Conversion of fused hips to cementless total hip arthroplasty long-term (23.5 years) functional outcome, survival and patient satisfaction.

Early osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) is a known indication for total hip arthroplasty (THA). Though screening tools and joint-preserving procedures have been established successfully, there still is a relevant number of patients suffering DDH. Due to the lack of long-term outcome studies, we like to close this gap and present the results of a highly specialized center. The study included 126 patients, who were treated in our institution with primary THA for DDH between January 1997 and December 2000. At the time of final follow-up, at a mean of 23years postoperatively, 110 patients (121 hips) were clinically evaluated using the Harris-Hip Score. In addition, complication and surgical revision rates were assessed. We collected surgery-related data like implant choice and special surgical features such as autologous acetabular reconstruction or femoral osteotomies. Additionally, the severity of preoperative DDH was measured radiographically according to Crowe classification. There were 91 female (83%) and 19 male (17%) patients with an average age of 51 ± 9.5years (range 21-65) included. Mean follow-up was 23 ± 1.3years (21-25), with a minimum of 21years being necessary for inclusion. Using revision for any indication as primary endpoint, the Kaplan-Meier survivorship was 98.3% at 10years and 81.8% at final follow-up. The overall revision rate was 18% (22 cases), which were split up as follows: 20 (17%) implant failures (loosened or broken components), one (1%) periprosthetic infection and one (1%) periprosthetic fracture. Regarding complications, we observed nine (7%) dislocations and one case (1%) with severe heterotopic ossification that required surgical excision. The mean Harris-Hip score at latest follow-up was 78 ± 14 points (32-95). Though implants and surgical techniques have improved over time, our results suggest THA in patients suffering DDH to be seriously challenging with relatively high overall complications in long-term observation and fair clinical outcome after 21years postoperatively. There is evidence that prior osteotomy might be associated with a higher revision rate.

Minimum 30-Year Results of Bilaterally Implanted Cemented and Cementless Total Hip Arthroplasty in Patients Younger Than 50 Years

BackgroundBreast cancer is the most common cancer in women worldwide and often necessitates a mastectomy. Many patients choose breast reconstruction (BR) to restore appearance and self-image. Common techniques include implant-based and autologous reconstruction, such as with the latissimus dorsi flap (LDF). This systematic review compares LDF and implant-based reconstructions to guide clinical decision-making and improve patient care.MethodsThis systematic review was conducted in accordance with PRISMA guidelines using PubMed, Cochrane, Web of Science, and VHL databases. Studies were included if they involved breast cancer patients who underwent mastectomy followed by either LDF or implant-based reconstruction. Study quality was assessed using STROBE guidelines.ResultsOut of 785 articles initially identified, 19 articles met the inclusion criteria. LDF and implant-based reconstructions had distinct indications, complication profiles, and long-term outcomes, with LDF reconstruction linked to lower revision rates, more natural aesthetic outcomes, and higher patient satisfaction despite donor site morbidity and more postoperative complications. Implant-based reconstruction had higher rates of revision and lower patient satisfaction, but is less invasive and associated with fewer postoperative complications.ConclusionLDF reconstruction is associated with lower revision rates, more natural aesthetic outcomes, and greater patient satisfaction despite higher donor site morbidity and increased postoperative complications. In contrast, implant-based reconstruction offers a less invasive option with fewer complications but is linked to higher revision rates and lower satisfaction. Optimal reconstruction outcomes require an individualized approach that carefully considers patient preferences, oncological factors, and procedural risks to support informed decision-making and enhance quality of life.This paper addresses a common clinical decision point in breast cancer care by directly comparing two widely used breast reconstruction techniques: LDF and implant-based reconstruction.Evidence-based insight into long-term outcomes, revision rates, and patient satisfaction is provided, which can help clinicians better counsel patients on their reconstruction options.This systematic review fills a gap in the literature by synthesizing data across multiple studies to guide future research and improve individualized breast reconstruction planning. Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Graphical Created in BioRender. Basson, M. (2025) https://BioRender.com/y34x74kSupplementary InformationThe online version contains supplementary material available at 10.1007/s00266-025-05335-4.

