Vertebral compression fractures (VCFs) can impair posture, gait, and daily activities in patients undergoing total hip arthroplasty (THA). However, limited data are available regarding the incidence, risk factors, and impact of VCFs on sagittal spinal alignment following THA. Therefore, the purpose of this study was to investigate the incidence and risk factors of VCFs after THA, and to evaluate their impact on sagittal spinal alignment and clinical outcomes. This retrospective cohort study included 220 patients (243 hips) who underwent primary THA, with a mean follow-up period of 6.1years. Data collected included patient demographics, Fracture Risk Assessment Tool (FRAX) scores, lumbar bone mineral density measured before THA, sagittal spinal alignment parameters, Harris Hip Score (HHS), and the occurrence of new VCFs. We analyzed changes in spinal alignment and identified risk factors associated with incident VCFs. VCFs occurred in 20% of hips during the follow-up period. Patients who developed VCFs demonstrated a significantly increased sagittal vertical axis, reduced lumbar lordosis angle, and lower postoperative HHS compared to those without VCFs. Preexisting VCF and higher preoperative FRAX scores were significantly associated with the development of new VCFs. Multivariate logistic regression analysis identified the FRAX score as an independent predictor of incident VCFs. In this 6.1-year retrospective cohort study, 20% of hips developed new VCFs after THA, which were associated with worsened spinal alignment and hip function. The higher FRAX score, calculated prior to THA surgery, is a useful predictor of VCF risk and may help identify individuals who require closer monitoring or preventive interventions during follow-up after surgery. Video Abstract.

PurposeTo compare AI-assisted 3D (AI-3D) preoperative planning versus two-dimensional (2D) X-ray preoperative planning for total hip arthroplasty (THA) using subgroup analyses (Crowe I–II vs. III–IV), and to examine associations between deformity severity and both planning accuracy and clinical outcomes via ordered trend analyses.MethodsSingle-centre retrospective cohort including 116 consecutive patients undergoing THA (May 2020–July 2023; AI-3D n = 61; 2D X-ray n = 55). Co-primary endpoints were exact implant size-match (cup/stem) and acetabular safe-zone attainment (Lewinnek/Callanan); Secondary endpoints included operative time, estimated blood loss, postoperative leg-length discrepancy (LLD), and 24-month functional scores—Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and pain on a visual analog scale (VAS)—plus implant survivorship. Analyses compared AI-3D versus 2D within prespecified Crowe subgroups; ordered trend tests across I–IV were performed in the pooled cohort.ResultsOverall comparisons showed that AI-3D demonstrated significantly higher accuracy in sizing prediction and acetabular cup positioning in this study: cup size-match 63.9% versus 41.8% (P = 0.017), stem size-match 65.6% versus 47.3% (P = 0.047), and Lewinnek/Callanan safe-zone attainment 91.8% versus 76.4% (P = 0.021); by contrast, operative time and blood loss did not differ significantly. Subgroup analyses suggested that this benefit was mainly confined to Crowe I–II, while in Crowe III–IV the differences were not significant. At the 24-month follow-up, HHS, WOMAC, VAS, and implant survivorship (≈ 98%) were comparable between groups. In trend analyses pooling both cohorts, cup match rates decreased as Crowe grade increased (P = 0.004), the extent of functional improvement (change in HHS (ΔHHS), change in WOMAC (ΔWOMAC)) rose with greater deformity severity (both P ≤ 0.001), and safe-zone attainment remained high without a clear monotonic trend.ConclusionsAI-3D preoperative planning provides measurable gains in implant sizing and acetabular cup positioning for THA, with benefits most evident in mild-to-moderate deformities (Crowe I–II). In severe deformities (Crowe III–IV), anatomical and reconstructive challenges appear to limit these advantages, emphasizing the continued importance of surgical expertise. Functional outcomes were comparable between AI-3D and conventional 2D planning. Overall, AI-3D may serve as a useful adjunct in complex cases, pending confirmation in larger multicentre and long-term studies.

