Hip Arthroplasty Group Research Articles

Simple Hip Value: a simple score to evaluate Hip function

BackgroundSeveral self-administered questionnaires are available for assessing hip function in clinical practice (HOOS-12, Oxford-12). These questionnaires can be used to assess and monitor patients with hip pathology. However, they are sometimes difficult to deploy in clinical practice. Recent studies on the shoulder and knee have shown that a single-question assessment provides a relevant evaluation of joint function, and correlates with more complex scores. However, this has not yet been evaluated for the hip. We set out to develop a single-question test that would enable patients to assess their hip function between 0 and 100. Therefore, we did a prospective study aiming to assess: (1) the relevance of the SHV (Simple Hip Value) test by comparing it with the Oxford-12 and HOOS-12 scores, (2) the discriminatory capacity and reproducibility of this test. HypothesisThe hypothesis of this study was that the assessment of hip function by a single-question patient-completed questionnaire (PROM) would be reliable and useful in clinical practice. Patients and methodsWe conducted a prospective study including 74 patients operated on for total hip arthroplasty from February 2020 to April 2021 in a high-volume center and 20 healthy subjects. The SHV questionnaire, as well as HOOS-12 and OXFORD-12 were submitted on average 18 months after surgery, with values scaled to 100 points. A second test containing the 3 questionnaires was resubmitted to 20 patients randomly chosen from hip arthroplasty group to evaluate the reproducibility of the test. To evaluate the discrimination capacity of our test, 20 controls were selected to respond to the three questionnaires. ResultsTest results were median SHV, Oxford-12 and HOOS-12 scores of 90/100 (Interquartile Range [IQR]: 80–95), 88.5 (IQR: 77.1–95.8) and 79.1 (IQR: 65.1–93.2), respectively. The SHV was strongly correlated with the Oxford-12 (Spearman coefficient: 0.63 [IQR: 0.45−0.76]) and the HOOS-12 (Spearman coefficient: 0.66 [IQR: 0.46−0.79]). The SHV differed significantly from the control group (90.0 vs 100.0 in the control group [p < 0.001]) and had excellent reproducibility (Interclass Correlation Coefficient [ICC]: ICC: 0.82 [CI95%, 0.59−0.93]). DiscussionThe SHV test seems to be a reliable, reproducible and discriminating tool for assessing hip function after total hip arthroplasty, thus offering a simplified and practical approach for practitioners. Further testing in different populations would be useful to validate this test. Level of evidenceIII; prospective comparative diagnostic study.

Valgus Osteotomy versus Arthroplasty for Ununited Femoral Neck Fractures: A Systematic Review

Abstract Background Fractures of the neck of femur in young adults tend, unlike their counterparts in older people, to be a relatively higher energy injury and require timely and meticulous diagnosis and management. Anatomical reduction and stable internal fixation are essentials for achieving the goals of treatment in this young population allowing preservation of the femoral head while minimizing rates of non-union and osteonecrosis. Aim of the Work The aim of this systematic review is to collate evidence from comparative studies to look for significant differences between valgas osteotomy &amp;arthroplasty in non united femoral neck fractures in &amp;lt; 50yr old patients. Patients and Methods Only studies with Randomized controlled trials and comparative non controlled trials had been included. The study included Valgas osteotomy &amp; arthroplasty for ununited femoral neck fractures. Application of inclusion and exclusion criteria to study Abstracts yielded 11articles. The full-text articles for these 40 studies were then reviewed and subjected to our inclusion criteria. A total of 11 articles were eligible for final systematic review. Results There was improvement in Harris hip score in all included studies ranged from 79.8 to 95. In comparison between two groups, groups with THA had significantly higher Harris hip score than osteotomy score. In this review reoperation and infection were common among osteotomy group than total hip arthroplasty group. Conclusion Although non-union problems following femoral neck fractures are common, the primary objective is to preserve the hip, by seeking alternative methods, specifically in young patients, and considering that the femoral neck can usually remain viable. Therefore, alternatives such as valgus osteotomy, which enables union by solving mechanical issues and allows patients to live with their own bones, have long been in use and successful Valgus intertrochanteric osteotomy is the treatment of choice for active patients aged less than 50 years with a nonunion of a femoral neck fracture. This technique requires precise preoperative planning and intraoperative skill. Patients should be warned of the risk of avascular necrosis, as well as the difficulty in performing revision arthroplasty in this setting.

