factor analysis. The overall rate of failure in closed reduction was 20%. The risk of failure of reduction increased with the grade of dislocation and was significantly higher for high dislocations (group 0-24: IHDI 4 vs IHDI 2 OR: 17.45, CI: 9.26-32.92; Tönnis 4 vs Tönnis 2 OR: 14.67, CI: 1.21-177.37; Graf IV vs Graf III OR: 3.4, CI: 2.27-5.09). Male gender was also a significant risk factor (OR: 2.27, CI: 1.13-4.56) in group 0-36. Conclusion: Higher grade dislocations and male gender are significant risk factors for failure of reduction in closed reduction in hip dislocation in DDH.

Characterisation of 3D-printed acetabular hip implants.

Three-dimensional printing is a rapidly growing manufacturing method for orthopaedic implants and it is currently thriving in several other engineering industries. It enables the variation of implant design and the construction of complex structures which can be exploited in orthopaedics and other medical sectors. In this review, we develop the vocabulary to characterise 3D printing in orthopaedics from terms defined by industries employing 3D printing, and by fully examining a 3D-printed off-the-shelf acetabular cup (Fig. 1). This is a commonly used 3D-printed implant in orthopaedics, and it exhibits a range of prominent features brought about by 3D printing. The key features and defects of the porous and dense regions of the implant are clarified and discussed in depth to determine reliable definitions and a common understanding of characteristics of 3D printing between engineers and medical experts in orthopaedics. Despite the extensive list of terminology derived here, it is clear significant gaps exist in the knowledge of this field. Therefore, it is necessary for continued investigations of unused implants, but perhaps more significantly, examining those in vivo and retrieved to understand their long-term impact on patients and the effects of certain features (e.g. surface-adhered particles). Analyses of this kind will establish an understanding of 3D printing in orthopaedics and additionally it will help to update the regulatory approach to this new technology.

[Radiographic measurements of acetabular component orientation with Widmer´s method in total hip arthroplasty. Descriptive case series]. / Mediciones radiográficas de la orientación del componente acetabular con el método de Widmer en la artroplastía total de cadera. Serie de casos descriptiva.

INTRODUCTION: total hip arthroplasty (THA) is one of the most performed surgeries worldwide, with high satisfaction rates. The orientation of the acetabular component has a direct impact on the risk of dislocation, recently with the support of robotic surgery the margin of error in implant placement has decreased; however, the conventional technique even without fluoroscopic support continues to have satisfactory results within the safety zone. MATERIAL AND METHODS: retrospective, cross-sectional, descriptive case series of patients treated with THA at Hospital General Xoco between 2022 and 2024. Degrees of anteversion and inclination were measured with Widmer's method on postoperative radiographs. RESULTS: the radiographs of 113 patients were studied, 80 female and 33 male, with a mean age of 63.2 ± 13.01 years (95% CI: 60.6-65.4), a mean inclination of 42.2° ± 8.1° (95% CI: 40.7-43.2) and anteversion of 14.3° ± 8.5° (95% CI: 12.5-15.4); 76% of the population was within Lewinnek safe zone; by etiology: osteoarthrosis 74%, sequelae of dysplasia 68% and intracapsular fracture 82%; difference between the values of the affected side: left 65%, right 83%, of 3.9° and 4.7°/6.4o and 9° in relation to the overall values of the population. CONCLUSION: in our population undergoing THA, without the use of robotic technique or support of imaging studies, anteversion and inclination figures were recorded within the Lewinnek safety parameters with a conventional method.

INTRODUCCIÓN: la artroplastía total de cadera (ATC) es una de las cirugías más realizadas a nivel mundial, con altos porcentajes de satisfacción. La orientación del componente acetabular tiene impacto directo en el riesgo de luxación; recientemente, con el apoyo de la cirugía robótica, el margen de error en la colocación de los implantes ha disminuido; sin embargo, la técnica convencional, incluso sin apoyo fluoroscópico, continúa teniendo resultados satisfactorios dentro de la zona de seguridad. MATERIAL Y MÉTODOS: serie de casos retrospectiva, transversal y descriptiva, de pacientes tratados con ATC en Hospital General Xoco entre 2022 y 2024. Se midieron los grados de anteversión e inclinación con el método de Widmer en las radiografías postoperatorias. RESULTADOS: se estudiaron las radiografías de 113 pacientes, 80 mujeres y 33 hombres, con edad media de 63.2 ± 13.01 años (IC95%: 60.6-65.4), se obtuvo una inclinación media de 42.2° ± 8.1° (IC95%: 40.7-43.2) y anteversión de 14.3° ± 8.5° (IC95% 12.5-15.4); 76% de la población se encontraba dentro de la zona segura de Lewinnek; por etiología: osteoartrosis 74%, secuelas de displasia 68% y fractura intracapsular 82%; diferencia entre los valores del lado afectado: izquierdo 65%, derecho 83%, de 3.9° y 4.7°/6.4° y 9° en relación con los valores globales de la población. CONCLUSIÓN: en nuestra población sometida a ATC, sin uso de técnica robótica o apoyo de estudios de imagen, se registraron cifras de anteversión e inclinación dentro de los parámetros de seguridad de Lewinnek con un método convencional.

