The alignment of the femoral with the acetabular components significantly influences the mechanics of the hip joint, especially in total hip arthroplasty (THA). Combined anteversion (CA) is a combination of femoral neck anteversion and acetabular anteversion (AA). CA is emerging as a significant factor that influences optimal THA outcomes. Our study aims to assess the impact of CA on postoperative functional outcomes in an Indian cohort where unique lifestyle demands may influence the anteversion characteristics. A retrospective study was conducted on 88 patients undergoing THA. Inclusion criteria included patients with unilateral THA due to femoral neck fractures or osteonecrosis of the femoral head. Computed tomography scans were used to identify and measure postoperative CA. We assessed the functional outcomes following THA at 7 days, 6 weeks, 3 months, 6 months, and 1 year, using the Harris hip score (HHS). Our findings indicate that the CA values ranged from 25.5° to 93.9°, with a mean of 59.3°±15.7°. Patients with CA between 40° and 70° exhibited significantly improved functional outcomes, with an improvement in the mean HHS from 67.57 at day 7, to 94.26 at 3 months, to 97.50 at 1 year (P<0.001). In contrast, CA below 40° or above 70° was associated with poor outcomes, which includes a high risk of dislocation in the group with >70° CA. Our study concludes that achieving a CA within the range of 40° to 70° is pivotal for optimal functional outcomes and for minimum complications in THA.

Surgeons are both interested in the relationship between spinopelvic parameters and acetabular orientation since concomitant diseases of the spine and hip are common. Spondylolysis of L5 is common in 4% to 8% of the population. L5 spondylolysis could potentially affect acetabular orientation since it is associated with alterations in the sacral and pelvic parameters. In our study, we aimed to assess the influence of L5 spondylolysis on acetabular orientation. In 23 patients with L5 spondylolysis and 46 control patients, we assessed the correlation between the pelvic parameters-pelvic incidence (PI), sacral anatomic orientation (SAO), and acetabular sagittal angle (ASA) using computed tomography analysis. The ASA is measured by the angle subtended by the line joining the anterior and posterior horns of the acetabulum in the midsagittal slice of the joint and the line through the anterior pelvic plane (APP). Twenty-three patients with L5 spondylolysis were matched by age and sex (16 males; mean age, 46.1 years) to 46 control patients (32 males; mean age, 46.3 years). The PI and the ASA were significantly higher in those with spondylolysis, which indicates greater acetabular coverage relative to the APP. Linear regression analysis suggested a greater influence on ASA by the SAO than PI. Clinicians should be aware of the impact of elevated PI on the changes to the sagittal acetabular inclination and its association with spondylolysis. It should also be noted that spondylolysis alone does not appear to influence acetabular inclination in the sagittal plane.

Internal fixation of undisplaced intracapsular hip fractures is typically achieved using either cannulated screws (CS) or a 2-hole dynamic hip screw (DHS). However, there is a lack of consensus on which of these is more effective clinically. Whilst several biomechanical analyses of cadaveric hips show a higher construct stability of DHS fixation, there is a paucity of large clinical studies investigating patient outcomes. Data from 2,705 patients at a single institution, including 322 internal fixations, were analysed retrospectively. Propensity scores were calculated to mitigate for the impact of covariates such as age, sex, Charlson comorbidity index and Nottingham Hip Fracture Score, producing an eligible group of 255 patients. The CS group included 204 patients (mean age, 82.5±7.5 years; female, 90.7%), the DHS group included 51 patients (mean age, 82.4±8.0 years; female, 90.2%). There were no differences between groups after propensity matching. There were no significant differences in outcomes between CS and DHS groups for reoperation rate (CS 5.9% vs. DHS 5.9%, P>0.999), death <30 days (CS 5.9% vs. DHS 5.9%, P>0.999), length of stay (CS 11.5 days vs. DHS 14.0 days, P=0.294) and hours to surgery (CS 31:03 hours vs. DHS 29:23 hours, P=0.618). However, operation time was significantly shorter for CS (CS 39.0 minutes vs. DHS 44.0 minutes, P=0.013), an 11% reduction. There is no difference in clinical outcomes between CS and DHS fixation of intracapsular hip fractures. However, in this cohort the operating time was approximately 5 minutes shorter in CS fixation.