Comparison of functional outcome between Bipolar Hemiarthroplasty and total Hip Arthroplasty for displaced femoral neck fractures in elderly patients

Objectives: The intention of this study to compare functional outcomes between Total Hip Arthroplasty and Bipolar Hemi Arthroplasty for displaced femoral neck fracture after 3 months and 1 year from injury in elderly patients. Methods: Prospectively 43 patients were enrolled in this study, ages more than 60, twenty-four of them managed by Total Hip Arthroplasty, and 19 were managed by Bipolar Hemi Arthroplasty. These patients were followed up postoperatively for one year, at (3 and 12 months), to compare functional outcomes using Haris Hip Score. Results: Duration of operation was significantly higher in Total Hip Arthroplasty (98.54 min) versus (62.63 min) in the Bipolar Hemi Arthroplasty group, and intra-operative blood loss also considerably higher in Total Hip Arthroplasty (322.5 ml) than Bipolar Hemi Arthroplasty (178.42 ml). Regarding complications, there is no difference between the two groups; however, the incidence of mortality higher in the Bipolar Hemi Arthroplasty population. Average Haris Hip Score, pain and the motion were significantly better after three months and one-year follow-up in the Total Hip Arthroplasty group. The function was nearly the same at both groups after three months but after one-year of follow-up function significantly better (p-value &lt;0.5) in the Total Hip Arthroplasty patients.Conclusion: Total Hip Arthroplasty provides better functional outcomes after three months and one year of follow-up than Bipolar Hemi Arthroplasty when used to manage femoral neck fracture for active old age patients. Bipolar Hemi Arthroplasty may be suitable for older inactive patients with narrow life expectancy with multiple comorbiditie

Evaluation of patients' post-operative results operated for hip fracture with computerized dynamic posturography: Proximal femoral nailing versus hip arthroplasty.

Proximal femoral nailing (PFN) and hip arthroplasty (HA) are the two most often utilized surgical procedures for treating hip fractures in older patients. The post-operative postural balance and functional outcomes of patients may be significantly influenced by the technical distinctions between PFN and HA. This will influence the surgeon's preferred course of therapy. To examine the functional outcomes of patients treated with PFN and HA following a hip fracture, this study used computerized dynamic posturography (CDP). The aim of that study was to evaluate how the two treatment modalities affected patients' post-operative balance, postural stability, and functional rehabilitation. A total of 26 patients who underwent proximal femoral surgery (15 patients PFN [58%] and 11 patients HA [42%]) due to hip fractures were evaluated at least 12 months postoperatively. They were tested by direct radiographs, hip joint examinations, Harris hip score (HHS), and CDP. Twelve (46%) of 26 patients were male and 14 (54%) were female. The mean age of the participants in the study was 67.9±14.2 years. The mean follow-up period was 24 (12-44) months. The average Harris score of PFN group was 79.3 (46.8-100) points and HA group was 83.7 (61.9-99.9) points. There was no significant difference between the groups in terms of Harris Score (P=0.54). The average of the mixed value of the balance results obtained with CDP (the Composite score) for PFN group was 70.5 (56-79) points, and for HA group was 71.9 (56-83) points. There was no significant difference between the groups in terms of the Composite Score (P=0.47). Accordingly, 12 (80%) of the patients who underwent PFN had good results and 3 (20%) of them had bad results. Eight (72.7%) of those who underwent HA had good results and 3 (27.3%) had bad results. There was no statistically significant difference (P=0.66). Comparing the composite score for balance results and HHS results for rehabilitation with the data of the patients who underwent PFN and HA, there was no statistically significant difference between these two techniques in terms of postural stabil-ity and balance as a result of CDP examination.

Influence of Intraoperative Nociception during Hip or Knee Arthroplasty with Supplementary Regional Anaesthesia on Postoperative Pain and Opioid Consumption.

