Monolithic Dual Mobility Cup Total Hip Arthroplasty Has High Complication Rates With Surgical Fixation in Elderly With Femur Neck Fracture.

BACKGROUND: This study is prospectively conducted to evaluate surgical complications of monolithic dual mobility cup total hip arthroplasty (THA) in elderly patients with fractured neck of the femur. METHODS: Ninety-seven patients (97 hips) with displaced femoral neck fracture who gave informed consent for participation were prospectively enrolled. Their mean age was 76.6 years (range, 60-95 years), and the mean bone mineral density T-score of neck of the femur was -2.8 (range, -1.2 to -5.5). All patients underwent THA with monolithic dual mobility cup, and computed tomography scans were obtained to evaluate radiographic parameters including anteversion, inclination, and loosening of acetabular cups, and periprosthetic acetabular fractures. RESULTS: With regard to cup orientation, mean inclination angle was 40.2° (range, 23.5°-63°) and mean anteversion was 32.6° (range, 7°-66.2°). The proportion of surgical outliers was 10.3% (10/97) in inclination and 35.1% (34/97) in anteversion. Early cup loosening within 2 weeks was detected in 2 hips. Periprosthetic acetabular fractures were identified in 6 hips (6/97, 6.2%). Of the 6 fractures, 5 nondisplaced fractures were healed with conservative management, but 1 fracture with displacement eventually led to cup loosening and the patient underwent revision surgery. Reoperation rate of the monolithic dual mobility cup was 4.1% (4/97). CONCLUSION: The use of the monolithic dual mobility was associated with improper cup fixation and periprosthetic acetabular fractures in the elderly with poor bone stock, although the dual mobility cup lowered the risk of early dislocation after THA.

Complications Associated With Medial Opening-Wedge High Tibial Osteotomy Using a Locking Plate: A Multicenter Study.

BACKGROUND: The aim of this study is to investigate complications following medial opening-wedge high tibial osteotomy using a locking plate. In addition, we aimed to compare postoperative outcomes between the complicated and the uncomplicated group. METHODS: This study enrolled 209 patients who underwent medial opening-wedge high tibial osteotomy between 2010 and 2015. Patients with a follow-up period of at least 2 years were enrolled. Medical records and radiologic data were retrospectively reviewed. The complications were assessed up to postoperative 2 years and categorized into major and minor complications. The preoperative and postoperative clinical statuses were assessed using the Western Ontario McMaster University Osteoarthritis Index. RESULTS: The mean patient age was 56.4 ± 5.9 years. Overall complication rate was 29.7%. Minor complications included undisplaced lateral hinge fracture (12.0%), hardware irritation (1.4%), displaced lateral hinge fracture (2.4%), delayed wound healing (1.9%), undisplaced lateral tibial plateau fracture (1%), and superficial wound infection (1%). Major complications were symptomatic hardware which needed hardware removal (4.8%), deep wound infection (1.9%), hardware failure with correction loss (1%), nonunion (0.5%), and early conversion to arthroplasty (0.5%). Most complications occurred intraoperatively (30.6%) and within 3 months postoperatively (40.3%). The major complication group showed a statistically higher Western Ontario McMaster University Osteoarthritis Index score than did other groups at postoperative 1 year (P = .013) and 2 years (P = .001). CONCLUSION: The overall complication rate was 29.7%. Most complications were minor. The most common complication was undisplaced lateral hinge fracture. Major complications occurred in 8.6%. The major complication group showed significantly worse clinical outcomes than did the uncomplicated and minor complication groups.

Difference in the degree of improvement in patient-reported outcomes after total knee arthroplasty between octogenarians and sexagenarians: a propensity score matching analysis.

