Hip Replacement Research Articles

Changes in the cortical bone reaction around the stem after uncemented total hip replacement using short tapered wedge stem

PurposeThis study examined the relationship between stem alignment and the cortical bone area around the distal end of the femoral component using three-dimensional computed tomography (3D-CT) images after uncemented total hip arthroplasty (THA). MethodsA total of 59 patients who underwent primary THA using an uncemented short tapered wedge stem from 2019 to 2021 were followed for at least 24 months. Patients were divided into groups based on stem position. Changes in stem position and cross-sectional area of femoral cortical bone at the distal end of the stem were examined using 3D-CT at 12 months and 24 months post-operatively and were compared with pre-operative values. ResultsThe 12-month post-operative cortical bone area around the stem showed significant differences compared with the pre-operative area in the anterior, posterior, and lateral zone 1. Differences at these same points were noted when comparing the 24-month post-operative area with the pre-operative area. No significant difference was found in the change in the cortical bone area over time among the neutral, flexed, and extended stem groups. In the varus stem group, a significant increase in cortical bone area over time was observed in lateral zone 2. In the valgus stem group, a significant increase in the cortical bone area over time was observed in medial zone 1. ConclusionsStem alignment may affect periprosthetic cortical bone changes after THA using an uncemented short tapered wedge stem. Cortical bone reaction was revealed laterally to the stem tip in the varus-aligned stem, and medially to the stem tip in the valgus-aligned stem.

Construction and Application Effect Analysis of Orthopedic Pain Care Ward under Multi-Disciplinary Cooperation Model

Aims/Background A multidisciplinary team (MDT) approach is a nurse-led pain management method that involves collaboration with staff from other departments. The purpose of this paper was to discuss the construction and application effect of a pain care ward in orthopedics utilizing the MDT approach. Methods A retrospective analysis of case data was conducted, selecting 90 patients with hip joint fractures who underwent hip replacement arthroplasty (HRA) at our hospital between February 2021 and February 2024. The patients were divided into two groups based on the nursing methods: a control group (n = 43), which received a conventional analgesic management program, and an intervention group (n = 47), which received the same conventional analgesic management program along with the implementation of an orthopedic pain care ward under the MDT approach. The study compared the pain knowledge and attitudes of the responsible nurses in both groups through questionnaires. Additionally, the accuracy of pain assessments and the awareness rates of patients’ pain-related health education were evaluated and compared between the two groups. Furthermore, the effectiveness of pain intervention, range of motion (ROM), and Hospital for Special Surgery (HSS) scores before and after the intervention were analyzed. The incidence of complications and overall nursing satisfaction were also compared between the two groups. Results The general knowledge, pain assessment, drug analgesia, comprehensive application, and total scores of nurses in the intervention group were significantly higher than those in the control group (p < 0.05). The accuracy rate of nurses’ pain assessments and the awareness rate of patients’ pain health education in the intervention group were 91.49% and 93.62%, respectively, both significantly higher than the 72.09% and 79.07% observed in the control group (p < 0.05). The total effective rate of pain intervention in the intervention group was 74.47%, significantly higher than the 53.49% in the control group (p < 0.05). After the intervention, both the ROM and HSS scores in the intervention group were significantly higher than those in the control group (p < 0.05). The overall incidence of complications in the intervention group was 6.38%, significantly lower than the 20.93% in the control group (p < 0.05). Finally, the total satisfaction rate with nursing care in the intervention group was 91.49%, significantly higher than the 74.42% in the control group (p < 0.05). Conclusion The construction and application of an MDT pain care ward can effectively enhance the accuracy of nurses’ pain assessments, increase patients’ awareness of pain-related health education, and improve the efficiency of pain interventions. Additionally, it can lead to better joint mobility and improved hip function, promoting the sustainable development of the pain care ward. These improvements contribute to higher patient satisfaction and enrich the quality of nursing services.

