BackgroundHip arthroscopy is commonly performed for various hip pathologies; however, patients over 40 years old have an increased risk of conversion to total hip arthroplasty (THA). Identifying risk factors for THA conversion can improve patient selection and surgical planning.Hypothesis/PurposeThis study aims to identify preoperative and intraoperative risk factors associated with THA conversion following hip arthroscopy in patients over 40 years old.Study DesignRetrospective cohort study.MethodsA total of 211 patients aged >40 years who underwent primary hip arthroscopy by a single surgeon between 2013 and 2023 were analyzed. Preoperative radiographic parameters, including lateral center-edge angle (LCEA), acetabular depth-to-width ratio (ADWR), and acetabular angle, were assessed alongside intraoperative findings such as chondral damage and ligamentum teres tears. Patient-reported outcomes (PROs) were evaluated using the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), and visual analog scale (VAS). Logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify significant predictors of THA conversion.ResultsConversion to THA occurred in 16 patients (7.5%). The conversion group had significantly lower LCEA (23.4° vs. 27.2°, p = 0.015) and higher acetabular angle (42.4° vs. 39.5°, p = 0.004), along with a higher incidence of ligamentum teres tears (38% vs. 19%, p = 0.019). Logistic regression identified lower LCEA (OR = 0.804), increased acetabular angle (OR = 1.144), and ligamentum teres tears (OR = 1.277) as independent risk factors for THA conversion (p < 0.05). ROC analysis demonstrated strong predictive accuracy (AUC = 0.87). While PROs improved postoperatively in both groups, only HOS showed a statistically significant difference, though of minimal clinical relevance.ConclusionLower LCEA, increased acetabular angle, and ligamentum teres tears are significant risk factors for THA conversion after hip arthroscopy in patients over 40 years old. Identifying these factors preoperatively may enhance surgical decision-making and patient counseling regarding long-term joint health.

BackgroundOptimal treatment for iliopsoas tendinitis (IPTs) after total hip arthroplasty (THA) with cup malposition is controversial between iliopsoas release alone and cup revision especially in young active patients. Moreover, arthroscopic iliopsoas tendon (IPT) release in these patients has been rarely described and mid-term effect of this on THA longevity and recurrence of groin pain is unclear. We performed arthroscopic IPT release for IPTs after THA and report mid-term outcome in two young patients with acetabular cup malposition.Case SummaryTwo patients visited the hospital for groin pain which started early after THA. Both patients showed non-specific findings on physical examination and no evidence of infection on laboratory tests. X-ray and CT scans showed reduced acetabular component anteversion angle and anterior cup prominence more than 16 mm. As therapeutic diagnosis, ultrasonography-guided lidocaine injection with steroid into IPT sheath was performed. Initially, groin pain improved, but after a few months, it worsened in both patients. Therefore, we performed arthroscopic IPT release under spinal anesthesia. Arthroscopy revealed synovitis with fibrous tissues around IPT and various lesions related to the implants after THA. IPT tenotomy and debridement with biopsy were performed and histopathology showed chronic inflammation with synovial hyperplasia.Both patient were encouraged to start walking immediately after surgery and returned to complete daily life early after surgery without recurrence of groin pain and any implant-related problems at 9 years postoperatively.ConclusionArthroscopic IPT release showed excellent mid-term outcome without recurrence of groin pain and implant-related problems in those with cup malposition.

