Translation, cross-cultural adaptation, reliability, and convergent and known-group validity of the Turkish full version of the Hip Disability and Osteoarthritis Outcome Score in patients with hip osteoarthritis.

Objectives: The study aimed to culturally adapt the full version of the Hip Disability and Osteoarthritis Outcome Score (HOOS) into Turkish and evaluate its reliability and validity. Patients and methods: Patients with hip osteoarthritis were included in the methodological crosscultural adaptation study between May 2022 and December 2022. We translated and adapted the HOOS into a Turkish version and validated it in a cohort of native Turkish-speaking patients with hip osteoarthritis. The HOOS includes five subscales named symptoms, pain, activities of daily living (ADL), sport and recreation (Sport/Rec), and quality of life (QoL). The psychometric properties of the Turkish HOOS were assessed. The reliability was investigated using test-retest reliability (intraclass correlation coefficient; ICC) and internal consistency methods (Cronbach's alpha). The convergent validity of the Turkish HOOS was evaluated by testing the predefined hypotheses using the correlations with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the European Quality of Life Scale (EQ-5D-3L), a generic QoL scale. Results: A total of 202 patients (131 females, 71 males; mean age: 55.2±9.7 years; range, 50 to 70 years) were recruited for the study. Cronbach's alpha values for each subscale of the HOOS were as follows: symptoms=0.76, pain=0.94, ADL=0.96, Sport/Rec=0.87, QoL=0.78, and total score=0.98, indicating it has high internal consistency. For all subscales and total score of the HOOS, the ICC values were between 0.77 and 0.86, indicating good to excellent test-retest reliability. All correlations between each subscale and total score of the Turkish HOOS, WOMAC, and EQ-5D-3L were moderate to strong. Therefore, 23 predefined hypotheses out of 24 were confirmed with a confirmation rate of 96%, indicating the Turkish version of the HOOS had adequate convergent validity. Conclusion: This study shows that the Turkish version of the HOOS has a convergent and knowngroup validity, internal consistency, and test-retest reliability. It can be used to assess the patient's perception of their hip and associated difficulties, as well as their symptoms and functional limitations.

Is It Possible to Treat Developmental Dysplasia of the Hip with Anterior Open Reduction and Pemberton Osteotomy Under 18 Months of Age?

PURPOSE OF THE STUDY: The purpose of the present study is to determine the outcome success of anterior open reduction with Pemberton osteotomy in patients under 18 months of age with developmental dysplasia of the hip. METHODS: We retrospectively reviewed the clinical and radiological results of 27 developmental hip dysplasia patients under 18 months of age (26 girls, 1 boy) who underwent anterior open reduction with Pemberton osteotomy. Bilateral surgery was performed in 18 patients and unilateral in nine patients. At the final follow-up, the clinical results were evaluated according to the McKay's clinical evaluation criteria, the radiological results according to the Severin's radiological evaluation criteria, and the presence of avascular necrosis according to the Kalamchi-MacEwen's classification criteria. RESULTS: We treated 36 hips of 27 patients who were younger than 18 months of age (range 10-18 months) at the time of surgery and followed up a minimum of 5 years (mean 6.5 years). At the final follow-up, 34 (94.4%) were assessed clinically as excellent, one hip (2.7%) as good and one hip (2.7%) as fair according to the McKay's clinical classification. Radiological classification revealed that, 97.2% of the hips were Severin Type-1 and 2.8% Severin Type-3. Avascular necrosis was observed in 5 of 36 hips (13.8%). Two hips were assessed as Type-2, two hips Type-3 and one hip Type-4 according to the Kalamchi-MacEwen's classification. CONCLUSION: We conclude that Pemberton osteotomy with anterior open reduction is useful technique for developmental hip dysplasia treatment of patients under the age of 18 months with good clinical and radiological results as well as with low complication rates.

Total Hip Arthroplasty With the Wagner Cone Femoral Stem in Patients With Crowe IV Developmental Dysplasia of the Hip: A Retrospective Study.

