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.

PurposeSeveral studies have compared various methods of treatment for displaced femoral neck fractures (FNF), including multiple cannulated screw fixation, in young and active patients. However, there have been few studies on the cephalomedullary nail with additional cannulated screw fixation in displaced FNF. Therefore, the aim of this study is to evaluate the outcomes of the cephalomedullary nail technique with either a cannulated screw or multiple cannulated screw fixation in displaced FNF.Materials and MethodsAmong 69 consecutive patients who underwent internal fixation for displaced FNF, 64 were included. Patients were divided into two groups. Patients in Group 1 underwent fixation utilizing a cephalomedullary nail with an additional screw. Group 2 patients underwent fixation utilizing a cephalomedullary nail with additional multiple cannulated screws. Radiologic and clinical outcomes were assessed at the final follow-up clinical appointment.ResultsNo significant difference was found in basic characteristics such as mean age, male to female ratio, and fracture classification between the study groups. The mean time to ambulation after surgery was significantly shorter in Group 1 (P<0.001). There was no statistically significant difference between the two groups in procedure-specific complication rate. However, the immobilization-related complication rate was significantly higher in Group 2 (P=0.017).ConclusionIn terms of enabling early ambulation in young and active patients, the cephalomedullary nailing with additional cannulated screws has the advantage in the management of displaced FNF. Furthermore, early ambulation lowers the rate of immobilization-related complications and shortens hospital stays.

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.

Periprosthetic joint infection (PJI) represents a significant obstacle within the realm of orthopedic procedures. Certain medical conditions, such as benign prostatic hyperplasia (BPH) which causes blockages in the lower urinary system, have been suggested as potential PJI contributing factors. Nevertheless, the available evidence remains inconclusive regarding these associations. For enhancing treatment strategies and ultimately improving results achieved by individuals receiving care, gaining a better understanding of these relationships is imperative. All in accordance with the PRISMA 2020 guidelines, an in-depth analysis was conducted utilizing structured and methodical review techniques, involving manual searches as well as databases like PubMed, EBSCO, and ProQuest. This review specifically included studies that provided information on both BPH and PJI. Through a meta-analytical approach, the data evaluation was conducted employing a random-effects framework. This process was facilitated by the use of Comprehensive Meta-Analysis software, version 3. Five research articles were analyzed, collectively revealing no meaningful correlation between BPH and an elevated likelihood of PJI, as indicated by the odds ratio (OR 1.228, 95% confidence interval [CI] 0.914-1.649, P=0.172). Moreover, no significant associations were yielded through further analyses for BPH studies for either total hip arthroplasty (OR 1.138, 95% CI 0.793-1.635, P=0.483) or total knee arthroplasty (OR 2.429, 95% CI 0.240-24.584, P=0.452) surgery. No association was substantiated between BPH and the incidence of PJI. It is possible that other factors, such as infections which are more likely to occur in individuals with BPH, could influence PJI rates.

PurposeThe study investigated the benefits of the direct anterior approach (DAA) compared to the posterolateral approach (PLA) in patients over 75 years of age.Materials and MethodsThis study included 144 patients who underwent total hip arthroplasty (THA) from December 2012 to November 2021. Group A had 93 patients with a mean age of 80.8±5.0 years, who underwent DAA. Group B had 51 patients with a mean age of 79.7±4.6 years, who underwent PLA. Clinical outcomes included operative time, time to ambulation, walking ability, and complications.ResultsThere were no demographic differences between the groups. The mean age was 80.9±5.0 years in Group A and 80.5±4.8 years in Group B. Mean operative time was 94.2±7.2 minutes in Group A and 91.2±8.8 minutes in Group B (P=0.02). Early ambulation within 3 days postoperatively was seen in 72 patients (77.4%) in Group A and 31 patients (60.8%) in Group B (P=0.03). No significant change was seen in modified Koval Index in Group A (4.35 to 4.06, P=0.51), while Group B showed a significant decrease (4.47 to 3.88, P=0.04). The postoperative modified Koval index negatively correlated with time to ambulation (P=–0.17, P=0.04). Dislocation occurred in 3 patients (3.2%) in Group A and 7 patients (13.7%) in Group B (P=0.02). No differences were found in medical complications or mortality.ConclusionTHA via DAA may provide earlier functional recovery than PLA, with comparable safety in patients over 75 years of age.

PurposeThrough the measurement of Graf’s alpha (α) angle, the Graf method uses two-dimensional ultrasound (US) to diagnose developmental dysplasia of the hip (DDH) in infants. However, this unidimensional index cannot fully reflect anatomic shape features and variations of iliac wing and bony acetabular roof (IW-AR) coronal outlines that may influence DDH. This study aimed to analyze the shapes of IW-AR outlines by revealing their mean shape, possible shape variations, and the impact of these variations on the α angle variability.Materials and MethodsBy segmenting US images of 510 infant hips, IW-AR outlines in Graf’s standard plane were obtained from a mixed screening population. A statistical shape model (SSM) was then developed to analyze the outline shapes.ResultsIn the IW-AR outlines, shape variations were described by linear combinations of six global and local shape modes. A global mode, dominantly causing an entire outline to bend about the vicinity of its apex, could affect the α angle in a large range (38°-70°). Although a local mode produced bending patterns that had a lesser impact on the α angle (up to 6°), it may relate to DDH diagnosis and clinical outcome.ConclusionShape variations in IW-AR outlines can be effectively modeled by using a compact SSM representative of the variations as linear combinations of a few global and local modes. The shape variations and the angle variability by the local modes should not be underestimated even though the effect of global modes on the α angle is dominant.

