Immediate and long-term effects of insufficient weight-bearing during growth on hip morphology and histopathology in rats.

Roburic acid inhibits glucocorticoid-induced osteonecrosis of the femoral head associated osteoclast activity via targeting PTP1B.

Acetabular dysplasia may persist in developmental dysplasia of the hip (DDH), leading to an increased risk of early hip degeneration. This study aimed to identify predictive factors for residual acetabular dysplasia (RAD) in children aged 2 to 5 years using magnetic resonance imaging (MRI). A retrospective study was conducted on 67 hips from 34 patients. The diameters of the femoral head and acetabular cartilages were measured on T2-weighted coronal images, and the difference and ratio of the cartilage diameters were calculated. The outcome measure was the Severin classification at the final follow-up. Patients were divided into 3 groups based on their age at the time of MRI, for additional evaluations. The mean age at the final follow-up was 13.4 (6.2 to 23.5) years, and the mean age at the MRI was 3.8 (2.4 to 5.9) years. The good and poor outcome groups comprised 48 (72%) and 19 (28%), respectively. The good outcome group had a smaller cartilage diameter difference (4.6±0.9 vs. 6.4±1.4mm; P <0.05), and larger cartilage diameter ratio (86±3 vs. 82±3%; P <0.05). A cartilage diameter difference of ≥5.5mm and a cartilage diameter ratio of ≤85% were associated with poor acetabular growth. The difference and ratio of the cartilage diameters was significantly different at all ages at which the MRI was performed. Combining cartilage diameter measurements with radiographic parameters improved predictive accuracy. Cases in which the acetabular cartilage diameter was larger than the femoral head cartilage diameter (difference ≥5.5mm, ratio ≤85%) showed poor subsequent acetabular development. Cartilage evaluation using MRI during childhood, particularly between 3 and 5 years of age, is useful for predicting acetabular development. Level III-retrospective comparative study.

Risk factors for allogeneic transfusion in young adults undergoing simultaneous bilateral direct anterior total hip arthroplasty within an ERAS framework.

Development of bioactive bone cement for necrotic femoral head decompression

Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited. Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses. A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates. Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.

Ceramic-on-ceramic bearings are widely used in total hip arthroplasty (THA); although rare, ceramic femoral head fracture represents a serious complication. This event typically occurs early or after trauma, whereas atraumatic late-onset fractures confined to the femoral head component are exceedingly uncommon. A 73-year-old patient developed sudden-onset hip pain and functional impairment 11 years after a primary ceramic-on-ceramic THA. The patient denied any preceding trauma. Radiographs demonstrated multiple ceramic fragments without clear identification of the donor site; intraoperative inspection confirmed a fractured femoral head with an intact liner. Revision surgery was performed with complete removal of ceramic debris and exchange to a new ceramic femoral head using a taper adapter while preserving the well-fixed stem. The postoperative course was uneventful, and the patient regained satisfactory function at follow-up. This case represents an exceedingly rare late atraumatic fragmentation of a ceramic femoral head in a ceramic-on-ceramic THA, with successful stem-preserving revision despite extensive intra-articular ceramic debris. Orthopedic surgeons and musculoskeletal radiologists should remain vigilant for this possibility in patients presenting with acute hip symptoms years after implantation. Prompt recognition and revision surgery are essential to achieve favorable outcomes.

Femoral neck fracture (FNF) is a common type of hip fracture, for which cannulated screw fixation is a primary internal fixation method. The optimal configuration for cannulated screw fixation remains controversial, with debate primarily focused on two approaches: parallel fixation configuration (PFC) versus non-parallel fixation configuration (NFC). The objective of this study was to compare the efficacy and safety of two configurations in the treatment of femoral neck fractures. Following PRISMA guidelines, we systematically searched PubMed, Embase, the Cochrane Library, and CNKI for studies comparing PFC and NFC in FNF fixation. Study quality was assessed using the Cochrane risk-of-bias tool and MINORS scale. Outcomes included femoral head necrosis, nonunion, femoral neck shortening, and fixation failure. Meta-analysis was conducted in RevMan 5.3, employing a fixed-effects model unless heterogeneity (I² > 50%) warranted an alternative approach. A total of 20 studies involving 1,508 patients were included in the meta-analysis. The meta-analysis showed that the NFC group had significantly better outcomes, including lower rates of femoral head necrosis (OR 0.50, 95% CI 0.34-0.74, P = 0.0005), nonunion (OR 0.41, 95% CI 0.26-0.65, P = 0.0001), femoral neck shortening (OR 0.40, 95% CI 0.28-0.57, P < 0.00001), and internal fixation failure (OR 0.34, 95% CI 0.22-0.52, P < 0.00001). Our findings indicate that NFC is more effective than traditional PFC for internal fixation of FNFs. Level of evidence Level III.

