Intraoperative live measurement of femoral head size for acetabular cup sizing: simple, accurate, and green!

PURPOSE: Templating is the first step in achieving a successful total hip arthroplasty. We hypothesize that native head size is highly correlated with implanted cup size. Therefore, the purpose of this study is to look for a correlation between sizes of the intra-operative measurement of the femoral head and the implanted cup. METHODS: This is a monocentric observational study conducted from December 2018 till January 2023. All patients admitted for a primary total hip arthroplasty were included and retrospectively reviewed. Intra-operative femoral head measurement, radiographic femoral head diameter, templated (planned) cup size, and definitive implanted cup size were recorded. RESULTS: The sample included 154 patients (85 female and 69 males) with a mean age of 66.2 ± 10.4 years. There were 157 THA cases; 82 on the right side and 75 on the left side. The native head size and acetate template on digital radiographs were the most significantly positively correlated with cup size (P < 0.0001) while the radiological head size was significantly negatively correlated with cup size (P = 0.009). The implanted cup was on average 2 ± 2 mm bigger than the native head size measured intra-operatively. CONCLUSION: The native femoral head diameter measured intra-operatively is a simple and reliable tool to help the surgeons choose the proper size of the acetabular cup, preventing complications during surgery hence optimizing results post operatively. This technique would contribute to a more ecofriendly orthopaedic reconstructive surgery.

Outcomes of total hip arthroplasty using dual mobility cups following failed internal fixation of proximal femoral fractures at a mean follow-up of 6 years.

INTRODUCTION: Performing total hip arthroplasty (THA) after failed internal fixation of proximal femoral fractures (PFF) is known to be associated with high rates of complications. Dual mobility cups (DMC) are known to lower dislocation events in high-risk patients. Very few reports investigated the outcomes of THA using DMC following failure of internal fixation for PFF. METHODS: This is a retrospective monocentric continuous study of 31 patients who underwent THA with DMC after failed internal fixation of PFF. The clinical assessment was based on the modified Harris hip score (mHHS) at the last follow-up. The complication rates and radiological analyses were recorded. RESULTS: The mean follow-up period was 5.96 ± 4.2 years. At the last follow-up, the mean mHHS was 92.9 ± 9.1 with 71% of the patients describing their operated hip as a forgotten hip. No dislocation or aseptic loosening events were noted. One patient developed a septic loosening of the implant. No significant radiological changes were recorded. Sixteen stems (51.6%) were placed in a neutral position, 13 (42%) in valgus (2.74 ± 1.72°), and 2 (6.4%) in varus (6.94 ± 2.02°). CONCLUSION: This study emphasizes the advantage of using DMC following failed internal fixation of PFF in reducing dislocation and complication events in this high-risk population.

Major acetabular defects: outcomes of first revision total hip arthroplasty using Kerboull cross-plate with allograft and cemented dual mobility cup at a maximum follow-up of fourteen years.

BACKGROUND: The use of dual mobility cups (DMC) has been shown to reduce hip instability after revision surgery. For severe acetabular bone loss, reconstruction with a Kerboull cross-plate and bone allograft would contribute to restoring native hip position and bone stock. Only two papers reported on the combination of Kerboull cross-plate with bone allograft and cemented DMC in revision total hip arthroplasty (THA). METHODS: This is a monocentric retrospective study (28 cases) of first-time revision THA using such a construct in American Association of Orthopaedic Surgeons (AAOS) grade III and IV acetabular bone defect. Detailed demographic, clinical and radiographic results were recorded and evaluated. RESULTS: With a mean follow-up of six ± 3.63 years, no case of instability was reported. The modified Harris Hip Score (mHHS) was 88.4 ± 10.1. No hook fracture or mechanical failure was observed. Non-progressive radiolucent lines were recorded. Osteointegration of the allografts was observed in all cases with a mean Grodet score of 7.9 ± 0.97. CONCLUSIONS: In first revision THA, the use of a Kerboull cross-plate with allograft and a cemented DMC in AAOS grade III and IV acetabular bone defects demonstrated excellent clinical and radiological outcomes with no recorded cases of dislocation or mechanical failure.

Writing for SICOT-J.

Every time a paper is submitted to the journal, we realize the effort and amount of work it takes for performing the study, writing, formatting, and submitting the paper for peer review. However, how many of these papers are suitable for publication? Medical writing considerations, including an understandable text that does not confuse reading, formality, and ethics in writing, should be kept in mind when preparing and writing a paper to be submitted for publication to a journal. This editorial note offers useful advice for the authors submitting their papers to a journal on what to keep in mind before submission, how to prepare a quality submission, how to win the editor for their paper to avoid rejection, and how to make it to the review process and maybe to get published. It is our belief that these tips and advice on medical writing apply to any author and any journal.

