HHS Scores Research Articles

THE FATE OF REVISION TOTAL HIP ARTHROPLASTY FOR INSTABILITY

Instability is a common indication for revision total hip arthroplasty (THA). However, even after the initial revision, some patients continue to have recurrent dislocations. This study investigates those at risk for recurrent dislocation after revision THA for instability at a single institution.Between 2009 and 2019, 163 patients underwent revision THA for instability at a single institution. Thirty-three of these patients required re-revision THA due to recurrent dislocation. Cox proportional hazard models with death as a competing event were used to analyze risk factors, including prosthesis sizing and alignment. Paired t-tests or Wilcoxon signed rank tests were used to assess patient outcomes (Veterans RAND 12 (VR-12) physical score, VR-12 mental score, Harris Hip Score, and hip disability and osteoarthritis outcome score for joint replacement).Duration of follow-up until either re-revision or final follow-up was a mean of 45.3 ± 38.2 months. The 1-year cumulative incidence for recurrent dislocation after revision was 8.7%, which increased to 19.6% at 5 years and 32.9% at 10 years postoperatively. In the multivariable analysis, high ASA score [HR 2.71], being underweight (BMI<18 kg/m2) [HR 36.26] or overweight/obese (BMI>25 kg/m2) [HR 4.31], use of specialized liners [HR 5.51–10.71], lumbopelvic stiffness [HR 6.29], and postoperative abductor weakness [HR 7.20] were significant risk factors for recurrent dislocation. Increasing the cup size decreased the dislocation risk [HR 0.89]. The dual mobility construct did not affect the risk for recurrent dislocation in univariate or multivariable analyses. VR-12 physical and HHS (pain and function) scores improved postoperatively at midterm.Patients requiring revision THA for instability are at risk for recurrent dislocation. Higher ASA scores, abnormal BMI, use of special liners, lumbopelvic stiffness, and postoperative abductor weakness are significant risk factors for re-dislocation.

Comparison of the clinical effects for different positions of the weight-bearing axis after high tibial osteotomy

PurposeTo analyze the clinical effects of different positions of the weight-bearing axis (WBA) after high tibial osteotomy (HTO).MethodsThe clinical data of 90 patients who underwent HTO in the Department of Orthopedics at our hospital from June 2018 to June 2021 were retrospectively analyzed. Patients were divided into groups A and B (n = 45 per group) according to different post-HTO WBA positions of the affected side. WBAs in both groups were at 50–60% and 62–66% of the tibial plateau, from inside to outside, respectively. American Hospital for Special Surgery Knee Score (HSS), visual analog scale (VAS) score, femorotibial angle (FTA), and medial proximal tibial angle (MPTA) were recorded and analyzed.ResultsAll patients were followed up with for 12 months. HSS scores increased gradually and VAS scores decreased gradually in both groups preoperatively, and at 3 months, 6 months, and 1 year postoperatively (P < 0.05). Compared to group A, group B had better HHS scores at 6 months and 1 year postoperatively (P < 0.05). There was no significant between-group difference in VAS scores at all aforementioned timepoints (P > 0.05). Postoperative MPTA and FTA were 89.56° ± 2.18° and 177.11° ± 2.63° in group A, and 89.07° ± 1.98° and 177.07° ± 2.36° in group B, respectively, with no significant between-group difference (P > 0.05).ConclusionPatients with post-HTO WBA ranges of 50–60% and 62–66% achieved knee joint function improvement and pain relief. Half a year later, those with a WBA range of 62–66% had better knee joint function scores. However, a comparison of long-term effects warrants further investigation.

Tri-Lock Bone Preservation Stem Versus Conventional Corail Stem in Primary Total Hip Arthroplasty via Direct Anterior Approach: A Short-Term, Retrospective, Comparative Study.