Impact of robot assistance on restoration of limb length and offset distance in total hip arthroplasty

To analyze the impact of robot assistance on the restoration of limb length and offset distance in total hip arthroplasty (THA). A retrospective analysis was conducted on the clinical data of 316 patients who underwent unilateral primary THA between September 2019 and August 2023. Among them, 117 patients underwent robot-assisted THA (group A), and 199 patients underwent conventional THA (group B). There was no significant difference between the two groups in the gender, age, or side of the hip replacement ( P>0.05); but there was a significant difference in the preoperative diagnosis ( P<0.05). The leg length discrepancy (LLD) and global offset (GO) dfference were measured on preoperative anteroposterior pelvic X-ray films, and absolute values were used for comparison between groups. The operations in both groups were successfully completed. Postoperative imaging measurements showed that the LLD and GO dfference in group A were significantly lower than those in group B ( P<0.05). Among them, group A had 32 cases (27.4%), 5 cases (4.3%), and 0 case (0) of LLD>3 mm, >5 mm, and >10 mm, respectively, while group B had 115 cases (57.8%), 75 cases (37.7%), and 22 cases (11.1%), respectively; and the differences in above indicators between groups were significant ( P<0.05). Group A had 40 cases (34.2%), 3 cases (2.6%), and 0 case (0) of GO dfference>5 mm, >10 mm, and >20 mm, respectively; group B had 103 cases (51.8%), 54 cases (27.1%), and 7 cases (3.5%), respectively. There was no significant difference in the proportion of patients with GO>20 mm between groups ( P>0.05), while there were significant differences in other indicators between groups ( P<0.05). Compared with traditional THA, robot assisted THA has more advantages in restoration of limb length and offset distance.

Effectiveness of Virtual Surgical Planning and Three-Dimensional Anatomical Models in Radiological Reconstruction of Center of Rotation and Pelvic Brim in Patients with Anterior Column Defects Requiring Revision Hip Arthroplasty

Background: The aim of this study was to show that virtual surgical planning (VSP) and printed anatomical models support the reconstruction of the center of rotation (COR) and pelvic BRIM during revision hip surgery using a dual-mobility revision cup system in patients with anterior pelvic column damage and soft tissue envelope deficiency. Methods: Patients with anterior pelvic column damage and soft tissue envelope deficiency underwent revision hip arthroplasty. Virtual planning included assessment of bone segmentation, positioning of the cementless revision cup while maintaining the COR, and the assumed inclination and anteversion angles. Results: The diameter of the planned revision cups was 65.5 ± 2.1 mm, and the diameter of the revision cups used was 65.3 ± 2.1 mm. The difference in COR position in the horizontal axis was 7.8 ± 9.3 mm, in the vertical axis was 4.3 ± 5.9 mm, and in the axial plane was 1.6 ± 3.3 mm. The differences in inclination angle and in the anteversion angle were 12.4° and 8.7°, respectively. Conclusions: The use of VSP and 3D models supports the process of performing RHA surgery in patients with damage to the anterior pelvic column and soft tissue envelope deficiency.

Study on the Analgesic Efficacy of Femoral Nerve Block for Post-Hip Arthroscopy Pain.

Postoperative pain management is challenging for hip arthroscopy, and the effectiveness and specific protocols of femoral nerve block (FNB) in hip surgeries remain insufficient. Therefore, we designed this study to investigate the analgesic efficacy and optimal drug concentrations of FNB after hip arthroscopy. A total of 148 patients undergoing hip arthroscopy were included and randomly divided into three groups: 0.3% ropivacaine FNB group, 0.4% ropivacaine FNB group, and 0.4% ropivacaine intra-articular injection (IAI) group (positive control). The main outcomes included dynamic and static visual analog scale (VAS) scores at various time points postoperatively, total intraoperative remifentanil consumption, and cumulative consumption of morphine within 24h postoperatively. Secondary outcomes included total intraoperative dexmedetomidine consumption, RASMAY sedation scores, and patients' satisfaction scores postoperatively. Both FNB and IAI anesthesia were shown to be safe for post-hip arthroscopy analgesia. Compared with IAI anesthesia, FNB showed no significant differences in analgesic effect within 12h postoperatively but had a better analgesic effect after 24h and lower remifentanil consumption intraoperatively. Group 0.4% ropivacaine showed lower dynamic VAS scores within the first 12h compared with 0.3% ropivacaine for FNB, however, there were no significant differences in patient satisfaction and sedation, and postoperative ambulation was delayed, indicating that the higher concentration of ropivacaine correlated with a longer time to ambulation. The IAI group had greater intraoperative opioid consumption and more side effects. Compared with IAI anesthesia, FNB can better alleviate post-hip arthroscopy pain and reduce opioid consumption. However, it requires specialized equipment and technical support and carries a certain risk of puncture. Chinese Clinical Trials Registry (ChiCTR2400091579).

Evaluating the clinical potential of bioceramic-rods for revascularization in osteonecrosis of the femoral head: a systematic review.