Patients with skeletal dysplasia are prone to degenerative hip disease thus requiring THA at a younger age than the general population. This is a technically demanding procedure with high complication and revision rates. Achieving good femoral fixation can be challenging because of the abnormal features of the hip. We therefore determined: (1) survivorship, (2) function, (3) radiographic findings, and (4) complications associated with a cementless custom-made femoral component used in THAs for patients with skeletal dysplasia and compared these parameters with those from other types of femoral fixation. Between 1992 and 2005, 40 THAs were performed in 25 patients with skeletal dysplasia using custom-made cementless femoral components. There were 15 men and 10 women with a mean age of 37.5 years (range, 18-61 years) and a mean height of 145 cm (range, 120-173 cm). Patients were followed clinically and radiographically for a minimum of 4.3 years (mean, 10.1 years; range, 4.3-18.2 years). The survivorship rates for the femoral and acetabular components were 92% and 70%, respectively, at 220 months. Revision arthroplasty was performed in four of 40 hips (10%). In two, the acetabular component was revised for aseptic loosening, one had both components revised for aseptic loosening, and one had an isolated femoral component revision for deep infection. The mean Harris hip score improved from 41 (range, 27-57) preoperatively to 80 (range, 51-94) at final followup. There were two intraoperative proximal femoral fractures and one dislocation. When compared with studies with equal followup, custom-made cementless components in THAs for patients with skeletal dysplasia apparently had lower revision and complication rates with comparable function and higher midterm survival.

Purpose: This study aimed to analyze the clinical and radiographic results with a minimum 10-year follow-up of short-stem total hip arthroplasty (THA) in patients aged 40 years or younger with osteonecrosis of the femoral head (ONFH). Methods: A retrospective analysis was conducted on 45 of 55 eligible patients with ONFH who underwent Metha® short-stem THA, with a minimum 10-year follow-up (82% follow-up rate). The clinical outcomes were measured using the Harris Hip Score (HHS) and Forgotten Joint Score (FJS). Radiography was used to assess osteointegration, stem subsidence, and stress shielding. Patient satisfaction was recorded. Results: The mean HHS significantly improved from 43.2 preoperatively to 97.4 at the final follow-up (p<0.0001), and the mean FJS score was 93.4. Radiography revealed osteointegration mainly in zones 1 (95.6%), 2 (88.9%), 6 (100%), and 7 (91.1%). The patient satisfaction was ‘very satisfied’ in 43 (95.6%) and ‘satisfied’ in 2 (4.4%) patients. The Kaplan-Meier survivorship for the overall implant system was 93.3% at 10 years, with revisions required in 3 cases (acetabular component or liner only). At 10 years, stem survivorship was 100% for any reason and 100% for aseptic loosening. Conclusions: Short-stem THA provides promising long-term clinical outcomes for patients aged 40 years or younger with ONFH. Radiographic results demonstrated physiological proximal load transfer with minimal stress shielding.

Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy

Anterior-approach total hip arthroplasty in patients with poliomyelitis: Long-term outcomes