Background and Objectives: Early postoperative mobilization is central for postoperative outcomes after lower extremity joint replacement surgery. By providing adequate pain control, regional anaesthesia plays an important role for postoperative mobilization. It was the objective of this study to investigate the use of the nociception level index (NOL) to determine the effect of regional anaesthesia in hip or knee arthroplasty patients undergoing general anaesthesia with additional peripheral nerve block. Materials and Methods: Patients received general anaesthesia, and continuous NOL monitoring was established before anaesthesia induction. Depending on the type of surgery, regional anaesthesia was performed with a Fascia Iliaca Block or an Adductor Canal Block. Results: For the final analysis, 35 patients remained, 18 with hip and 17 with knee arthroplasty. We found no significant difference in postoperative pain between hip or knee arthroplasty groups. NOL increase at the time of skin incision was the only parameter associated with postoperative pain measured using a numerical rating scale (NRS > 3) after 24 h in movement (-12.3 vs. +119%, p = 0.005). There was no association with intraoperative NOL values and postoperative opioid consumption, nor was there an association between secondary parameters (bispectral index, heart rate) and postoperative pain levels. Conclusions: Intraoperative NOL changes may indicate regional anaesthesia effectiveness and could be associated with postoperative pain levels. This remains to be confirmed in a larger study.

Functional assessment of bipolar hemiarthroplasty versus total hip replacement in trans cervical neck fracture of femur in elderly patients a prospective observational study

Background: Bipolar hemiarthroplasty and total hip arthroplasty are widely accepted methods of treatment for displaced femoral neck fracture in elderly patients. This study is to compare the functional outcomes of bipolar hemiarthroplasty and total hip arthroplasty in such patients. Methods: This is a prospective study in which data of all patients with age more than 60 with trans cervical neck of femur fracture undergoing total hip arthroplasty and bipolar hemiarthroplasty in a tertiary care centre in Mumbai is studied. They were followed up and compared with the Modified Harris Hip Score. The results were compared between the two groups for statistical significance. Results: There was a significant difference seen in pain and gait at 6 and 12 months between two groups with better scores in the total hip arthroplasty group. Better functional activities were seen at 3 and 6 months in the total hip arthroplasty group. A significant difference was seen in the Total Modified Harris Hip Score at 3, 6 and 12 months and was better in the total hip arthroplasty group as compared to the hemiarthroplasty group. Conclusions: Bipolar hemiarthroplasty is the preferred approach after a displaced femoral neck fracture in the elderly population, but due to potential complications like inguinal pain and low functional outcome, total hip replacement should be considered as the first line of surgical management for the neck of femur fracture in such patients. It has been found to have a good functional outcome, fewer gait disturbances and less post-operative pain.

Total hip arthroplasty reduces the risk of dislocation after femoral neck fracture

IntroductionFemoral neck fracture in the elderly patient can either be managed using hemi-arthroplasty (HA) or total hip arthroplasty (THA). The aim of this study was to explore the rate of three selected complications in each procedure: is the dislocation rate higher with HA compared to THA? Is the blood transfusion rate higher with THA compared to HA? Do the patients who underwent THA require more ICU transfer than the patients who underwent HA? Is the ICU transfer correlated to the use of cement for stem fixation? MethodBased on a national health-care database, a comparative and retrospective study was conducted. 96,184 patients were included after having a surgery for femoral neck fracture between 2014 and 2017. The mean follow up was 3.5 years (Min. 2 years–Max. 5 years). The population was divided into two groups: hemiarthroplasty (HA) and total hip arthroplasty (THA). The primary outcome was the dislocation rate and the secondary outcomes were the blood transfusion rate and the need for ICU after surgery. ResultsAt two years of follow up in the Hemiarthroplasty group, 3647 patients had a dislocation episode over 64,106 patients: 5.69%. In the Total Hip Arthroplasty group: 1904 patients had a dislocation episode over 32,078 patients: 5.94% (p=0.26711). The percentage of deceased patient without dislocation was 17.76% in the HA group and 11.56% in the THA group (p<0.001). The univariate hazard ratio for dislocation was higher in the THA group: HR 1.063 IC 95% (0.993–1.138) p=0.077. The multivariate analysis calculating competitive risk with death and dislocation found THA to be a protective factor of dislocation HR 0.926 IC 95% (0.866–0.991) p=0.0266. The rate of blood transfusion was 5.59% in the THA group and 7.03% in the HA group (p<0.001), The multivariate analysis found HR=1.062 IC 95% (0.99–1.139) p=0.0955. The need for ICU transfer after the surgery was 7.04% in the HA group and 8.08% in the THA group (p<0.001). The multivariate analysis found HR 0.995 IC 95% (0.921–1.076) p=0.9094. Finally, only cement was found as an independent risk factor of ICU transfer after surgery: HR 1.254 IC 95% (1.164–1.35) p<0.0001. ConclusionTHA for femoral neck fracture allows to reduce the risk of dislocation compared to hemiarthroplasty. The multivariate analysis failed to prove the superiority of one procedure over the other regarding blood transfusion risk and the need for ICU transfer. The use of cemented stem appears to be a risk factor of ICU transfer after hip arthroplasty. Level of evidenceIII, Retrospective comparative study.