BACKGROUND: As the population ages, the use of primary total knee arthroplasty (TKA) is on the rise in the octogenarian population. AIMS: The objective of this study was to compare patient-reported outcomes after TKA in octogenarians versus sexagenarians. METHODS: This retrospective case-controlled comparative study with a propensity score matching analysis was conducted by 251 patients who underwent TKA for degenerative osteoarthritis of the knee. After the propensity score matching analysis, 38 octogenarians and 41 sexagenarians were identified. Range of motion (ROM), degree of flexion contracture, Charlson Comorbidity Index score, Knee Society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, the 36-Item Short-Form Health Survey (SF-36), postoperative complications, length of stay, and 90-day mortality after TKA were compared. The degree of improvement of each functional parameter was also assessed. RESULTS: There was no significant difference in the degree of improvement in postoperative ROM, flexion contracture, or KSS. There were only significant differences in length of hospital stay and volume of blood transfusion (p < 0.001 and p = 0.004, respectively). The octogenarian patient group showed significantly inferior outcomes for WOMAC and SF-36 score compared to the sexagenarian patient group (p = 0.009 and p = 0.022, respectively). CONCLUSION: Although the functional improvements after TKA were excellent regardless of age, TKA seemed to contribute little to quality of life in octogenarian patients. Therefore, a careful approach to improving satisfaction with subjective outcomes is needed for octogenarian patients who undergo TKA.

Dislocations after use of dual-mobility cups in cementless primary total hip arthroplasty: prospective multicentre series.

BACKGROUND: The purpose of this study was to investigate the incidence of dislocation and specific complications of the dual-mobility cup. METHODS: The arthroplasties involved 167 hips in 165 patients; 51 hips (30.5%) were in men and 116 (69.4%) were in women. The active articulation E1® dual-mobility cup (Biomet, Warsaw, IN, USA) was used, and the surgical approach was posterolateral in 120 hips and anterolateral in 47 hips. RESULTS: Four (2.3%) dislocations were observed. Mean time of dislocation was 30.5 days post-operatively. Three incomplete reductions occurred during closed reduction. When comparing parameters between dislocation and no-dislocation groups, there were no differences in patient and surgical parameters. However, all dislocations occurred in patients with femoral neck fractures and in the posterolateral approach group. CONCLUSION: The incidence of dislocation in total hip arthroplasty (THA) using a dual-mobility cup was acceptable, and cup diameter of the dislocation group was substantially larger than that of no-dislocation group. Based on clinical outcomes of our study, we conclude that the dual-mobility cup is a reliable option in THA, and further studies are necessary.

Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty-a multicentric analysis.

BACKGROUND: The objective of this study was to analyze the prevalence and causes of early re-operation after hip replacement surgery using short bone-preserving stems in a large multicentre series. Specifically, we evaluated the clinical features of periprosthetic fractures occurring around short stems. METHODS: A total of 897 patients (1089 hips) who underwent primary total hip arthroplasty or bipolar hemiarthroplasty from January 2011 to February 2015 using short bone-preserving femoral stems were recruited. Mean patient age was 57.4 years (range, 18-97 years), with a male ratio of 49.7% (541/1089). Re-operation for any reason within two years was used as an endpoint. The incidence and clinical characteristics of the periprosthetic femoral fractures were also recorded. Mean follow-up period was 5.1 years (range, 2-7.9 years). RESULTS: Early re-operation for any reason was identified in 16 (1.5%) of 1089 hips. The main reason for re-operation was periprosthetic femoral fracture, which accounted for eight (50%) of the 16 re-operations. The overall incidence of periprosthetic femoral fracture at two years was 1.1% (12/1089). According to the Vancouver classification, two fractures were AG type and the other ten were B1 type. Advanced age, higher American Society of Anesthesiologist grade, femur morphology of Dorr type C, and the use of a calcar-loading stem increased the risk for periprosthetic femoral fracture. CONCLUSION: Periprosthetic femoral fracture was the major reason for re-operation after hip replacement surgery using short bone-preserving stems accounting for 50% (8/16) of re-operations two years post-operatively, but did not seem to deteriorate survivorship of implanted prostheses.

Safety and efficacy of bi-annual intra-articular LBSA0103 injections in patients with knee osteoarthritis.