CT-based radiomics for modeling surgical decision-making in young and middle-aged patients with ARCO stage III osteonecrosis of the femoral head: an age-stratified retrospective study.

Acute thrombocythemic myeloproliferative disease in mice has been reported upon introduction of Middle T gene expression of mouse polyomavirus. Merkel cell polyomavirus (MCPyV) is an oncogenic human polyomavirus that accounts for approximately 80% of all Merkel cell carcinomas. In this study, we assessed the presence of MCPyV DNA in fresh bone marrow (BM) aspirates from patients with myeloproliferative neoplasms (MPNs) using MCPyV-specific DNA polymerase chain reaction (PCR). MCPyV DNA prevalence was significantly higher in 78 BM samples from MPN patients (17.9%, 14/78) than in 66 BM controls undergoing femoral head replacement surgery (3%, 2/66; Fisher's exact test, p = 0.0063; OR = 7.95% confidence interval (CI) = 1.53-32.06). Notably, positivity was predominant in essential thrombocythemia (ET; 11/14). MCPyV mRNA was detected in MCPyV-DNA-positive samples, indicating low-level viral transcription. Interestingly, MCPyV positivity was significantly correlated with female sex but not with age or specific MPN genetic mutations, except for myeloproliferative leukemia virus oncogene (MPL) mutations. These findings suggest a potential association between MCPyV and MPNs, particularly ET, and support further investigation into the role of human polyomavirus in megakaryocytic lineage biology.

Dexras1 plays a crucial role in glucocorticoid-induced osteonecrosis of the femoral head by mediating imbalance between osteogenesis and adipogenesis.

Orthopaedic surgical decision making is a combination of clinical intuition, radiological measurements, and referenced standards. As clinicians and researchers, we consider hip pathology as a mechanical problem described in geometric and statistical language. For a clinical measurement to be useful, it must be easy to perform, reproducible, and demonstrably associated with the risk of the condition it seeks to diagnose or prevent. Using acetabular dysplasia as an analytic lens, this review discusses what our radiographs actually tell us about hip morphology risk, by separating population reference ("normative") intervals from outcome-anchored decision limits and by tracing the evidentiary lineage of the field's workhorse measurements. We revisit the origins, current use, and statistical power of the lateral center-edge angle, acetabular index/Tönnis angle, femoral head extrusion index, and Graf ultrasonography classification and synthesize what is known about their reproducibility and what clinical decisions can appropriately be made. We examine how nomenclature drift fuels routine miscommunication and show that superficially similar measurements are often tied to reference datasets they were neither derived from nor validated against. The current, normal or not, phenotypic model of risk allocation is considered, and the alternative of a continuous, dose-response relationship is proposed. The aim of this narrative review is to prompt clinicians and researchers to consider has our use of legacy morphological risk models actually curtailed osteoarthritis progression in conditions such as hip dysplasia and can we continue to depend on them? Or do models grounded more in lineage than validation now warrant a fundamental reconstruction.

Functional reconstruction after resection of malignant pelvic tumors involving zones I + II ± IV remains a major challenge in orthopaedic oncology. Conventional hip transposition can reduce prosthesis-related complications, but it is often associated with limb shortening and femoral head malrotation. We propose a modified hip transposition technique-femoral lengthening and retroversion hip transposition with a customized three-dimensionally (3D) printed femoral prosthesis-to address deficiencies in limb length, femoral head positioning, and fixation stability, and we evaluate its effectiveness in reducing complications and improving functional outcomes. In the context of a small, initial patient series, we asked: (1) What was the postoperative functional outcome, as assessed by Musculoskeletal Tumor Society 1993 (MSTS-93) score, after reconstruction using this technique? (2) What were the frequency and nature of complications associated with the method? (3) How well was limb length restored at a minimum follow-up of 3 years? Between January 2019 and December 2021, a total of 49 patients underwent resection and reconstruction for pelvic zone I + II ± IV tumors. Of these, 18% (9) received the modified hip transposition with a customized 3D-printed femoral lengthening and retroversion prosthesis. This approach was selected for patients in whom sufficient proximal femur was preserved to allow controlled osteotomy and femoral lengthening, who were unsuitable for standard hemipelvic endoprosthetic reconstruction because of extensive bone or soft tissue defects, who had histologically confirmed primary malignant or aggressive pelvic tumors, and who were expected to have long-term survival without distant metastasis. The remaining 82% (40) of patients treated during the same period underwent alternative reconstruction strategies, including hemipelvic endoprosthetic reconstruction, external hemipelvectomy, or conventional hip transposition. No patients were lost to follow-up. Three patients died of pulmonary metastases during follow-up and were included in the analysis with their actual follow-up durations. The six surviving patients had a median (range) follow-up time of 43 months (37 to 50). Among the nine patients included in this study, three were male and six were female, with a median (range) age of 55 years (19 to 73). At final follow-up, functional outcomes were assessed using the MSTS-93 score, complications were recorded and categorized, and limb-length discrepancy (LLD) was measured radiographically. The six surviving patients achieved a median (range) MSTS-93 score of 24 (21 to 27) with minimal or no pain. Four patients used a cane for ambulation, and two walked independently. Two patients experienced delayed wound healing, which resolved with dressing changes; no prosthetic infections or mechanical failures occurred. Median (range) postoperative LLD was 1.0 cm (0.5 to 2.0) after intraoperative prosthesis adjustment. This modified hip transposition technique utilizing patient-specific osteotomy guides and a 3D-printed femoral lengthening and retroversion prosthesis allowed adjustment of limb length and femoral rotation in this small series, with minimal postoperative LLD and no major complications observed. Larger studies with longer follow-up times will be needed to confirm the feasibility and functional benefit of this method as a valuable complement to existing reconstructive options, particularly for patients with extensive soft tissue defects and high functional demands. Level IV, therapeutic study.

