Osteoarthritis of the coxofemoral joint in 24 horses: Evaluation of radiography, ultrasonography, intra-articular anaesthesia, treatment and outcome.

BACKGROUND: Few case reports describe equine coxofemoral joint osteoarthritis (CFJOA). OBJECTIVES: To evaluate diagnostic findings and outcome of horses with CFJOA and to provide a score facilitating radiographic assessment. STUDY DESIGN: Retrospective case series. METHODS: History, clinical signs, ultrasonographic, radiographic and intra-articular anaesthesia findings, treatments, outcome, and necropsy results of horses with CFJOA presented between 2002 and 2023 were collated. Radiographic findings were categorised to develop a radiographic score which was applied by two masked examiners. Intra- and inter-observer reliability was determined using weighted Cohen's kappa (Cκ) and the correlation between radiographic and ultrasound findings via Spearman correlation coefficient. RESULTS: The study included 24 horses (median age 14 years). Most of them (20/24) were chronically lame. Frequent clinical signs included unilateral gluteal muscle atrophy (18/21), lengthening of the stride of the affected limb (13/19) and locomotion on three tracks (13/20). Both imaging modalities enabled evaluation of periarticular osteophytes (correlation coefficient r = 0.64; p = 0.003). Additionally, radiography allowed detection of irregular joint spaces, subchondral bone opacity changes and femoral head flattening/tapering. Inter-observer (Cκ = 0.846) and intra-observer (Cκ = 0.853 and Cκ = 0.842) agreement was excellent. If treated, mostly intra-articular corticosteroids were administered (16/18). Nine horses were euthanised immediately or during follow-up examination. Post-mortem, the Ligamentum capitis ossis femoris was commonly found ruptured. All surviving horses remained lame. MAIN LIMITATIONS: Retrospective analysis of clinical records and subjective outcome assessment based on owner follow-up with potential recall bias. Due to overall disease severity, associations between different grades of clinical findings, radiographic abnormalities and outcome could not be evaluated. CONCLUSIONS: Typical clinical signs may indicate CFJOA. Standardised evaluation of ventrodorsal radiographs allows a comprehensive diagnosis. Postmortem findings suggest joint instability as a possible causative factor that may contribute to the poor prognosis and resistance to medical therapy of the disorder.

Investigating sagittal spinopelvic alignment and equivalent stress on the femoral head in patients with rapidly destructive coxarthrosis.

PURPOSE: Rapidly destructive coxarthrosis (RDC) is a rare syndrome of unknown etiology. This study evaluated sagittal spinopelvic alignment (SSPA) in patients with RDC and compared it with that in patients with hip osteoarthritis (HOA). In addition, finite element analysis (FEA) was performed to investigate the distribution of stress on the femoral head in RDC versus HOA. METHODS: This retrospective study included patients who had undergone primary total hip arthroplasty for RDC (n = 33) and HOA (n = 99; age- and sex-matched to patients with RDC) at three hospitals from June 2014 to September 2020. Preoperative SSPA parameters and inflammatory blood markers were compared between the two groups. FEA on the computed tomography data was performed for four patients from each group with similar pelvic tilt (PT) and lateral center-edge angle (LCEA). The distribution of Drucker-Prager equivalent stress was assessed at the loaded area of the femoral head. RESULTS: Patients with RDC had significantly higher PT, lower sacral slope, decreased lumbar lordosis (LL), higher sagittal vertical axis, and higher pelvic incidence minus LL than patients with HOA, indicating sagittal spinal imbalance. Blood test revealed patients with RDC had higher levels of inflammation markers than patients with HOA. FEA revealed no statistically significant difference in the degree of stress concentration or the maximum equivalent stress between the two groups when PT and LCEA were comparable. CONCLUSION: Patients with RDC tend to have sagittally imbalanced spine. Decreased acetabular coverage of the femoral head may heighten mechanical load of the hip joint in patients with RDC.

Increased bone resorption that outpaces increased bone formation: An important pathology of rapidly destructive coxarthrosis.