IntroductionThis study aimed to figure out the relationship between hip morphology and chondral injury.Materials and MethodsPatients who received hip arthroscopy in our institution from 2013 to 2022 was reviewed, and patients under 40 years old with chondral injury under arthroscopy and without osteoarthritis change in preoperative X-ray were enrolled. Plain film and CT were used to evaluate the hip morphology.Results60 patients were enrolled in our study with mean age of 31 years old. Acetabulum cartilage injury is related with smaller lateral center edge angle (LCEA)(38.3° vs 31.7°, p=0.031), and the smaller posterior acetabular sector angle (PASA) is risk factor of severe chondral wear (89.55° vs 69.34°, p=0.002). In addition, the severity of femoral chondral injury is related with the larger LCEA (29.86 vs 40.45, p=0.001) and smaller PASA (94.36° vs 42.4°, p<0.001). Full thickness of chondral injury indicated less favorable clinical outcomes including pain scale and patient reported outcomes than no or partial thickness injury group.DiscussionPatients with poor posterior coverage of acetabulum would present with more severe chondral injury in both femur and acetabulum articular surface, which might be related to the lower stability of hip joint during motion, But the more excessive coverage acetabulum may cause more femoral chondral injury. The depth of chondral injury caused worse clinical outcomes.ConclusionThe posterior and superior coverage of acetabulum is related with the chondral injury of hip joint in young patient group and the severity of chondral injury also caused poor clinical outcomes.

PurposeAcetabular retroversion following rotational acetabular osteotomy (RAO) has been reported as a risk factor for limiting range of motion and progression of osteoarthritis. In our experience, postoperative acetabular retroversion was identified more frequently when the ischial osteotomy line was directed more anteriorly (i.e., when the osteotomy angle was larger). We then hypothesized that the ischial osteotomy direction would affect the rotational behavior of the osteotomized fragment and contribute to acetabular retroversion. The purpose of this study was to clarify that the ischial osteotomy angle was greater in patients with postoperative acetabular retroversion compared to those with anteversion.MethodsWe analyzed 100 hips (male/female: 8/92, mean age at surgery: 32.3 years, mean preoperative CE angle: 7°) that underwent eccentric RAO in our department. On postoperative CT axial images, the acetabular anteversion angle (AAA) at the femoral head center level was measured. Hips with AAA ≥ 0° and < 0°were classified into the anteversion and retroversion group, respectively. The ischial osteotomy angle—defined as the angle between the ischial osteotomy line and the horizontal line—was measured at four levels: at the ischial spine, 1 cm distal, 1 cm proximal, and 2 cm proximal to the ischial spine. We compared the ischial osteotomy angles between the anteversion and retroversion groups.ResultsThe anteversion group included 81 hips, and the retroversion group included 19 hips. The ischial osteotomy angles (anteversion group: retroversion group, p-value) were as follows:1 cm distal to the ischial spine: 31°±11°:38°±16°, p=0.092at the ischial spine: 29° ± 9°: 38°±14°, p=0.0131 cm proximal to the ischial spine: 30°±10°:37°±13°, p=0.0272 cm proximal to the ischial spine: 32°±11°:38°±12°, p=0.071DiscussionThe ischial osteotomy angle was significantly larger (i.e., ischial osteotomy was directed more anteriorly) in the acetabular retroversion group. It is possible that when the osteotomized fragment was abducted to obtain lateral coverage, the posteroinferior portion acted as a hinge and rotated anteriorly, resulting in retroversion.ConclusionIn rotational acetabular osteotomy, if the ischial osteotomy is directed anteriorly, acetabular retroversion may occur after surgery. Therefore, careful attention should be paid to the direction of the ischial osteotomy.

PurposeThe current study aims to evaluate the outcomes of the Bernese periacetabular osteotomy when performed for secondary hip dysplasia.MethodsIn this retrospective case series, 20 patients with secondary hip dysplasia due to underlying neuromuscular conditions (ambulatory cerebral palsy) or skeletal dysplasias (multiple epiphyseal dysplasia, residual Perthes, hereditary multiple exostosis), who underwent the Bernese periacetabular osteotomy, were included.ResultsStatistically significant radiological and clinical improvements were noted for the acetabular angle, Tonnis angle, lateral central edge angle and Harris hip scores post-operatively over an average follow-up period of 5 years. Adjunctive procedures were required for patients with underlying neuromuscular conditions (proximal femur osteotomy) and hereditary multiple exostosis (surgical hip dislocation).ConclusionsThe Bernese periacetabular osteotomy, together with adjunctive procedures, is a viable surgical option for patients with secondary hip dysplasia.