Proximal femur fractures primarily affect the elderly, with significant morbidity, mortality, and socioeconomic impact. The main complication of short trochanteric intramedullary nailing is the cut-out of the cervicocapital screw through the femoral head. The objective of this study was to analyze the influence of technical errors in short trochanteric intramedullary nailing for the treatment of trochanteric femur fractures on the mechanical failure of osteosynthesis. A total of 540 patients who underwent surgery for a trochanteric femur fracture using short trochanteric intramedullary nailing were included in a single-center, retrospective study conducted between February 2012 and July 2018. Thirty patients (5.6%) experienced mechanical failure of the osteosynthesis at the 3-month follow-up. An anterior position of the cervicocapital screw, accumulation of technical errors, a tip-apex distance > 25mm, and an intra-focal entry point were significantly associated with cervicocapital screw cut-out. The mechanical failure rate is 5.6%. Short trochanteric intramedullary nailing requires precise execution to reduce the risk of cervicocapital screw cut-out, which is a source of osteosynthesis failure.

Neurogenic hip dysplasia (NHD) is aclinically significant musculoskeletal complication in children with neurological disorders, particularly infantile cerebral palsy (CP). It contributes substantially to pain, functional limitations, and reduced quality of life. Muscle imbalance and impaired dynamic hip stability lead to progressive deformity of the femoral head and acetabulum, increasing the risk of subluxation and dislocation. Risk strongly correlates with GMFCS level and is highest in non-ambulatory children (levels IV-V). Diagnosis and monitoring rely on radiographic parameters such as the Reimers migration index, Rutz classification and other classification systems, although some measures have limitations in CP. Management requires long-term, interdisciplinary care. GMFCS-based hip surveillance enables early detection and timely intervention before irreversible damage occurs. Treatment decisions must be individualized, as not all dysplasia is symptomatic. Options range from conservative measures with limited long-term efficacy to soft-tissue procedures and reconstructive surgery (e.g., VDRO with or without pelvic osteotomy), while salvage procedures are reserved for severe cases. Overall, NHD is a multifactorial, complex disease that requires structured diagnostics, continuous monitoring, and early, patient-specific therapy with the active involvement of families, with the aim of improving function and quality of life.

This aim of this study was to document the management and outcomes of dogs having total hip replacement (THR) following a failed hip toggle.Retrospective case series.Eleven dogs that had a failed hip toggle and subsequent conversion to THR.Medical records were examined for pertinent information regarding the initial luxation event, the hip toggle surgery, coxofemoral joint conformation and any pre-existing pathology, THR materials, complications and outcomes. Pre- and postoperative hip toggle and THR radiographs were examined. The Liverpool Osteoarthritis in Dogs questionnaires were sent to all clients with dogs in this study.Hip toggles failed due to re-luxation (n = 8) and chronic lameness (n = 3). Radiographs identified osteoarthritis in 10/11 dogs. The percentage of femoral head coverage was <50% in 8/11 dogs. The initial luxation aetiology was traumatic (n = 5), atraumatic (n = 4) and unknown (n = 2). A pre-THR culture was performed for 5/11 dogs via Fine Needle Aspirate (FNA), femoral toggle rod or button and suture material. The intrapelvic toggle rod was removed intraoperatively and cultured in six dogs. Complications were intraoperative (n = 2) and postoperative (n = 2), and were minor (n = 1), major (n = 2) and catastrophic (n = 1). The Liverpool Osteoarthritis in Dogs scores were obtained for 8/11 dogs, with a median score of 6.5. A successful outcome was documented for 9/11 dogs.Total hip replacement was successful in 9/11 dogs. The median Liverpool Osteoarthritis in Dogs scores were within the previously published range for dogs having uncomplicated THR. Despite the requirement for additional considerations, THR can be safely and effectively performed in dogs following failed hip toggle surgery.