To evaluate the safety, reliability, and effectiveness of bioceramic rods (BR) in treating osteonecrosis of the femoral head (ONFH), compared with other treatments such as core decompression and autologous bone grafting. Systematic review and meta-analysis. Pubmed, Embase, and CNKI databases from January 2011 to July 2023. Included studies involved patients treated with bioceramic rods. Studies were required to have a follow-up time of more than six months and no statistically significant differences in baseline information between groups in controlled studies. Exclusions included literature reviews, case reports, conference abstracts, animal experiments, and studies without defined success criteria or lacking analysis on factors influencing efficacy. The primary outcome measure was the Harris Hip Score (HHS) improvement rate. Secondary outcomes included the femoral head stability and survival rate, alongside the hip replacement rate. The systematic review revealed significant improvements in symptom relief and functional recovery using BR for the treatment of ONFH. An average follow-up of 20.44 months showed an overall HHS improvement rate of 33.93%. Hip preservation efficacy with BR was superior to core decompression and autologous bone grafting. The overall femoral head survival rate was 84.42%, with results sustained for three years. The success rate of hip preservation was notably higher with early intervention, which showed better outcomes when the overall HHS improvement exceeded 27%, and rates of excellent and good outcomes approached 90%. Bioceramic rods offer a safe, minimally invasive, reliable, and effective treatment option for ONFH, ensuring substantial symptom relief and functional recovery. The technique's success in early disease stages suggests a strong potential for broader clinical adoption. Although additional benefits from combining BR with stem cells, platelet-rich plasma, and traditional Chinese medicine are noted, definitive conclusions on enhanced therapeutic effects remain inconclusive.

A non-intrusive reduced-order model for finite element analysis of implant positioning in total hip replacements.

Sophisticated high-fidelity simulations can predict bone mass density (BMD) changes around a hip implant after implantation. However, these models currently have high computational demands, rendering them impractical for clinical settings. Model order reduction techniques offer a remedy by enabling fast evaluations. In this work, a non-intrusive reduced-order model, combining proper orthogonal decomposition with radial basis function interpolation (POD-RBF), is established to predict BMD distributions for varying implant positions. A parameterised finite element mesh is morphed using Laplace's equation, which eliminates tedious remeshing and projection of the BMD results on a common mesh in the offline stage. In the online stage, the surrogate model can predict BMD distributions for new implant positions and the results are visualised on the parameterised reference mesh. The computational time for evaluating the final BMD distribution around a new implant position is reduced from minutes to milliseconds by the surrogate model compared to the high-fidelity model. The snapshot data, the surrogate model parameters and the accuracy of the surrogate model are analysed. The presented non-intrusive surrogate model paves the way for on-the-fly evaluations in clinical practice, offering a promising tool for planning and monitoring of total hip replacements.

Persistent elevation of plasma markers of cellular senescence after hip fracture: a pilot longitudinal study

IntroductionHip fractures may result from and contribute to accelerated biological aging. We aimed to evaluate the impact of hip fracture and its surgery on the senescence-associated secretory phenotype (SASP) index, a composite of peripheral protein markers where higher scores are thought to indicate greater levels of cellular senescence and accelerated aging.MethodsWe examined the SASP index in plasma over 12 weeks post-surgery and its prediction of long-term post-surgical functional outcomes. We included 60 older adults: 20 recruited immediately after hip fracture surgery, and 40 comparison individuals who were either healthy or suffering chronic psychosocial stress (caregiving). We assessed 22 SASP biomarkers and calculated the SASP index score for each hip fracture participant immediately following fracture surgery and 4 and 12 weeks later. Functional recovery was assessed at 12, 26, and 52 weeks after hip replacement surgery.ResultsThe hip fracture group had higher SASP index scores than the comparison groups, after adjusting for potential confounding variables (p = 0.021). SASP index scores in hip fracture patients increased further by week 4 after surgery (p &amp;lt; 0.001), declining by week 12 but remaining elevated overall. However, the SASP index scores were not significantly associated with functional recovery after hip replacement surgery at 26 or 52 weeks after surgery. In conclusion, after hip fracture surgery SASP scores are elevated, continue to rise over time, and do not return to normal by 12 weeks post-surgery.DiscussionOur findings support the need to investigate this phenomenon of post-operative senescence, including whether novel interventions such as senolytics would help older adults facing major surgery.

Sequence variants associated with BMI affect disease risk through BMI itself.