To investigate the effectiveness of hip arthroscopy in the treatment of patients with femoroacetabular impingement (FAI) syndrome combined with ligamentum teres injury. A retrospective analysis was conducted on 23 patients (23 hips) with Cam-type FAI syndrome combined with ligamentum teres injury who met the selection criteria between April 2022 and May 2024. The cohort included 12 males and 11 females, with a mean age of 29.16 years (range, 16-57 years). According to Tönnis classification, there were 5 cases of grade 0, 10 cases of grade Ⅰ, and 8 cases of grade Ⅱ in hip osteoarthritis. The disease duration ranged from 6 to 24 months, with an average of 12 months. Under hip arthroscopy, hypertrophic synovium and the damaged ligamentum teres were debrided, while the torn labrum and cartilage were repaired, and femoral head-neck osteoplasty was performed to eliminate impingement, restore the normal morphology of the acetabulum and femoral head-neck, and suture the joint capsule. Acetabular lateral center-edge angle (LCEA) and α angle (reflecting the degree of non-sphericity at the femoral head-neck junction) were measured before and after operation, and the modified Harris hip score (mHHS), the International Hip Outcome Tool-12 (IHOT-12), and the visual analogue scale (VAS) score for pain were evaluated. The operation was successfully completed in all patients. The incisions healed by first intention after operation, and there was no perioperative complications such as iatrogenic cartilage injury, fracture, infection, neurovascular traction injury, or lower extremity venous thrombosis. All the 23 patients were followed up 12-24 months, with an average of 14.6 months. The pain of hip joint significantly relieved, and the function of hip joint improved; no complication such as joint stiffness, joint instability, and osteonecrosis of the femoral head occurred. The α angle, VAS score, mHHS score, and IHOT-12 score at last follow-up were significantly better than those before operation ( P<0.05); there was no significant difference in LCEA compared to preoperative value ( P>0.05). Hip arthroscopy is a safe and effective treatment for patients with FAI syndrome combined with ligamentum teres injury, which can achieve satisfactory effectiveness.

Background: We aimed to investigate the relationship between spinopelvic parameters, spinal deformities, and femoral and acetabular anteversion in patients who were candidates for total hip arthroplasty (THA). Methods: The femoral and acetabular anteversion angles were measured using computed tomography (CT) scans. Additionally, spinopelvic parameters were assessed with the appropriate graphs. We utilized SPSS software to analyze the relationship between different types of spinopelvic deformities, spinopelvic parameters, and femoroacetabular anteversion angles. Results: A one-way analysis of variance (ANOVA) showed a significant effect of deformity type on femoral and acetabular version (P &lt; 0.001). Post hoc analysis using Tukey’s honestly significant difference test (HSD) revealed that patients with stuck sitting deformity had significantly higher femoral and acetabular anteversion compared to others (P &lt; 0.001). The anterior pelvic plane (APP) significantly predicted both femoral and acetabular anteversion in the regression model. Conclusion: Our observations indicate that spinopelvic deformities significantly impact femoral and acetabular anteversion, with the “stuck sitting” group exhibiting the highest values.