BACKGROUND: The aim of this study is to assess treatment of Crowe type IV hip dysplasia with the Wagner cone femoral stem combined with transverse subtrochanteric shortening osteotomy and augmenting the osteotomy site using the intercalary segment as a strut autograft. METHODS: One hundred twenty-seven hips of 91 patients diagnosed with Crowe type IV hip dysplasia and treated with total hip arthroplasty using the Wagner cone stem combined with transverse subtrochanteric shortening osteotomy were retrospectively evaluated by clinical and radiographic outcomes as well as complications. RESULTS: The mean follow-up was 8.4 years. The Harris Hip Score and the Western Ontario and McMaster University Osteoarthritis Index scores were significantly improved postoperatively (P = .000). Intraoperative femoral cracks were observed in 70 hips (55.1%) and all femurs healed smoothly. Femoral cracks did not have a significant effect on clinical outcomes, except for heterotopic ossifications (P = .032). The probability of 10-year survivorship of the components free of revision for any reasons as end point was 94.5%; when only the femoral components were considered the survivorship was of 96.9%. CONCLUSION: Transverse subtrochanteric shortening and augmenting the osteotomy site using the intercalary segment of bone resected from the shortened femur with the Wagner cone stem is an effective and reliable technique in the management of total hip arthroplasty in Crowe type IV hip dysplasia. Stable and firm placing of the femoral component which leads to an increased frequency of intraoperative femoral cracks does not have an unfavorable effect on clinical and radiological outcomes.

The efficacy, safety, and cost-effectives of combined administration of Intravenous and Local Tranexamic Acid in the management of Patients Undergoing Primary Total Hip Arthroplasty: A prospective, blinded and randomized clinical study.

OBJECTIVE: The aim of this study was to compare the efficacy, safety, and cost-effectiveness of combined administration of intravenous and local tranexamic acid with those of either intravenous or local administrations in patients undergoing primary total hip arthroplasty (THA). METHODS: This prospective, blinded, and randomized clinical study was performed on patients undergoing unilateral primary THA from September 2018 to December 2019. A total of 90 patients were included and prospectively allocated to one of three groups: the combined group (n= 30, 14 male, 16 female; mean age = 54.9 ± 12 years), intravenous (IV) group (n = 30, 13 male, 17 female; mean age = 54.9 ± 12.3 years), and local group (n = 30, 13 male, 17 female; 50.3 ± 12.3). Tranexamic acid was used systemically by IV application (15mg/kg) in IV group, locally in the surgical field (2g) in local group as well as combined systemic and local together in combined group. The amount of blood loss, number of erythrocyte suspension transfusion, and changes in hemoglobin and hematocrit levels were documented accordingly. The estimated mean tranexamic acid and erythrocyte suspensions cost, extra nurse care, monitoring and laboratory costs associated with blood transfusion, and total hospital costs were compared among groups. RESULTS: No differences existed in hemoglobin and hematocrit levels after surgery among the groups. The combined group required fewer blood transfusion compared to the local and IV groups, and the total amount of ES was statistically significantly lower (P = 0.039) in the combined group. Although the medication cost was higher in the combined group than in the other groups (P < 0.001), combined group was more cost-effective (P < 0.001) when the total costs related to blood loss were evaluated. No occurrence of deep vein thrombosis or pulmonary embolism was found in the study. CONCLUSION: Combined administration of IV and local tranexamic acid seems to be more effective in reducing the requirement and amount of blood transfusion without increasing the risk of thromboembolic complications in primary THA compared to IV or local administrations. Despite increasing the prophylaxis costs, combined administration of TXA can result in lower total hospitalization costs by decreasing blood loss and consequent treatment costs in primary THA. LEVEL OF EVIDENCE: Level I, Randomized Controlled Trial.

Minimum 10-Year Results of Cementless Ceramic-On-Ceramic Total Hip Arthroplasty Performed With Transverse Subtrochanteric Osteotomy in Crowe Type IV Hips.