With the development of osteoporosis, the principal compressive trabeculae (PCT) of proximal femur is preferentially retained and regarded as the main loadbearing structure of the femoral head. However, the significance of PCT in lag screw fixation has not been clarified. The CT data of intact proximal femurs from 93 elderly patients were reconstructed with a personalized threshold segmentation method. The midcoronal plane of proximal femur was established, in which the PCT contour was extracted, and the analytical screw-tracts were created. The relative CT values of PCT in different screw-tracts were compared. The relationship between PCT and lag screws was analyzed by measuring the effective anchoring length (EAL), the maximum screwing depth (MSD) and the upper edge length (UEL) in each screw-tracts. Continuous PCT contours were extracted in the midcoronal plane from all models. The relative CT value of the upper PCT (1.59 ± 0.21) was significantly lower than that of the middle and lower PCT (1.94 ± 0.32 and 1.92 ± 0.36, respectively). The mean EAL of the upper screw-tract was 20.79 ± 2.71mm, which was significantly higher than that of the middle and lower screw-tracts (19.52 ± 3.19mm and 19.10 ± 4.51mm, respectively). The mean MSD of the lower screw-tract was 36.96 ± 3.62mm, which was significantly higher than that of the upper and middle screw-tracts (22.52 ± 2.98mm and 31.40 ± 2.80mm, respectively). The mean UEL of the middle screw-tract was 22.46 ± 4.76mm, which was significantly higher than that of the upper and lower screw-tracts (14.26 ± 4.02mm and 19.81 ± 3.87mm, respectively). Strong correlations were found between the patient's height and the MSD of the middle and lower screw-tracts (R = 0.543 and R = 0.568 respectively). For the elderly, the PCT is the main load-bearing structure between the femoral head and neck, and should be regarded as the target for lag screw fixation. Both the middle and lower PCT can provide ideal screw-tracts for lag screw fixation. In order to obtain the maximum anchoring strength, the upper positioned lag screw should be placed deep, while the lower positioned should be placed shallow.

Spiron short-stem hip arthroplasty for the treatment of avascular necrosis of the femoral head (AVNFH) in young patients preserves the bones, resulting in favorable and easy conditions when the hip is replaced again. The purpose of this study is to describe several anatomical features of the hip joint in adult Vietnamese people and to assess the efficacy of Spiron short-shaft hip arthroplasty. 129 healthy hips and 64 hips of 46 AVNFH patients underwent Spiron short-stem arthroplasty and were followed up from Jan-2012 - Dec-2022. Patients were performed digital X-rays to determine anatomical parameters in order to select the proper joint size. Patients' clinical outcomes and complications were evaluated at 12, 36, and 48 months after arthroplasty. Among the 46 patients, only 4.4% were women. The patients had an average age of 40.6 years and a mean preoperative Harris score of 45.9. AVNFH patients' anatomical indices were all lower than those of healthy people. After 48 months of arthroplasty, severe pain symptoms decreased from 71.9% to 3.1%, walking limitation decreased from 59.4% to 4.7%, and Harris score good and excellent (80-100 points) increased from 0.0% to 78.2%. Complications included 1.6% wound infection and 3.1% acetabular displacement after 48 months. Other complications, such as lateral popliteal nerve injury, decreased from 6.3% (12 months) to 1.6% after 48 months, while bone loss and periarticular lumina increased from 3.1% (12 months) to 18.8-21.9% (48 months). After 48 months, 12.5% of patients underwent re-arthroplasty. Although Spiron short-stem hip arthroplasty for young Vietnamese patients has significantly improved clinical symptoms and bone preservation, the rate of complications and re-arthroplasty remains relatively high due to the skill and surgical indication selection of surgeons. Therefore, surgeons need to receive careful and closely monitored training in the Spiron hip arthroplasty technique.

Angiogenesis-osteogenesis coupling lithium-loaded bioglass/GelMA hydrogel for bone regeneration.

Injectable thermosensitive hydrogel delivering resveratrol protects articular cartilage via SIRT1/HIF1α/MMP13 signaling.