The objective of this study is to assess the safety and efficacy of repeated intra-articular injection of high molecular weight hyaluronic acid (LBSA0103) at a 26-week interval, in patients with osteoarthritis of the knee. The study was an open-label, single arm, multicentre prospective trial conducted in patients with symptomatic knee osteoarthritis. The intervention consisted of two intra-articular injections of LBSA0103, with the second injection performed 26 weeks after the first injection. The primary outcome was the incidence of adverse drug reactions related to each injection. Assessment of efficacy of repeated injections in terms of maintenance of pain relief was a secondary objective of this study. Of the 185 patients screened, 174 patients received the first injection and 153 patients received both injections of LBSA0103. Nine adverse drug reactions occurred in seven patients (4.02%) after the first injection, while only one adverse drug reaction occurred (0.65%) after the second injection. As a secondary outcome measure, the improvements in the efficacy parameters including total WOMAC score and weight-bearing pain were all significant at both week 13 and 39 compared to the baseline value (P < 0.001), and improvements after the second injection were consistent with those after the initial injection of LBSA0103 (between week 26 and week 39, P < 0.001). Repeated intra-articular injection of LBSA0103 at a 26-week interval is safe without increased risk of adverse drug reactions. Additionally, LBSA0103 is effective in reduction of osteoarthritis knee pain and in maintenance of pain reduction for a 39-week period when a second injection is administered.

Efficacy and safety of single injection of cross-linked sodium hyaluronate vs. three injections of high molecular weight sodium hyaluronate for osteoarthritis of the knee: a double-blind, randomized, multi-center, non-inferiority study.

BACKGROUND: This randomized, double-blind, multi-center, non-inferiority trial was conducted to assess the efficacy and safety of a cross-linked hyaluronate (XLHA, single injection form) compared with a linear high molecular hyaluronate (HMWHA, thrice injection form) in patients with symptomatic knee osteoarthritis. METHODS: Two hundred eighty seven patients with osteoarthritis (Kellgren-Lawrence grade I to III) were randomized to each group. Three weekly injections were given in both groups but two times of saline injections preceded XLHA injection to maintain double-blindness. Primary endpoint was the change of weight-bearing pain (WBP) at 12 weeks after the last injection. Secondary endpoints included Western Ontario and McMaster Universities Osteoarthritis index; patient's and investigator's global assessment; pain at rest, at night, or in motion; OMERACT-OARSI responder rate; proportion of patients achieving at least 20 mm or 40% decrease in WBP; and rate of rescue medicine use and its total consumption. RESULTS: Mean changes of WBP at 12 weeks after the last injection were -33.3 mm with XLHA and -29.2 mm with HMWHA, proving non-inferiority of XLHA to HMWHA as the lower bound of 95% CI (-1.9 mm, 10.1 mm) was well above the predefined margin (-10 mm). There were no significant between-group differences in all secondary endpoints. Injection site pain was the most common adverse event and no remarkable safety issue was identified. CONCLUSIONS: This study demonstrated that a single injection of XLHA was non-inferior to three weekly injections of HMWHA in terms of WBP reduction, and supports XLHA as an effective and safe treatment for knee osteoarthritis. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01510535 ). This trial was registered on January 6, 2012.

Open-wedge high tibial osteotomy versus unicompartmental knee arthroplasty: no difference in progression of patellofemoral joint arthritis.

PURPOSE: The purpose of this retrospective comparative study was to evaluate and compare, radiographically and clinically, progression of osteoarthritis (OA) in the patellofemoral (PF) compartment after open-wedge high tibial osteotomy (OWHTO), and unicompartmental knee arthroplasty (UKA) over a minimum follow-up of 5 years. METHODS: In this study, 42 knees in an OWHTO group were compared with 59 knees in a UKA group in terms of radiographic parameters, such as the grading system for OA progression in the PF compartment, and clinical parameters, such as the PF pain and function scores over a minimum follow-up of 5 years. RESULTS: There was no significant difference of OA progression in the PF compartment between the two groups on knee radiography. Compared with the preoperative grades, the UKA group showed significant progression of OA in the medial PF compartment at the final follow-up, whereas the medial PF compartment showed significant stepwise progression by only one grade when compared to the OWHTO group. The PF pain and function scores showed no statistical differences between the two groups at the final follow-up, regardless of OA progression. CONCLUSIONS: There was no significant difference between OWHTO and UKA in terms of progression of OA in the PF compartment or deterioration of PF function score over a minimum follow-up of 5 years. However, the medial PF compartment of the UKA group was minimal, and worsened or progressed by only one grade. LEVEL OF EVIDENCE: III.

