PurposeReoperation due to infection remains a devastating complication of total hip arthroplasty (THA). Prescriptions for supplemental testosterone are also increasing yearly, which is relevant given the populations who undergo THA and those prescribed testosterone have significant overlap. This study aimed to evaluate supplemental testosterone as a risk factor for all cause reoperation and reoperation due to infection.Materials and MethodsUtilizing the MarketScan Commercial Claims Database (Merative), we performed a retrospective matched cohort study. Out of 61,133 THA procedures in men, Mahalanobis nearest neighbor matching was utilized to achieve a final population for analysis consisting of 1,956 patients prescribed testosterone and the 19,560 patients not prescribed testosterone. Data analyses included univariate and multivariate regression. There were no significant demographic differences between the groups.ResultsPrescription testosterone within 1 year of THA was a significant predictor of all cause reoperation (OR=1.6, CI=1.2-2.2, P=0.001) and reoperation due to infection (OR=1.8, CI=1.1-2.7, P=0.01). Men prescribed testosterone were at higher cumulative incidence for both all cause reoperation and reoperation due to infection at years 1 to 5 (P<0.05 for all years). There were more prescriptions for testosterone in the south (P<0.001). Younger age (OR=1.0, CI=0.9-1.0, P=0.01) and diabetes mellitus diagnoses were risk factors for reoperation due to infection (OR=1.6, CI=1.0-2.4, P=0.03).ConclusionMen prescribed testosterone within 1 year prior to THA were more likely to undergo all-cause reoperation and reoperation due to infection. Arthroplasty surgeons should that younger patients have a higher rate of reoperation due to infection as well.

PurposeWith a focus on dislocation rates, this study aims to compare the posterior or posterolateral approach (PLA) with the piriformis-sparing approach (PSA) in elderly patients undergoing cementless hemiarthroplasty for displaced femoral neck fractures.Materials and MethodsThis retrospective study included 194 patients who met the eligibility criteria and underwent surgery using the PLA (n=140) or the PSA (n=54). Patient data were reviewed for age, sex, body mass index, postoperative dislocation rate, presence of neurological conditions or other comorbidities, surgical duration, length of hospital stay, follow-up period, infection rate, admission to the intensive care unit (ICU), and mortality rate.ResultsIn Group 1 (PLA), 12 out of 140 patients (8.6%) experienced dislocation within a postoperative period of 1 to 5 years. Dislocations occurred in three out of 54 patients (5.6%) in Group 2 (PSA). Although the difference was not statistically significant (P=0.565), a significant difference was observed between the groups in terms of mortality (P=0.015) and surgical duration (P=0.0001).ConclusionIn terms of functional outcomes and postoperative pain management, the advantages of modified PLA have been highlighted in recent studies. Although no statistically significant difference was found in this study, a 3% lower dislocation rate was demonstrated by the PSA as compared to the PLA.

PurposeChloroprocaine spinal anesthetic may facilitate quicker postoperative recovery in total hip arthroplasty (THA) than mepivacaine due to its shorter duration of action and rapid metabolization, which could reduce time to ambulation and discharge. Given the increasing emphasis on same-day discharge (SDD) protocols in THA to improve efficiency and reduce healthcare costs, evaluating the impact of chloroprocaine on discharge timing and postoperative outcomes is critical. This study compared the clinical outcomes and safety of chloroprocaine compared to mepivacaine in SDD primary THA.Materials and MethodsThis retrospective study compared the spinal anesthesia used on 226 patients who underwent primary THA performed between November 2020 to June 2023. The surgical outcomes of chloroprocaine (n=97) versus mepivacaine (n=129) spinal anesthesia, including estimated blood loss (EBL), operative time, discharge time, and 90-day readmissions or emergency department visits, were assessed. Anesthesia-related complications such as hypotension, bradycardia, urinary retention, and post anesthesia care unit outcomes were also documented.ResultsBaseline characteristics were similar between groups. The chloroprocaine group had significantly lower EBL, shorter operative times, and faster discharge times. No significant differences were observed between groups in anesthesia complications or postoperative nausea, vomiting, or headaches. Additionally, there were no differences in surgical complications.ConclusionFor direct anterior approach primary THA, chloroprocaine spinal anesthesia was associated with reduced blood loss, shorter operative times, and faster SDD, with no cases of unplanned direct admissions. These results indicate that chloroprocaine spinal anesthesia can be utilized as a safe and effective alternative to mepivacaine in outpatient THA.