Total hip arthroplasty (THA) among octogenarians presents greater challenges than among the younger patient population because of the high risk of perioperative morbidity and mortality and poor bone quality. We determined the clinical performance and radiographic results of an ultrashort, proximally porous-coated and tapered metaphyseal-fitting cementless femoral stem for octogenarians. A total of 100 unselected octogenarians (112 hips) were included in this retrospective study. All patients received the ultrashort, proximally porous-coated and tapered cementless stem during the study period, but patients who could not walk preoperatively were excluded from the analysis. Their mean age was 82.3±12.1 years (range, 80-92 years). Assessment was performed with the Harris Hip Score; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score; thigh pain; University of California, Los Angeles (UCLA) activity score; and radiographic results. The mean duration of follow-up was 7.6 years (range, 6-9 years). At the final follow-up, the mean Harris Hip Score was 87±13 points, the mean WOMAC score was 26±8 points, and the mean UCLA activity score was 4.5 points. Osseointegration was obtained for 105 (94%) acetabular components and 110 (98%) femoral components. Kaplan-Meier survivorship analysis at 9 years showed that the survival rate for the acetabular component was 94% (95% CI, 91-98) and that of the femoral component was 98% (95% CI, 91-100), with aseptic loosening or revision as the end point. The ultrashort cementless femoral component provides stable fixation without the need for diaphyseal fixation among octogenarians. [Orthopedics. 2022;45(3):181-186.].

Acromegaly is a rare and chronic hormonal disorder. Persons with acromegaly frequently live well into adulthood. Patients with active acromegaly have multiple joint-related issues; however, acromegalic arthropathy (AA), which is secondary osteoarthritis (OA), is considered one of the most common musculoskeletal complications of acromegaly. This study aims to analyze a cohort of patients who underwent total hip arthroplasty (THA) for AA at our institution and present the long-term clinical outcomes and causes of revision in these patients. All patients, who underwent total hip arthroplasty due to secondary osteoarthritis related to acromegaly between January 2001 and December 2019 at our institution, were included in this retrospective study. There were 15 patients (22 hips) with a mean follow-up of 12years (range 4-20). Survivorship free of component revision was determined using Kaplan-Meier analysis. Patient-reported clinical outcomes were assessed using Harris Hip Scores. At the final follow-up, the status of the implant was known in all 15 hips. No patients were lost to follow-up. Five patients (9 hips) were deceased. Three hips (14%) underwent a revision surgery at a mean of six years (range 3-10). Survivorship free of component revision was 81% at 15years. Mean Harris Hip Scores at final follow-up were fair (mean 64.3, range 32-91), but significantly improved compared to preoperative scores (p < 0.05). Acromegaly is a rare disorder that has direct effects on bone and joints. Our results suggest that THA can result in successful clinical and functional outcomes in patients with AA of the hip however the risk of aseptic loosening should also be considered in this patient population.

Revision total hip arthroplasty (THA) remains a significant challenge when there is severe femoral bone loss. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision THA in patients with femoral bone loss treated with Zweymüller SLR-Plus stem. A retrospective review of 82 patients who underwent revision THA using tapered rectangular femoral stem between 1997 and 2007 was undertaken. Of the 82 patients, 9 patients were lost to follow-up and were excluded from the study. The most common reason for revision was aseptic loosening (92%), periprosthetic femur fracture (5%), and infection (3%). Bone loss was categorised preoperatively according to the Paprosky classification. The mean clinical follow-up was 14 years (range 10-19 years). Their mean age at the time of index surgery was 54.7 ± 15.3 (range 30-82) years. The mean Harris Hip Score was significantly improved at final follow-up (68.1 ±10.3) compared with that before the revision surgery (30.4 ± 7.7) (p < 0.0001). Of the 75 stems, 69 (92%) stems were radiographically stable at the last evaluation. Among the 69 stems, 64 hips (85%) had radiographic evidence of bone ingrowth and 5 (5%) had stable fibrous fixation of the stem. Among the 7 hips that were re-revised, 5 hips were re-revised for aseptic loosening, whereas 2 were re-revised for an infection. Kaplan-Meier survivorship analysis, with removal of the stem for any cause as the endpoint, revealed that the 15-year rate of survival of the components was 90% (95% CI, 0.83-0.97). Revision THA in patients with proximal femoral bone loss using Zweymüller SLR-Plus stem led to a high rate of osseointegration of the stem and good clinical results at long-term follow-up.