Comparison of osteoconductivity and absorbability of beta-tricalcium phosphate and hydroxyapatite in clinical scenario of opening wedge high tibial osteotomy.

The purpose of this study was to compare the osteoconductivity, and absorbability of hydroxyapatite or beta-tricalcium phosphate in clinical scenario of opening wedge high tibial osteotomy Total 41 knees of 40 patients with follow up period of more than 1 year were enrolled. These patients were divided into two groups, Group I (22 knees, 21 patients) used hydroxyapatite and Group II (19 knees, 19 patients) used beta-tricalcium phosphate as a substitute in the opening gap. According to proven method, the osteoconductivity was assessed radiographically by the extent of new bone formation at osteotomy space and absorbability was evaluated by measuring the area occupied by substitute at immediate postoperative, postoperative 6 months and 1 year. Regarding preoperative demographic data, no significant differences were found between two groups. No statistically significant differences were found between two groups regarding lower limb alignment (mechanical femorotibial angle, weight-bearing line%) and posterior tibial slope at postoperative and final follow up radiographs. Concerning the osteoconductivity, there were no significant differences between two groups in any zone. However, the absorption rate was significantly greater in the Group II than in Group I at 6 months (Group I: 13.7 ± 6.8, group II: 35.3 ± 15.8, P = 0.001) and 1 year (Group I: 24.2 ± 6.3, Group II: 49.6 ± 14.3, P < 0.0001). The complications related to bone substitutes were not observed. Both hydroxyapatite and beta-tricalcium phosphate showed satisfactory gap healing without complications and can be successfully used as alternative healing materials in opening wedge high tibial osteotomy. Our study showed that beta-tricalcium phosphate has superior absorbability than hydroxyapatite. But osteoconductivity showed no significant difference.

Computer navigation is effective in reducing blood loss but has no effect on transfusion requirement following primary total knee arthroplasty: a meta-analysis.

PURPOSE: This meta-analysis was designed to evaluate the effects of computer navigation on blood conservation after total knee arthroplasty (TKA) by comparing postoperative blood loss and need for allogenic blood transfusion in patients undergoing computer navigation and conventional primary TKAs. METHODS: Studies were included in this meta-analysis if they compared change in haemoglobin concentration before and after surgery, postoperative blood loss via drainage or calculated total blood loss, and/or allogenic blood transfusion rate following TKA using computer navigation and conventional methods. For all comparisons, odds ratios and 95 % confidence intervals (CI) were calculated for binary outcomes, while mean difference and 95 % CI were calculated for continuous outcomes. RESULTS: Twelve studies were included in this meta-analysis. The change in haemoglobin concentration was 0.39 g/dl lower with computer navigation than with conventional TKA (P = 0.006). Blood loss via drainage was 83.1 ml (P = 0.03) lower and calculated blood loss was 185.4 ml (P = 0.002) lower with computer navigation than with conventional TKA. However, the need for blood transfusion was similar for the two approaches (n.s.). CONCLUSIONS: The primary TKA with computer navigation was effective in reducing haemoglobin loss and blood loss, but had no effect on transfusion requirement, compared with conventional primary TKA. These findings suggest the importance of analysing several blood loss parameters, because each may not always accurately reflect true postsurgical bleeding. LEVEL OF EVIDENCE: Meta-analysis, Level III.

Does patella position influence ligament balancing in total knee arthroplasty?