Hip joint morphology varies by sex and age. Computed tomography (CT) provides excellent evaluation of acetabular morphology; however, a description of the normal range of CT measurements in healthy children is lacking. This study aimed to describe the acetabular morphology on CT in healthy children by sex and at specific ages. Children who underwent pelvic CT from February 2016 to 2022 were retrospectively studied. The anterior pelvic plane was the basis for measuring lateral center-edge angle (LCEA), acetabular angle, anterior center-edge angle (ACEA), acetabular version (AcetV), anterior acetabular sector angle (AASA), and posterior acetabular sector angle (PASA). This study included 55 females and 55 males. The mean age was 12.5 years (range: 1-18 years). Patients were grouped by age: 2-7 years (n = 50 hips), 8-11 years (n = 50 hips), and 12-18 years (n = 120 hips). Mean AcetV was 16.5° (range: 5.8-29.5°), mean AASA was 58.38° (range: 40.0-69.4°), mean PASA was 90.6° (range: 68.8-111.00°), mean LCEA was 27.9° (range: 19.0-40.4°), mean acetabular angle was 45.1° (range: 33.6-55.9°), and mean ACEA was 47.6° (range: 23.0-64.4°). The AcetV, AASA, PASA, LCEA, and ACEA increased with age, while the acetabular angle decreased (P < 0.001). AcetV and PASA were highest in females (P < 0.001). Hip joint development varies by sex across specific ages. The measurements reported provide descriptive reference data that may be used as an assessment tool for early identification of pediatric hip deformities and aid surgical planning.

There is a need to estimate acetabular morphometric parameters in asymptomatic individuals from the North Indian population. Therefore, it is of interest to evaluate the prevalence of acetabular dysplasia, which has not been extensively studied in this specific population. A cross-sectional analysis of 100 radiographs was conducted to measure parameters such as center-edge angle, acetabular angle and acetabular depth. The data revealed gender-based differences in acetabular parameters, with significant variations noted between the right and left sides. Thus, we show valuable data for improving hip implant design, understanding osteoarthritis and supporting clinical and forensic applications. This study contributes to more precise and population-specific orthopedic interventions.

The orientation of the acetabulum in the axial and coronal planes is well studied in the pathogenesis of impingement and instability of the hip. In contrast, the sagittal orientation of the acetabulum (SOA) is not well understood. To determine (1) the SOA in a large cohort of mature hips and (2) to assess the relationship between the SOA and acetabular version, acetabular center-edge angles (CEAs), and spinopelvic alignment. Descriptive laboratory study. A total of 3695 patients (7390 mature hips) who underwent computed tomography (CT) scans for assessment of nonorthopaedic abdominal and pelvic conditions were studied. An automated measurement software was utilized to reconstruct 3-dimensional models from CT scans and to measure the SOA, functional SOA (not neutralizing pelvic position on sagittal plane), acetabular version, as well as acetabular CEAs and spinopelvic alignment, including the pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). The SOA was on average (± SD) 19.6°± 7.5°. The functional SOA (not neutralizing pelvic position on sagittal plane) was on average (± SD) 20.5°± 5.7°. The functional SOA had a statistically significant but negligible correlation with PI (r = 0.13; P < .001) and SS (r = -0.06; P < .001), and a weak positive correlation with PT (r = 0.23; P < .001). The SOA had a positive moderate correlation with the cranial (r = 0.41; P < .001) and central acetabular version (r = 0.39; P < .001) and a strong correlation (r = 0.63; P < .001) with caudal acetabular version. A 10° increase in SOA was associated with a 6.6° increase on the caudal acetabular version. The SOA had a moderate negative correlation (r = -0.48; P < .001) with the CEA at 3 o'clock (anterior for left and right hips). A 10° increase in SOA was associated with a 4.9° decrease in CEA at 3 o'clock. The acetabulum is on average 19.5° cephalically oriented in the sagittal plane in asymptomatic individuals. The SOA correlates with acetabular version and cannot be presumed based on spinopelvic alignment. The assessment of the SOA may aid in the diagnosis of hip impingement and instability, allowing a more precise correction of the acetabulum in hip arthroscopy and osteotomies.