Objectives:Long-term outcomes following matrix-induced autologous chondrocyte implantation (MACI) are required to better demonstrate later-stage clinical outcomes, patient satisfaction and longevity of repair tissue. This prospective study sought to present the long-term (minimum 10 year) clinical and radiological outcomes of the largest prospectively assessed MACI dataset yet to be reported and compare outcomes in patients undergoing tibiofemoral (TF) versus patellofemoral (PF) MACI.Methods:Between September 2002 and December 2012, 204 patients that underwent MACI were prospectively registered into a research program and assessed pre-surgery and at 2, 5 and 10 years. Of these, 168 patients (182 grafts) were available for clinical review at a minimum 10 years (range 10 to 16 years), of which 151 also underwent MRI. Included in the 182 MACI grafts with minimum 10-year review were: 83 medial femoral condyle (MFC), 32 lateral femoral condyle (LFC), 35 trochlea and 32 patella.Clinically, patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 36-item Short Form Health Surveys (SF-36), a visual analogue scale for pain frequency (VAS-F) and severity (VAS-S), satisfaction and peak isokinetic knee extensor and flexor strength. Limb symmetry indices (LSIs) were calculated for strength measures. Grafts were scored on MRI via the magnetic resonance observation of cartilage repair tissue (MOCART) system, with a focus on tissue infill and an overall MRI graft composite score.Results:All PROMs significantly improved (p<0.0001) over the pre- and post-operative period to 2-years post-surgery (Figure 1), with no statistical change (p>0.05) from 2-years to final 10-year follow-up. While the peak isokinetic knee extensor LSI improved significantly over time (p=0.016), at final follow up the mean LSI for peak isokinetic knee flexor and extensor strength was 99.1% and 92.8%, respectively. At final follow-up, 93% of patients were satisfied with MACI to provide knee pain relief, 77% were satisfied with their ability to participate in sports and 89% were satisfied overall. A statistically significant decline was observed from 5 years post-surgery to final follow-up in the MOCART variable of subchondral lamina (p=0.002), while a non-statistical decline was observed in tissue infill (p=0.066) and the overall MRI composite score (p=0.072) (Figure 2), with the MRI-based progression of one patient over the period demonstrated in Figure 3. Of the 151 grafts reviewed via MRI at 10 years or beyond, 14 (9.3%) had failed as defined by graft de-lamination or a graft bed devoid of any repair tissue. Furthermore, of the 36 patients (out of the prospectively recruited 204) that were not available for longer term review, 7 had already proceeded to total knee arthroplasty (TKA) and 1 patient had undergone secondary MACI at the same MFC site due to earlier graft failure. Therefore, a total of 22 patients (10.8%) had essentially failed at or before the final review time. At final follow-up, patients that underwent MACI in the TF (versus PF) joint reported significantly better KOOS sub-scale scores for Pain (p=0.013, TF mean 86.5, PF mean 80.1), Sport (p<0.001, TF mean 71.5, PF mean 60.5) and Quality of Life (p=0.010, TF mean 65.8, PF mean 58.7), as well as a greater knee extensor strength LSI (p=0.002, TF mean 96.0%, PF mean 85.8%). While the TF group demonstrated better 10-year MOCART scores for tissue infill (p=0.027, TF mean 3.2, PF mean 2.9), there were no other differences in MRI-based scores including the overall MRI composite score (p=0.481, TF mean 3.0, PF mean 3.1).Conclusions:This study reports the largest prospective series of patients with long-term review, demonstrating good clinical scores, levels of patient satisfaction and graft survivorship beyond 10 years. Patients undergoing TF (versus PF) MACI reported better long-term clinical outcomes, despite largely similar MRI-based outcomes.