BACKGROUND he present study was performed to evaluate the clinical efficacy of Tri-Lock bone preservation stems vs conventional Corail stems in primary total hip arthroplasty via direct anterior approach. MATERIAL AND METHODS In this retrospective analysis, patients receiving THA via DAA in a single-center hospital from January 2019 to March 2020 were assessed for eligibility and assigned to either a Tri-Lock BPS group or a Corail group based on the use of prostheses. Outcome measures for the efficiency evaluation of the 2 prostheses included perioperative outcomes, imaging results, Harris Hip Score, Western Ontario and McMaster University Osteoarthritis Index, and visual analog scale scores at 3, 6, 12, and 24 months postoperatively. RESULTS A total of 204 patients were included, including 98 patients (98 hips) in the Tri-Lock BPS group and 106 patients (106 hips) in the Corail group. Patients receiving Tri-Lock BPS exhibited better pain relief than those with Coral stems. Tri-Lock BPS had a higher safety profile vs Corail stems by significantly reducing the risk of complications (P=0.004). A markedly increased HHS score (84.42±16.27 vs 78.61±12.78, P=0.002) and a lower WOMAC score (25.08±15.39 vs 32.14±11.56, P=0.001) at 3 months postoperatively were observed in patients with Tri-Lock BPS vs those with Corail stems, indicating better restoration of hip function using Tri-Lock BPS. CONCLUSIONS During total hip arthroplasty via DAA, Tri-Lock BPS causes a smaller surgical wound, reduces the operative time and intraoperative bleeding, and produces less soft-tissue damage vs Corail stems, providing great benefits in femoral prosthesis placement.

Clinical effect of closed reduction minimally invasive fixation in intra-articular comminuted fractures of the femoral condyle.

To evaluate the advantages of double reverse traction closed reduction combined with minimally invasive fixation in treating femoral condylar comminuted fractures. We retrospectively enrolled a total of 24 patients with femoral condylar comminuted fractures (AO = 33C3) admitted to Third Hospital of Hebei Medical University from March 2018 to February 2020. The patients were divided into two groups: experimental group (double reverse traction, n = 12) and control group (conventional surgery, n = 12). Patient demographics, fracture characteristics, operation time, incision length, and postoperative complications were then collected. The Hospital for Special Surgery (HSS) scores were recorded at the last follow-up visit. The average surgical time was 52.2 (41-73) min in the experimental group and 71.2 (45-103) min in the control group. In addition, the mean total incision length was 13.8 (11-17) cm in the experimental group and 16.3 (14-19) cm in the control group. The average HHS scores at the final follow-up were 86.3 (78-93) and 82.7 (76-90) in the experimental group and control group, respectively. It was found that double reverse traction closed reduction combined with minimally invasive fixation can provide good repositioning results and functional extremity. Moreover, patients tolerate postoperative functional knee exercises well.

MINIMIZING COMPLICATIONS IN BIKINI INCISION DIRECT ANTERIOR APPROACH TOTAL HIP ARTHROPLASTY: A SINGLE-SURGEON SERIES OF 865 CASES

The purpose of this study was to report all complications during the first consecutive 865 cases of bikini incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon. The secondary aims of the study are to report our clinical outcomes and implant survivorship. We discuss our surgical technique to minimize complication rates during the procedure.We undertook a retrospective analysis of our complications, clinical outcomes and implant survivorship of 865 DAA THA's over a period of 6 years (mean = 5.1yrs from 2.9 to 9.4 years).The complication rates identified in this study were low. Medium term survival at minimum 2-year survival and revision as the end point, was 99.53% and 99.84% for the stem and acetabular components respectively. Womac score improved from 49 (range 40-58) preoperatively to 3.5(range 0-8.8) and similarly, HHS scores improved from 53(range 40-56) to 92.5(range 63-100) at final follow-up (mean = 5.1 yrs) when compared to preoperative scores.These results suggest that bikini incision DAA technique can be safely utilised to perform THA.

Application evaluation of multidisciplinary collaboration model with health care integration in perioperative period of femoral neck fracture

ABSTRACT This study was to analyze application effect of multidisciplinary collaboration model with health-care integration in perioperative period of femoral neck fracture. As a prospective study, 124 patients with femoral neck fracture who underwent artificial joint replacement in our hospital from August 2020 to August 2021 were selected as the study subjects. According to the random allocation, they were divided into the group A (n = 62, multidisciplinary collaboration model with health-care integration) and the group B (n = 62, conventional care) to analyze the clinical value of different intervention measures in perioperative period by comparing the hip joint activity, quality of life and incidence of perioperative complications between the two groups. Compared with group B, the average HHS score and hip joint activity after intervention in group A were notably higher (P < 0.05), the VAS score after intervention was overtly lower (P < 0.001), and the GQOLI-74 score of group A after intervention was visibly higher (P < 0.001), with no overt difference in the overall incidence of perioperative complications between the two groups (P > 0.05). The application of multidisciplinary collaboration model with health-care integration in femoral neck fracture can effectively improve the hip joint function, reduce the severity of pain and benefit patients, and further studies will help to establish a better solution for such patients.