To explore and analyze the clinical efficacy of robotic-assisted versus traditional total hip arthroplasty. A total of 186 patients with end-stage hip joint diseases treated from January 2023 to April 2025 were selected as the research subjects. Among them, 85 patients were screened out using propensity score matching and divided into two groups according to different treatment methods:manual total hip arthroplasty (mTHA) group (mTHA group) and robotic-assisted total hip arthroplasty (rTHA) group (rTHA group). In mTHA group, there were 50 patients, including 18 males and 32 females, age ranged from 37 to 78 years old with a mean of (60.12±10.93) years old;body mass index (BMI) ranged from 16.6 to 32.0 kg·m-2 with an average of (23.98±3.78) kg·m-2;27 cases involved the left hip, and 23 cases involved the right hip. In the rTHA group, there were 35 patients, including 14 males and 21 females, age ranged from 31 to 76 years old with an average of (57.14±12.18) years old;the BMI ranged from 17.1 to 33.0 kg·m-2 with a mean of (22.76±2.54) kg·m-2;13 cases involved the left hip, and 22 cases involved the right hip. The following parameters were analyzed and compared between the two groups:acetabular anteversion angle, acetabular abduction angle, difference in combined offset, difference in lower limb length, proportion of acetabula located in the Lewinnek safe zone after surgery, operation time, visual analogue scale (VAS) score, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, and Harris hip score (HHS). All patients were followed up for 3 to 9 months, with an average of (6.8±1.3) months. In rTHA group and mTHA group, the abduction angles were (40.73±4.62)° and (40.95±4.71)° respectively;the differences in combined offset were (0.42±0.28) mm and (0.60±0.23) mm respectively;the WOMAC scores were(20.9±5.4) and (20.2±4.6) respectively;and the VAS were (1.1±1.0) and (1.0±0.8) respectively. There were no statistically significant differences in the above indicators between the two groups (P>0.05). However, statistically significant differences were observed between the two groups in the following aspects(P<0.05):the differences in lower limb length were (3.17±0.15) mm and (5.28±0.47) mm respectively;the postoperative acetabular anteversion angles were(22.84±2.83)° and (25.72±3.29)° respectively;the HHS were (80.7±5.5) and (74.8±6.3) respectively;and the operation times were (148.20±46.82) minutes and (81.84±18.76) minutes respectively. Robot-assisted total hip arthroplasty demonstrates superior implant accuracy and improved early functional recovery compared with traditional manual THA. Nevertheless, it is associated with significantly longer operation time. Long-term prosthesis survival rate requires further follow-up verification.

To explore the differences in clinical efficacy between enhanced workflows and express workflows in robotic-assisted total hip arthroplasty(THA). A retrospective analysis was conducted on 46 patients who underwent robotic-assisted THA between November 2020 and May 2021. They were divided into the enhanced workflows group and the express workflows group based on the surgical methods. There were 20 patients in the enhanced workflows group, including 11 males and 9 females;aged from 51 to 78 years old with an average of (67.30±7.52) years old. The BMI ranged from 18.24 to 24.03 kg·m-2 with an average of(23.80±3.01) kg·m-2. There were 26 patients in the express workflows group, including 12 males and 14 females;aged from 57 to 84 years old with a mean age of (67.58±7.29) years old, and their BMI ranged from 19.72 to 30.08 kg·m-2 with an average of (24.41 ±2.92) kg·m-2. The operation time, hospital stay, and perioperative complications of the patients were recorded. The postoperative acetabular prosthesis anteversion angle, abduction angle, limb length, and offset distance data were measured. The Harris hip score at the latest follow-up was recorded. All patients completed the surgery as planned and were followed up, with the follow-up period ranging from 47 to 54 months with a mean of (49.78±1.85) months and the length of hospital stay ranging from 2 to 11 days with an average of (6.57±1.82 ) days. The operation time of enhanced workflows group was (93.41±16.41) minutes, which was longer than that of the express workflow groups (75.19±18.36) minutes, and the difference was statistically significant (P<0.05). In enhanced workflows group, the postoperative acetabular anteversion angle was (19.20±4.46)°, the limb length discrepancy was (-1.55±9.13) mm, and changes of the offset was (-5.15±6.77) mm. The corresponding values in express workflows group were (20.46±3.29)°, (2.19±4.39) mm, and (-2.39±4.34) mm, respectively. There was no statistically significant difference in these indicators between the two groups(P>0.05). One patient in the enhanced workflows group developed deep venous thrombosis after surgery. No cases of dislocation or periprosthetic infection. At the latest follow-up, all patients had well-positioned prostheses without loosening. Harris hip score was (90.50±1.67) points in enhanced workflows group and (90.73±2.36) points in the express workflows group, with no statistically significant difference between the two groups (P>0.05). The clinical efficacy of robot assisted total hip arthroplasty technology is satisfactory. The enhanced workflows will increase the surgical time. For patients with normal anatomical hip joint disease, this study did not find significant advantages in joint stability and functional scoring for the enhanced workflows.