Radial head fractures are among the most common fractures in adults. In recent years, there has been an increasing trend in the use of radial head arthroplasty (RHA) for both traumatic and post-traumatic injuries. However, current literature on long-term outcomes after RHA remains scarce. The main objective of this study was to evaluate long-term implant survival and clinical outcomes following RHA. The secondary aim was to compare outcomes between press-fit and cemented implants. All patients who underwent primary RHA, using the Radial Head System (Tornier SAS, Montbonnot-Saint-Martin, France), between 2005 and 2022 at a single high-volume trauma center were retrospectively reviewed. A minimum follow-up of two years was required for inclusion. At final clinical follow-up, visual analogue scores (VAS) for pain, the Mayo elbow performance index (MEPI), and range of motion were assessed. Revision surgery was defined as any surgery in which the prosthesis was removed or replaced. Implant survival was calculated using the Kaplan-Meier method. A total of 68 patients were included in this study, with 48 (71%) being female. Press-fitted implants were used in the majority of patients (n=40, 59%). Median follow-up was 7.7 [IQR: 3.3-12.1] years. Overall implant survival at 15-years follow-up was 79% [95% CI: 70-90]. Cemented implants demonstrated superior 15-year implant survival compared to press-fitted implants 93% [95% CI: 84-100) vs 70% [95% CI: 57-86], p= 0.028). Revision rate was 17.6% with a median time to revision of 12.8 [IQR: 7.4-20.5] months. At the final follow-up, the median VAS for pain at rest and after exercise was 0 (IQR: 0-15) and 10 [IQR: 0-55], respectively. Median MEPI score was 85 (IQR: 85-100). Median flexion-extension and pronation-supination arcs were 130 (IQR: 120-135) and 150 (IQR: 140-160), respectively. Radial head arthroplasty demonstrates a 15-year survival rate of 79% [95% CI: 70-90], with cemented implants showing superior outcomes compared to press-fitted implants. Despite a relatively high early revision rate, long-term patient-reported outcomes measures and range of motion are positive after RHA.

The purpose of this retrospective study is to report the clinical and radiological outcome of total hip arthroplasty in patients with previous hip arthrodesis. We retrospectively reviewed 28 (40 hips) prospectively followed patients in whom ankylosed hips were converted to total hip arthroplasty (THA) between 2010 and 2014 in our institution. The average age at the time of the conversion operation was 40.8±9.8years (range 24-62). The ankylosis had lasted 20.4±13.0years (range 3-56) before conversion surgery. The etiology of the ankylosis was septic arthritis in 10 (25%), post-traumatic hip osteoarthritis in 8 (20%), developmental hip dysplasia in 6 (15%), rheumatoid arthritis in 6 (15%), primary osteoarthritis in 5 (12.5%) and ankylosing spondylitis in 5 (12.5%) hips. The indications for arthroplasty were intractable low back pain in 14 (50%), hip pain in 24 (85.7%), and ipsilateral knee pain in 19 (67.8%) patients. Harris Hip Score (HHS) was used to rate the clinical results before and after the surgery. Radiographic evaluations included component malposition and loosening. All complications during the study period were recorded. The mean follow-up period was 39.9±10.6months (range 24-60). The mean preoperative HHS was 33.3±8.6 (range 18-50) and the mean HHS at the final follow-up was 74.9±8.6 (range 52-97). There was a statistically significant increase in HHS (p=0.0001). HHS was excellent in 1, good in 6, fair in 14 and poor in 7 patients. Increase in HHS was lower than 20 points in one patient (18 points), and one patient required two-staged exchange procedure due to deep infection. Thus, according to our success criteria (increase in HHS more than 20 points, radiographically stable implant, and no further surgical reconstruction), 92.8% (26/28) of patients had benefit from the surgery. Trendelenburg sign was positive in 12 hips. There was limb length inequality in 11 patients (mean 0.5cm, range 1-3cm). No patients had heterotopic ossification, sciatic nerve palsy or dislocation. There were five intra-operative fractures of the greater trochanter that were treated with cable wiring. One patient had trochanteric avulsion injury and was treated with trochanteric grip and cables. One patient (2.5%) had deep infection one year after the conversion THA and was treated with two-staged exchange procedure. Conversion hip arthroplasty is an effective treatment method which provides functional recovery and patient satisfaction. However, a proper surgical technique and planning is necessary to minimize the complications.