Single-taper conical tapered stem in total hip arthroplasty for developmental dysplasia of the hip: A long-term evaluation

IntroductionConical tapered stems may be useful implants to manage the reconstruction of complex dysplastic anatomies. The aims of this paper were to assess: 1) the preoperative CT features of the dysplastic femurs; 2) survival rates, complications and reasons for revision; 3) the clinical outcomes; 4) the radiographic outcomes of single-taper conical stems in dysplasia (defined as center edge angle < 20°) at a long-term follow-up. HypothesisMonoblock conical stem provides a 10-year survival rate of at least 95%, with excellent clinical outcomes and bony ingrowth. Materials and methodsIn total, 100 THAs in 85 patients (15 bilateral cases) were enrolled. The average age of the patients at surgery was 50.9±11.5 years. Assessment of the native femoral morphology was performed using CT-scan, coronal (neck-shaft angle, offset, center of rotation position) and axial parameters (anteversion, mediolateral and anteroposterior femoral diameters). Clinical (HHS score) and radiological (osseointegration, subsidence and offset reconstruction) outcomes were evaluated at the last available follow-up. ResultsThe mean follow-up was 9.34±5.61 years. Severely distorted anatomies from Crowe I to Crowe IV were included, with a mean canal flare of 4.3 and a mean femoral antetorsion of 34°. The survival rates were stable at long-term (98.9% at 10 and 15 years): no aseptic loosening occurred. The mean postoperative HHS was 89.8±6.8 points. Ninety-nine percent of the stems showed bone ingrowth, from 6 months to the last available follow-up. Subsidence occurred in 18% of the cases (mean value: 2.5mm, range: 1–6mm) in the first month, with subsequent stabilization. A mild proximal stress shielding occurred in 28% of the THAs. Radiolucent lines were detected in the 8% of the cases. There was a postoperative loss of offset in 12% of the cases. DiscussionConical stems in dysplastic hips achieved bony ingrowth at long-term outcome, even in complex anatomies. Subsidence, proximal stress shielding and imperfect offset restoration may occur with this implant. Level of proofIV; retrospective study.

Outcomes of total hip arthroplasty after failed free vascularized fibular grafting for osteonecrosis of the femoral head.

Total hip arthroplasty (THA) after vascularized fibular grafting (VFG) is technically demanding with poorer outcomes compared to primary THA in patients with osteonecrosis of the femoral head (ONFH). The purpose of this study was to compare the outcomes of THA after VFG after removal of the graft with that of primary THA. ONFH patients treated by VFG at a single institution were studied retrospectively. THAs after VFG performed by single arthroplasty surgeon with a single type of THA prosthesis were enrolled in the study. A control cohort of patients was created by 1:1 matching with the THA after VFG cohort according to age, gender, and American Society of Anesthesiology (ASA) score from ONFH patients treated by primary THA. Early and long-term outcomes were compared between the two groups. A total of 24 hips were included in the THA after VFG group and compared with 24 primary THA hips. No significant difference was noted in stem position. The THA after VFG group had increased blood loss and longer duration of operation time. There were two cases of intraoperative femur fractures in the THA after VFG group. The femoral stem of both groups were stable, with no cases of revision, and similar HHS scores at the last follow-up. THA after VFG may have similar short to midterm outcomes with primary THA after removal of the residual abutting bone graft and correct positioning of the femoral stem.

Use of a Minimally Invasive Traction Repositor versus Conventional Manual Traction for the Treatment of Tibial Fractures: A Comparative Study from a Tertiary Hospital in China.

