No differences in clinical and radiographic outcomes between standard versus high offset collared stems for primary total hip arthroplasty at five years follow-up.

PURPOSE: To compare clinical and radiographic outcomes of propensity-matched patients undergoing THA using standard versus high offset stems at five years. METHODS: The authors retrospectively reviewed a consecutive series of primary THAs performed between 01/09/2015-31/12/2017 using a fully-hydroxyapatite coated collared stem, with either a standard (n = 365) or high (n = 110) offset. Outcomes collected included: modified Harris Hip Score (mHHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and radiographic measurements including limb length discrepancy (LLD), stem subsidence, and stem radiolucencies. RESULTS: Propensity score matching resulted in 80 hips per group. Preoperatively there were no significant differences in patient demographics, surgical data and radiographic measurements, except the standard offset group had significantly smaller femoral (40.0 ± 7.5 vs 48.4 ± 6.2, p < 0.001), acetabular (92. ± 6.3 vs 94.8 ± 7.3, p = 0.011) and global (132.0 ± 10.3 vs 143.2 ± 8.2, p < 0.001) offsets compared to the high offset group. At a minimum five years follow-up, there were no significant differences in mHHS (93.2 ± 11.0 vs 93.1 ± 10.6, p = 0.553), OHS (45.1 ± 4.1 vs 45.3 ± 4.6, p = 0.623), and FJS (85.1 ± 19.3 vs 82.7 ± 23.0, p = 0.910). There were also no differences in radiographic measurements, including LLD (1.5 ± 4.8 vs 1.1 ± 3.5, p = 0.537), stem subsidence (0% vs 0%, p = 1.000), and stem radiolucencies (severe: 6% vs 1%, p = 0.152). CONCLUSION: The present matched-cohort study found no significant differences between standard versus high offset straight fully-hydroxyapatite coated collared stems for primary THA in terms of clinical and radiographic outcomes at five years. These findings may suggest that uncemented collared high offset stems are not associated with an increased risk of radiolucencies and loosening compared to uncemented collared standard offset stems.

Effect of duration of preoperative pain on outcomes of total temporomandibular joint replacement.

The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (ß = -0.27; 95% CI -0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.

Epidemiology of Musculoskeletal Injuries in Tennis Players During the French Open Grand Slam Tournament From 2011 to 2022.

Background: The epidemiology of musculoskeletal injuries at the Australian Open, Wimbledon, and US Open tennis tournaments has been investigated in recent studies; however, there is no published literature on the incidence of musculoskeletal injuries at the French Open. Purpose: To describe the incidence, location, and type of musculoskeletal injuries in tennis players during the French Open tournament from 2011 to 2022. Study Design: Descriptive epidemiology study. Methods: A review was performed of all injuries documented by a multidisciplinary medical team during the French Open from 2011 to 2022. All musculoskeletal injuries that occurred during the main draw of the female and male singles or doubles matches were included. Descriptive statistics were used to summarize the data. Injury locations were grouped into regions as well as into upper limb, trunk, and lower limb. Results: In total, there were 750 injuries in 687 tennis players, resulting in a mean of 62.5 injuries per tournament; however, there were no obvious trends in injury incidence over the time frame evaluated. The number of injuries in female and male players was similar (392 vs 358, respectively). The most common injury regions were the thigh/hip/pelvis (n = 156), ankle/foot (n = 114), and spine (n = 103). The most common injury types were muscle-related (n = 244), tendon-related (n = 207), and joint-related (n = 163), and the most affected muscles were the adductors (n = 45), rectus abdominis (n = 38), and lumbar muscles (n = 25). Conclusion: Over the 12-year period from 2011 to 2022 female and male players experienced similar numbers of musculoskeletal injuries, with most injuries occurring in the lower limbs compared with the upper limbs and trunk.

Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis.

Purpose: to systematically review comparative studies reporting revision rates, clinical outcomes, or radiographic outcomes of total hip arthroplasty (THA) using collared versus collarless conventional-length uncemented hydroxyapatite (HA)-coated stems. Methods: In adherence with PRISMA guidelines, a literature search was performed on Medline, Embase, and Scopus. Comparative clinical studies were eligible if they reported outcomes of collared versus collarless uncemented HA-coated stems for primary THA. Two reviewers screened titles, abstracts, and full-texts to determine eligibility; then performed data extraction; and assessed the quality of studies according to Joanna Briggs Institute (JBI) checklist. Results: The search returned 972 records, 486 were duplicates, and 479 were excluded after title/abstract/full-text screening. Three further studies were included from the references of eligible studies and from discussions with subject matter experts, resulting in 11 included studies. The JBI checklist indicated six studies scored ≥7 points and four studies ≥4 points. Pooled data revealed collared stems had significantly lower revision rates (OR = 0.45; 95% CI = 0.31-0.64) and subsidence (MD = -1 mm; 95% CI = -1.6--0.3), but no significant difference in intraoperative complication rates (OR = 0.94; 95% CI = 0.67-1.32) in the short term to mid-term. Unpooled data indicated that collared stems provide equivalent survival, equivalent or better outcomes, and equivalent or lower complication rates. Conclusion: In comparative studies, collared stems have lower revision rates than collarless stems, as well as equivalent or better clinical and radiographic outcomes. Differences could be due to a protective effect that the collar offers against subsidence, particularly in undersized or misaligned stems. Further studies are warranted to confirm long-term results and better understand differences between registry data and clinical studies.