Rapid joint destruction caused by rapidly destructive coxarthrosis (RDC) can increase surgical complexity and intraoperative blood loss. This single-center retrospective study investigates osteoporosis-related biomarkers for early RDC diagnosis and explores new treatment targets. We included 398 hip joints from patients who underwent total hip arthroplasty, examining medical records for preoperative patient demographics, bone mineral density of the hip and lumbar spine from dual-energy X-ray absorptiometry scans, and osteoporosis-related biomarkers including TRACP-5b, total P1NP, intact parathyroid hormone, and homocysteine. We compared RDC and osteoarthritis (OA) patients, and univariate analysis showed that RDC patients were older (p < 0.001) and had lower serum levels of albumin (p < 0.001) and higher serum levels of TRACP-5b, total P1NP (p < 0.001), and homocysteine (p = 0.006). Multivariable analysis showed that the ratio of serum TRACP-5b to total P1NP had a more significant difference in RDC patients than in OA patients (p = 0.04). Serum TRACP-5b levels were negatively correlated with the time between RDC onset and blood collection, and Japanese Orthopedic Association pain score. Receiver operating characteristic curve analysis revealed that the ratio of serum TRACP-5b to total P1NP had the highest area under the curve value. This study is the first to demonstrate that the ratio of serum TRACP-5b to total P1NP-increased bone resorption that outpaces increased bone formation-is significantly elevated in patients with RDC and that TRACP-5b is higher in the early stages of RDC. Inhibiting serum levels of TRACP-5b, activated osteoclasts, during early RDC may suppress disease progression.

Autologous point-of-care stromal vascular fraction transplantation in dogs with advanced osteoarthritis of the knee and hip joints.

OBJECTIVE: The aim of the study was to assess lameness in dogs with advanced osteoarthritis of the hip and knee joints after a single autologous point-of-care transplantation of the Stromal Vascular Fraction (SVF) into the affected joint. MATERIALS AND METHODS: During a minilaparotomy, 10 g of falciform fat was removed from each patient for each joint to be treated. A modern and time-saving procedure (ARC TM System, InGeneron GmbH, Houston, USA) was used for the in-house preparation of the SVF, so that the isolated cells could be applied to the respective joint within 2 h after fat removal. In total, five knee joints of five patients and seven hip joints of four patients were treated. RESULTS: Improvement in lameness according to owner questionnaires was seen in 3 of 5 patients with knee joint arthritis and 2 of 4 patients with hip joint arthritis. Based on gait analysis, only one dog with gonarthrosis and one dog with coxarthrosis showed improvement up to a maximum of 3 months after surgery. CONCLUSION: This is the first case series on the treatment of osteoarthrosis of the knee or hip joint using point-of-care transplantation of the SVF. In individual cases, this method may represent a therapeutic approach for the treatment in dogs with advanced cox- or gonarthrosis, although only a short-term effect can be expected, which calls into question the effort and costs involved.

Relevant Predictors in the Association Between Patients' Functional Status and Scar Outcomes After Total Hip Arthroplasty.

BACKGROUND: We aimed to investigate the relevant predictors in the association between the functional status and the consequences of the persistence of scars in patients with traumatic versus non-traumatic coxarthrosis after total hip arthroplasty (THA). METHODS: A total of 203 patients undergoing THA after traumatic or non-traumatic coxarthrosis were asked to complete the Mekeres' Psychosocial Internalization Scale (MPIS), in which they self-evaluated on a Likert scale (between one and five) by selecting the rating that corresponded to their personal opinion and the activities of daily living (ADL) form at six months postoperative. The statistical data were processed using the IBM SPSS Statistics software version 22.0 (IBM Corp., Armonk, NY). A combined assessment of the internalization of scars using MPIS and ADL forms after THA allowed for the identification of relevant predictors of the quality of life six months post-surgery in patients with traumatic or non-traumatic coxarthrosis. RESULTS: Depending on the coxarthrosis etiology (traumatic or non-traumatic), the results were further processed by a univariate ANOVA, considering the independent variables represented by symptoms, the number of surgical procedures, and the postoperative evolution, which are acting on the outcomes of physical functioning (the dependent variable) in the postoperative phase. In the case of the traumatic group, our results suggest that the number of surgical interventions, the ability to internalize scars, and autonomy in terms of body care are predictors of the quality of life. In patients with non-traumatic coxarthrosis, an important role in predicting quality of life is played by the administered treatment and the ability to maintain their autonomy regarding self-hygiene six months post-surgery. CONCLUSIONS: The predictive regression equation suggests that the quality of life in patients with traumatic coxarthrosis can be predicted by the number of surgical interventions, the administered treatment, the ability to internalize scars, and the autonomy regarding body care activities. On the other hand, for patients with non-traumatic coxarthrosis, an important role in predicting the quality of life is played by the treatment and the ability to maintain autonomy in terms of body hygiene activities.