BackgroundClosed reduction and intramedullary nail fixation of tibial fractures may not utilize a fracture table or reduction aids like a femoral distractor, and only manual traction will help aid the reduction process. This study aimed to describe and further investigate the effectiveness of an originally designed minimally invasive traction repositor (MITR) for the treatment of tibial fractures.MethodsFrom January 2018 to April 2021, a total of 119 eligible patients with tibial shaft fractures were included and retrospectively assigned to two groups according to different reduction methods: MITR group vs conventional manual traction (CMT) group. The baseline characteristics between the two groups were comparable, including age, gender, BMI, residence, smoking history, drinking history, injury mechanism, fracture type, ASA, method of anesthesia, and surgical delay (all P > 0.05). The operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, number of intraoperative fluoroscopies, VAS, HSS, fracture healing time, and complications were compared.ResultsAll patients completed the follow-ups with an average of 18.5 months (range 12–42 months). The operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, and number of fluoroscopies were significantly decreased in the MITR group (all P < 0.05). At one month postoperatively, the VAS score was statistically lower in the MITR group (1.8±0.8) than in the CMT group (2.6±1.5). At 6 months postoperatively, the HHS score was statistically higher in the MITR group (90.8±2.3) than in the CMT group (86.4±3.8). We observed no statistical difference in the mean fracture healing time, bone nonunion, implant failure, and infection between the two groups (all P > 0.05).ConclusionCompared with CMT, MITR facilitates the minimally invasive treatment of tibial fractures and has the advantages of operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, number of fluoroscopies, and satisfactory VAS and HSS scores.

Outcome measures and survivorship following total hip arthroplasty in adolescent population.

The most frequent indication for total hip arthroplasty (THA) in adolescent patients has been juvenile idiopathic arthritis (JIA). However, in recent years, other causes have become more prevalent. (1) What is the survivorship following THA across the diagnostic spectrum in adolescent population? (2) How are quality of life results affected by systemic medical conditions? We retrospectively reviewed all consecutive THA in patients under 21years of age, performed at our Institution between 1993 and 2018. There were 34 prostheses implanted in 26 patients with a mean age of 18.4years (range 11 to 21). The most frequent diagnosis was JIA (14 hips), followed by avascular necrosis (10 hips). Patient reported outcomes were assessed using Harris and Oxford Hip Scores (HHS and OHS), Visual Analogue Scale (VAS) and EuroQol-5D. Survivorship for revision and aseptic loosening was determined with Kaplan Meier analysis. At final follow-up, the overall survival rate was of 89.3% at 12-year follow-up. Three acetabular components underwent revision surgery for aseptic loosening. Clinical HHS significantly improved from 37.5 to 90.6 points (p < 0.001). Mean OHH was 37.4 points, with a final VAS of 1.64 points. Mean 5Q-5D was 0.704 with an interquartile range of 0.4 to 1.0. JIA patients displayed worse pre-operative HHS scores, and at final follow-up had worse HHS, OHS, VAS and EQ-5D scores compared to the rest of the patients. Complications included three intra-operative femoral fractures, one sciatic nerve palsy and one adductor contracture. THA in adolescent patients provides improved functional outcomes with acceptable revision rates at mid-term follow-up.

Umbilical Cord PRP vs. Autologous PRP for the Treatment of Hip Osteoarthritis.

Umbilical cord platelet-rich plasma (C-PRP) has more growth factors and anti-inflammatory molecules compared with autologous PRP (A-PRP) derived from peripheral blood. The aim of this study was to compare intra-articular C-PRP or A-PRP injections in terms of safety and clinical efficacy for the treatment of patients with hip osteoarthritis (OA). This study investigated the results of 100 patients with hip OA treated with three weekly ultrasound-guided injections of either C-PRP or A-PRP. Clinical evaluations were performed before the treatment and after two, six, and twelve months with the HHS, WOMAC, and VAS scores. No major adverse events were recorded. Overall, the improvement was limited with both treatments. Significant improvements in VAS (p = 0.031) and HHS (p = 0.011) were documented at two months for C-PRP. Patients with a low OA grade (Tonnis 1-2) showed a significantly higher HHS improvement with C-PRP than A-PRP at twelve months (p = 0.049). C-PRP injections are safe but offered only a short-term clinical improvement. The comparative analysis did not demonstrate benefits compared with A-PRP in the overall population, but the results are influenced by OA severity, with C-PRP showing more benefits when advanced OA cases were excluded. Further studies are needed to confirm the most suitable indications and potential of this biological injective approach.