Mendelian Randomization studies indicate that BMI contributes to various diseases, but it's unclear if this is entirely mediated by BMI itself. This study examines whether disease risk from BMI-associated sequence variants is mediated through BMI or other mechanisms, using data from Iceland and the UK Biobank. The associations of BMI genetic risk score with diseases like fatty liver disease, knee replacement, and glucose intolerance were fully attenuated when conditioned on BMI, and largely for type 2 diabetes, heart failure, myocardial infarction, atrial fibrillation, and hip replacement. Similar attenuation was observed for chronic kidney disease and stroke, though results varied. Findings were consistent across sexes, except for myocardial infarction. Residual effects may result from temporal BMI changes, pleiotropy, measurement error, non-linear relationships, non-collapsibility, or confounding. The attenuation extent of BMI genetic risk score on disease associations suggests the potential impact of reducing BMI on disease risk.

An overview of cell salvage in orthopaedic hip and knee arthroplasty surgery.

Blood management is a critical aspect of patient care during surgical procedures. In the United Kingdom, there is a growing recognition of the need to integrate intraoperative cell salvage into blood management protocols, especially for invasive surgeries where significant blood loss is anticipated. While donated blood (allogeneic blood) is traditionally used in such cases, it carries risks and potential complications. Consequently, intraoperative cell salvage presents itself as an appealing alternative, particularly in hip and knee arthroplasty procedures. Intraoperative cell salvage involves the collection and reinfusion of a patient's own blood (autologous blood) lost during surgery. Studies have consistently shown that autologous blood collected via intraoperative cell salvage has fewer complications and greater benefits compared to donated blood. However, despite these advantages, the widespread adoption of intraoperative cell salvage in UK hospitals remains limited, primarily due to associated costs. While the integration of intraoperative cell salvage into blood management services may incur initial expenses, research suggests that it could ultimately prove to be cost-effective. This is because improved patient outcomes associated with intraoperative cell salvage may lead to reduced postoperative complications and shorter hospital stays. Thus, there is a growing imperative to overcome financial barriers and promote the implementation of intraopertive cell salvage as a standard practice in perioperative care across UK health care settings. The purpose of this scoping literature review is to consolidate the available information on the current use of intraoperative cell salvage and to identify intraoperative cell salvage techniques and devices described for use in an arthroplasty setting.

Feasibility of continuous physical activity monitoring: first-month recovery markers following joint replacement surgery

Background The role of physical activity (PA) monitoring during the recovery after orthopaedic surgeries is unclear. This study aimed to explore early changes in the pattern and level of PA following orthopedic surgeries. Methods This observational feasibility study included 11 hip replacement patients (four females) with a mean age of 66 years and five knee replacement patients (four females) with a mean age of 65 years. A PA tracker was used to collect the patients’ daily PA data, including duration of various activity categories, steps taken, and activity intensity count. The PA tracker recorded data from two weeks prior to surgery until four weeks after the surgery. Ratios of PA parameters for each of the first four weeks following surgery were calculated in relation to preoperative measurements. Results Compared to preoperative measurements, during the first four weeks after the surgery, the time spent in a recumbent position decreased from 112% to 106%, while continuous walking time and activity intensity count increased from 27% to 77% and from 35% to 73%, respectively. Step counts increased from 18% to 67%, and sit-to-stands rose from 65% to 93%. No significant changes were found in sitting, standing, sporadic walk time, and sporadic steps. Conclusion Continuously measuring PA using wearable sensors was feasible in orthopedic patients during the perioperative period. Continuous step count, walking time, activity intensity count showed noticeable changes and stable patterns demonstrating their potential for remote monitoring of patients during the early postoperative period.

The use of multipotent mesenchymal cells in the complex treatment of osteonecrosis of the femoral head.

Background. Avascular necrosis of the femoral head (ANFH) is a disabling disease that often leads to hip replacement. However, due to the increasing incidence among the young population, various methods of organ-preserving treatment have been proposed aimed at slowing the progression of ANFH and preserving the function of the hip joint. Today, the procedure for introducing mesenchymal cells into the focus of osteonecrosis causes a lot of controversy and disagreement, which is the subject of discussion in our review. Aim of the study: a non-systematic analysis of the accumulated literature data on the effectiveness, safety, advantages and disadvantages of treating patients with early stages of avascular necrosis of the femoral head using the tunneling method using multipotent mesenchymal cells, as well as their impact on reducing the risk of disease progression and long-term treatment results. Material and Methods. A 10-year literature search (2013-2023) was conducted in the PubMed, Scopus and eLIBRARY databases. According to our inclusion criteria, the review included 8 high-quality studies that used mesenchymal cells to treat ANFH. Results. We analyzed 548 hips from 8 studies based on our inclusion and non-inclusion criteria. The mean follow-up period was from 24 to 360 months. In most cases, functional indicators improved. Radiological progression to the next stage occurred in 31.25% of cases and the need for hip arthroplasty was 30.6% in the group where mesenchymal cells were used. Conclusion. The use of multipotent mesenchymal cells in the complex treatment of ANFH in the early (I, II according to ARCO) stages of ANFH can improve the function of the hip joint, slow down the progression of the disease and reduce the need for hip arthroplasty.