The main aim of this study is to compare the functional and radiological outcomes of the acetabular distraction technique and the cup-cage construct technique in the management of chronic pelvic discontinuity. In this prospective interventional study, 36 patients with chronic pelvic discontinuity were initially split into two equal groups and underwent surgery utilizing either the acetabular distraction technique or the cup-cage construct technique. The patients were followed up for 2 years to assess the functional and radiological outcomes of the techniques. Six patients were lost during follow-up (two of them died, four discontinue follow-up). The two groups did not differ significantly with regards to the clinical (Harris hip score) and radiological (stability of the construct, graft incorporation, and absence of loosening or migration) outcomes. Both the techniques displayed significant postsurgical improvements in both the Harris hip score and limb length discrepancy. Both acetabular distraction and the cup-cage construct techniques may be used to treat pelvic discontinuity without any significant difference in the clinical outcomes, as measured by Harris hip score, and in the radiological outcomes. Acetabular distraction appears to be more effective in treating discontinuity as a secondary outcome of neglected acetabular fracture.

Osteochondroplasty and femoral neck osteotomy can be used in conjunction with surgical hip dislocation (SHD) for added benefit to patients with sequelae of Perthes disease. The aim of the current systematic review was to provide a critical analysis of the literature and present the outcomes of SHD with relative femoral neck lengthening in sequelae of Perthes disease. Electronic database searches with relevant keywords were conducted in PubMed and Embase. This review included studies which described relative femoral neck lengthening outcomes on sequelae of Perthes disease. A study required a minimum postoperative follow-up period of one year for inclusion in this review. Seven retrospective studies with 244 patients were included in the review. Five studies reported objective improvement in functional scores. Approximately 9% (12/137) of patients reported complications and the overall pooled proportion of patients requiring subsequent total hip arthroplasty was 8% (95% confidence interval with a range of 4% to 11%). Used in conjunction with relative femoral neck lengthening SHD has opened a new treatment means for the correction of deformities resulting from sequelae of Perthes disease. Notable improvements in clinical and functional outcomes can be expected after this procedure. Low rates of postoperative complications and future conversions to total hip arthroplasty were also noted. The results of the review are limited by the non-uniform inclusion of study participants in terms of preoperative grading as well as any occurrence of prior, concomitant or subsequent surgical procedures.

Hip arthroscopy is an increasingly common orthopedic procedure. Although the number of reported complications is low, emergency room visits in the early postoperative period do occur. This study aims to evaluate the impact of demographic, insurance, and clinical factors on the likelihood of postoperative emergency department (ED) visits following hip arthroscopy. Through the identification of key risk factors, including insurance status, comorbidities, and procedural specifics, the objective of this study is to inform clinical practices and enhance patient outcomes through targeted risk management. A retrospective review of a multi-center institutional database identified patients who underwent hip arthroscopy between 2014 and 2022. Medical records were analyzed for ED visits within the first 30 postoperative days. Diagnoses leading to ED visits were classified by pathology such as pain, musculoskeletal, or infection. Factors associated with increased odds of ED visits were assessed utilizing a multivariate regression analysis. Of the 879 hip arthroscopies, 3.1% of patients had ED visits within 30 postoperative days. Medicaid patients were 2.88 times more likely to visit the ED (P=0.025). The presence of hypertension (P=0.013) or autoimmune conditions (P=0.041) further increased the odds. The use of a capsular closure technique during surgery reduced ED visits by 69.1% (P=0.026). Following hip arthroscopy, patients with Medicaid insurance, hypertension, and auto-immune disorders are more likely to require ED visits within 30 days. In contrast, the use of a capsular closure technique significantly reduces the likelihood of such visits.

For femoral reconstruction in revision total hip arthroplasty (rTHA), cementless, diaphyseal engaging femoral components are the most commonly-used implants. At present, there are no reviews that directly compare the design features of these implants. We performed a manual review of the designs of commercially available diaphyseal engaging femoral stems. We compiled and compared the design features of these implants. Clinical outcomes of modular and monoblock stems were also compared. We identified five modular and four monoblock stems in the manual review of commercial companies manufacturing these stems. Distal stem taper varied from 2° to 3.5°, and the number of splines varied from 8 to 16. The stems varied in their stem lengths, offsets, and surface finish. Although there are no clinically significant differences in the restoration of leg length between monoblock compared to modular stems. The modular stems appear to perform slightly better with respect to subsidence and restoration of leg length. A source of concern for modular stems are mechanical implant failures that occur almost exclusively at modular junctions. Current evidence does not support any difference in dislocation rate, intraoperative or postoperative fracture, aseptic loosening, re-revision rates, or clinical outcomes between monoblock and modular stems. With the knowledge of the distinct features of implants, surgeons must make choices associated with specific design characteristics that could be pivotal to the success of the operation. Our understanding of design differences will help us minimize chances of failure and choose patient-specific implants that will lead to a high rate of success.