Louis Ombrédanne, a founding member of SICOT.

This paper describes the life and work of Louis Ombrédanne, one of the founding fathers of the SICOT, a notorious French orthopaedic and paediatric surgeon with a strong interest in plastic surgery and reconstruction of post-traumatic defects and also with limb lengthening and treatment of sequalae. Born in Paris in 1871 as a son of a general practitioner doctor, Ombrédanne was a brilliant student enjoying anatomy and surgery since the early years. He was appointed as a Surgeon in 1902 in Paris and became Professor of Surgery in 1907. During the First World War, he worked in Verdun, one of the most exposed hospitals near the battlefield where over 700.000 people died and many cases were affected by head and neck burns and destructions, requiring surgical reconstruction. After the war, Ombrédanne developed Pediatric Surgery and it seems that his powerful drive and charisma explain why these specialties are studied together with orthopaedics in Europe and later in the World. Many innovations like the anaesthetic inhaler with face mask were authored by Ombrédanne and also techniques of limb lengthening, thoracic plasty. He described malignant hyperthermia in children and worked in the Sick Children Hospital in Paris, today Hôpital Necker. In 1929, Ombrédanne participated with a group of enthusiastic surgeons and teachers from many countries to the creation of SICOT during a historical meeting held in Hotel Crillon in Paris. This paper introduces Ombrédanne's work to the current readers and is a tribute to the work of our ancestors who made possible the development of our specialty.

Dual-mobility cups could yield lesser infections than conventional cups: a meta-analysis of comparative studies.

INTRODUCTION: Dual-mobility cups (DMC) are gaining popularity mainly for their reduced rate of dislocation following total hip arthroplasty (THA). Currently, indication for DMC use extends beyond patients with high risk of dislocation or revision THA cases. Many authors reported DMC outcomes in primary THA for all aetiologies. However, some reports claimed that the use of DMC is accompanied with higher rates of infection compared with conventional cups (CC) in both primary and revision THA. RESEARCH QUESTION: Does the use of DMC generate higher rates of infection when compared with conventional cups? OBJECTIVES: The aim of this meta-analysis was to look for significant difference in the rate of post-operative infection between DMC cups and conventional cups. METHODOLOGY: MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched since inception. Only studies with comparative design reporting the outcome infection rate were included. RESULTS: Seventeen retrospective comparative studies were located comprising 248,541 patients: 16,020 in the DMC group and 232,521 in the CC group. The mean follow-up period was 37.5 ± 42 and 50.2 ± 48.7 months for the DMC and CC groups, respectively. The meta-analytical results indicated the following: (a) significantly lesser infections following DMC compared with CC in revision THA (odds ratio (OR) = 0.75 (95% CI = 0.653 to 0.874, P = 0.0002, I2 = 25%); (b) for primary THA and for large-sampled registries, significance was found using only the fixed-effects model estimate; and (c) no significant difference was found for the subgroup of cohort studies. CONCLUSION: Our results clearly refute the claim that DMC would yield higher rates of infection. On the contrary, the findings demonstrated that the use of DMC reduces the risk of post-operative infection in revision THA and a similar lower infection trend for primary THA when compared with the standard cups.

Current concepts in robotic total hip arthroplasty.

INTRODUCTION: Total hip replacement provides mostly fair functional and clinical results. Many factors play an essential role in hip stability and long-term outcomes. Surgical positioning remains fundamental for obtaining accurate implant fit and prevent hip dislocation or impingement. Different categories of robotic assistance have been established throughout the previous years and all of the technologies target accuracy and reliability to reduce complications, and enhance clinical outcomes. MATERIALS AND METHODS: An overview is proposed over the principles of robotic assistance in hip arthroplasty surgery. Accuracy, reliability, management of the bone stock, clinical outcomes, constraints and limits of this technology are reported, based on recent literature. RESULTS: Potential advantages regarding pre-operative planning accuracy, cup positioning, maintenance of the center of rotation, preservation of an adequate bone stock nay clinical short- and mid-term outcomes are balanced with some reported disadvantages and limits like hip anatomical specificity, cost-effectiveness, engineering dependence. DISCUSSION: The use of robotic-assisted THA presents clear and evident benefits related to accurate implant positioning and maintenance of a minimal bone while allowing. For some authors, an early improvement in functional results and patient's recovery. This technology demonstrated a shorter surgical time and a short learning curve required to optimize its use and this technology presents promising outcomes and results and potential use in routine clinical application but its limitation of use is still present especially the cost of the robot, the need for the presence of an engineer during the surgery, its availability of use in all hospitals as well as the difficulty presented in dysplastic or dysmorphic hip joints.