PurposeThere has been a substantial rise in the performance of hip arthroscopy procedures in pediatric patients. However, with regards to procedural technique or patient-surgeon demographics, the utilization of hip arthroscopy remains less understood. This study aimed to determine whether the incidence of pediatric hip arthroscopy is continuing to increase and if surgical techniques have changed over time.Materials and MethodsAll pediatric patients who underwent hip arthroscopy between 2014 and 2022 were retrospectively reviewed from a multi-institutional database within a single health-system. Pearson correlation was utilized to determine trend significance while a two-sample Z test was performed to compare proportions. As no cases were performed in 2014, proportion trends were calculated from 2015 onward.ResultsSeventy-three hip arthroscopies performed on 64 patients (9 staged bilateral) were evaluated. Between 2015 and 2022, there was a 266.67% increase in the annual number of pediatric hip arthroscopy procedures performed and a 400% increase in the number of surgeons performing hip arthroscopy annually. Femoroacetabular impingement (FAI)-related pathology accounted for 90.4% of all indications. Furthermore, the proportion of cases performed for isolated FAI increased over time (R=0.72, P=0.03). Cases were increasingly performed as outpatient procedures (R=0.72, P=0.03). A growing percentage of cases included capsular closure (R=0.91, P=0.003). However, no significant trends were seen in labral management.ConclusionOver time, the number of procedures and the number of surgeons performing hip arthroscopy increased. A growing proportion of cases were performed by non-pediatric trained surgeons, in an outpatient setting, for isolated FAI and capsular closure.

PurposeUse of cementless femoral stems for treatment of displaced femoral neck fractures is increasing; however, factors influencing early stability remain uncertain. The aim of this study was to identify patient-, morphology-, and surgery-related determinants of early subsidence using a single tapered, proximally porous-coated cementless stem.Materials and MethodsPatients who underwent cementless bipolar hemiarthroplasty (BHA) or total hip arthroplasty (THA) for displaced femoral neck fractures between September 2021 and August 2022 were reviewed retrospectively. Analysis was performed on standardized radiographs taken immediately postoperatively and at 3 and 6 months. Engh’s method was used for measurement of stem migration, with ≥5 mm defined as significant. Femoral morphology (Dorr type), bone mineral density (BMD), stem alignment, and canal fill ratio (CFR) were assessed. Pearson correlation and multivariate regression were performed for identification of independent determinants of subsidence.ResultsEighty-six patients met inclusion criteria, and 8.14% showed significant subsidence. Age, BMI, ASA class, fracture pattern, Dorr type, Koval grade, BMD, and operation type showed no association with subsidence. Male sex and larger stem size showed association with greater early subsidence. Varus alignment showed the strongest association, whereas greater metaphyseal fill (high CFR) was protective.ConclusionEarly subsidence of cementless stems in femoral neck fractures is driven primarily by modifiable surgical factors. Achieving neutral alignment and adequate metaphyseal fill markedly reduces early migration, while the impact of demographic and bone-quality variables is limited. Optimizing these technical parameters may enhance initial stability in cementless arthroplasty.

PurposeOver the past decade, hip resurfacing arthroplasty (HRA) has seen a resurgence in popularity due to an increased success rate attributed to numerous novel techniques. Preoperative digital templating is an effective technique that overcomes the technical difficulties of HRA. However, literature on this technique is sparse. Our study aims to fill this void by exploring the impact of preoperative digital templating on implant sizing and component positioning in hip resurfacing surgeries.Materials and MethodsThis is a retrospective study of patients operated with HRA from 2019 to 2024 in our institution (Hôpital Nord, Marseille). Pre- and postoperative data were collected to determine the size of the implants and their positioning on preoperative templates and postoperative X-rays.ResultsThere was no difference in the optimal positioning of implants and the same leg-length discrepancy when individuals with intraoperative changes in implant size from the templates were compared to those with templates that were identical to the postoperative implant sizes. No correlation was found between the changes in the size of the implants and covariates, such as age, side, body mass index, and etiology of the disease.ConclusionThis study highlights the need for intraoperative adjustments of the implant size and optimal positioning during a hip resurfacing surgery, taking into account the crucial information revealed by a preoperative digital templating to optimize the success rate.

PurposeIntertrochanteric hip fractures are commonly seen in the elderly population. Osteosynthesis is technically demanding and has a high rate of failure, especially in osteoporotic bones. Furthermore, delayed ambulation after surgery can be a risk factor for systemic complications. Active prevention of prolonged bed-ridden can improve the quality of life postoperatively. For early ambulation, the authors chose hemiarthroplasty as the surgical method. The purpose of this study was to assess the efficacy of cemented bipolar hemiarthroplasty with a wiring technique for unstable intertrochanteric hip fractures in the elderly.Materials and MethodsA retrospective review was conducted on the records of 41 patients with unstable intertrochanteric hip fractures treated with cemented bipolar hemiarthroplasty between January 2019 and December 2022. The mean patient age was 82 years, and cemented bipolar hemiarthroplasty with a wiring technique was performed in all cases. Clinical and radiologic outcomes were analyzed. The rate of complications and modified Harris hip score (HHS) at one-year follow-up were reviewed.ResultsEarly ambulation was initiated at a mean of 7.8 days postoperatively. Eight patients had systemic complications but recovered prior to discharge. There were no complications of loosening, dislocation, or infection indicated at the minimum one-year postsurgical follow-up. The mean modified HHS was 75.8.ConclusionCemented bipolar hemiarthroplasty with a wiring technique showed positive clinical results in the treatment of unstable intertrochanteric hip fractures in elderly patients with osteoporosis. Furthermore, early ambulation could prevent recumbency-related complications. As a result, this technique is considered a good surgical alternative for an aging population.