[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.

Trends in hip fracture rates in US male veterans.

Osteoporotic fracture has been understudied in men. In US male veterans aged 50 years and older between 2002 and 2019, hip fracture incidence increased between 2006 and 2019, fewer than 6% of men underwent DXA, and fewer than 0.5% of men were treated. Investigation of low screening and treatment rates is warranted. PURPOSE: In the United States, the annual incidence of osteoporotic hip fracture is estimated to be 250,000 to 300,000; the one-year mortality in some studies has been as high as 32%. Reports that hip fracture rates in US women 65 years and older may no longer be declining led to this investigation of hip fracture in men, a less studied population. We assessed the trends in the incidence of hip fracture in US male veterans 50 years and older of age as well as the rates of diagnosis and treatment in such men. METHODS: We assessed the recent trends of hip fracture incidence in a nation-wide male veteran population 50 years and older of age. Using data from the US Veterans Affairs Informatics and Computing Infrastructure (VINCI) 2002-2019, we calculated the annual age-standardized hip fracture incidence. Secondary objectives included evaluating the annual proportion of hip fracture patients who underwent dual-energy X-ray absorptiometry (DXA) before or after the fracture and/or received osteoporosis medication after the hip fracture over the study period. RESULTS: Hip fracture incidence increased in male veterans from 2006 to 2019. Fewer than 6% of men underwent a DXA scan and fewer than 0.5% received osteoporosis medications up to two years after a hip fracture. CONCLUSIONS: Despite available screening methods such as DXAs and medications for primary and secondary prevention of osteoporotic fractures, hip fracture incidence is not decreasing in older male veterans. Our study highlights a need for closer attention to fracture risk in men.

First year report of the IMSS Multicenter Hip Fracture Registry.

The population has aged; there is a greater risk of osteoporosis and hip fracture. We describe the standards of care for hip fractures in various hospitals of Mexico. A total of 1042 subjects participated. The acute mortality was 4.3%. SIGNIFICANCE: Hip fracture registries provide a means to compare care and establish improvement processes. BACKGROUND: The Mexican population has aged; thus, there is a greater risk of osteoporosis, and its main consequence is hip fracture due to fragility. Its incidence is high, and it is expected to increase due to aging in our country. International guidelines provide standardized recommendations for the care of people with hip fractures, while hip fracture registries provide a means to compare care with local, national, and international clinical standards and establish improvement processes. OBJECTIVE: Describe the standards of care for hip fractures in various hospital centers of the Mexican Social Security Institute. METHODS: This was an observational, multicenter, longitudinal, and descriptive study. It included 24 hospital centers in Mexico. Informed consent was obtained. Data were recorded during the hospital stay, epidemiological data, and management, and follow-up was carried out 30 and 120 days after discharge. The information was analyzed using SPSS version 22.0. RESULTS: A total of 1042 subjects aged 79.5 ± 7.6 years participated, mostly women (n = 739; 70.9%) from the community (n = 1,021; 98.0%) and with functional independence (Barthel 80.9 ± 22.2). The transfer time to the emergency room was 4.6 ± 14.6 days. Pertrochanteric hip fracture was the most common (n = 570, 54.7%). The most common type of procedure was dynamic hip screw (DHS) (n = 399; 40.1%). Documented thromboprophylaxis was granted in 91.5% (n = 953) and antibiotic prophylaxis in 53.0% (n = 552) of the patients. The goal of 36 h for the surgical procedure was achieved in 7.6% of the subjects (n = 76), with the most frequent cause being a delay in scheduling (n = 673, 67.6%). The mean time from emergency room to surgery was 7.8 ± 7.0 days. The acute mortality rate was 4.3%. Secondary pharmacologic prevention upon discharge occurred in 64.2% of patients. At 30 days, 370 subjects (37.1%) were lost to follow-up, with a mortality of 3%, while at 120 days, 166 subjects (27.8%) were lost, with a mortality of 2.8%. CONCLUSION: In the hospital centers where the study was carried out, there are still no standards of care for hip fractures, which makes it necessary to rethink the care for this population group through a strategy focused on meeting those standards.