What Is the Best Treatment Choice for Concomitant Ipsilateral Femoral Neck and Intertrochanteric Fracture? A Retrospective Comparative Analysis of 115 Consecutive Patients.

Although a concomitant ipsilateral femoral neck and intertrochanteric fracture has been considered to be a rare type of injury, its incidence has been increasing, especially among elderly hip fracture patients. However, there is limited evidence on the optimal treatment option. This study surveys surgical outcomes of different implants in order to assist in selecting the best possible implant for a combined femoral neck and intertrochanteric fracture. The postoperative complications after the treatment of a concomitant ipsilateral femoral neck and intertrochanteric fracture via cephalomedullary nail (CMN), dynamic hip screw (DHS), and hip arthroplasty groups were analyzed by retrospectively reviewing the electronic medical records of 115 consecutive patients. The patient demographics and perioperative details showed no significant discrepancies amongst different surgical groups, except for the operative time; a CMN had the shortest mean operative time (standard deviation) of 85.6 min (31.1), followed by 94.7 min (22.3) during a DHS, and 107.3 min (37.2) during an HR (p = 0.021). Of the 84 osteosynthesis patients, 77 (91.7%) achieved a fracture union. Only one (3.2%) of the 31 HR cases had a dislocation. The sub-analysis of the different osteosynthesis methods showed a higher incidence of excessive sliding and the nonunion of the fracture fragment in the DHS group than that in the CMN group (p = 0.004 and p = 0.022, respectively). The different surgical methods did not significantly vary in other outcome variables, such as the re-operation rate, mortality, and hip function. For the surgical treatment of combined femoral neck and trochanteric fractures, osteosynthesis did not differ significantly from an HR in terms of the overall postoperative complications, reoperation and mortality rate, and hip function, however, the risk of nonunion and more mechanical complications should be considered when choosing a DHS. Our suggestion for the treatment of a femoral neck and ipsilateral trochanteric fracture is that a surgeon should choose wisely between an HR and a CMN depending on the patient's age, the displacement of the femoral neck, and one's expertise.

Effect of Treatment Modality on Mobility and Quality of Life in Unstable Intertrochanteric Fractures

Purpose: The aim of the study was to investigate mobility and quality of life in patients who underwent osteosynthesis with proximal femoral nail (PFN), or arthroplasty for unstable intertrochanteric fractures.&#x0D; Methods: Treatment outcomes of 117 patients (76 Female/41 Male) who were treated with PFN (Group 1, n=66), hemiarthroplasty (Group 2, n=42), or total hip arthroplasty (Group 3, n=9) between 2008 and 2014 were retrospectively evaluated. The mobility of the patients was evaluated with the Palmer and Parker mobility score, and the quality of life was evaluated with the Barthel quality of life index.&#x0D; Results: The mean ages in the groups were 83.51 (range, 75-97) years, 84.72 (range, 75-109) years, and 83.37 (range, 75-94) years; respectively. The mean follow-up periods were 23.26 (range, 3-43.9) months, 19.24 (range, 3-38) months, and 20.1 (range, 3-40) months; respectively. There was no statistical difference between the 3 groups in terms of age and follow-up time (p&gt;0.05). Palmer-Parker mobility scores were 6.23 for Group 1, 3.68 for Group 2, and 4.22 for Group 3. Barthel Indexes were 68.73 for Group 1, 37.75 for Group 2, and 52.77 for Group 3. Group 1 had a statistically significantly higher Palmer-Parker mobility and Barthel Index score than Group 2 and Group 3 (p

How does the side of lumbar disc herniation influence the psoas muscle size at the L4-5 level in patients operated for unilateral hip arthroplasty?