Management and Treatment of Coxarthrosis in the Orthopedic Outpatient Clinic.

Coxarthrosis, or hip osteoarthritis (OA), is one of the main causes of hip pain, which can affect patients of all ages, being one of the most common reasons for patients presenting to the specialized outpatient clinic. The objective of our research was to determine the number of patients with coxarthrosis who presented to the Department of Orthopaedics and Traumatology within the Emergency County Hospital of Drobeta Turnu Severin, between 2017-2019, the sex, age, social environment of the patients. All patients underwent a thorough clinical examination to determine the risk factors, the favouring factors and their correlation with the paraclinical data obtained through imaging investigation (pelvis X-ray, computer tomography and nuclear magnetic resonance). The study included 462 patients, aged between 23 and 89 years old, who were diagnosed with varying degrees of coxarthrosis within the specialized outpatient clinic. The main risk factors were obesity, osteoporosis, chronic smoking, rural environment, female sex, the existence of a hip injury and intense physical exertion. The main purpose of the research was to analyse a series of data, which would bring information on the incidence, distribution by age groups, sex, living environment and professional activity of the population with coxarthrosis, in order to develop a therapeutic management as effective as possible.

Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis / Primary total hip arthroplasty in patients with sequelae of poliomyelitis

Introducción: La prótesis total de cadera (PTC) en pacientes con secuelas de poliomielitis (SP) supone un reto quirúrgico. La morfología displásica, la osteoporosis y la debilidad glútea dificultan la orientación, incrementan el riesgo de fractura y reducen la estabilidad del implante. El objetivo de este estudio es describir una serie de pacientes con SP tratados mediante PTC. Material y métodos: Estudio descriptivo retrospectivo de pacientes con SP intervenidos mediante PTC entre 1999 y 2021 en un hospital de tercer nivel, con seguimiento clínico y radiológico y evaluación funcional y de las complicaciones hasta el presente o hasta el fallecimiento, con un mínimo de 12meses. Resultados: Se intervinieron 16 pacientes, implantándose 13PTC en el miembro parético, 6 por fractura y 7 por coxartrosis, mientras que las otras 3PTC se implantaron en el miembro contralateral. Se implantaron 4 cotilos de doble movilidad como medida antiluxante. Al año postoperatorio, 11 presentaban un balance articular completo sin aumentar los casos de Trendelenburg. El Harris Hip Score (HHS) mejoró 32,1puntos, la escala visual analógica (EVA), 5,25puntos, y la escala de Merlé-d’Augbiné-Poste, 6puntos. La corrección de la discrepancia de longitud fue de 13,77mm. La mediana del seguimiento fue de 3,5años (1-24). Dos casos se revisaron por usura del polietileno y 2 por inestabilidad, sin registrarse infecciones, fracturas periprotésicas o aflojamiento del cotilo o vástago. Conclusiones: La PTC en pacientes con SP permite mejorar la situación clínico-funcional con una tasa de complicaciones aceptable. El riesgo de luxación podría minimizarse con cotilos de doble movilidad.(AU)

Introduction: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. Material and methods: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. Results: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d’Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. Conclusions: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.(AU)

[Translated article] Primary total hip arthroplasty in patients with sequelae of poliomyelitis / Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis

Introducción: La prótesis total de cadera (PTC) en pacientes con secuelas de poliomielitis (SP) supone un reto quirúrgico. La morfología displásica, la osteoporosis y la debilidad glútea dificultan la orientación, incrementan el riesgo de fractura y reducen la estabilidad del implante. El objetivo de este estudio es describir una serie de pacientes con SP tratados mediante PTC. Material y métodos: Estudio descriptivo retrospectivo de pacientes con SP intervenidos mediante PTC entre 1999 y 2021 en un hospital de tercer nivel, con seguimiento clínico y radiológico y evaluación funcional y de las complicaciones hasta el presente o hasta el fallecimiento, con un mínimo de 12meses. Resultados: Se intervinieron 16 pacientes, implantándose 13PTC en el miembro parético, 6 por fractura y 7 por coxartrosis, mientras que las otras 3PTC se implantaron en el miembro contralateral. Se implantaron 4 cotilos de doble movilidad como medida antiluxante. Al año postoperatorio, 11 presentaban un balance articular completo sin aumentar los casos de Trendelenburg. El Harris Hip Score (HHS) mejoró 32,1puntos, la escala visual analógica (EVA), 5,25puntos, y la escala de Merlé-d’Augbiné-Poste, 6puntos. La corrección de la discrepancia de longitud fue de 13,77mm. La mediana del seguimiento fue de 3,5años (1-24). Dos casos se revisaron por usura del polietileno y 2 por inestabilidad, sin registrarse infecciones, fracturas periprotésicas o aflojamiento del cotilo o vástago. Conclusiones: La PTC en pacientes con SP permite mejorar la situación clínico-funcional con una tasa de complicaciones aceptable. El riesgo de luxación podría minimizarse con cotilos de doble movilidad.(AU)

Introduction: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. Material and methods: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. Results: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d’Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. Conclusions: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.(AU)

Composition and micromechanical properties of the femoral neck compact bone in relation to patient age, sex and hip fracture occurrence.

Current clinical methods of bone health assessment depend to a great extent on bone mineral density (BMD) measurements. However, these methods only act as a proxy for bone strength and are often only carried out after the fracture occurs. Besides BMD, composition and tissue-level mechanical properties are expected to affect the whole bone's strength and toughness. While the elastic properties of the bone extracellular matrix (ECM) have been extensively investigated over the past two decades, there is still limited knowledge of the yield properties and their relationship to composition and architecture. In the present study, morphological, compositional and micropillar compression bone data was collected from patients who underwent hip arthroplasty. Femoral neck samples from 42 patients were collected together with anonymous clinical information about age, sex and primary diagnosis (coxarthrosis or hip fracture). The femoral neck cortex from the inferomedial region was analyzed in a site-matched manner using a combination of micromechanical testing (nanoindentation, micropillar compression) together with micro-CT and quantitative polarized Raman spectroscopy for both morphological and compositional characterization. Mechanical properties, as well as the sample-level mineral density, were constant over age. Only compositional properties demonstrate weak dependence on patient age: decreasing mineral to matrix ratio (p = 0.02, R2 = 0.13, 2.6 % per decade) and increasing amide I sub-peak ratio I∼1660/I∼1683 (p = 0.04, R2 = 0.11, 1.5 % per decade). The patient's sex and diagnosis did not seem to influence investigated bone properties. A clear zonal dependence between interstitial and osteonal cortical zones was observed for compositional and elastic bone properties (p < 0.0001). Site-matched microscale analysis confirmed that all investigated mechanical properties except yield strain demonstrate a positive correlation with the mineral fraction of bone. The output database is the first to integrate the experimentally assessed microscale yield properties, local tissue composition and morphology with the available patient clinical information. The final dataset was used for bone fracture risk prediction in-silico through the principal component analysis and the Naïve Bayes classification algorithm. The analysis showed that the mineral to matrix ratio, indentation hardness and micropillar yield stress are the most relevant parameters for bone fracture risk prediction at 70 % model accuracy (0.71 AUC). Due to the low number of samples, further studies to build a universal fracture prediction algorithm are anticipated with the higher number of patients (N > 200). The proposed classification algorithm together with the output dataset of bone tissue properties can be used for the future comparison of existing methods to evaluate bone quality as well as to form a better understanding of the mechanisms through which bone tissue is affected by aging or disease.

Levodopa-Carbidopa Intestinal Gel Injection for Patient with Severe Parkinson's Disease Followed by Total Hip Arthroplasty: A Case Report and Literature Review.