Modified periacetabular osteotomy technique in the management of acetabular dysplasia

Purpose: Evaluating the results of modified PAO in the management of acetabular dysplasia. Patients and Methods: This prospective study included 13 cases. All cases were diagnosed with acetabular dysplasia then treated by PAO using our modified technique. In all included patients, the retro-acetabular cut was performed before the ischial cut during PAO surgery. Eight cases were stage IV and five were stage III according to Severin classification. The mean preoperative HHS was 83 points. The mean preoperative acetabular angle of Sharp value was 49 degrees. The mean preoperative LCEA value was 12 degrees. Results: The mean postoperative HHS at the final follow up was 87 points. The mean postoperative acetabular angle of Sharp value was 37 degrees. The mean postoperative LCEA value was 32 degrees. According to HHS score, six cases had excellent results, six had good results, and one case had fair outcome. Lateral femoral cutaneous nerve neuropathy occurred in two patients, and superficial wound infection was encountered in one patient.Conclusion: Performing the retro-acetabular cut before the ischial cut prevented posterior column fracture Interruption in all cases, making PAO safer and easier to perform, and reducing its risk.

Does augmentation of intramedullary nails by a buttress plate effectively restore lateral wall integrity in intertrochanteric fractures.

Recent studies have proved the importance of intact lateral trochanteric wall, thus buttressing/fixing the broken lateral trochanteric wall irrespective of the implant, is likely to improve the alignment and outcome. We compared the outcome of lateral wall buttressing by trochanteric buttress plate (TBP) supplemented to proximal femoral nailing versus proximal femoral nailing alone in patients of broken lateral wall intertrochanteric fractures. Sixty patients of intertrochanteric factures (IT) of femur with broken lateral wall were randomized into group A or B and were treated with either proximal femoral nail (PFN) alone or proximal femoral nail augmented with trochanteric buttress plate (PFN + TBP), respectively. The TBP plate used was primarily fixed to proximal femur via 8mm hip screw and 6.4mm antirotation screw of the PFN. Operative time, blood loss, radiation exposure, quality of reduction, functional outcome, union time, and complications were compared. The mean age was 60.03 + 7.60 (range 42 to 70years), with male to female ratio of 4:1 and left to right ratio of approximately 1:1. The mean follow up in the series was 16.2months (range 13 to 36months). Mean duration of surgery, mean intra-operative blood loss, and mean number of exposures in group A (PFN alone) were 64.88 + 12.24min (48 to 88), 93 + 1.18ml (60 to 120), and 32.13 (24 to 46) and in group B (PFN with TBP plate) were 91.86 + 12.78min (70 to 122min), 144.8 + 3.6ml (116 to 208ml), and 56.6 (38 to 112), respectively. Twenty-five patients and 28 patients in groups A and B respectively achieved score of 4 Chang quality reduction. Mean union time was 13.4weeks in group A whereas in group B was 11.6weeks. Mean HHS score in group A was 87.86 with 90% patients in comparison to 94.13 and 97% cases having excellent to good results in group B. In group A, 24 patients, while 29 patients in group B, had excellent to good results. Four patients had hip pain, four had impingement of screws, two had screw migration, three had Z/reverse effect, and four patients had shortening of more than 1cm in group A. In group B, only one patient had impingement and none of the patient had hip pain, infection, implant failure, Z effect, or shortening. The lateral trochanteric wall in IT fractures is significantly important, and when the lateral wall is broken, it can lead to poor results. TBP plate which is applied laterally on femur along with nail and fixing the plate with hip screw and antirotational screw provides faster union, early weight bearing, better reduction, and so better hip functions. TBP can be used successfully to augment, fix, or buttress the lateral trochanteric wall giving excellent to good results but at the cost of surgical time, blood loss, and radiation exposure.

Earlier functional recovery and discharge from hospital for THA patients operated on via direct superior compared to standard posterior approach: a retrospective frequency-matched case-control study.