Success rate of single versus multiple debridement, antibiotics, and implant retention (DAIR) in hip and knee periprosthetic joint infection: a systematic review and meta-analysis.

PURPOSE: This systematic review aimed to compare outcomes between multiple and single debridement, antibiotics, and implant retention (DAIR) procedures for early periprosthetic joint infection (PJI) in hip and knee arthroplasty. METHODS: Four databases were searched from inception till January 2024 for original studies investigating the outcomes of multiple DAIR in hip and knee PJI. The primary outcome was the success rate in eradicating joint infection. This review was conducted per PRISMA guidelines. RESULTS: A total of 9 observational studies with 1104 participants were included, with a mean age and BMI of 58.37 years (95%CI: 25.77-90.98) and 31.43 kg/m2 (95%CI: 28.89-34.98), respectively. The mean follow-up period was 58.37 months (95%CI: 25.77-90.98), and the average MINORS score assigned to the review was 17.6 ± 3.46, indicating a low overall risk of bias. An equivalent success rate between single and double DAIR was observed, at 67% (95%CI: 64-71%) and 70% (95%CI: 48-86%), respectively, with no statistically significant difference between the two treatment modalities (p = 0.740). Additionally, the success rate for triple DAIR ranged from 50 to 60%. CONCLUSION: This study suggests that double DAIR is a valid treatment option for acute PJI after TKA and THA, with a success rate comparable to single DAIR (70% vs. 67%, p = 0.740). Triple DAIR achieved success rates ranging from 50 to 60%. However, caution is warranted when interpreting these results due to heterogeneity in host comorbidity factors, DAIR protocols, and antibiotic regimens. LEVEL OF EVIDENCE: Therapeutic, Level III.

Effect of Sclerosis Bands in Femoral Head Necrosis on Non-Vascularized Fibular Grafting-A Finite Element Study.

OBJECTIVE: Femoral head necrosis is a challenging condition in orthopaedics, and the occurrence of collapse is an important factor affecting the prognosis of femoral head necrosis. Sclerosis bands are known to influence the collapse of the femoral head, yet there is a lack of research on the biomechanical role of sclerosis bands in non-vascularized fibular grafting surgery. This study aims to evaluate the biomechanical impact of sclerosis bands in femoral head necrosis and their role in non-vascularized fibular grafting surgery (NVFG) using finite element analysis. METHODS: We constructed 11 finite element models based on CT scan data of a normal hip joint, simulating different sclerosis band thicknesses and defect scenarios. The models were analyzed for changes in femoral head displacement and von Mises stress. We constructed a hip joint model based on CT data from a normal hip joint, and after reconstruction, assembly, and optimization using 3-matic. We created five groups consisting of 11 finite element analysis models of the hip joint. Mesh partitioning and mechanical parameter settings were performed in ANSYS. The changes and differences in femoral head displacement and von Mises stress of these models were analyzed. RESULTS: Increasing sclerosis band thickness led to reduced peak displacement of the femoral head by 28.6%, 42.9%, and 47.6%, and increased surface von Mises stress by 28.3%, 13.8%, and 13.0%, respectively. Post-surgery, peak displacement decreased in all groups compared to pre-surgery levels. Increasing sclerosis band thickness post-surgery resulted in decreased maximum von Mises stress of the femoral head by 13.9%, 3.0%, and 8.1%. Defect volume in the defect groups correlated with increased peak displacement of the femoral head by 10.0%, 30.0%, and 100.0%, and increased surface maximum von Mises stress of the femoral head by 9.3%, 14.0%, and 15.1%. CONCLUSION: Sclerosis band formation exacerbates von Mises stress concentration on the femoral head surface. However, thicker sclerosis bands improve post-NVFG stability and mechanical performance. Larger anterior lateral sclerosis band defects significantly compromise postoperative stability, increasing the risk of collapse. Protecting the anterior lateral sclerosis band during NVFG surgery is crucial.

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.

Joint-line obliquity angle is significantly affected by hip abduction and adduction: A simulated analysis.