Charnley femoral cemented stem with a permeable and resorbable cement restrictor and low-viscosity cement - Clinical and radiographical evaluation of 100 cases at a mean follow-up of 6.55 years.

INTRODUCTION: In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the "second-generation cementing technique." The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. MATERIAL AND METHODS: This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan-Meier method. RESULTS: Mean follow-up was 6.55 ± 2.6 (range 1-11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. DISCUSSION: As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. CONCLUSION: Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.

Dual Mobility Acetabular Cup Versus Hemiarthroplasty in Treatment of Displaced Femoral Neck Fractures in Elderly Patients: Comparative Study and Results at Minimum 3-Year Follow-up.

BACKGROUND: Hip fractures are serious injuries associated with relatively high mortality rates and disabilities, commonly seen in elderly persons. There is an ongoing debate regarding the advantages of various hip arthroplasty devices. This study aimed to analyze the long-term advantages of 2 different surgical procedures and assess if the dislocation rate, Harris Hip Score (HHS), and functional independence measure (FIM) are more favorable in dual mobility (DM) than those in hemiarthroplasty (HA). HYPOTHESIS: Dual mobility procedures provide better postoperative outcomes than HA in terms of HHS, FIM, and dislocation rate. MATERIALS AND METHODS: The survey was a prospective, comparative interventional single-blinded study performed at the University Clinical Center of Kosovo, a tertiary health-care institution. A total of 94 patients underwent DM or conventional bipolar HA for repair of displaced femoral neck fractures within 2 weeks of injury. Primary outcomes were postoperative dislocation rate, FIM, and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, mortality rate, and postoperative infection rate. RESULTS: There were no significant differences for most parameters between the groups. We found a significant difference in the dislocation rate between the 2 groups, wherein there were no dislocations in the DM group and 3 dislocations in the HHS group (0% vs 6.4%). In terms of postoperative HHS at 12 months and 3 years, DM provided better outcomes (<0.034 and <0.014, respectively). DISCUSSION: Dual mobility compares favorably to HA in terms of dislocation rate and HHS, while no difference was found for FIM. In order to have a more complete overview, we recommend more intense long-term studies including several heterogeneous parameters to compare the clinical outcomes between DM and HA. LEVEL OF EVIDENCE WITH STUDY DESIGN: Level II.

Use of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years' average follow-up.

BACKGROUND: In the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors. HYPOTHESIS: Acetabular reconstruction can be performed equally well with frozen or processed morselized allografts. MATERIALS AND METHODS: This retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years±1.89 [5-12.32]) than that of the processed grafts (8.22 years±1.77 [5.05-15.48]) (p=0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years±14.2 [17-80]) than in the processed group (57.5 years±13.0 [12-94]) (p<0.001) and were also younger at the time of THA revision (67.8 years±12.2 [36.9-89.3] versus 70 years±11.7 [25-94.5]) (p=0.041). RESULTS: There were more complications overall in the frozen allograft group (46/242=19.0%) than the processed allograft group (35/256=13.2%) (p=0.044) with more instances of loosening in the frozen group (20/242 [8.2%]) than in the processed group (6/266 [3.3%])(p=0.001). Conversely, the dislocation rate (16/242=6.6% vs. 17/266=6.4%) (p=0.844) and infection rate (18/242=7.4% vs. 15/266=5.7%) (p=0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p=0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p=0.006) and a relative risk of 1.95 (95% CI: 1.26-2.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23-4.70) (p=0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52-6.51) (p=0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26-8.26) (p=0.022). DISCUSSION: Our hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabular bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior. LEVEL OF EVIDENCE: III, comparative retrospective study.

Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring?