BackgroundThe management of retro-acetabular osteolysis in revision hip arthroplasty with acetabular component retention remains controversial and challenging due to limited access to the area.Surgical technique and methodsFourteen patients with well-fixed and well-aligned acetabular components underwent revision surgery and a retained shell. A vinyl urinary catheter and syringe were used to deliver demineralized bone matrix putty to the bone defect after debridement. Clinical outcome and radiographic follow-up were scheduled at a minimum of 2 years.ResultsThe revision arthroplasty survivorship rate with this technique was 85.7% (12 of 14 patients) at a median follow-up of 6 years. One cup failed due to an aseptically loosening cup, and another from late septic loosening. Significant improvement of the University of California Los Angeles (UCLA) score, Harris Hip Score (HHS) pain subscale, and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) were observed at a median 6-year follow-up.ConclusionsManagement of retro-acetabular osteolysis with injected demineralized bone matrix using a syringe and vinyl urinary catheter is a reliable, easy, low-cost method with satisfactory mid-term clinical outcome improvement.Video Supplementary InformationThe online version contains supplementary material available at 10.1186/s42836-025-00349-4.

Femoral neck fractures often lead to complications such as delayed union or nonunion due to limited blood supply to the femoral head. Enhanced external counterpulsation (EECP) is a non-invasive method that improves peripheral and tissue perfusion. This study aimed to evaluate whether postoperative EECP could promote fracture healing and improve hip function recovery after cannulated screw fixation for femoral neck fractures. This single-center, prospective, randomized controlled trial included patients with acute femoral neck fractures eligible for cannulated screw fixation. Participants were randomized in a 1:1 ratio into two groups using a computer-generated random sequence. Group assignments were sealed in opaque envelopes to ensure allocation concealment. Baseline characteristics were comparable between groups. Three weeks postoperatively, patients in the EECP group underwent daily 1-hour EECP sessions for 7 consecutive weeks, while the control group received standard care without EECP. Color Doppler ultrasound was used to measure the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) of the medial femoral circumflex artery on the ipsilateral fracture side. Fracture union time, as well as the incidences of avascular necrosis of the femoral head (ANFH) and nonunion, were recorded. The Harris Hip Score (HHS) was assessed at 3, 6, and 12 months postoperatively. A total of 64 patients completed at least 24 months of follow-up, including 31 in the EECP group and 33 in the control group. After the final EECP session, the EECP group demonstrated significantly higher PSV and EDV values compared to the control group (both p < 0.0001; 95% CI: -10.55 to -7.42, -3.83 to -3.22, respectively), while RI values were significantly lower (p < 0.0001, 95% CI: 0.04 to 0.06). All fractures healed in both groups, but the mean healig time was significantly shorter in the EECP group (p < 0.0001, 95% CI: 1.24 to 2.72). There was no significant difference between the two groups in the occurrence rate of ANFH (p = 0.615, 95% CI: -3.08 to 0.54). At 3 months postoperatively, there was no significant difference in HHS between the two groups (p = 0.165, 95% CI: -3.08 to 0.54). However, at 6 and 12 months, the EECP group showed significantly higher HHS values compared to the control group (p < 0.0001, 95% CI: -10.91 to -7.36; p = 0.0006, 95% CI: -10.81 to -3.12, respectively). Enhanced external counterpulsation appears to be a safe and potentially beneficial adjunctive strategy for the management of femoral neck fractures treated with cannulated screw fixation. The application of enhanced external counterpulsation may promote fracture healing and facilitate hip function recovery by improving blood perfusion of the femoral head and the fracture site. Chinese Clinical Trial Register (ChiCTR); Registration number: ChiCTR2000034312; Date of registration: 01/07/2020.

Total hip arthroplasty (THA) is a widely performed and highly successful orthopedic procedure; however, intraoperative acetabular periprosthetic fractures (IAPF) remain a significant yet underreported complication. The increasing prevalence of THA, coupled with rising cases of osteoporosis, necessitates a better understanding of the incidence, risk factors, and long-term impact of these fractures. Despite advances in surgical techniques and implant designs, IAPFs present considerable challenges, affecting implant stability and patient outcomes. The aim of this study is to analyze the complications, reoperation rates, and functional outcomes associated with both conservative and surgical treatments of IAPF. A systematic review was conducted following PRISMA guidelines to evaluate studies published between 1999 and 2024 on the management and outcomes of IAPF. A comprehensive search of PubMed, Cochrane Library, and Web of Science identified 104 relevant studies, of which 11 met the inclusion criteria. Data extraction focused on fracture classification, treatment approaches, postoperative complications, reoperation rates, and functional outcomes. The quality of included studies was assessed using the Modified Coleman Methodology Score (mCMS). A total of 323 THAs were analyzed, with 225 fractures managed conservatively and 98 requiring surgical intervention. Conservative treatment was associated with higher complication (15.5%) and reoperation rates (14.2%) compared to surgical treatment (5.1% and 3%, respectively;p = 0.015 andp = 0.006). The most common complication in the conservative group was aseptic cup loosening, whereas surgical patients experienced fewer mechanical failures. Functional outcomes, as measured by the Harris Hip Score (HHS), Postel Merle d'Aubigné (PMA) score, and Japanese Orthopaedic Association (JOA) Hip Score, demonstrated significant postoperative improvements across both treatment groups. However, study heterogeneity and methodological limitations restricted direct comparisons. IAPFs remain a complex complication in THA, necessitating individualized treatment based on fracture stability and implant fixation. While conservative management is viable in stable cases, surgical intervention may lead to better long-term outcomes in select patients. Standardized classification systems and treatment protocols are needed to improve clinical decision-making and optimize patient care. Future research should focus on refining management strategies and incorporating patient-specific risk factors such as bone mineral density and implant design.