BACKGROUND: Patients with Parkinson's disease have a high dislocation rate after total hip arthroplasty (THA). This study describes a case with severe Parkinson's disease who developed rapidly destructive coxarthrosis (RDC) and underwent THA using a dual mobility cup after a levodopa-carbidopa intestinal gel (LCIG) infusion. CASE PRESENTATION: The patient is a 59-year-old female with a ten-year history of Parkinson's disease, which was first treated with oral levodopa. The patient developed RDC of the right hip joint. However, THA was difficult owing to Parkinson's disease and its treatment side effects, such as wearing-off, dyskinesia, and freezing of the gait, Thus, LCIG was initiated, and improvement in wearing-off and dyskinesia was observed. Two months after the LCIG therapy, the disease was controlled well. THA was subsequently performed using a dual mobility cup to prevent postoperative dislocation. Postoperatively, LCIG therapy was continuously administered to carefully manage the disease, which was controlled well with no increase in wearing-off and dyskinesia after surgery. At 1 year after surgery, the walking speed, stride length, and the Harris hip score improved compared to preoperatively. The UPDRS III motor score improved to eight without signs of wearing-off or dyskinesia. The Hoehn-Yahr scale was II in the "on" period and remained unchanged 1 year after surgery. The patient could walk without a cane and had satisfactory functional outcomes. CONCLUSION: This case proved that LCIG treatment performed preoperatively, followed by THA using a dual mobility cup, and strict management of Parkinson's disease could result in a satisfactory clinical course without recurrence of wearing-off and dyskinesia. Similar procedures may benefit other patients with Parkinson's disease who have previously been deemed unsuitable for THA.

[Translated article] Primary total hip arthroplasty in patients with sequelae of poliomyelitis.

INTRODUCTION: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. MATERIAL AND METHODS: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12 months. RESULTS: Sixteen patients underwent surgery, with 13 THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1 year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1 points, the visual analogue scale (VAS) 5.25 points, and the Merlé-d'Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5 years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. CONCLUSIONS: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimised with dual mobility cups.

Primary total hip arthroplasty in patients with sequelae of poliomyelitis. / Artroplastia total de cadera primaria en pacientes con secuelas de poliomielitis.

INTRODUCTION: Total hip arthroplasty (THA) in patients with residual poliomyelitis (RP) is a surgical challenge. Dysplastic morphology, osteoporosis and gluteal weakness hinder orientation, increase fracture risk and reduce implant stability. The aim of this study is to describe a series of patients with RP treated by THA. MATERIAL AND METHODS: Retrospective descriptive study of patients with RP treated with THA between 1999 and 2021 in a tertiary hospital, with clinical and radiological follow-up and functional and complication evaluation until present or death, with a minimum of 12months. RESULTS: Sixteen patients underwent surgery, with 13THA implanted in the paretic limb, 6 for fracture and 7 for osteoarthritis, while the remaining 3 were implanted in the contralateral limb. Four dual mobility cups were implanted as an antiluxation measure. At 1year postoperatively, 11 had complete range of motion with no increase in Trendelenburg cases. The Harris hip score (HHS) improved 32.1points, the visual analog scale (VAS) 5.25 points, and the Merlé-d'Augbiné-Poste scale 6 points. The length discrepancy correction was 13.77mm. Median follow-up was 3.5years (1-24). Two cases were revised for polyethylene wear and two for instability, with no infections, periprosthetic fractures, or cup or stem loosening. CONCLUSIONS: THA in patients with RP allows improvement of the clinico-functional situation with an acceptable complication rate. The risk of dislocation could be minimized with dual mobility cups.

Femoral Neck Fractures in Elderly Patients With Coxarthrosis and High Dislocation: The Application of Conservative Treatment.

OBJECTIVE: In this study, our aim was to evaluate the results obtained by conservative treatment of femoral neck fracture in patients with untreated Crowe type 4 coxarthrosis with high dislocation. METHODS: This was was a retrospective study done at the Orthopaedics and Traumatology Clinic in a secondary care public hospital between 2002 and 2022, in Türkiye. Femur neck fractures were evaluated in six patients who had untreated Crowe type 4 coxarthrosis with high dislocation. RESULTS:  In the study, we had six patients with undiagnosed developmental dysplasia of the hip (DDH) who suffered femoral neck fractures. The youngest among these patients was 76 years old. Conservative treatment (bed rest, analgesics, non-steroidal anti-inflammatory drugs, and, if needed, opiates and low molecular weight heparin for antiembolic treatment) was found to reduce Harris Hip Score (HHS) and Visual Analogue Scale (VAS) scores significantly (p<0,05). Stage 1 sacral decubitus ulcer occurred in two (33.3%) patients. Patients acquired daily activity capacity similar to their situations before fracture within five to six months. None of the patients suffered embolisms and there was no union in the fracture line of the patients.  Conclusion: Based on our data, we think that conservative treatment is a remarkable option for these patients, as the complication risks are low and positive results can be obtained. Thus, we may conclude that conservative treatment can be considered in femoral neck fractures of elderly patients with DDH.