Japanese International Hip Outcome Tool 12 (iHOT12J) and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) have been used in patients with hip labral injuries. However, patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID) from iHOT12J and JHEQ have not been investigated. We analyzed PASS score and MCID between iHOT12J and JHEQ preoperatively and at 2 years postoperatively in patients underwent hip arthroscopy. PASS score and MCID were calculated using pre- and two years post hip arthroscopy iHOT12J and JHEQ data from 99 patients. Anchor-based method was used to calculate PASS, which involved dividing patients into two groups based on their JHEQ satisfaction visual analog scale as well as performing receiver operating characteristic (ROC) curve analyses. ROC curve and PASS score were computed using obtained values and Youden index, respectively. Value with the greatest sensitivity and specificity was target value. MCID was calculated with 0.5 standard deviation (SD) method by dividing the mean of iHOT12J and JHEQ values, obtained from pre- and at two years post-surgery, by 0.5. PASS scores were 74.2 for iHOT12J and 62.0 for JHEQ. SD was 24.8% for iHOT12J and 19.4 for JHEQ. MCID was 12.4 for iHOT12J and 9.7 for JHEQ. Achievement rates of PASS and MCID were 73/99 (73.7%) for iHOT12J and 89/99 (89.9%) for JHEQ. PASS score and MCID could serve as measurable benchmarks to define significance in patient-reported outcome measure values for clinical outcomes or variables of postoperative hip arthroscopy.

Despite contradictory results of various published data on the subject, the complications of total hip arthroplasty (THA) in femoral neck fracture (FNF) compared to those in osteoarthritis (OA) are yet to be further elucidated. We queried PubMed, Cochrane, and Google Scholar from inception until October 2024 for studies that compared the surgical outcomes of THA in the management of FNF and OA. We evaluated the overall complications, such as dislocations, prosthetic joint infection (PJI), intraoperative fractures, periprosthetic fractures (PPFx), mechanical loosening, venous thromboembolism (VTE), hematoma, leg length discrepancy (LLD), and revisions. In addition, surgical parameters such as the duration of surgery and the length of stay (LOS) were also assessed. Eleven studies were included in our meta-analysis. The use of THA in FNF is associated with high risks of overall complications (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.00-2.49, P=0.05), dislocations (OR 2.12, 95% CI 1.07-4.21, P=0.03), PJI (OR 1.75, 95% CI 1.50-2.05, P<0.00001), PPFx (OR 1.62, 95% CI 1.18-2.22, P=0.003), and intraoperative fractures (OR 3.82, 95% CI 1.59-9.19, P=0.003) in comparison to those in the OA group treated with THA. FNF patients had a long LOS (mean difference=3.34, 95% CI 0.69-5.99, P=0.01). There was no statistically significant difference observed in the risk of VTE, hematoma, LLD, mechanical loosening, the number of revisions, and the duration of surgery between the FNF and OA groups, which were treated with THA. There is an increased risk of complications in patients undergoing THA for FNF than in patients undergoing THA for OA.

Hip fracture surgery is a high-stakes topic due to elevated mortality and high economic costs, making the identification of optimal treatment for displaced femoral neck fracture (FNF) pivotal. Our study aimed to evaluate and compare (1) surgery-associated parameters and (2) mortality rates following multiple screw fixation (MSF) or cementless bipolar hemiarthroplasty (BHA) in patients with displaced FNF using twenty years of data from a single tertiary referral center. Between January 2000 and January 2018, we analyzed 1,153 cases of displaced FNFs treated at our institution with either MSF or cementless BHA. We evaluated (1) surgery-associated parameters, (2) hospitalization duration, and (3) postoperative complications and mortality rates at one and five years following the surgical procedure. MSF showed a reduced waiting period preceding surgery, a shortened duration of the surgical procedure, but an extended period of hospitalization. There was an increase of estimated blood loss and postoperative transfusion with cementless BHA compared to that with MSF. Both the procedures did not differ in postoperative complications. The one-year and five-year mortality rates were also similar in both groups. Since cementless BHA and MSF surgeries did not distinctly differ in mortality rates at one year and at five years, it is crucial that surgeons make personalized surgical decisions based on the individual characteristics of the patient. Surgeons should carefully weigh the advantages of MSF, which include shortened surgery time and low blood loss against the benefits (e.g., reduced hospitalization period) of cementless BHA.