BackgroundOsteonecrosis of the femoral head (ONFH) is a challenging orthopedic condition that often leads to progressive joint destruction and disability. This study aims to simplfy the surgical tehniques and idealize the position of bone grafting for the repair of ONFH, and its preliminary clinical results were reported.​MethodsAnatomical studies were first conducted on four fresh frozen cadaveric specimens (8 hips). Arterial perfusion was performed to precisely investigate the medial femoral circumferential vessels supplying to the posterior greater intertrochanter. Based on the anatomical findings, vascularised posterior inter-trochanteric bone graft and the corresponding surgical instruments were meticulously designed to ensure accurate creation of the decompression tunnel and precise fitting of the bone graft​From August 2018 to August 2021, a total of 20 patients (24 hips) underwent the medial femoral circumferential vascularized posterior intertrochanteric bone grafting procedure at our institution. Clinical data, imaging findings, ARCO staging, and Harris hip scores were systematically collected. Intraoperative parameters, including operative time and blood loss, were also recorded. Postoperatively, patients were followed up for at least two years. Hip preservation failure was defined as a decrease in the Harris score, radiographic progression of ONFH, or the necessity for THA.​ResultsThe cadaveric study revealed that the deep branch of the medial femoral circumflex artery (MFCA) consistently gave rise to 2–3 branches supplying the posterior intertrochanteric bone. The first branch originated from the superior margin of the quadratus femoris attachment, and the remaining two branches were located beneath the quadratus femoris. The branches supplying the posterior intertrochanteric bone are carefully dissected and preserved, a 4-5cm long, 1.5-16 cm thick and deep bone graft is cut, which is used to improve the vascularization and mechanical stability within the osteonecrosis.​There are 20 patients (24 hips) prospectively enrolled, including 15 male patients (19 hips). The average postoperative followup duration was 24.2 ± 5.6 months. Four patients had to undergo THA due to disease progression, while the remaining 20 hips continued to be monitored. The final mean postoperative Harris hip score (HHS) was 75.1 ± 13.7. Among the 24 hips, 20 did not require THA, resulting in a hip preservation rate of 83%. Based on comprehensive evaluations of clinical function, symptoms, and radiographic findings, 71% of the hips were considered to have achieved successful hip preservation.​ConclusionsThe modified vascularized posterior intertrochanteric bone grafting is a simple yet effective hip - preserving surgical technique. It enables precise placement of the vascularized bone graft directly under the subchondral bone, and the good blood supply of the graft significantly promotes bone repair. This technique provides a simple，reliable and ideal graft position to repair the ONFH, the clinical outcomes seem to be related to the degree of femoral head collapse, with less favorable results associated with more severe collapse, its long term efficacy needs studied further.

Objective: To assess the functional &amp; radiological outcomes of proximal femoral nailing (PFN) in treating subtrochanteric femur fractures in adults. Study Design: Prospective study. Setting: Afridi Medical centre &amp; Teaching Hospital Peshawar Pakistan. Period: Jan 2022 to October 2024. Methods: Patients of age 20 to 80 years admitted due to acute subtrochanteric (ST) femur fractures were included in the study. Open &amp; pathological ST fractures were excluded. The Harris Hip Score was utilised to assess the postoperative outcomes. In all the cases, patients were put on immobilization preoperatively followed by closed reduction &amp; fixation with PFN under spinal anaesthesia. Both radiological outcome by examining radiological union at fracture site and functional outcome through determining Harris Hip Score were determined at 4 months postoperatively. Microsoft excel was used for data analysis. Results: Radiological union was observed in the patients as early as 14 weeks postoperatively followed by radiological union in all the patients at 16th week postoperatively and no non-union case was observed in our study. Out of all 91 cases only 5 cases were having mild surgical site infection which was managed accordingly the sterile dressing and oral antibi.=otics. The overall Harris hip score to be 90.75±6.85 in our study. Among total 91 patients 68 (74.72%) patients fall in excellent, 15 (16.48%) in good, 6 (6.6%) in fair while 2 (2.2%) in poor categories of Harris hip score. Conclusion: PFN is an effective implant for treating femoral subtrochanteric fractures. The advantages include reduced surgical exposure, increased stability, and early mobilisation. Because it allows for early and stable mobilization, PFN may be superior for treating subtrochanteric fractures in the elderly as well.