Hip-Spine Syndrome: A Focus on the Pelvic Incidence in Hip Disorders.

Since Offierski and MacNab reported a close association between the hip and spine as hip-spine syndrome in 1983, many studies on spinal alignment in hip disorders have been conducted. Notably, the pelvic incidence angle (PI) is the most important parameter and is determined by the anatomical variations in the sacroiliac joint and hip. Studies on the association of the PI with hip disorders can help in understanding the pathophysiology of hip-spine syndrome. A PI increase has been observed during the evolution of bipedal locomotion in humans and in the acquisition of gait during child development. Although the PI is a fixed parameter that is stable and unaffected by posture from adulthood onwards, it has become clear that it increases in the standing position in older people. While it may be associated with a greater risk of developing or progressing to spinal disorders, the association between the PI and hip disorders remains controversial because of the multifactorial nature of hip osteoarthritis (HOA) and the wide range of PIs in HOA (18-96°), making the interpretation of results difficult. However, several hip disorders (i.e., femoroacetabular impingement and rapid destructive coxarthrosis) have been shown to be associated with the PI. Further investigation on this topic is, therefore, warranted.

T1 pelvic angle is associated with rapid progression of hip arthrosis.

PURPOSE: To evaluate the association between global spinal malalignment and rapid progression of hip arthrosis. METHODS: This was a retrospective, case-control study including 90 patients, contributing 90 hips, who underwent hemi- or total hip arthroplasty at our institution. For analysis, hips were classified into a rapid progression group, defined as ≥ 2 mm destruction of the femoral head or loss of the hip joint space within a 12-month period (n = 30), and a non-rapid progression group, defined by no observable hip disease progression over a period more than 12 months (n = 60). Logistic regression analysis identified factors that predicted rapid progression, with a receiver operating characteristic curve analysis used to confirm factors. RESULTS: Significant between-group differences were identified for the following parameters: pelvic tilt (P = 0.002, PT), sagittal vertical axis (P = 0.002, SVA), and T1 pelvic angle (P < 0.001, TPA). On multiple logistic regression, PT (P = 0.002), SVA (P = 0.002), and TPA (P < 0.001) were predictive of a rapid progression on hip arthrosis, with the area under the curve being greater for TPA than PT (P = 0.035). CONCLUSION: Global spinal alignment is associated with rapid progression of hip arthrosis. TPA could assist in identifying patients at risk for rapid progression of hip arthrosis, allowing for time management.

Anatomic acetabular reconstruction with femoral head autograft for developmental dysplasia of the hip (DDH) with a minimum follow-up of 10 years.

BACKGROUND: DDH with coxarthrosis causes significant deformity and bone deficiency. Various reconstructive techniques have been proposed to treat developmental dysplasia of the hip. However, the existing literature has not yet reached a consensus on the best technique regarding long-term survival. OBJECTIVES: This study aims to evaluate the long-term survival of uncemented hydroxyapatite (HA) coated acetabular components augmented with a femoral head autograft. METHODS: We retrospectively reviewed the cases of 31 hips in 29 patients (24 female, 5 male, mean age 45.06 years) treated with HA-coated cementless components and femoral head autograft between 2000-2008 with a minimum follow-up of 10 years. Graft resorption, cup loosening and the anatomical hip centre were determined. Functional outcomes were calculated using the Harris Hip Scoring system. The survival of the acetabular component was evaluated using the Kaplan-Meier method. RESULTS: In 24 hips (77,4%), we reconstructed the hip centre anatomically. The remaining cups had variable deviations from the anatomical rotation centre. Only one patient required revision due to loosening. Survival analysis revealed 96.8% survival at 10 years. The mean Harris Hip Score was 39.23 preoperatively and 84.77 at final follow-up. There was no statistical correlation between revision and any of the measured parameters. DISCUSSION: Acetabular reconstruction with a femoral head autograft allows for anatomical cup positioning, early structural support and increases bone stock for future revisions. Although our prior cemented cup study showed that anatomical cup orientation is critical, this study demonstrated the absence of a correlation between implant failure and cup positioning, suggesting that HA-coated cementless cups are more stable and forgiving. CONCLUSIONS: HA-coated acetabular cups augmented with femoral head autograft provided long-term, reliable and durable cup fixation in dysplastic hips of young adults.