Long-term follow-up results of ceramic-on-ceramic (COC) total hip arthroplasty (THA), specifically, in patients with osteonecrosis of the femoral head (ONFH) are unknown. We evaluated (1) clinical results and radiological outcomes, (2) ceramic-related complications: noise and ceramic fracture, (3) osteolysis, and (4) survivorship after alumina COC THA in ONFH patients with longer than 10-year follow-up. From May 2003 to June 2009, 325 ONFH patients (403 hips) underwent primary THAs at our department. Among them, 231 patients (293 THAs) were followed for 10 to 16 (mean, 12.9) years. There were 148 men and 83 women, their mean age at the time of THA was 47.2 years, and their mean body index was 24.0 kg/m2. The postoperative CT scans were done in 160 hips. Grinding sensation or squeak was noted in 6.8% (20/293), ceramic head fracture occurred in 2.4% (7/293) and acetabular osteolysis developed in 0.7% (2/293). All 7 ceramic fractures occurred in 28-mm short-neck heads. There was no detectable wear or prosthetic loosening, and the 16-year survivorship was 96.0% (95% confidence interval; 93.8% to 98.2%). The mean Harris hip score was 91.7 (range, 84 to 100) points at the final follow-up. The 10- to 16-year results of alumina COC THAs were encouraging with an excellent survivorship. However, ceramic fracture and noise still remain matters of concern. We recommend not to use 28-mm short-neck ceramic head to avoid ceramic head fractures. III.

BackgroundTo evaluate long-term outcomes, treatment costs, and quality of life associated with curative treatment of newly diagnosed stage I non-small cell lung cancer (NSCLC), by comparing surgery to stereotactic body radiation therapy (SBRT).MethodsMulticenter consecutive prospective study of newly diagnosed stage I NSCLC patients independently assigned surgery or SBRT by a multidisciplinary tumor board, recruited prior to therapy initiation (n = 59). Outcomes included total hospital charges, toxicities, complications, readmissions, and patient satisfaction/ quality of life (FACT-L). Multivariable logistic regression models analyzed the association of treatment type with dichotomous endpoints controlling for age, Charlson Comorbidity Index (CCI), and pre-treatment FACT-L; multiple linear regression was used for delta FACT-L.ResultsOf the 55 evaluable patients, 19 (35%) were males and 36 (65%) females. Thirty (55%) patients received SBRT and 25 (45%) received surgery with a mean age of 73 (57–85) and 67 (55–84) years, respectively. Median follow-up time was 514 days after SBRT and 648 days after surgery. The mean CCI for SBRT and surgery patients was 3.87 and 2.36, respectively. SBRT patients experienced significantly greater improvement in quality of life compared to surgery (delta FACT-L, 14, 95%CI, 2 to 26, p = 0.0232) after adjusting for baseline FACT-L. CCI but not age, treatment type, or baseline FACT-L was significantly associated with readmissions (OR, 1.42, 95%CI, 1.08 to 2.00, p = 0.0226). Interestingly, CCI was significantly lower (2.36 ± 1.66, 3.87 ± 2.84, p = 0.0418) yet total hospital charges were significantly greater ($251,759±$215,643, $129,238±$86,588, p = 0.0009) for patients receiving surgery verses SBRT.ConclusionsAlthough limitations include small sample size and absence of recurrence data, these analyses justify further evaluation of long-term outcomes, including cost and quality of life, to optimize treatment assignment of early stage NSCLC patients. These observations reveal that, despite targeting patients with higher CCI, SBRT is more cost-effective, with a greater improvement in quality of life than surgery.Trial registrationCentral Institutional Review Board (IRB) approval was obtained under expedited review and deemed minimal risk to patients (WCG Clinical IRB00000533 Study 1171593). All participating sites obtained local IRB approval before study initiation. Informed consent was obtained from all patients prior to study entry.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13014-025-02699-4.