Proper orientation of the acetabular cup in total hip arthroplasty (THA) is essential to reduce dislocation risk, improve range of motion, and enhance implant longevity. Misalignment can lead to complications such as impingement, wear, and aseptic loosening. Patient positioning on the operating table is a critical yet often overlooked factor influencing pelvic tilt and cup placement accuracy during THA. This study aimed to evaluate the impact of preoperative patient positioning on acetabular component placement and explore whether surgeon experience affects cup placement precision. In this prospective case series, 135 patients undergoing non-navigated THA in the supine position at a single tertiary center were included. Preoperative photographs captured pelvic inclination, which was compared to postoperative cup orientation measured on radiographs. Patients were divided into three groups based on surgeon experience (< 5 years, 5–15 years, > 15 years). Statistical analyses assessed relationships among patient positioning, cup orientation, leg length discrepancy, and surgeon experience. Greater pelvic inclination measured before sterile draping was significantly associated with a smaller acetabular cup angle (Pearson’s R = -0.72, p < 0.001). Surgeons with > 15 years of experience demonstrated less variability in cup orientation and leg length discrepancy than those with fewer years of experience (p < 0.001). Despite variations in pelvic positioning, the overall postoperative cup angle was consistent across groups. Preoperative patient positioning significantly impacts acetabular cup orientation, with more experienced surgeons better able to compensate for these deviations. Positioning protocols and surgeon training on pelvic orientation may enhance THA outcomes, particularly for early-career surgeons.

Eccentric rotational acetabular osteotomy (ERAO) is an effective treatment for acetabular dysplasia, but delayed union of the superior pubic ramus is a concern. This study identified risk factors for delayed pubic union post-ERAO and evaluated its clinical impact. This retrospective study included 101 patients who underwent ERAO during 2014-2022, grouped according to one year pubic union status: union (n = 78) and delayed union (n = 23). We compared demographics, pre-and postoperative radiographic parameters (including lateral, anterior, and posterior centre-edge angles; acetabular sector angles; acetabular anteversion; pubic osteotomy site; and femoral head centre lateralisation), and clinical outcomes. Multivariate logistic regression identified older age (odds ratio [OR], 1.07; 95% CI, 1.00-1.13), a more medial pubic osteotomy site relative to the iliopectineal eminence (OR, 1.28; 95% CI, 1.10-1.49), and insufficient femoral head centre medialisation (OR, 1.40; 95% CI 1.12-1.74) as independent risk factors for delayed union. The pubic osteotomy site cutoff was 12.0mm medial to the iliopectineal eminence (AUC 0.759). The delayed union group exhibited significantly higher rates of inferior pubic ramus stress fractures (17.4% vs. 1.3%, p = 0.009), although two year JOA scores were similar between groups. Older age, pubic osteotomy more medial to the iliopectineal eminence, and insufficient femoral head medialisation are key risk factors for delayed pubic union after ERAO. While these factors did not directly affect hip function at two years postoperatively, they significantly increased the risk of inferior pubic ramus stress fractures. Therefore, accurate pubic osteotomy and careful avoidance of femoral head lateralisation are essential.