PurposeHemiarthroplasty of hip joint is a frequently performed procedure in geriatric patients, especially in cases of trauma. Several risk factors are associated with this surgery, including postoperative delirium, which has been linked to poorer functional recovery, longer hospital stays, and higher short- and long-term mortality rates. The present study aimed to compare the rates and risk factors of postoperative delirium and its correlation with neglected cases in geriatric patients.Materials and MethodsThis retrospective study was performed at Surabaya Orthopedic and Traumatology Hospital, using a manual medical record database ranging from 2019 to 2023. The study focused on geriatric patients who underwent hemiarthroplasty for hip fracture. Demographic, preoperative, and procedural data were collected and analyzed, followed by a review of postoperative outcomes.ResultsOut of 219 patients who underwent hip fracture surgery, 23 were neglected cases while 29 cases developed postoperative delirium. Statistical analysis showed no correlation between the neglected cases and the increased incidence of delirium. Several independent risk factors were identified for postoperative delirium, such as age ≥75 years (odds ratio [OR]=7.766, 95% confidence interval [CI]=1.921-31.393), history of dementia (OR=6.768, 95% CI=1.793-25.555), use of general anesthesia (OR=11.600, 95% CI=1.896-70.972), American Society of Anesthesiologists class 3 (OR=3.245, 95% CI=1.215-8.664), and obesity (OR=9.911, 95% CI=2.009-48.947) (all P<0.05).ConclusionPatients with neglected hip fractures who underwent hemiarthroplasty did not show higher incidence of postoperative delirium. The risk factors found in this study can be used to determine whether neglected or non-neglected patients are at high risk of postoperative delirium.

PurposeThis study aimed to determine the incidence of postoperative primary total hip arthroplasty (THA) stem revision due to periprosthetic fractures (PPF) and analyze related patient and surgical factors.Materials and MethodsUtilizing the Kaplan–Meier analysis and Cox regression method to identify risk factors for stem revision due to PPF, this study analyzed 331,009 primary THA procedures from the Dutch Arthroplasty Register between 2007 and 2021.ResultsAt 10-year follow-up, the incidence rate was 0.7%. Patient specific factors with significant incidence probabilities were higher age (hazard ratio [HR] 1.29 per 10 years, 95% confidence interval [CI] 1.22-1.36), female sex (HR 1.30, 95% CI 1.16-1.45), American Society of Anesthesiologists (ASA) class II (HR 1.56, 95% CI 1.27-1.93) and ASA class III-IV (HR 2.07, 95% CI 1.59-2.71), Charnley score B2 (HR 1.46, 95% CI 1.23-1.72) and Charnley score C (HR 1.81, 95% CI 1.26-2.59), and higher body mass index (BMI) (HR 1.02 per kg/m2, 95% CI 1.00-1.03). Surgery specific factors with significant incidence probabilities were interventions with an uncemented stem (HR 4.55, 95% CI 3.85-5.26), and anterior approach compared to posterolateral approach (HR 1.25, 95% CI 1.03-1.52).ConclusionThe highest risk of PPF in THA requiring stem revision was found in older female patients with high ASA class, Charnley score and BMI as well as uncemented implants. This result may prompt surgeons to strive for cemented stem fixation in patients with declining bone stock when feasible. Furthermore, care should be taken when using anterior approaches for patients with specific risk factors.

PurposePelvic ring fractures are associated with high morbidity and mortality due to severe hemorrhage. The Young–Burgess (Y-B) classification is widely used to assess fracture mechanism and stability, but its ability to predict transfusion needs and vascular injury patterns remains unclear. This study analyzed the correlation between Y-B classification, transfusion volume, and embolization patterns in pelvic fracture patients.Materials and MethodsWe retrospectively studied 207 patients with pelvic ring fractures who underwent angiography at Dankook University Hospital trauma center between February 2014 and August 2023. We collected data on demographics, Y-B classification, transfusion volumes within 24 hours, and embolized vessels. Embolization was performed based on angiographic vascular injury evidence.ResultsOf the 207 patients, we performed embolization in 153 patients (73.9%). There was no significant difference between the mean age of 61.3 years in the embolization group and 58.7 years in the non-embolization group. However, embolization rates based on Y-B classification differed significantly (P=0.009). Unstable fractures (lateral compression type 3 [LC3], anteroposterior compression type 3 [APC3], vertical shear [VS] type) were associated with high transfusion volumes and embolization rates. The superior gluteal artery (LC3), internal iliac artery (APC3), and iliolumbar artery (VS) were most frequently embolized.ConclusionUnstable pelvic ring fractures are associated with increased transfusion requirements and risk of major vascular injury necessitating embolization. The Y-B classification provides relevant guidelines for risk stratification and targeted intervention. It is recommended to prepare in advance for large volumes of transfusion and for prompt vascular evaluation in unstable fracture patterns.