Hip resurfacing arthroplasty reduces dislocation and infection rates without differences in clinical outcomes compared to short and standard stems: A Network Meta-Analysis.

To compare the clinical efficacy of the direct anterior approach (DAA) versus the posterolateral approach (PLA) in hemiarthroplasty for treating femoral neck fractures in elderly patients. In a prospective controlled study, elderly patients with femoral neck fractures undergoing hemiarthroplasty at Fujian Provincial National Regional Trauma Center from February 2023 to February 2025 were randomized to the DAA or PLA group. Primary outcomes included Harris Hip Score (preoperatively, and at 1week, 1month, and 3months postoperatively) and Visual Analogue Scale (VAS) pain score. Secondary outcomes included operative time, intraoperative blood loss, transfusion rate, perioperative changes in hemoglobin and creatine kinase, complications, limb length discrepancy, drainage volume, ICU admission rate, hospital stay, and other clinical indicators. 102 patients completed the surgery and 3-month follow-up (DAA: 50; PLA: 52). Baseline characteristics and comorbidities were comparable between groups (P > 0.05). The DAA group had a significantly higher Harris Hip Score at 1week postoperatively compared to the PLA group (60.97 ± 2.78 vs. 58.92 ± 2.49, P < 0.001), though no significant differences were noted at 1 or 3months. The overall trend in Harris Hip Score differed significantly between the groups (P = 0.006). VAS pain scores showed no difference at any time point. Limb length discrepancy postoperatively was significantly less in the DAA group [1.725 (0.930, 3.595) mm] than in the PLA group [3.935 (1.940, 5.458) mm, P < 0.001]. No significant differences were observed in operative time, blood loss, transfusion rate, perioperative marker changes, complications, ICU admission, hospital stay, or mortality. DAA in hemiarthroplasty does not increase operative time, blood loss, or complications compared to PLA. DAA provides better early postoperative functional outcomes and less limb length discrepancy in elderly patients with femoral neck fractures.

ObjectivePeriprosthetic femoral fracture has become the most common reason for reoperation after total hip arthroplasty (THA). The aim of this study was to evaluate patient-reported outcomes (PROMs) after undergoing surgery due to a periprosthetic femoral fracture.MethodsPatients registered with a periprosthetic femoral fracture in the surgical theater protocols and in advance included in an institutional quality register were included in the study. PROMs were compared for each patient before primary THA, at 3 and 12 months follow-up and at the endpoint after fracture surgery. The PROMs investigated were numeric rating scale pain, Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score—Physical Function Short-form (HOOS-PS) and Forgotten Joint Score.ResultsA total of 27 patients were included in the study. Pain level after periprosthetic fracture surgery were comparable to the pain level registered at 3 and 12 months after THA. The same were found for HHS and HOOS-PS. In addition, both pain scores, HHS and HOOS-PS were significantly improved after fracture surgery compared to before the primary THA.ConclusionsPain and function scores after periprosthetic surgery were comparable to the findings at 3 and 12 months follow-up after primary THA surgery. Despite a limited number of patients, the present study report unique results including PROMs both pre- and post-THA and after the periprosthetic femoral fracture.

Excellent long-term outcomes with an anatomic cementless stem (SPS Evolution) designed using a CT-scan database and inserted with 3D CT-scan preoperative planning: A prospective cohort study.

Positive 10-year clinical outcomes of a total hip arthroplasty system with a unique femoral stem design.

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

Pain worsens peripartum after hip arthroscopy for femoroacetabular impingement and may not return to pre-pregnancy improvement.