Background/Objectives: Total hip arthroplasty (THA) is a widely accepted and effective intervention for advanced degenerative hip disease. However, prosthetic dislocation remains one of the most common postoperative complications. This study aimed to evaluate the biomechanical consequences of implant positioning variations and their influence on prosthetic stability. Methods: A three-dimensional finite element model (FEM) of the pelvis and hip joint was developed using SolidWorks Professional 2025, based on CT imaging of an anatomically normal adult. Multiple implant configurations were simulated, varying acetabular cup inclination and anteversion angles, femoral stem depth, and femoral offset. Muscle force vectors replicating single-leg stance conditions were applied according to biomechanical reference data. The mechanical performance of each configuration was quantified using the safety factor (SF), defined as the ratio of allowable material stress to calculated stress in the model. Results: The configuration with 45° cup inclination, 15° anteversion, standard femoral offset, and optimal stem depth demonstrated the highest SF values (9-12), indicating a low risk of mechanical failure or dislocation. In contrast, malpositioned implants-particularly those with low or high anteversion, excessive offset, or shallow stem insertion-resulted in a marked decrease in SF values (2-5), especially in the anterosuperior and posterosuperior quadrants of the acetabular interface. Conclusions: The findings underscore the critical importance of precise implant alignment in THA. Even moderate deviations from optimal positioning can substantially compromise biomechanical stability and increase the risk of dislocation. These results support the need for individualized preoperative planning and the use of assistive technologies during surgery to enhance implant placement accuracy and improve clinical outcomes.

Background: Morphometry of acetabulum has important clinical implications as it is crucial to the orthopaedic surgeons for surgical planning before acetabulumsurgery andacetabular cupplacement during total hip arthroplasty andhelp the cliniciansto assess hip dysplasia and hip osteoarthritis. It is also useful to theprosthetistsfor designing better prosthesis of hip joint. Gender differences in the morphometric parameters of acetabulum assist the forensic experts in determination of sex. The present study was designed to evaluatecenter edge angle, acetabular angle of Sharp and Tonnis Angle in adult Bangladeshi population, determine gender differencesand compare findings of the present study with the studieson other Methods: This was a cross sectional analytical study conducted on the Department of Anatomy, Sir Salimullah Medical College, Dhaka from July 2020 to June 2021.Standardized plain anteroposterior pelvic radiographs of seventy adult Bangladeshi population age ranging from 25- 45 years were collected to measure center edge angle, acetabular angle of Sharp and Tonnis angle unilaterally on the radiographs with MB ruler software. Comparisons between male and female parameters were done with unpaired t-test. Statistical analyses were performed using SPSS 24 software .Results: In the present study, the total mean center edge angle was 34.29°±5.66°,the mean center edge angleof male and female were33.95°±5.64° and 35.03°±5.53° respectively. The mean acetabular angle of Sharp was 39.33°±3.29°.The mean valueof male and femalewere 39.53°±3.82° and 39.39°±3.21°respectively. The mean Tonnis angle was 6.74°±4.26°. In male itwas 6.85°±4.05°, while in femaleitwas 6.62°±4.51°. The present study showed no statistically significant gender differencein mean center edge angle, acetabular angle of Sharp and Tonnis anglein adult Bangladeshi population. Conclusion: In the present study center edge angle, acetabular angle of Sharp and Tonnis angle showed no significant gender difference in adult Bangladeshi population. Sir Salimullah Med Coll J 2024; 32: 23-28