The direct superior hip approach (DSA) has been less researched than other approaches in the literature. We retrospectively compared the early postoperative and functional outcomes of patients with hip osteoarthritis undergoing total hip arthroplasty (THA) via DSA with a matched control group using a standard posterior approach (SPA). The DSA group comprised 100 THAs performed via DSA by a senior surgeon between January 2018 and May 2019. Patients with primary osteoarthritis and ASA score ⩽3 who were eligible for surgery were included. The DSA group was compared to a matched cohort of 100 patients operated on with a SPA in the same period by another chief surgeon. Patients were matched for age, sex, and ASA score. All patients received the same postoperative chemoprophylaxis, pain management and physiotherapy. 2 independent attending arthroplasty surgeons assessed the incision length, operative time, blood loss, hospital stay, and complications. VAS, HHS, and HOOS scores were also evaluated for a year postoperatively. Mean incision length and hospital stay were significantly lower in the DSA group. DSA patients had non-significantly lower intraoperative blood loss, transfusion needs, and postoperative pain than SPA patients. Mean operation time and complication rate did not differ between groups. The DSA group demonstrated significantly greater functional scores than the SPA group at the first postoperative month. No differences in scores were recorded following the third month. The DSA approach may provide earlier functional recovery and hospital discharge for THA patients compared with SPA. DSA was equivalent to SPA concerning pain and blood loss, showing minimal complication rates.

A systematic review and meta-analysis comparing complications following total hip arthroplasty for systemic lupus erythematosus versus for non-systemic lupus erythematosus

BackgroundOsteonecrosis of the femoral head is one of the most severe complications in systemic lupus erythematosus (SLE) patients. Total hip arthroplasty (THA) is an effective treatment for femoral head necrosis. However, there is no consensus on the specific effect of THA on SLE patients. The objective of the present study was to review the current evidence regarding rates of THA complications and postoperative function in systemic lupus erythematosus.MethodsTwo independent reviewers searched PubMed, Cochrane Library, and EMBASE from January 1, 2000, to December 29, 2021. The primary outcomes were postoperative complications, including deep vein thrombosis (DVT), hematoma, wound infection, dislocation, periprosthetic fracture, revision, mortality.ResultsA total of 179 articles yielded 28 studies eligible for inclusion with 10 studies used for meta-analysis. This study found a statistically significant difference in DVT, dislocation, wound infection, periprosthetic fracture, and revision.ConclusionsThis meta-analysis shows that SLE patients with THA are at an increased risk of DVT, wound infection, dislocation, periprosthetic fracture, revision, periprosthetic joint infection, following THA in comparison with non-SLE patients with THA. There was no adequate evidence to support the notion that the risk of seroma or hematoma following THA is increased in SLE. Also, there was no significant difference in HHS scores between SLE patients and non-SLE patients after THA.

A Systematic Review and Meta-Analysis on Randomized Control Trials for Preoperative Rehabilitation in Patients Planning for Joint Replacement Surgery for Better Outcomes.

Background The clinical influence of the preoperative and postoperative therapies for recovery after the joint replacement surgery is still questionable. This study of systematic review and meta-analysis focuses on analyzing the clinical effects of preoperative rehabilitation among the patients who are planning to opt for joint replacement surgery for enhanced results. Objective Randomized clinical trials were selected where preoperative therapeutic exercises were performed by adults for preoperative rehabilitation in patients who were planning for replacement surgery for better outcomes and identified through databases and screening. Two reviewers were responsible for extracting appropriate studies, relevant data, assessing the risks, therapeutic validity, etc. Material and Methods. We performed random-effects meta-analysis for calculation of risk ratios and odds ratios, for knee and hip surgery cases. Analysis of length of hospital stay, short-term-based recovery period during hospital stay, total hip replacement functional recovery during hospital stay, short-term recovery of self-reported functioning, etc. was performed. Results Functional scores, postoperative pain, recovery time, length of hospital stay, and quality of life were studied. Of the seven studies included, the data of 614 patients were studied. The total number of participants in both exercise and control groups was analyzed to assess the bias of the study where the risk ratio was 0.96 and (0.74–1.25) was the 95% CI. Short-term-based recovery period during hospital stay for knee replacement was analyzed where 0.87 was the risk ratio and (0.61–1.23) was the 95% CI and for hip replacement where 0.99 was the risk ratio and (0.68–1.44) was the 95% CI. The RR for total hip replacement functional recovery during hospital stay was 0.80 with 95% CI (0.54–1.19). The RR for short-term recovery of self-reported functioning was 0.98 with 95% CI (0.76–1.26). Outcome analysis for pain and functionality evaluation was performed and assessed using WOMAC, HOOS, and HHS scores where the standardized mean difference was 0.38 and (0.20–0.57) was the 95% CI in hip surgery pain analysis and in knee surgery, 0.00 was the standardized mean difference and (−0.18–0.19) was the 95% CI. Conclusion Long-term outcomes were not affected by the preoperative rehabilitation. Though there was a slight improvement in early postoperative pain, this is not much of clinical significance.