Parámetros radiográficos y funcionales de pacientes con coxartrosis secundaria a displasia de desarrollo de cadera sometidos a artroplastia total de cadera, en el servicio de traumatología y ortopedia del Hospital Obrero Nº1 durante las gestiones 2018 ­ 2020 / Radiographic and functional parameters of patients with coxarthrosis secondary to developmental dysplasia of the hip undergoing total hip arthroplasty, in the traumatology and orthopedics service of Hospital Obrero Nº1 during the management 2018-2020

La displasia del desarrollo de cadera del adulto (D.D.C.) es una patología que sin un manejo adecuado temprano llega a una artrosis en tiempo corto, culminando en prótesis de cadera (P.T.C.) Revisar los parámetros radiográficos y funcionales pre y postquirúrgicos que presentan los pacientes con D.D.C. que fueron sometidos (P.T.C.) Se trata de un estudio descriptivo, retrospectivo y cohorte transversal de pacientes con antecedente de coxartrosis secundaria a (D.D.C.) sometido a tratamiento quirúrgico (P.T.C.), se encontraron 45 pacientes de los cuales 29 casos cumplieron con los criterios del estudio, se realizó medición de los parámetros radiográficos pre y postquirugicos, además de utilizar el Score Harris Hip modificado y la escala analógica visual de dolor EVA. Según el género encontramos 27 mujeres y 2 varones, media de edad de 51 años, no existió diferencia significativa en lado afectado, los grados que encontramos según clasificación Crowe fueron grado 1 y 2, y según Hartofilakidis en grados Tipo A, Tipo B1 y B2, de acuerdo a la mediciones radiográficas en preoperatorio la mayoría se encontraban alteradas y se aprecia la corrección en las mediciones radiográficas postoperatorias y se encontró datos favorables en Score Harris Hip modificado, como en el EVA. Los parámetros radiográficos y funciones son datos importantes en el pre y post-quirúrgico para una adecuada planificación quirúrgica y hacer un seguimiento adecuado nuestros resultados, llegando a corregir las deficiencias encontradas.

Developmental dysplasia of the hip in adults (D.D.C.) is a pathology that, without proper early management, leads to osteoarthritis in a short time, culminating in hip prostheses (P.T.C.) To review the pre- and post-surgical radiographic and functional parameters presented by patients with D.D.C. that were subjected (P.T.C.) This is a descriptive, retrospective and cross-sectional cohort study of all patients with a history of coxarthrosis secondary to (DDC) undergoing surgical treatment (PTC). Pre- and post-surgical radiographic parameters were measured, in addition to using the Harris Hip Score. modified visual analog scale of pain VAS.45 patients were found, of which 29 cases met the study criteria, 27 women and 2 men, mean age 51 years, there was no significant difference on the affected side, the grades found according to Crowe classification were grade 1 and 2, and according to Hartofilakidis in Type A, Type B1 and B2 grades, according to the preoperative radiographic measurements, most were altered and the correction in the postoperative radiographic measurements is appreciated, favorable data are found in the modified Harris Hip Score, as in VAS .Radiographic parameters and functions are important pre- and post-surgical data for proper surgical planning and adequate follow-up of our results, correcting the deficiencies found.

Hip structure analysis and femoral osteodensitometry in aged postmenopausal women with hip osteoarthritis and femoral neck fracture.

PURPOSE: Osteoarthritis (OA), osteoporosis, and bone fractures are frequent aging-related conditions. Regardless of the growing research interest in the effects of hip OA on femoral fracture risk, data about the region specificity of osteodensitometric and hip structure analysis (HSA) parameters of the proximal femora are lacking in aged postmenopausal women with hip OA compared to individuals with femoral neck fragility fracture. METHODS: This study included 76 postmenopausal women admitted for total hip arthroplasty due to non-traumatic femoral neck fracture (FN_Fx group, n = 39) and hip osteoarthritis (OA group, n = 37). RESULTS: Osteodensitometric parameters differed significantly between the OA and FN_Fx groups, depicting lower bone mineral density in the FN_Fx group (p < 0.05). The most significant increase in these parameters was registered in the intertrochanteric region of the OA group. Moreover, the OA-induced changes in HSA-derived parameters displayed significant regional heterogeneity, with the intertrochanteric region showing the most notable difference between OA and FN_Fx group. CONCLUSION: Our data may indicate that OA displayed the most prominent positive effect on the intertrochanteric femoral region, revealing the regional heterogeneity in structural geometry and biomechanical indices of proximal femora in OA individuals. Since we did not observe significant differences in the femoral neck region, we may speculate that OA does not have a substantial protective effect on the femoral neck fracture risk in aged postmenopausal women.