Objective: To evaluate the functional outcomes and complication rates in patients with unstable intertrochanteric fractures treated with PFNA-2. Study Design: Retrospective study. Setting: Department of Orthopedics, Ghurki Trust and Teaching Hospital, Lahore. Period: January 2022 and December 2023. Methods: 86 patients (46 men and 40 women) with unstable intertrochanteric femur fractures treated with PFNA-2. For a year, the patients were monitored. Twelve months after surgery, the Modified Harris Hip Score (MHHS) was used to evaluate functional results. Results: The mean age of patients was 73.53 ± 16.66 years. Post-operatively, the mean MHHS was 80.38 ± 9.28. Functional outcomes were excellent in 16 patients (18.6%), good in 42 patients (48.8%), fair in 24 patients (27.9%), and poor in 4 patients (4.7%). Postoperative complications were observed in 8 patients (9.3%), including 4 cases of helical screw back-out (4.7%), 2 cases of cellulitis (2.3%), and 2 cases of deep vein thrombosis with cellulitis (2.3%). Conclusion: PFNA-2 demonstrates good functional outcomes and a low complication rate in handling unstable intertrochanteric fractures, particularly in the elderly. Its biomechanical advantages and minimally invasive nature make it a favorable option for surgical fixation.

Traction-related urinary complications in hip arthroscopy using a perineal post: Prevalence, risk factors, and outcomes.

Pauwels type Ⅲ femoral neck fractures are characterized by poor stability and high postoperative complication rates, and the optimal internal fixation regimen remains to be verified. The aim of this study was to compare the effectiveness between simple cannulated screws internal fixation and cannulated screws combined with lateral femoral neck support plate internal fixation in the treatment of Pauwels type Ⅲ femoral neck fractures. A retrospective analysis was performed on 68 patients with Pauwels type Ⅲ femoral neck fractures. Control group was treated with 3 cannulated screws internal fixation, and observation group was treated with lateral femoral neck support plate on the basis of control group. The operation time, intraoperative blood loss, hospitalization time, visual analogue scale (VAS) score, Harris Hip score (HHS) and postoperative complications were compared between two groups. The central finding of this study is that the observation group provided significantly superior patient-reported and functional outcomes. Regarding postoperative complications, including fracture nonunion, avascular necrosis of the femoral head, and wound infection, the incidence was lower in the observation group compared with the control group. Specifically, the observation group demonstrated markedly better hip function, with HHS significantly higher than the control group at both 3-month (68.35 ± 2.37 vs. 59.41 ± 2.55, P < 0.001) and 6-month (92.06 ± 2.46 vs. 80.03 ± 5.23, P < 0.001) follow-ups. Moreover, patients in the observation group experienced substantially less pain, as reflected by a significantly lower VAS score at the critical 6-month time point (0.47 ± 0.56 vs. 1.09 ± 0.67, P < 0.001). Compared with simple cannulated screws fixation, the combination of cannulated screws and a lateral femoral neck support plate provides more stable fixation, reduces postoperative pain, and facilitates faster recovery of hip joint function, without increasing the risk of complications. This approach allows for satisfactory fracture reduction and favorable functional outcomes, making it a reliable surgical strategy for the treatment of Pauwels type III femoral neck fractures.

Background Paprosky 3B acetabular defects challenge revision total hip arthroplasty (THA) due to conventional techniques’ high failure rates. This study evaluates midterm outcomes and biomechanical performance of 3D-printed split-type triflange acetabular cups for Paprosky 3B defects. Materials and methods From 02/01/2017 to 10/30/2021, we retrospectively assessed 14 patients with Paprosky 3B defects using 3D-printed split-type triflange cups. Preoperative CT-based 3D models guided implant design with porous surfaces and optimized screw fixation. Clinical outcomes were assessed via Harris Hip Score (HHS) and Oxford Hip Score (OHS). Radiographic parameters and implant stability were analyzed. Biomechanical characteristics were evaluated through finite element analysis (FEA) under physiological loads representing single-leg stance, walking, and jogging (700N, 2800N, and 4200N). Results At mean 74.2-month follow-up, HHS improved from 31.9 ± 8.5 to 82.9 ± 5.9 (p &amp;lt; 0.05) and OHS from 7.6 ± 2.3 to 35.4 ± 3.1 (p &amp;lt; 0.05). Anatomical hip center restoration was achieved with comparable postoperative and contralateral rotation center measurements. Radiographic analysis confirmed stable fixation in all cases without loosening. FEA revealed distinct biomechanical behavior between bone models. In both normal and osteoporotic models, stress concentrated at the superior flange screw fixation site and the superior acetabular rim. Under 700N loading, interfacial micromotion at all measurement points (P1-P3) remained below the 40 μm threshold for osseointegration. However, at higher loads (2800N and 4200N), P1 micromotion significantly exceeded this critical threshold in both models, reaching 122.861 μm and 131.244 μm respectively at maximum loading, while P2 and P3 maintained acceptable levels. Conclusion Custom 3D-printed split-type triflange prostheses achieve excellent midterm functional restoration and biomechanical stability in Paprosky 3B defects. Key advantages include precise hip rotation center reconstruction, favorable stress distribution, and reduced intraoperative morbidity. Early partial weight-bearing is safe, though high-impact activities should await radiographic confirmation of osseointegration. Long-term validation of durability is warranted.