Study Design: Retrospective study. Objection: There can be a relationship between degenerative diseases in the spine and hip. Summary of Background Data: Degenerative diseases in the spine and hip may occur concomitantly. This study was done to investigate the cross-sectional area of psoas muscle size and incidence of lumbar disc herniation after unilateral hip arthroplasty. Methods: The data files of patients who were operated on for unilateral hip arthroplasty between January 2014- and 15 May 2021 at the Recep Tayyip Erdogan University Hospital were retrospectively analysed for the relationship between the psoas muscle volume and the incidence of lumbar disc herniation. The patients were divided according to their operated sides. Results: The data files of 48 patients were retrospectively analysed. The patients were divided into two groups according to the operated side of their hip joints. Gender and age differences were not significant, and the mean ages were 68,68 years old in the right hip arthroplasty group, and 69,39 in the left hip arthroplasty group. Conclusions: A complex interaction between the development of lumbar disc herniations and increased contralateral cross-sectional area of the psoas muscle at the L4-5 level was observed in patients operated for unilateral hip arthroplasty. This interaction can be a compensatory mechanism to counteract the spinal imbalance.

The role of internal fixation in the treatment of femoral head necrosis with ipsilateral hip fracture.

Whether internal fixation or hip arthroplasty is the most appropriate initial treatment for patients with ipsilateral hip fracture and osteonecrosis of the femoral head remains unknown. In this study, the prognoses of patients who underwent internal fixation or hip arthroplasty were analyzed and compared to explore the role of internal fixation in treating such patients.We retrospectively reviewed 69 patients diagnosed with osteonecrosis of the femoral head and ipsilateral hip fracture from 1999 to 2018. They were divided into the hip arthroplasty or internal fixation group. The visual analog scale and Harris score were used. The incidence of complications and the conversion to arthroplasty were also investigated to further explore the role of internal fixation.Male patients (male/female: 25/31 vs 20/38, P = .015), younger patients (average age: 46.80 ± 13.14 vs 61.07 ± 15.61, P < .001), and patients with femoral neck fractures (fracture type, femoral neck/trochanter: 21/31 vs 12/38, P = .003) were more likely to receive 1-stage hip arthroplasty. Of 38 patients undergoing internal fixation, fracture nonunion was identified in 9, and progression of osteonecrosis was identified in 16. Meanwhile, conversion to secondary hip arthroplasty occurred in 13 patients. Four independent risk factors for conversion to secondary hip arthroplasty were identified: age of ≤60 years (odds ratio [OR] = 9.786, 95% confidence interval [CI] = 2.735–35.015), male sex (OR = 6.790, 95% CI = 1.718–26.831), collapse of the femoral head before injury (OR = 7.170, 95% CI = 2.004–25.651), and femoral neck fracture (OR = 8.072, 95% CI = 2.153–30.261). A new scoring system was constructed for predicting conversion to hip arthroplasty in patients undergoing internal fixation treatment. A cutoff of ≤2 points indicated low risk for conversion, 3 to 4 points indicated moderate risk, and ≥5 points indicated high risk.Patients who underwent internal fixation had worse prognoses than those who underwent 1-stage hip arthroplasty. However, in this study, hip arthroplasty conversion did not occur in most patients who received internal fixation. Using the new scoring system to identify patients who may require conversion to replacement may help make appropriate patient management and clinical decisions.

Retrospective Review of Arthroplasty Radiographs: How to Define an Adequate Radiograph.