PURPOSE: In vivo comparative gap measurements were performed in three different patella positions (reduced, subluxated and everted) using offset-type-force-controlled-spreader-system. METHODS: Prospectively, 50 knees were operated by total knee arthroplasty using a navigation-assisted gap-balancing technique. The offset-type-force-controlled-spreader-system was used for gap measurements. This commercially available instrument allows controllable tension in patella-reduced position. The mediolateral gaps of knee extension (0°) and flexion (90°) angle were recorded in three different patella positions; reduced, subluxated and everted. Any gap differences of more than 3 mm were considered as a meaningful difference. Correlation between the difference with the demographic data, preoperative radiologic alignment and intraoperative data was analysed. For statistical analysis, ANOVA and Pearson's correlation test were used. RESULTS: The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Statistically significant difference was observed for the lateral gap of patella eversion compared to gap of patella reduction in knee flexion position (p < 0.05). There were notable cases of variability in knee flexion position. Significant portion of 12 (24 %) knees of patella subluxation and 33 (66 %) knees of patella evertion demonstrated either increased or decreased gaps in knee flexion position compared to the gaps of patella reduction position. CONCLUSION: The gaps in patella eversion demonstrated smaller gaps both in knee extension and flexion position compared to the gaps of patella reduction position. The amount of decreased gaps was more definite in knee flexion position. Therefore, the intraoperative patellar positioning has influence on the measurement of the joint gap. Keeping the patella in reduced position is important during gap balancing. LEVEL OF EVIDENCE: I.

Current status of second-look arthroscopy after meniscal allograft transplantation: review of the literature.

INTRODUCTION: Clinical assessments do not accurately reflect the status of meniscal transplants and cannot evaluate the graft condition itself and joint preservation effects of meniscal allograft transplantation correctly. The purpose of this review was to assess the need and to ascertain the indication and the role of second-look arthroscopy for objective evaluation after MAT. MATERIALS AND METHODS: We performed a literature search to identify all published clinical studies on MAT with the following medical subject heading (MeSH) terms: "meniscus," "meniscal transplant," "transplantation and allograft," "meniscal and transplant." Include in the review are studies with at least 6 months clinical, radiological, and/or histological follow-up in human subjects. Evaluation method of MAT was reviewed with an aim to describe the frequency of second-look arthroscopy, its feasibility, patient compliance, purposes, and results. RESULTS: We identified 15 clinical studies that satisfied our inclusion and exclusion criteria. Only two studies always performed second-look arthroscopies. Most of the second-look arthroscopy was conducted mainly for the objective evaluation of meniscal allograft transplantation but, in several studies, arthroscopy was performed to treatment of other knee problem. CONCLUSIONS: Although second-look arthroscopy has inevitably ethical issues, especially for asymptomatic and well-functioning knees, in this review, it could be a more dependable method available to detect meniscal healing if performed for certain indications such as a symptomatic patient with a magnetic resonance image indicating abnormalities.

Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty.

PURPOSE: Open debridement with prosthesis retention (ODPR) has been considered as a reasonable treatment option for acute periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). However, multiple recent studies have challenged this contention. This study was undertaken to determine the success rate of ODPR, whether the success rate was affected by the ODPR timing or by the microorganisms. METHOD: We retrospectively reviewed 52 cases of ODPR performed in four institutions to treat acute PJI which met the definition of PJI by the International Consensus Group on PJI. We recorded patient demographics; time from index TKA and symptom duration; the microorganisms involved; and whether the infection was controlled or not. RESULTS: The overall success rate of ODPR was 71 %, and early postoperative infection and acute hematogenous infection had a success rate of 82 and 55 %, respectively. Success rate was associated with a shorter symptom duration in patients with acute hematogenous infections (p = 0.040). However, success was not influenced by the type (p = 0.992) or virulence of the causative microorganisms (p = 0.706). CONCLUSION: ODPR should be considered as a viable treatment option for acute PJI following TKA. The promptness of ODPR is of paramount importance for success of ODPR, rather than the causative organism type or virulence.

The effects of weight-bearing conditions on patellofemoral indices in individuals without and with patellofemoral pain syndrome.