Successful experience of hip arthroplasty with a unipolar endoprosthesis

Introduction. Fractures of the femoral neck occupy a significant place in traumatology and orthopedics and represent a serious pathological problem. Without surgical treatment, this pathology leads to complications and death of the patient within a year. Hip replacement is the choice of treatment method that allows the injured patient to be mobilized as early as possible. This promotes and has a positive effect on the timing and effectiveness of rehabilitation measures and minimizes the risk of developing possible complications. The purpose of this publication is to demonstrate the successful experience of treating a patient with a fracture of the right femoral neck with displacement of fragments using endoprosthetics. Materials and methods. To write the article, we used medical documentation data from a trauma hospital, the results of instrumental research and dynamic observation of the patient. A search was also carried out in the open electronic scientific databases PubMed of the US National Electronic Medical Library and the databases of the Russian scientific electronic library elibrary, using keywords and phrases: Results. Endoprosthesis replacement of the hip joint with a unipolar endoprosthesis was performed. On the sixth day after the surgical intervention, the patient was discharged in satisfactory condition for outpatient treatment by a traumatologist at his place of residence. The wound and sutures have no signs of inflammation, sensitivity and blood supply to the limb are preserved. The patient moves independently using a walker. Discussion. Analyzing the results of surgical treatment in the described clinical case, we can conclude that the method of hip replacement is highly effective in elderly people. Conclusion. Endoprosthesis replacement surgery is low-traumatic and allows the patient to be mobilized early. Our experience allows us to believe that treatment with endoprosthetics is effective for fractures of the femoral neck and allows us to achieve positive results in the early stages.

Pericapsular nerve group block reduces opioid use and pain after hip surgery: A systematic review and meta-analysis of randomized controlled trials.

While the pericapsular nerve group (PENG) block has become increasingly popular for managing pain after hip surgery, its efficacy remains controversial. We systematically searched Pubmed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials to assess current evidence about the efficacy of the PENG block. Patients who received PENG block were compared to those who received sham/no block in terms of opioid consumption and pain within 24h after surgery, time to first opioid requirement, functional recovery, risk of nausea and vomiting, and patient dissatisfaction. The quality of evidence was assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system. We meta-analyzed six trials involving 416 patients who received preoperative PENG block and 415 who received sham/no block. Patients did not receive any other type of multimodal analgesia. Within 24 h after hip surgery, PENG block significantly reduced postoperative opioid consumption (MD = -12.03, 95% CI: -21.47 to -2.59, P < 0.01, I2 = 97%), particularly in subpopulations undergoing hip replacement, hip fracture, or who had spinal anesthesia, and it significantly decreased dynamic pain scores, but not static scores, without increasing risk of nausea or vomiting or patient dissatisfaction. Individual studies suggested that the PENG block can prolong the time to the first opioid requirement and can improve functional recovery. Most meta-analyses provided evidence of moderate quality according to the GRADE system. The available evidence indicates that preoperative PENG block can significantly decrease opioid consumption and pain early after hip surgery, and it may also promote early functional rehabilitation. However, the limited number of included studies and sample size make it difficult to draw firm conclusions. The decision on whether to apply the PENG block should take into account the patient's age and the type of surgery and anesthesia.

Ultrasound-guided anterior iliopsoas muscle space block compared with fascia iliaca compartment block in elderly hip surgery: A randomized controlled trial.

