Rate of revision and wear penetration in different polyethylene liner compositions in total hip arthroplasty: a Bayesian network meta-analysis.

The present Bayesian network meta-analysis compared different types of polyethylene liners in total hip arthroplasty (THA) in terms of wear penetration (mm/year) and rate of revision. The type of liners compared were the crosslinked ultra-high molecular weight polyethylene (CPE/UHMWPE), Vitamin E infused highly cross-linked polyethylene (HXLPE-VEPE), modified cross-linked polyethylene (MXLPE), highly cross-linked polyethylene (HXLPE), Cross-linked polyethylene (XLPE). This study was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. In June 2024, PubMed, Scopus, Embase, Google Scholar, and Cochrane databases were accessed. A time constraint was set from January 2000. All investigations which compared two or more types of polyethylene liners for THA were accessed. Only studies that clearly stated the nature of the liner were included. Data from 60 studies (37,352 THAs) were collected. 56% of patients were women. The mean age of patients was 60.0 ± 6.6 years, the mean BMI was 27.5 ± 2.0 kg/m2. The mean length of follow-up was 81.6 ± 44.4 months. Comparability was found at baseline between groups. XLPE and HXLPE liners in THA are associated with the lowest wear penetration (mm/year) and the lowest revision rate at approximately 7 years of follow-up.

Return-to-sports criteria used by professional team physicians in elite athletes after hip arthroscopy - a qualitative study.

OBJECTIVES: The purpose of this study was to explore currently utilized readiness to Return to Sport (RTS) criteria after Hip Arthroscopy (HA) used in elite athletes to gain novel insights into the RTS decision-making process of professional team physicians. The authors hypothesized that even among this group of highly specialized physicians, there exists variability of measures and criteria used to determine RTS after HA. METHODS: A total of 15 qualitative semi-structured interviews with professional team physicians were conducted by a single trained interviewer. The interviews were used to identify team physician concepts and themes regarding the criteria used to determine RTS after HA. Themes and sub-themes were identified using a general inductive analysis and a coding process. A hierarchical approach in coding helped to link themes. RESULTS: Four key themes and several subordinate themes were identified from the interviews that seem to influence the return to sports decision. The most important RTS criteria were muscle strength (especially symmetric hip strength and muscle bulk with low side-to-side variance compared to the contralateral side) followed by pain-free sport-specific activity (pain-free drill skills and play at a lower level), physical examination (with major emphasis on the absence of hip pain with a painless hip range of motion compared to the contralateral side), and functional testing (including full squats, Ober test, FABER test, and pain-free FADIR position). CONCLUSION: Besides objective findings, including muscle strength, we identified time after surgery as well as subjective findings, including absence of pain and feedback of clinical team members that influence RTS decision after HA. We showed that even among specialized professional team physicians, the main criteria to RTS in these categories were not consistent necessitating the further development of specific RTS guidelines.

Incidental findings are frequent in shoulder CT and MRI scans and increase with age.

Objectives: CT and MRI scans of the shoulder can lead to the identification of incidental findings (IF), which can have a major impact on the further treatment of the patient. The aim of this retrospective study was to record the prevalence of IF, incidentalomas (IT) and malignant IT for CT and MRI examinations of the shoulder and to investigate the effect of patient characteristics on the statistical occurrence of IF, IT and malignant IT. Materials and methods: A total of 903 shoulder examinations (415 CT, 488 MRI) were retrospectively analyzed for the presence of IF, subsequently categorized (harmless IF, IT requiring clarification, malignant IT) and analyzed regarding patient characteristics. The statistical analysis was carried out using independent t- and chi-square tests. A significance level of p < 0.05 was set. Results: Among the 903 patients evaluated (436 female, 467 male), 153 (16.9%) patients experienced IF (harmless IF: 101 (11.2%) patients, IT: 94 (10.4%), malignant IT: 4 (0.4%). The average age of the patients without IF and IT was significantly lower compared to the patients with IF and IT (p < 0.001). While IF occurred in 31.1% of the CT, IF was only detected in 4.9% of the MRI (p < 0.001). Conclusion: IF have a high prevalence (16.9%), especially in CT examinations of the shoulder, which increases with age. The exact detection and initiation of appropriate therapy is of great clinical importance, as early detection of life-threatening diseases enables more effective treatment and a potential gain in health and lifespan.

Comparison of In Vivo Stiffness of Tendons Commonly Used for Anterior Cruciate Ligament Reconstruction - A Shear Wave Elastography Study.

RATIONALE AND OBJECTIVES: There are currently no studies investigating the in vivo stiffness of the most commonly used autografts for anterior cruciate ligament reconstruction (ACLR) using Shear wave elastography (SWE). We hypothesize that there are differences regarding the elastic properties between the three tendons commonly used for ACLR and that they are influenced by patient-related factors. MATERIALS AND METHODS: 80 healthy subjects (25 females, 55 males, age: 25.33 ± 4.76 years, BMI: 23.76 ± 3.14 kg/m2, 40 semiprofessional athletes, athlete group [AG], age: 25.51 [19-29]; 40 healthy controls, control group [CG], age: 25.50 [20-29]) were recruited as participants. In addition to patient reported outcome scores, every participant underwent a standardized multimodal ultrasound protocol consisting of B-mode-ultrasound (B-US), Color Doppler-ultrasound (CD-US) and a SWE examination of the bilateral quadriceps tendon (QT), patellar tendon (PT) and semitendinosus tendon (ST). RESULTS: The highest shear wave velocity (SWV) were observed in ST (4.88 (4.35-5.52) m/s, ST vs QT, p = 0.005; ST vs PT, p < 0.001) followed by QT (4.61 (4.13-5.26) m/s, QT vs PT, p < 0.001) and PT (3.73 (3.30-4.68) m/s). Median QT, PT and ST stiffness was significantly higher in AG compared to CG. Male subjects tend to have stiffer QT and PT than female subjects. Positive correlation with SWV was obtained for age and activity level. CONCLUSION: There are significant differences regarding in vivo tendon stiffness between the most frequently used autograft tendon options for ACLR. The quantitative information obtained by SWE could be of particular interest for graft choice for ACLR.