OBJECTIVE: The purpose of this study is to evaluate differences between the patellofemoral joint indices after supine, non-weight-bearing and standing position, and weight-bearing Merchant view radiographs in individuals without and with patellofemoral pain syndrome (PFPS). MATERIALS AND METHODS: Radiographs of 44 knees without PFPS and 51 knees with PFPS were retrospectively evaluated. In both positions, the non-weight-bearing and weight-bearing Merchant views, patellar indices such as patellar tilt angle, lateral patellofemoral angle, lateral subluxation distance, lateral patellar displacement, and congruence angle were measured, respectively. The differences between the patellofemoral joint indices in knees with and without PFPS were analyzed using univariate and multivariate regression analysis, in regards to correlation factors. RESULTS: The patellar tilt angle (p = 0.0002), lateral subluxation distance (p = 0.038), lateral patellar displacement (p = 0.0004), and congruence angle (p < 0.0001) on the weight-bearing Merchant view was significantly decreased in normal knees without PFPS. In pathologic knees with PFPS, the patellar tilt angle (p < 0.0001), lateral subluxation distance (p < 0.0001), lateral patella displacement (p < 0.0001), and congruence angle (p < 0.0001) on weight-bearing Merchant view was also significantly decreased. The difference between the patellofemoral indices was significantly more in knees specifically with PFPS (p < 0.05). CONCLUSIONS: These results suggest that patellofemoral indices measured during non-weight-bearing supine position do not sufficiently represent the patellofemoral kinematics during normal weight-bearing activities. We conclude that this study establishes the clinical significance and relevance of assessing the patellofemoral kinematics by weight-bearing, standing Merchant view radiographs, when evaluating patients with patellofemoral problems.

In vivo gap analysis in various knee flexion angles during navigation-assisted total knee arthroplasty.

Achieving rectangular flexion and extension gaps is important during gap balancing technique in total knee arthroplasty (TKA). However, assessment of gaps throughout the range of knee motion is obscure. One hundred knees operated by TKA using a navigation-assisted gap balancing technique were evaluated. Intraoperatively, after achieving rectangular flexion and extension gaps, mediolateral gaps in each flexion angle (0°, 45°, 90°, 120°) were recorded. Patients were divided into 4 groups; Group I: no gap difference (n = 64), Group II: lax in midflexion (n = 20), Group III: lax in deep flexion (n = 8) and Group IV: lax in both midflexion and deep flexion (n = 8). This study demonstrated that significant proportion (36%) of TKA cases had laxity in midflexion (45°) even when rectangular extension (0°)-flexion (90°) gap was achieved.

Versatile application of short stem during total hip arthroplasty.

Total hip arthroplasty (THA) is one of the most commonly performed orthopedic surgery worldwide. Current research and development had improved the designs of modern total hip prosthesis. Although long femoral stems are widely used, short stems are thought to preserve more native host bone and optimize proximal load transfer utilized with the advent of less invasive surgery. Modular short femoral stems in THA may have versatile applicability by virtue of their unique geometry, mechanism of fixation, and modularity. In this report, we present two unique case scenarios where the use of short stems has given successful results.

Prospective, randomized study between Insall-Burstein II and NexGen legacy with a minimum 9-year follow-up.

A randomized, prospective, comparative study was performed in 2 related, adjacent generation posterior stabilized total knee prostheses, to evaluate whether the newer design improved the clinical and radiographic outcome for treatment of advanced osteoarthritis of the knee. Ninety one total knee arthroplasties in 84 patients (45 Insall-Burstein II and 46 NexGen Legacy posterior stabilized [both from Zimmer, Warsaw, Ind] prostheses) with an average of 10.3 years of follow-up (range, 9-11.8 years) were included. The preoperative diagnoses were primary osteoarthritis in all patients. At the latest evaluation, there were no significant differences detected in the mean clinical and functional knee scores, average postoperative active range of motion, and anterior knee pain between the Insall-Burstein II and the NexGen Legacy groups postoperatively.

Dual mobility articulation total hip arthroplasty for displaced neck fracture in elderly with neuromuscular disorder.