PURPOSE: Different methods for quantifying joint-line obliquity (JLO) have been described, including joint-line obliquity angle (JLOA), Mikulicz joint-line angle (MJLA) and medial proximal tibial angle (MPTA). The goal of the present study was to quantify the variation of JLOA based on the position of the hip. The hypothesis of our study is that JLO is significantly influenced by the abduction/adduction of the limb, unlike MJLA. METHODS: One hundred long-leg-weightbearing X-rays were used. At time 0 and after 30 days, two observers performed different measurements, including (1) distance between pubic symphysis and center of the femoral head, (2) distance between center of the femoral head and center of the ankle joint, (3) distance between center of the ankle and medial malleolus, (4) hip-knee-ankle angle, (5) MPTA, (6) lateral distal femoral angle, (7) joint-line congruency angle, (8) JLOA, (9) MJL and (10) angle between Mikulicz line and line perpendicular to the ground. The changes of the JLOA based on the position of the hip (abducted, neutral, bipedal stance adduction and monopodal stance adduction) were calculated with trigonometric formulas and with simulation on an orthopaedic planning digital software. RESULTS: The JLOA change between adducted and abducted positions was on average 12.8° (SD 0.9 mm). The MJL did not vary significantly based on hip position. CONCLUSIONS: The adduction/abduction of the lower limb has a considerable impact on JLOA. Methods like MJLA which are not affected by hip position should be preferred for JLO evaluation. LEVEL OF EVIDENCE: Diagnostic study, level III.

Head size in Delta ceramic-on-ceramic total hip arthroplasty: a comparative registry study.

INTRODUCTION: Optimal bearing size in total hip arthroplasty (THA) has not been clearly ascertained, but large diameter ceramic balls may improve function and implant stability, with minimal concerns for wear. Delta ceramic-on-ceramic (COC) THA were stratified based on head diameter (32, 36 and 40 mm), aiming to assess: 1) survival rates, reasons for revision and hazard ratios for failure; 2) survival rates and hazard ratios for aseptic loosening, dislocation/primary instability, liner failure. MATERIALS AND METHODS: A regional arthroplasty registry was enquired about Delta COC THA performed for primary osteoarthritis, stratified by head size. 13,161 primary cementless THAs were included in the study, with a mean follow-up of 5.7 years (range: 0-17): 3980 (30.2%) 32 mm balls, 8327 (63.3%) 36 mm heads, 854 (6.5%) 40 mm heads. RESULTS: The three cohorts achieved similar survival rates (p = 0.99) and adjusted hazard ratios (p > 0.05). No revisions for head breakage or metallosis occurred. When revision for cup aseptic loosening was the endpoint, the survival rates of three cohorts (p = 0.08) and the adjusted hazard ratios (p > 0.05) were similar. The three cohorts achieved comparable survival rates when revision for dislocation/primary instability was the endpoint (p = 0.08). When the endpoint was revision for liner breakage, 32 mm cohort showed higher rates of revision (p = 0.01). No liner failure was detected in the 40 mm cohort. CONCLUSIONS: 32 mm, 36 mm and 40 mm provided similar 10-year survival rates in Delta COC THA. 40 mm heads emerged as safe options but did not lower the revisions for dislocations/primary instability. LEVEL OF EVIDENCE: IV (therapeutic study).

Intraoperative fluoroscopic confirmation of the knee improves the accuracy of stem anteversion in total hip arthroplasty with direct anterior approach using traction table.

BACKGROUND: Stem anteversion (SA) in total hip arthroplasty (THA) is crucial for postoperative outcomes, affecting dislocation risk and hip function. Accurate SA placement is challenged by intraoperative estimation methods, with discrepancies reported between predicted and true SA. This study investigates the effect of conventional methods and intraoperative fluoroscopic confirmation on SA accuracy in THA performed with a direct anterior approach using a traction table. METHODS: This involves 200 patients undergoing primary THA from August 2019 to January 2023, divided into a conventional group (n = 100) and a fluoroscopic group (n = 100). Postoperative SA measurements were conducted using computed tomography scans. Statistical analysis focused on comparing the SA angles and the prevalence of excessive SA (≥>35° and ≥>40°) between the groups. RESULTS: The fluoroscopic group showed a lower average SA angle (24.3° ± 8.3°) compared to the conventional group (30.0° ± 11.3°), with a statistically significant difference (p < 0.01). Excessive SA (≥>40°) was found in 17% of the conventional group, significantly reduced to 5% in the fluoroscopic group (p < 0.01). Similarly, SA exceeding 35° was present in 39% of the conventional group, compared to only 11% in the fluoroscopic group (p < 0.01), indicating a substantial reduction in excessive SA placements with fluoroscopic guidance. DISCUSSION: The study demonstrates that intraoperative fluoroscopic guidance significantly enhances the accuracy of SA placement in THA, reducing the variability and proportion of excessive SA. This suggests a critical reevaluation of conventional estimation methods in favor of fluoroscopic confirmation to improve surgical outcomes. CONCLUSION: Intraoperative fluoroscopic confirmation of knee external rotation angle markedly decreases the proportion of excessive SA and enhances the precision of stem placement in THA with a direct anterior approach. This technique represents a significant advancement in surgical practice, offering a simple and effective method to achieve optimal postoperative results.