IntroductionAdequacy of postoperative hip and knee radiographs has a direct impact on its interpretation. We undertook a quality improvement project by creating local standards to meet the arthroplasty team expectations for a satisfactory radiograph. The purposes of the study are 1. Assessment of the adequacy of radiographs according to defined criteria, and 2. Correlation of system and patient factors with inadequate radiographs.MethodsStage I: We conducted a single centre, retrospective audit to check the adequacy of a postoperative radiography following a total hip or knee replacement. A total of 100 radiographs were assessed against the nine criteria laid out with the consensus of orthopaedic surgeons and radiologists.Stage II: We created a quality improvement proforma for use in the radiology department. We re-assessed 100 radiographs during the second cycle against the nine criteria to check the adequacy of hip and knee arthroplasty radiographs,ResultsStage I: Of 100 radiographs, 51 were from the knee and 49 from the hip arthroplasty group. Sixty-nine radiographs were adequate considering overall criteria, and 31 radiographs were inadequate. The inadequacy in radiographs was related to the visibility of prosthesis, cement or relevant anatomy.Stage II: We created a quality improvement performa for use in radiology department, highlighting the nine initial criteria. One hundred radiographs of hip and knee arthroplasty were re-assessed. Overall, 84 radiographs fulfilled the criteria of being adequate.ConclusionAdequacy of knee and hip arthroplasty radiographs is essential in picking up pathologies that can be missed otherwise. We present simple criteria to improve the adequacy of x-ray and prevent repetition of radiographs.

Comparison of proximal femoral nail antirotation and total hip arthroplasty in the treatment of femoral intertrochanteric fracture.

Objectives:To investigate the effects of proximal femoral nail antirotation (PFNA) and total hip arthroplasty for the treatment of femoral intertrochanteric fractures.Methods:Clinical data from 110 femoral intertrochanteric fracture patients treated at our hospital between January 2019 and July 2020 were analyzed retrospectively. Patients were divided into two groups based on the type of surgical intervention used. One group included patients (n= 59) who had undergone PFNA internal fixation and another group (n=51) included patients who had undergone total hip arthroplasty. Perioperative situation, joint function progression, and complication incidence were assessed.Results:Total hip arthroplasty group was associated with longer operation durations, longer incisions, and more intraoperative blood loss than PFNA group (P<0.05). Joint function and pain scores in the total hip arthroplasty group were superior than PFNA group (P<0.05). The Harris score of total hip arthroplasty group was significantly higher than that of PFNA group at three, six and 12 months after operation (P<0.05). The rate of complications in patients after total hip arthroplasty was lower than that of PFNA group (P<0.05) within 12 months of the surgery.Conclusion:PFNA and total hip arthroplasty can both achieve good results for treatment of femoral intertrochanteric fractures. PFNA offers less trauma and shorter operations, while total hip arthroplasty offers advantages in terms of more rapid limb function improvements and shorter rehabilitation processes. The two kinds of surgery have advantages, and the clinical needs to have a careful look at various factors and choose the appropriate operation method.

A comparative study of functional outcome of bipolar hemiarthroplasty versus total hip arthroplasty in fracture neck of femur in elderly patients

Introduction: Fractures of the femoral neck are an international public health problem mainly occurring in elderly patients and resulting in high mortality. With the aging population, the incidence of these fractures is steadily increasing. Treatment choices for the neck of femur fractures in the elderly age group includes hemiarthroplasty (HA) and total hip replacement (THR). The treatment option must be decided by the type of fracture, condition of the patient, functional demands, medical and mental ability to cope with the surgery. This study compares bipolar hemiarthroplasty (BH) and total hip replacement (THR) in elderly patients with neck of femur fracture. Aim: To evaluate the functional outcome, complications and mortality of Bipolar Hemiarthroplasty and Total Hip Arthroplasty as a treatment modality in neck of femur fracture patients. Materials and Methods: A prospective study was conducted in the Department of Orthopaedics, Rajah Muthiah medical college, in which 30 Patients of age 55 years and above who underwent hip arthroplasty (BHA or THA) for neck of femur fracture with follow up were included. Patients were separated into two groups by random allocation. Patients of group 1 (15 patients) were treated by bipolar hemiarthroplasty and group 2 (15 patients) by total hip arthroplasty. Both groups were followed up post-operatively for one year, at 6, 12 months, for surgical complications including dislocation, fracture, surgical site infection, and, one-year mortality and functional outcome using Modified Harris Hip Score. Results: Modified Harris Hip Score was higher in Total hip arthroplasty group compared to bipolar hemiarthroplasty group, pain was similar in both groups post operatively. Gait and range of motion were higher in the Total Hip Arthroplasty group, no significant difference was seen in mortality and post-operative complications between the two groups. Conclusion: In our study, we conclude that Total hip arthroplasty is ideal to treat femoral neck fractures in elderly patients with arthritic changes and has a lower risk of re operation when compared to Bipolar hemiarthroplasty, however bipolar hemiarthroplasty has a better outcome in cases of acute femoral neck fractures, based on our study.