[Persistent or recurrent symptoms after surgery for femoroacetabular impingement syndrome (FAIS) : Pathology, diagnostics and therapy]. / Persistierende oder wiederkehrende Beschwerden nach femoroazetabulärer Impingement-Chirurgie : Ursachen, Diagnostik und Therapie.

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) has gained vast importance in the last two decades. Multiple studies have shown that if untreated, early osteoarthritis of the hip joint may result. Hip arthroscopy is one of the fastest growing procedures in the orthopedic cosmos, having already replaced the majority of (mini) open techniques in FAIS surgery. However, with the recent remarkable increase in the volume of hip arthroscopies performed worldwide, the number of patients with persistent or recurrent symptoms after FAIS surgery is also growing. PATHOLOGY: Potential underlying pathologies are misresection of the bony deformity, insufficiency fracture of the femoral head neck junction or the femoral subchondral head itself (SIFFH), adhesions, failed chondrolabral or capsular treatment, septic arthritis, heterotopic ossification or a wrong indication in the case of osteoarthritis that is already too advanced. Most of these occur more often during the extensive learning curve for hip arthroscopy. DIAGNOSTICS: High-quality imaging plays a key role in determining the need for revision surgery vs. further conservative treatment. Therapeutical avenues are shown with the common goal of proper detection and correction of the underlying pathology to address unsatisfactory FAIS treatment outcomes and ensure long-term survival of the native hip joint.

Routine data-based quality indicators for the treatment of gonarthrosis and coxarthrosis patients in the ambulatory care sector - A study protocol for a cluster-randomised pilot trial to evaluate the MobilE-ARTH study.

BACKGROUND: In 2019, Germany had the highest rate of hip replacement surgery and the fourth highest rate of knee replacement surgery among more than 30 OECD countries. The age-standardised rates were estimated at 174 hip joint and 137 knee joint replacements per 100,000 population. Against this background, the contrast between financial incentives for surgery and missing incentives for non-surgical treatment options is repeatedly discussed. Quality indicators (QIs) can serve to measure and transparently present the quality of evidence-based care. Comparing results in the form of audit and feedback has been shown to improve e.g. guideline-compliant ambulatory care. Existing QIs targeting the care of gon- and coxarthrosis mainly focus on discharge management after joint replacement surgery and/or require additional data collection. Therefore, as part of the MobilE-ARTH project, a set of QIs for ambulatory care prior to joint replacement surgery calculable based on routine data is being developed. The present study's aim is to evaluate the impact of this QI set in terms of providing feedback on the quality of care. METHODS: The MobilE-ARTH project comprises (Phase 1) developing a QI set following the RAND/UCLA Appropriateness Method, (Phase 2) implementing the QIs in established physician networks of a German statutory health insurance (SHI) within a prospective, non-blinded, cluster-randomised pilot study, and (Phase 3) evaluating the QI set's effectiveness. The physicians in the intervention networks will (a) receive feedback reports providing information about the routine data-based QIs of their gon- and/or coxarthrosis patients and aggregated results for their network, and (b) be invited to two voluntary, facilitated network meetings. In these network meetings, the physicians can use the information provided on the feedback reports to discuss multiprofessional care pathways for patients with gon- and/or coxarthrosis. Selected indicators of the QI set will serve as primary and secondary outcome measures. Routine data will be analysed within multi-level models using an intention-to-treat approach. DISCUSSION: Feedback reports help maintaining clinical standards and closing the gap between evidence and medical practice, thus enabling an overall improvement in health care. Providing physicians with QI-based information on quality of care promotes identifying strengths and weaknesses in medical treatments. TRIAL REGISTRATION: German Clinical Trials Register, number DRKS00027516 , Registered 25th January 2022 - Prospectively registered.