PURPOSE: Neuromuscular disease is well known to be at increased risk of complications following hip replacement surgeries. This study is prospectively conducted to investigate clinical performance and survivorship of total hip arthroplasty (THA) using dual mobility articulation in femoral neck fractures of elderly with neuromuscular disease. MATERIALS AND METHODS: We prospectively enrolled 162 patients (162 hips) with displaced femoral neck fracture who gave informed consent for dual mobility articulation THA. Of the 162 patients, 35 patients had neuromuscular disease including cerebral palsy, poliomyelitis, hemiplegia, and Parkinson disease (NM group). The other 127 patients had no history of neuromuscular disease (non-NM group). The mean age was 76.5 years (range, 60 - 95) and female ratio was 71.0% (115/162). Clinical outcomes including Harris hip score (HHS), University of California Los Angles activity (UCLA) score were compared between the two groups. Computed tomography and serial radiographs were obtained after surgery. Postoperative complications and reoperation including revision were recorded. RESULTS: Pain-VAS and all clinical scores of the NM group were comparable to those of the non-NM group. The incidence of dislocation in the NM group did not differ from that in Non-NM group (2/35, 5.7% versus 5/127, 3.9%, p = 0.645). Reoperation was performed in 3 hips (3/35, 8.6%) of the NM group and in 4 hips (4/127, 3.1%) of the non-NM group (p = 0.173). Kaplan-Meier survivorship with an end point of revision for any reason was 97.1% (95% confidence interval [CI], 0.92 to 1.03) in the NM group and 98.4% (95% CI, 0.96 to 1.01) in the non-NM group at 7.3 years after surgery. CONCLUSIONS: In elderly with neuromuscular disease, THA with dual mobility articulation is a reasonable option as a treatment for femoral neck fractures.

Intra-articular Injection of Type I Atelocollagen to Alleviate Knee Pain: A Double-Blind, Randomized Controlled Trial.

OBJECTIVE: Collagen disruption is one of the underlying causes of knee pain in patients with osteoarthritis and/or diverse cartilage defects. Atelocollagen is a type of collagen that lacks telopeptides and thus has reduced antigenicity. The intra-articular injection of type I atelocollagen supplements collagen levels in the disrupted articular cartilage. This randomized controlled trial evaluated the effects of the intra-articular injection of atelocollagen for the management of knee pain. DESIGN: Two hundred patients with osteoarthritis, chondromalacia, or other cartilage defects were randomly assigned to receive a 3-mL intra-articular injection of atelocollagen (BioCollagen group) or saline (Placebo group). Clinical improvement was evaluated over a 24-week period using the 100-mm visual analogue scale (VAS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the 36-item Short-Form Health Survey (SF-36). RESULTS: VAS scores were significantly better in the BioCollagen group as compared with the Placebo group at 24 weeks. More patients in the BioCollagen group reported exceeding 20% and 40% VAS improvements. The WOMAC and SF-36 scores were also significantly improved from baseline after the intra-articular injection of atelocollagen; although, the differences between the BioCollagen and Placebo groups were not significant. There were no unexpected or severe adverse events reported for either group. CONCLUSIONS: The results show that an intra-articular injection of atelocollagen effectively alleviates knee pain, as intended. Therefore, the intra-articular injection of atelocollagen can be considered an alternative solution to controlling knee pain due to osteoarthritis and diverse cartilage defects.

Percutaneous screw fixation of acetabular fractures: applicability of hip arthroscopy.

Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy and a risk of intra-articular penetration. Evidence is lacking for any tools to provide visual scrutiny of fracture reduction and intra-articular screw penetration. We report 2 cases of fracture of the acetabulum that developed in young female athletes, in which the anterior column was fixed with a percutaneous screw by use of hip arthroscopy as an assisting tool for intra-articular observation. In our experience this method was found to be promising in terms of anatomic reduction of the fracture site, avoiding articular penetration during screw insertion, with additional advantages of joint debridement, lavage, and reduction in radiation exposure.