PurposeThe coronavirus disease 2019 (COVID-19) pandemic led to mandatory screening of hospitalized patients. This study aims to assess the impact of COVID-19 admission delays on clinical outcomes, specifically complications and mortality, in elderly patients following hip fracture surgery.Materials and MethodsThis study included 563 patients (aged ≥70 years) who underwent hip fracture surgery between February 2018 to January 2021 and were followed up for at least one year. The cohort was divided into two groups: a pre-COVID-19 pandemic group (control group) and a COVID-19 pandemic group (study group). The patients who tested positive for COVID-19 were excluded. The demographic data, the time from injury to surgery, admission to surgery, postoperative complications, and 1-year mortality were collected and compared between the two groups.ResultsThe time from injury to surgery was significantly longer in the study group compared to the control group, primarily due to delays in the time from injury to hospital visit and from hospital visit to admission (4.6 days vs. 3.7 days, P=0.026). However, there was no significant difference between the groups from admission to operation. The incidence of postoperative medical complications and one-year mortality rate were significantly higher in the study group (P=0.025 and P=0.034).ConclusionOur findings suggest that delays in the time from injury to hospital visit and hospital visit to admission during the COVID-19 pandemic led to significant delays in hip fracture surgery for elderly patients. These delays were associated with increased postoperative medical complications and a higher one-year mortality rate.

PurposeComplex acetabular fractures involving both columns often require two approaches, one anterior and other posterior, for adequate reduction and fixation. Treatment of such fractures using modified Stoppa approach (MSA) either alone or in combination with lateral window of the ilio-inguinal approach has been reported. Whether this line of management is appropriate or not is a matter of further investigation. This study presents the clinical and radiological outcomes of acetabular both-column fractures using this approach.Materials and MethodsForty-one patients treated with MSA for anterior column with posterior hemi transverse (AC with PHT), associated both columns, T-type, and transverse fractures were postoperatively assessed at a minimum of one year. Their immediate postoperative reduction quality, as well as the clinical, radiological, and functional outcomes at the most recent follow-up visit were reviewed.ResultsMost patients were young males injured in motor vehicle accidents who underwent surgery after a mean delay of 4.8 days. The mean surgical time was 122.44 minutes, and mean blood loss was 413.41 mL. AC with PHT fracture was the most common. In 78.0% of cases, anatomical reduction was achieved. At one year, excellent radiologic, clinical, and functional outcomes were observed in 78.0%, 51.2%, and 73.2% patients, respectively. There were eight cases with major complications.ConclusionUsing the MSA with satisfactory short-term results, it was possible to address acetabular fractures involving both the anterior and posterior elements in a select group of patients. A pelvi-acetabular surgeon should have expertise in using multiple surgical approaches including the MSA.

PurposeThe textured titanium surfaces used in many total hip arthroplasty (THA) implants are designed to promote osseointegration. However, these surface types may also facilitate bacterial adherence and risk of infection. This aim of this study is to characterize the bacterial growth and viability on the different titanium surfaces used in THA implants.Materials and MethodsSmooth and rough titanium samples were cleaned, sterilized, and prepared for bacterial testing. Staphylococcus aureus cultures were applied to the samples, incubated to allow for bacterial adherence, and stained to visualize and quantify bacterial coverage using fluorescence imaging and ImageJ software. Student’s t-test was used to compare the percentage of bacterial coverage at each timepoint between smooth and rough samples. Finally, scanning electron microscopy (SEM) was used to observe and compare the surface structure and bacterial adherence at a microtopographic level.ResultsMicrotopographic differences between surfaces showed extensive irregularities in the rough samples as compared to the uniform grooved surface of the smooth samples. Confocal imaging showed greater bacterial coverage on the rough surfaces compared to smooth ones at all timepoint including 6 hours (7.85% vs. 3.89%, P=0.049), 12 hours (17.68% vs. 9.54%, P=0.0038), and 24 hours (20.77% vs. 13.26%, P=0.0024). SEM images further confirmed more bacterial proliferation on rough titanium surfaces, especially at the 12-hour mark, with evidence of extra-cellular-matrix.ConclusionOur findings demonstrate that rough titanium surfaces allow for greater in-vitroS. aureus growth with biofilm formation as early as 24 hours.

PurposeTo compare the risk of periprosthetic and medical complications following dual mobility cup total hip arthroplasty (DMC-THA) and bipolar hemiarthroplasty (BHA) for femoral neck fractures in patients with neurological disorders.Materials and MethodsThis retrospective study included patients with neurological disorders who underwent DMC-THA (n=1,153) or BHA (n=4,612) between 2016 and 2022, identified from the Korean Health Insurance Review and Assessment Service database. Propensity score matching was performed at a 1:4 ratio to adjust for baseline characteristics. The primary outcome was periprosthetic complications; the secondary outcome was medical complications.ResultsCompared with the BHA-matched group, the DMC-THA group showed a higher rate of early periprosthetic fracture (2.6% vs. 1.4%, P=0.02) and late dislocation (1.1% vs. 0.5%, P=0.03). No significant differences were observed in periprosthetic joint infection or revision. Regarding medical complications, DMC-THA was associated with more transfusions (63.1% vs. 57.6%, P<0.001) but fewer urinary tract infections (3.4% vs. 5.1%, P=0.01). Multivariable analysis identified DMC-THA as an independent risk factor for early periprosthetic fracture (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.39-6.80, P=0.004) and late dislocation (OR 2.53, 95% CI 1.18-5.42, P=0.02).ConclusionDMC-THA was not superior to BHA in preventing dislocation and was associated with a higher risk of periprosthetic fracture and late dislocation in neurologically impaired patients. Surgeons should recognize the risks of using DMC-THA implants as a sole strategy to prevent instability in this high-risk population.