The role of the medial buttress plate in the treatment of Pauwels type II and III femoral neck fracture in nonelderly patients: a retrospective study and preliminary results

BackgroundThe purpose of this study was to compare the effectiveness of multiple cannulated screws combined with medial buttress plate or not for the treatment of unstable femoral neck fracture in nonelderly patients.MethodsSixty-nine nonelderly patients with Garden type III-IV femoral neck fracture were retrospectively analyzed. The patients were divided into MCS (multiple cannulated screws) group and CMBP (combined with medial buttress plate) group according to the surgical method. Patient’s demographic data, Harris Hip Score, EQ-5D index and complications at a minimum of 2 years follow-up were analyzed.ResultsThere were 47 patients in the MCS group (35 male and 12 females) with a mean age of 40.28 ± 12.64 years, whereas 22 patients in the CMBP group (17 male and 5 females) with a mean age of 43.86 ± 12.55 years. In the MCS group, there were 1 (2.1%) avascular necrosis, 5 (10.6%) postoperative nonunion, 5 (10.6%) implant failure, and 2 (4.3%) femoral neck shortening. While 1 (4.5%) implant failure, 2 (9.1%) postoperative nonunion and 2 (9.1%) impingement in the CMBP group. For patients with Pauwels type II and III femoral neck fracture, the CMBP group had higher HHS scores at 3 months after surgery than the MCS group (P < 0.05), whereas there was no statistical significance at 6 months, 1 year, and 2 years (P > 0.05). The same results were found in the EQ-5D index.ConclusionsIn our cohort, we observed better outcomes in the CMBP group at 3 and 6 months, with later results similar between groups. However, there were fewer complications in the CMBP group, without obviously blood-supply disruption, especially in Pauwels type II and III. Further, anatomic reduction and stable fixation may contribute to satisfactory outcomes in the treatment of nonelderly displaced femoral neck fractures.

Large Locking Fusion Plate and Cable Fixation in the Treatment of Periprosthetic Femoral Fracture (PFF) After Total Hip Arthroplasty

<i>Objective</i> To investigate the clinical effect of large locking fusion plate and cable fixation in the treatment of Periprosthetic femoral fracture (PFF) after total hip arthroplasty (THA). <i>Methods </i>Clinical data of 15 cases of PFF after THA treated with large locking fusion plate and cable fixation from June 2012 to June 2019 in our hospital were retrospectively analyzed. These cases included 4 males and 11 females, whose age were 61-82 years old, with an average age of 71.3 years, 6 cases on the left side and 9 cases on the right side. We performed total hip arthroplasty in 10 patients and hemiarthroplasty in 5 patients. There were 5 cases of Type B1 fracture, 8 cases of type B2 fracture, and 2 cases of type B3 fracture. Preoperative and postoperative hip function, HSS score, Harris score and surgical complications were observed and evaluated. <i>Results </i>15 patients were followed up 15-77 months after the operation (mean 36.9 months), and the hip function was significantly improved. The preoperative HSS score of knee function was 4.13±1.69, and the postoperative HSS score of knee function was 90.93±3.06, with11 excellent cases, 4 good cases and 0 general cases, with an excellent rate of 100%. Preoperative Harris score of knee function was 3.73±1.16. Harris score of hip function was 89.33±3.73 at the last follow-up. Among of all Harris scores, 10 cases were excellent, 3 cases were good, and 2 cases were general, with an excellent rate of 86.7%. Postoperative HHS and Harris scores were higher than those before surgery (P=0.031, P<0.001). No blood vessel or nerve injury occurred during the operation. During the postoperative follow-up, no complications such as periprosthetic infection, loosening, dislocation, nonunion of fracture and refracture occurred in 14 cases, and one case suffered refracture after the operation, which was healed after the nail and stick system fixation. <i>Conclusion</i> The application of large locking fusion plate and cable in the treatment of femoral periprosthetic fractures after total hip arthroplasty is simple, easy to operate, less complications, satisfactory clinical results, and worthy of promotion.

Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?

BackgroundThe “cup-in-cup” technique allows for revision of failed total hip arthroplasty (THA) when the cementless cup is well fixed. Furthermore, it can be used for liner wear or mechanical failure where liner replacement may be impossible or impractical. Recently, the “cup-in-cup” technique in combination with dual mobility cups (DMC) has drawn increased attention. Our aim was to report on the clinical and radiographic outcomes following this surgery.MethodsFrom 2015 to 2020, 33 patients treated with the DMC- “cup in cup” technique were retrospectively reviewed. Fourteen patients had died while 19 were available for the final follow-up (FU), of which 15 underwent both a radiograph and a FU visit, 2 underwent a radiograph only and 2 underwent a telephone interview only. Patient-related outcome measures included the HHS and the WOMAC. Radiographs were assessed for implant loosening and positioning. Primary endpoint was revision of any cause and secondary endpoint was loosening of the DMC at the latest FU. The survival analysis was conducted using the Kaplan-Meier method.ResultsThe mean age at surgery was 78.6 ± 7.1 (63–93) years and the mean surgery duration was 124.4 ± 52.0 (60–245) minutes. Recurrent dislocation (42.4%), periprosthetic fracture (39.4%) and polyethylene wear (6.1%) were the most frequent reasons for surgery. The mean FU duration (n = 19) was 28.5 ± 17.3 (3–64) months. The mean HHS score at FU was 59.4 ± 22.2 (29–91) and the mean WOMAC score was 59.7 ± 25.6 (15.6–93.8).Two cups were revised due to instability and one revision was performed due to periprosthetic joint infection, accounting for an overall cup survival rate of 86.8% after a mean FU of 22.9 ± 18.0 (1.5–64.6) months. The survival rate free of loosening was 90.9% after a mean FU of 22.3 ± 18.5 (1.5–64.7) months.ConclusionsWe found that the cementation of a DMC in a well-fixed cup is a promising short- to mid-term treatment addressing THA instability especially in elderly and frail patients, who benefit from a reduced operation time. Proper cementation technique, adequate cup positioning as well as selection of a sufficiently large DMC are crucial for treatment success. Longer FUs will be needed in the future in order to further prove the benefit of this technique.

Outcomes of acute versus delayed total hip arthroplasty following acetabular fracture.

Post-traumatic arthritis is known complication following acetabular fracture. The aim was to compare mid- to long-term outcomes of acute THA (aTHA) for acetabular fracture and delayed THA (dTHA) following failure of ORIF or conservative management. We retrospectively analysed 60 THA (21 aTHA; 39 dTHA) performed for acetabular fracture between 2004 and 2014 in 60 patients with a mean age of 59years (20-94). Functional and Radiographic outcomes were assessed at a mean follow-up of 5years (2-13) utilizing Oxford, Harris Hip (HHS), and Postel Merle d'Aubigné (PMA) scores and Brooker classification. The mean HHS (73), Oxford (32) and PMA (12) scores were significantly lower in the aTHA group. Acute THA was significantly associated with lower postoperative Oxford (β = -4.2), HHS (β = -7.8), and PMA (β = -2.2) scores at mean 5years (2-13). Eleven patients returned to the operating room. There were no significant differences between THA performed in acute or delayed fashion. The two primary reasons for revision were periprosthetic joint infection (n = 5) and aseptic loosening (n = 4). Survivorship free from reoperation at 10years was 91% and 82% for aTHA and dTHA, respectively (p = 0.24). Increased PMA scores were associated with decreased overall survival of the THA free from reoperation (HR = 0.60). The degree of heterotopic ossification was significantly higher in the aTHA group (p <0.001). Acute THA in the setting of acetabular fracture is a technically challenging procedure. However, in the present series, aTHA provided satisfactory immediate stability and good survivorship at 10years in a medically vulnerable patient population. Level 3; Therapeutic study.