High hip center arthroplasty in the treatment of severe hip dysplasia: Are knee and ankle compromised?

BackgroundThere is limited information about the effect of hip center location on gait parameters of knee and ankle. This study aimed to compare anatomical vs. high hip center arthroplasty according to gait parameters of knee and ankle and investigate whether the high hip center has any adverse effect on these joints or not. Methods20 patients who underwent unilateral total hip arthroplasty (Group 1; 10 patients with anatomical reconstruction, Group 2; 10 patients with high hip center) due to Crowe type III-IV developmental dysplasia of the hip and completed 2 years of follow-up were included. The patients were examined by 3-D gait analysis. FindingsThe maximum extension of the knee on the operated side was lower in Group 2 (p = 0.044). Longitudinal knee joint force was higher in Group 2 on both operated (p = 0.041) and non-operated sides (p = 0.031). Lateral knee joint force was also higher in Group 2 (p = 0.023). No significant difference was detected in ankle parameters. InterpretationUnilateral high hip center has been shown to restrict the dynamic knee range of motion on the operated side and increase the knee load on both sides, thus putting the knees at risk for osteoarthritis. Level of evidenceLevel III, Retrospective comparative study.

Femoral Head and Liner Exchange in Patients with Atraumatic Dislocation. Results of a Retrospective Study with 6 Years Follow-Up.

Background and Objectives: Femoral head and liner exchange is an established treatment for polyethylene wear but has had a more limited role in the treatment of other conditions including dislocation, because of concerns about an increased postoperative dislocation rate. Some authors have considered dislocation associated with polyethylene wear to be a contraindication for this procedure. Materials and Methods: Our retrospective review evaluated the outcome of head and liner exchange in a small consecutively operated heterogeneous cohort of 20 patients who presented with dislocation unrelated to trauma, component malposition or component loosening. Of this group, 12 had prior primary total hip arthroplasty, and 8 had prior revision total hip arthroplasty, and included 4 patients with prior revision for dislocation. Mean follow-up was 6 ± 3.5 years (range 1–145 months). Results: Kaplan–Meier analysis revealed a revision-free implant survival from any cause of 80% (confidence interval 95%:64.3–99.6%) at 5 years after head and liner exchange (index surgery). At final follow-up, 83.3% of patients (n = 10) with prior primary total hip arthroplasty and 62.5% of patients (n = 5) with prior revision total hip arthroplasty, had not required subsequent revision for any cause. None (0%) of the primary total hip arthroplasty group and 3 (38%) of the revision arthroplasty group had required revision for further dislocation. Of the eight revision arthroplasty patients, four had a prior revision for dislocation and three of these four patients required further revision for dislocation after index surgery. The fourth patient had no dislocation after index surgery. One additional patient who had prior revision surgery for femoral component fracture suffered dislocation after index surgery, but was successfully treated with closed reduction. Conclusions: In our study population, femoral head and liner exchange was an effective treatment option for patients with prior primary total hip arthroplasty and also for a highly select group of revision total arthroplasty patients with no prior history of dislocation. Femoral head and liner exchange does not appear to be a viable treatment option for patients who have had revision total arthroplasty after prior dislocations.

Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

PurposeTo determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients.MethodsData from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points.ResultsPatients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11–4.74).ConclusionTreatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.

