Fluoroscopy-guided direct anterior approach total hip arthroplasty provides more accurate component positions in the supine position than in the lateral position.

PURPOSE: The position of the acetabular and femoral components is critical for stability and wear resistance. The aim of this study is to investigate whether the fluoroscopy-guided direct anterior approach in the supine position (S-DAA) is more helpful in improving the position of acetabular and femoral components than the fluoroscopy-guided direct anterior approach in the lateral decubitus position (L-DAA). METHODS: A retrospective analysis of 76 cases of fluoroscopy-guided direct anterior approach total hip arthroplasty (38 cases in the S-DAA and 38 cases in the L-DAA group) was performed in one hospital from 2019 to 2021. The differences in inclination, anteversion, femoral offset (FO), global offset (GO), and leg length discrepancy (LLD) measurements during and after surgery were analyzed. The postoperative femoral offset (FO), global offset (GO), leg length discrepancy (LLD), and preoperative and postoperative Harris hip score were compared between the two groups. RESULTS: In the S-DAA group, there were no significant differences in the mean intraoperative inclination angle anteversion angle, FO, GO, and LLD compared to the postoperative values, whereas in the L-DAA group, there were significant differences between the intraoperative and postoperative measurements (P < 0.001, P = 0.009, P＜0.001, P＜0.001 and P = 0.008, respectively). Additionally, there were significant differences in the accuracy of LLD, FO, and GO between the two groups (P < 0.001). Compared with the L-DAA group, the average differences of inclination, anteversion, LLD, FO, and GO during and after operation in the S-DAA group were smaller, and the consistency was higher. There was a significant difference in Harris hip score between the two groups at 1 week after surgery (P = 0.033). There was no significant difference in Harris hip score between 1 month and 3 months after surgery (P = 0.482 and P = 0.797, respectively). CONCLUSIONS: In the supine group, the direct anterior approach (DAA) provides more accurate positioning of the acetabular and femoral components. However, there was no significant difference in hip joint function and activity between the two groups at follow-up.

Relationship between 25-hydroxy vitamin D and knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.

Objective: In order to examine the relationship between 25-hydroxyl vitamin D and knee osteoarthritis (KOA), a meta-analysis of 8 randomized controlled trials (RCTs) publications was hereby performed. Methods: For the purpose of finding pertinent research, the databases of PubMed, Embase and the Cochrane Library were searched. Factors including tibial cartilage volume, joint space width (JSW), synovial fluid volume, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were correspondingly evaluated, and the results were expressed using SMD and 95% confidence intervals (CI). Results: The present meta-analysis evaluated the effects of vitamin D supplementation in patients with knee osteoarthritis, with 3,077 patients included. The results showed that vitamin D administration had a statistically significant impact on the amount of synovial fluid, Visual Analog Scale (VAS) and tibial cartilage. The pain and function scales of the WOMAC scale presented a statistically significant difference, and there was no discernible difference between the vitamin D and placebo groups in the stiffness scale. Additionally, bone marrow lesions and alterations in the diameter of the joint space were not influenced by the administration of vitamin D, and according to a subgroup study, a daily vitamin D supplement containing more than 2,000 IU significantly slowed the development of synovial tissue. Conclusion: Vitamin D supplementation did benefit those suffering from knee discomfort and knee dysfunction. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022332033, identifier: CRD42022332033.

[Timing of artificial femoral head replacement in the treatment of femoral intertrochanteric fracture with intramedullary nail failure in elderly patients].

OBJECTIVE: To analyze the timing of artificial femoral head replacement in elderly patients with femoral intertrochanteric fracture after intramedullary nail failure. METHODS: From July 2013 to September 2019, 17 elderly patients with femoral intertrochanteric fracture after intramedullary nail fixation failure were treated with artificial femoral head replacement. According to the interval from diagnosis of internal fixation failure to pedestrian femoral head replacement, the patients were divided into early operation and delayed operation groups. Among them, there were 8 cases of early operation, 5 males and 3 females;the age ranged from 80 to 89 years old with an average of (84.88±2.79) years old;the interval was 1 to 7 days with an average of(4.13±1.73) d. There were 9 cases of delayed operation, 4 males and 5 females;the age ranged from 80 to 89 year old with an average of(84.22±3.03) years old;The interval was 15 to 30 with days an average of (25.56±4.36) d. The operation time, intraoperative blood loss, the first postoperative weight-bearing time, postoperative hospital stay, the number of complications and deaths were compared between two groups. Harris score was used to evaluate hip function at 1 and 12 months after operation. RESULTS: The incision healed well after operation. There was 1 case of urinary tract infection in the early operation group;in the delayed operation group, there were 2 cases of intermuscular venous thrombosis, 1 case of pulmonary infection, 3 cases of urinary tract infection and 1 case of prosthesis dislocation. All 17 patients were followed up for 12 to 16 months with an average of (14.76±1.86) months. There was no significant difference in operation time, intraoperative blood loss and the number of deaths between two groups(P>0.05). There were significant differences in the first weight-bearing time, postoperative hospital stay and the number of complications between two groups(P<0.05). One month after operation, there was significant difference in Harris score between two groups(P<0.05). There was no significant difference in Harris score between two groups 12 months after operation(P>0.05). CONCLUSION: After the failure of intramedullary nail fixation of femoral intertrochanteric fracture in elderly patients, there is no significant difference in mortality and final hip function between early operation and delayed operation. However, early pedestrian femoral head replacement can make patients go down to the ground earlier, shorten the length of hospital stay, effectively reduce the complication rate and restore hip function as soon as possible.