BackgroundPostoperative patients with hip fractures (HFs) frequently experience severe pain, swelling, and restricted mobility in the affected joint, substantially compromising their quality of life. As a non-pharmacological intervention, acupuncture has shown promise in supporting rehabilitation following various fractures, a notion corroborated by a growing body of clinical research. Therefore, this study aims to systematically assess the efficacy and safety of acupuncture in promoting postoperative recovery among patients after HF surgery.MethodsThe study will randomly divide 244 patients into either the acupuncture group or the sham acupuncture group with an allocation ratio of 1:1. All patients will receive four treatments within a one-week period and a follow-up evaluation one month after the treatment course. The primary outcome will be measured using the Harris Hip Score (HHS). Secondary outcomes will include the Visual Analog Scale (VAS), the Self-Rating Depression scale (SDS), the Self-Rating Anxiety scale (SAS), the lower extremity swelling scale, levels of inflammatory factor level (IL-2, IL-6, TNF-α), the Short Form 36 Health Survey (SF-36), rate of remedial analgesia, the blinded assessment, and the treatment expectations scale. Safety will be assessed throughout the trial. All results will be analyzed following the intention-to-treat principle.DiscussionThis prospective trial will provide high-quality evidence for evaluating the effectiveness and safety of acupuncture in postoperative recovery from HF, and the results may provide new options for clinical treatment.Trial registrationClinicalTrials.gov Identifier: ITMCTR2025001644.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-025-06450-3.

To investigate the short-to-medium-term clinical efficacy of total hip arthroplasty(THA) with Pinnacle ES constrained liner in the treatment of femoral neck fractures(FNF) associated with lower limb neuromuscular disorders. A retrospective analysis was conducted on 16 patients who underwent primary THA using Pinnacle ES constrained liner for FNF with lower limb neuromuscular disorders and had complete follow-up data, treated between January 2020 and January 2023. There were 7 males and 9 females, with a mean age of (68.42±3.58) years old ranging from 61 to 75 years old. Among them, 10 cases had left-sided fractures and 6 had right-sided fractures;based on the Garden classification, 11 cases were type Ⅲ and 5 cases were type Ⅳ. The affected limbs were complicated with sequelae of poliomyelitis (2 cases), Parkinson's disease (2 cases), and sequelae of cerebral infarction (12 cases). All operations were performed via a posterolateral approach. Prosthesis position was evaluated using imaging data. Hip function was assessed by the Harris hip score(HHS) and Merle D'Aubigne hip score. During the follow-up period, the occurrence of complications such as prosthetic dislocation, loosening, and infection was recorded. One patient died of advanced tumor 2 years after surgery, and the remaining 15 patients were followed up for 24 to 64 months with a mean of (34.8±5.5) months. The operation time ranged from 50 to 90 minutes with a mean of (75.56±8.15) minutes, and the blood loss ranged from 150 to 200 ml with a mean of (170.32±12.56) ml. All patients achieved primary wound healing after surgery. Intraoperatively, femoral calcar splitting occurred in 2 cases, which were treated with titanium cable binding;no neurovascular injuries were observed in any case. The mean HHS increased from (18.95±2.25) preoperatively to (88.02±2.42) at the last follow-up, and the mean Merle D'Aubigne Score increased from (3.05±0.06) preoperatively to (16.65±0.93) at the last follow-up. Postoperative follow-up X-rays showed good prosthetic position, and no complications such as dislocation, prosthetic loosening, periprosthetic fracture, or deep infection occurred during the follow-up period. Total hip arthroplasty with Pinnacle ES constrained liner is effective in the treatment of femoral neck fractures associated with lower limb neuromuscular disorders. It can significantly improve hip function, reduce the postoperative prosthetic dislocation rate, provide good initial stability, and achieve satisfactory short-to-medium-term clinical efficacy.