Risk Factors for Physician Burnout in Early Career Arthroplasty Surgeons

Introduction We sought to identify the prevalence and risk factors for physician burnout and job satisfaction among arthroplasty surgeons within their first five years of practice. Methods The American Association of Hip and Knee Surgeons (AAHKS) Young Arthroplasty Group was surveyed for this study. The survey collected data regarding surgeon demographics, extracurricular activities, and job satisfaction. The abbreviated Maslach Burnout Inventory (aMBI) was utilized to evaluate emotional exhaustion, depersonalization, and personal accomplishment. Demographic and practice variables were analyzed to identify any association with aMBI scores. Results 82 surgeons (35%) responded to the survey with 78% satisfied with their current job. Surgeons who were satisfied with their current job were more likely to have hobbies outside of orthopedics (OR = 7.50, p = 0.005), be younger (OR = 11.11, p = 0.047), and to be employed in a physician-owned practice type (OR = 9.09, practice, p = 0.019). The median personal accomplishment score was higher for those reporting hobbies outside of orthopedics (16 vs. 13.5, p = 0.040), performing research (16.5 vs. 16, p = 0.006), and having less call (17 vs. 14.5, p = 0.001). Depersonalization and emotional exhaustion scores were not related to any characteristic measured. Conclusion Emotional exhaustion, depersonalization, and sense of personal accomplishment varied greatly amongst early career arthroplasty surgeons. Having hobbies outside of orthopedics was most strongly associated with a sense of greater personal accomplishment and job satisfaction. Understanding risk factors related to burnout may help improve identification and prevention of this potential cause of job dissatisfaction and turnover.

The Rate of Correctly Planned Size of Digital Templating in Two Planes—A Comparative Study of a Short-Stem Total Hip Implant with Primary Metaphyseal Fixation and a Conventional Stem

(1) Background: Preoperative templating is mainly conducted on an anteroposterior pelvic overview X-ray. For short stem hip arthroplasty, the choice of the optimal size is especially crucial to avoid complications. Thus, the study aimed to determine if there is an increased rate of correctly planned sizes using two radiological planes. (2) Methods: 50 patients with a conventional stem and 100 with a short stem total hip arthroplasty were analyzed. Without knowing the implanted size, three independent orthopedic surgeons performed digital templating: once using the anteroposterior pelvic overview only and once using the lateral view in addition. (3) Results: The rate of correctly planned sizes (+/−1 size compared to the inserted size) of templating with one plane was 86.3% ± 9.5% in short stem hip arthroplasty and 88.4% ± 6.0% in conventional stem arthroplasty. By adding the lateral view, the rate of correctly planned sizes was 89.9% ± 12.0% for the short stem hip arthroplasty group and 89.4% ± 9.8% for the conventional group (p &gt; 0.1). (4) A potential positive effect of preoperative templating using an additional lateral X-ray view for short stem implants may be suggested based on the results of this study, which did, however, not reach statistical significance.

Less blood loss in supercapsular percutaneously assisted versus posterolateral total hip arthroplasty

BackgroundAlthough excellent clinical outcomes of supercapsular percutaneously assisted total hip arthroplasty (SuperPath) have been reported, the peri-operative blood loss has rarely been reported. The current study determined the blood loss during SuperPath and compared the blood loss with conventional posterolateral total hip arthroplasty (PLTH).MethodsThis retrospective study enrolled patients who underwent unilateral primary THA between January 2017 and December 2019. The demographic data, diagnoses, affected side, radiographic findings, hemoglobin concentration, hematocrit, operative time, transfusion requirements, and intra-operative blood loss were recorded. The peri-operative blood loss was calculated using the OSTHEO formula. Blood loss on the 1st, 3rd, and 5th post-operative days was calculated. Hidden blood loss (HBL) was determined by subtracting the intra-operative blood loss from the total blood loss.ResultsTwo hundred sixty-three patients were included in the study, 85 of whom were in the SuperPath group and 178 in the posterolateral total hip arthroplasty (PLTH) group. Patient demographics, diagnoses, affected side, operative times, and pre-operative hemoglobin concentrations did not differ significantly between the two groups (all P > 0.05). Compared to the PLTH group, the SuperPath group had less blood loss, including intra-operative blood loss, 1st, 3rd, and 5th post-operative days blood loss, and HBL (all P < 0.05). Total blood loss and HBL was 790.07 ± 233.37 and 560.67 ± 195.54 mL for the SuperPath group, respectively, and 1141.26 ± 482.52 and 783.45 ± 379.24 mL for the PLTH group. PLTH led to a greater reduction in the post-operative hematocrit than SuperPath (P < 0.001). A much lower transfusion rate (P = 0.028) and transfusion volume (P = 0.019) was also noted in the SuperPath group.ConclusionSuperPath resulted in less perioperative blood loss and a lower transfusion rate than conventional PLTH.