PURPOSE: The objective was to identify predictive factors for intraprosthetic dislocation (IPD) and to understand how improvements in dual mobility cups (DMC) have helped to reduce dramatically the occurrence of this complication. METHODS: DM mobile inserts retrieved from 93 hips were divided into three groups: first-generation DMC with IPD ("firstDMC-IPD"), first-generation DMC with over 15 years of implantation without IPD ("firstDMC-noIPD"), and latest-generation DMC ("newDMC"). The predictive factors for IPD based on clinical, prosthetic, radiological and intraoperative characteristics were analysed by multivariate analysis. The surface of each retrieved mobile insert was analysed using three-dimensional CT scan in order to compare their rim wear. RESULTS: Three predictive factors for IPD were found: a high BMI, a wide rough stem neck and a large cup size. Wear of the firstDMC-noIPD inserts was significantly less than those of firstDMC-IPD inserts and significantly more than those of newDMC inserts. For the firstDMC-IPD inserts, the rim's outer surface wear was significantly greater than the rim's inner surface wear. CONCLUSIONS: IPD is a specific complication related to wear of the DM mobile insert due to failure of the liner's retaining rim, especially from the rim's outer surface. This long-term issue is different to the early traumatic complication, which can happen after an attempt at closed reduction of a DM THA dislocation. Recent modifications in the design and the coating of contemporary DMC and femoral stems, as well as improvements in the mobile insert itself, seem to corroborate our assumptions about the IPD mechanism and contribute to the quasi-disappearance of this complication.

Revision total hip arthroplasty with a Kerboull plate: comparative outcomes using standard versus dual mobility cups.

INTRODUCTION: Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting. MATERIALS AND METHODS: This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months. RESULTS: Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed. CONCLUSION: The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups.

Mortality Rate and Mid-Term Outcomes of Total Hip Arthroplasty Using Dual Mobility Cups for the Treatment of Femoral Neck Fractures in a Middle Eastern Population.

BACKGROUND: The dual mobility cups (DMCs) were shown to reduce dislocation rate following total hip arthroplasty for any etiology, including femoral neck fractures. No reported studies evaluating DMC results for femoral neck fracture in a Middle Eastern population were found in the literature. METHODS: This study aims to look for mortality rate, clinical, and functional outcomes in a population having specific rituals involving extreme hip positions as part of their daily activities. RESULTS: Of an initial sample of 174 patients (177 operated hips), 18 (10.3%) patients (20 hips) died after a mean of 39.6 ± 13.8 months (ranging from 2 to 49 months) with only 3 (1.7%) during the first post-operative year. Twelve patients (13 hips) were lost to follow-up and 19 patients (19 hips) had their radiological data incomplete. In the final sample of 125 patients (125 hips), no dislocation, aseptic loosening, or infection was encountered. The mean modified Hip Harris Score was of 94.8 ± 8.4. The mean modified Hip Harris Score of 40 patients who used to practice regularly oriental sitting position or prayers was 94.1 ± 3.1. After surgery, 36 of these 40 patients (90%) described their hip as "a forgotten hip." Multivariate analyses found correlation only between mortality and cardiovascular co-morbidities. CONCLUSION: DMC implants showed excellent clinical and functional results. The majority of patients having rituals and customs involving extreme hip positions were able to resume their daily activities. The observed low mortality rate should incite future research to investigate its correlation with the use of DMCs.

Primary cementless total knee arthroplasty with or without stem extension: a matched comparative study of ninety eight standard stems versus ninety eight long stems after more than ten years of follow-up.

INTRODUCTION: Using a cementless fixation for total knee arthroplasty (TKA) is controversial. We hypothesized that cementless tibial base plate with a monoblock long stem (MLS) would provide secure tibial alignment and stable fixation when bone conditions were considered as poor for a cementless fixation. The purpose of this study was to compare the mean eight year survivorship of cementless standard keels (SK) vs cementless MLS. MATERIAL METHODS: We report a matched series of 98 cases of SK and 98 cases of MLS in patients with poor bone conditions. The two cohorts were statistically compared. Revision for tibial loosening was used as the endpoint in the survivorship analysis. RESULTS: We recorded two cases of tibial loosening and three cases of bipolar loosening in the SK group (0% MLS vs 5% SK). No tibial loosening occurred in the MLS group (statistically significant). No tibial periprosthetic or intra-operative fractures occurred in either group. The survivorship at eight years of follow-up was 95.6% in the SS cohort vs 100% in the MLS cohort using revision for tibial loosening as the endpoint. DISCUSSION: This study was not randomized. Its strength was that it took into account the comparative midterm outcomes of a matched cohort of patients implanted with two types of cementless components in the same bone conditions. We did not record any tibial loosening in the MLS group. Using long stems has been criticized but we did not observe any adverse reactions and no intra-operative tibial fracture occurred. CONCLUSION: MLS improves the alignment and fixation of cementless TKA. This is a safe solution when bone conditions are poor or modified by previous surgery.