BACKGROUND: Total hip arthroplasty (THA) performed for developmental dysplasia of the hip is a technically difficult procedure with a high complication rate, especially in the presence of completely dislocated hips. This study aimed to evaluate at least 10 years of follow-up results of cementless, ceramic-on-ceramic (CoC) THA performed with transverse subtrochanteric osteotomy in Crowe type IV hips. METHODS: We retrospectively reviewed 50 patients' 67 hips that underwent CoC, cementless THA with transverse subtrochanteric osteotomy between 2008 and 2011. Clinical and radiological data of the hips were examined. Clinical results were evaluated using the Harris Hip Score and the Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS: The mean Harris Hip Score improved from 22.9 ± 9.9 preoperatively to 94.1 ± 8.1 at the final follow-up (P < 0.001). The median Western Ontario and McMaster Universities Osteoarthritis Index score improved from 72 (interquartile range: 17) preoperatively to 2 (interquartile range: 17) postoperatively (P < 0.001). The preoperative mean leg length discrepancy was improved from 4.9 ± 1 cm to 1.5 ± 1 cm in unilateral cases at the last follow-up (P < 0.001). Revision surgery was required because of nonunion in two patients, prosthetic infection in one patient, and aseptic femoral loosening in the other patient. The overall ten-year survival rate was 94% for femoral stems and 98.5% for acetabular components as per Kaplan-Meier survival analysis. CONCLUSION: Transverse subtrochanteric shortening osteotomy combined with using cementless acetabular and femoral components with a CoC bearing surface promises successful clinical results and high prosthesis survival in the treatment of Crowe IV hips at long-term follow-up.

Silver ion doped ceramic nano-powder coated nails prevent infection in open fractures: In vivo study.

BACKGROUND: Despite improvement in operative techniques and antibiotic therapy, septic complications still occur in open fractures. We developed silver ion containing ceramic nano powder for implant coating to provide not only biocompatibility but also antibacterial activity to the orthopaedic implants. QUESTIONS/PURPOSES: We hypothesised silver ion doped calcium phosphate based ceramic nano-powder coated titanium nails may prevents bacterial colonisation and infection in open fractures as compared with uncoated nails. METHODS: 33 rabbits divided into three groups. In the first group uncoated, in the second group hydroxyapatite coated, and in the third group silver doped hydroxyapatite coated titanium nails were inserted left femurs of animals from knee regions with retrograde fashion. Before implantation of nails 50 µl solution containing 10(6)CFU/ml methicillin resistance Staphylococcus aureus (MRSA) injected intramedullary canal. Rabbits were monitored for 10 weeks. Blood was taken from rabbits before surgery and on 2nd, 6th and 10th weeks. Blood was analysed for biochemical parameters, blood count, C-reactive protein and silver levels. At the end of the 10 weeks animals were sacrificed and rods were extracted in a sterile fashion. Swab cultures were taken from intramedullary canal. Bacteria on titanium rods were counted. Liver, heart, spleen, kidney and central nervous tissues samples were taken for determining silver levels. Histopathological evaluation of bone surrounding implants was also performed. RESULTS: No significant difference was detected between the groups from hematologic, biochemical, and toxicological aspect. Microbiological results showed that less bacterial growth was detected with the use of silver doped ceramic coated implants compared to the other two groups (p=0.003). Accumulation of silver was not detected. No cellular inflammation was observed around the silver coated prostheses. No toxic effect of silver on bone cells was seen. CONCLUSION: Silver ion doped calcium phosphate based ceramic nano powder coating to orthopaedic implants may prevents bacterial colonisation and infection in open fractures compared with those for implants without any coating.

Ultrasonographic Graf type IIa hip needs more consideration in newborn girls.

PURPOSE: According to hip ultrasonography by Graf's method, the type IIa hip has a certain degree of physiological delay in ossification of the bony acetabular roof. The aim of this case-control study was to evaluate the natural history of the type IIa hip. METHODS: Four hundred and thirty-one type IIa hips were identified in 312 of 1,690 ultrasonographically screened newborns with a mean age of 27 days. Parents were accurately informed about the prognosis of such a hip condition and invited for ultrasonographic re-examination at 6-7 weeks of age. RESULTS: Type IIa hip was more common in newborn girls than in boys (P < 0.001). Among 431 type IIa hips, 146 (34 %) missed the follow-up examination at 6-7 weeks of age. Among the completely followed 285 hips, 225 (79 %) developed into a normal hip at 6-7 weeks of age. Newborn boys' hips had a higher rate of spontaneous normalization than girls' hips at 6-7 weeks of age (P = 0.006). All but one type IIa(+) hip became type I without any treatment. According to our management protocol, 35 type IIa(-) hips and one type IIa(+) hip, which later became type IIb, underwent treatment. The rate of treatment was higher in newborn girls' hips than in boys' hips (P = 0.019). CONCLUSIONS: As Graf type IIa hip is more common, has a lower rate of spontaneous normalization and higher rate of treatment in newborn girls than in boys, we recommend paying more attention the type IIa hip in newborn girls. The rate of missing the required follow-up is unacceptably high due to parents' insensitivity regarding the type IIa hip.