Objective: To investigate the differences in prosthesis implantation accuracy, biomechanical indicators, and 2-year postoperative clinical outcomes between robotic-assisted traditional posterior approach (RA-PLA) and robotic-assisted direct anterior approach (RA-DAA) in total hip arthroplasty (THA). Methods: This study is a prospective randomized controlled trial. Patients with unilateral femoral head ischemic necrosis or primary hip osteoarthritis who meet the inclusion and exclusion criteria and were admitted to the Orthopedics Department of Xinqiao Hospital, Army Medical University from May 2022 to September 2022. Divided into RA-PLA group and RA-DAA group through central randomization. Use cumulative and fitting methods to analyze the learning curve of robotic surgery and eliminate cases before the inflection point of the learning curve. Compare the abduction angle and anteversion angle of acetabular cup implantation between two groups of patients, as well as the rate of falling into the safe zone, the difference in length between the two lower limbs, hip joint eccentricity, rotation center height, the complete accuracy of prosthesis planning (the number of cases in which acetabular cup prosthesis, femoral stem prosthesis specifications, and neck shaft angle were completely consistent with surgical planning during surgery/total cases×100%), patient reported outcome indicators (including Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC), and 12 item Short Form Health Survey (SF-12) score) and clinical outcomes. Data comparison was conducted using independent sample t-test, Wilcoxon rank sum test, chi square test, Fisher's exact probability method, or repeated measures analysis of variance. Results: A total of 98 patients were included in this study, with 48 in the RA-PLA group and 50 in the RA-DAA group. After excluding cases before the inflection point of the learning curve, 30 patients were included in each group. There was no statistically significant difference in baseline data between the two groups before surgery (all P>0.05). There was no significant difference in the values of the anterior tilt angle and abduction angle between the two groups of acetabular cups compared to preoperative planning (all P>0.05). The proportion of patients who fell into the Lewinnek and Callanan safe zones was 90.0% (27/30) and 96.67% (29/30), respectively (χ2=0.268, P=0.605). There was no significant difference in postoperative lower limb length, hip joint eccentricity, and rotation center height deviation and grading between the two groups (all P>0.05). The complete accuracy of prosthesis planning in the RA-DAA group was higher than that in the RA-PLA group (86.7% (26/30) compared to 63.3% (19/30),χ2=4.356,P=0.037).All patients were followed up for more than 2 years. In terms of postoperative HHS, WOMAC, and SF-12 score, there was no statistically significant difference in the inter group effect comparison (all P>0.05), but there was a significant statistical significance in the time effect (all P<0.05). There was no significant difference in the incidence of perioperative complications and adverse events between the RA-DAA group and the RA-PLA group (20.0% (6/30) vs. 13.3% (4/30),χ2=0.480,P=0.488). Conclusions: RA-DAA and RA-PLA techniques can achieve similar clinical efficacy after two years of surgery, and both can achieve similar reconstruction accuracy in terms of acetabular cup implantation angle, lower limb length, hip joint eccentricity, and rotation center height. The accuracy of prosthesis planning in RA-DAA is higher.

Objective: To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA). Methods: A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results: All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference (t=0.231,P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference (t=1.792,P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation (t=6.282,P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference (t=2.635,P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up (t=22.630,P<0.01). Conclusion: The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

In this pilot study, we analyzed whether there is an association between hip radiographic parameters and the severity of osteonecrosis secondary to sickle cell disease, according to the Ficat and Arlet, and Ohzono classifications. This descriptive cross-sectional study included 20 patients aged 18 to 45years treated at Professor Edgard Santos University Hospital (HUPES). All patients underwent an anteroposterior pelvic radiograph at HUPES. Clinical and radiographic data were collected, including the classification of osteonecrosis according to Ficat and Arlet, and Ohzono, as well as the following radiographic parameters: position of the hip center, femoral head extrusion index, Wilberg angle, Tönnis acetabular roof angle, and cervicodiaphyseal angle. Seven hips were excluded because they had already undergone surgical treatment. Of the 33 hips evaluated, most were in advanced stages of osteonecrosis. The cervicodiaphyseal angle showed a significant difference between advanced stages (III and IV) and early stages (IIA and IIB) in the Ficat & Arlet classification, while other parameters did not present statistically significant differences. The study identified significant variations in the cervicodiaphyseal angle between different stages of osteonecrosis. Despite being limited by the small sample size and excluding post-surgical cases, the study provides an initial basis for the radiographic characterization of osteonecrosis associated with Sickle Cell Disease. It indicates the need for future research with larger samples.

Influence of Hip Prosthesis Position on Postoperative Gait After Primary THA in Patients With Unilateral Femoral Head Necrosis.