Elderly hip fracture patients experience severe pain. Surgical stress and pain during position changes for spinal anesthesia puncture can adversely affect hemodynamics. The objective of this study was to compare the perioperative analgesic efficacy of anterior iliopsoas muscle space block with supra-inguinal fascia iliaca compartment block (S-FICB) in elderly patients undergoing hip surgery. In this randomized control trial, 66 patients were randomly assigned to either the iliopsoas space or the S-FICB group. Each patient received 30 mL of ropivacaine 0.375%. Perioperative pain scores were assessed and compared in both groups. The primary outcome was pain scores during changes in position for neuraxial anesthesia. Secondary outcomes included postoperative pain intensity, inflammatory markers for 12 to 24 hours, and perioperative adverse reactions. The iliopsoas space group demonstrated a faster median block onset of 7 [6-8] minutes compared to S-FICB 14.50 [13-16] minutes (P < .001). Neuraxial anesthesia position changes resulted in lower pain scores for iliopsoas 2 [1-2] versus S-FICB 3 [3-4] (P < .001). Resting pain scores were similar at 12 hours post-surgery, but during exercise, the iliopsoas group had significantly lower scores [1-2] compared to S-FICB 4 [2-4] (P < .001). After 24 hours, C-RP levels were lower in the iliopsoas group (14.86 ± 1.23 mg/L) than S-FICB (17.90 ± 1.25 mg/L) (P < .001). The 2 groups differed from one another (P < .001). These findings suggest that iliopsoas space block may offer faster, superior dynamic pain control, and potentially reduced inflammation compared to FICB block for postoperative pain management. In elderly hip fracture patients, the anterior iliopsoas space block works slightly better than S-FICB at providing effective perioperative analgesia.

Radiographic Outcome Following Treatment of Residual Hip Dysplasia with Pemberton Versus Salter Osteotomy: Comparison of Results in Patients Followed to Skeletal Maturity.

Salter osteotomy (SO) and Pemberton acetabuloplasty (PA) are procedures to treat skeletally immature patients with developmental dysplasia of the hip (DDH). The purpose of this study was to compare the radiographic results and rate of residual dysplasia (RD) after treatment with SO and with PA. This was a retrospective analysis of pediatric patients treated with either SO or PA for DDH between 1980 and 2013 who were skeletally mature at the time of follow-up. The preoperative and postoperative acetabular index (AI) and postoperative lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) were collected. RD was defined as an LCEA or ACEA of <20° or an acetabular inclination (AIn) of >15° at skeletal maturity. Continuous variables were compared between treatment groups with 2-sample t tests, and categorical variables were compared using chi-square tests. Multivariable analysis was used to identify risk factors for RD with p < 0.05. The study included 113 hips in 102 patients with a mean follow-up of 10.5 years. The SO group had 73 hips treated at a mean patient age of 5.4 years, and the PA group had 40 hips treated at a mean age of 5.3 years. The preoperative AI did not differ between the treatment groups (32.2° versus 31.3°, p = 0.658), nor did the immediate postoperative AI (20.0° versus 20.2°, p = 0.459). At the time of final follow-up, the SO group had a significantly smaller AIn (8.6° versus 13.2°, p = 0.001), a trend toward a greater LCEA (26.2° versus 21.6°, p = 0.056), and a similar ACEA (24.1° versus 26.1°, p = 0.808). By the abovementioned definition, 36 hips (31.9%) had evidence of RD, with a lower rate in the SO group (26.0% versus 42.5%, p = 0.07). Patients who had a positive family history of hip dysplasia were more likely to have RD (odds ratio = 4.311, 95% confidence interval = 1.125 to 16.528). Patients with RD could be effectively treated with either SO or PA, with overall good radiographic outcomes. However, SO achieved a better AI and may thus yield better long-term health of the affected hip. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

COMPARISON OF ULTRASOUND-GUIDED LUMBAR ERECTOR SPINAE PLANE BLOCK AND TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK FOR POST-OPERATIVE ANALGESIA IN TOTAL HIP REPLACEMENT SURGERIES: A PROSPECTIVE RANDOMIZED STUDY

Objectives: The objective of the study is to compare the efficacy of ultrasound-guided lumbar erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (QLB) in providing post-operative analgesia for patients undergoing total hip replacement (THR) surgeries. Methods: This prospective, randomized, double-blind study compared the efficacy of ultrasound-guided lumbar ESPB and transmuscular QLB (QLB-t) for post-operative analgesia in THR surgeries. Ninety patients were randomized into three groups: ESPB, QLB, and a control group. Primary outcomes included the duration of analgesia, measured by numeric rating scale scores, and secondary outcomes assessed total analgesic consumption and the incidence of post-operative nausea and vomiting (PONV) within 24 h. For statistical purposes, p&lt;0.05 was taken as statistically significant. Results: This study compared lumbar ESPB and QLB for post-operative analgesia in THR surgeries. At the 1st h, pain scores were significantly lower in the ESPB (1.30) and QLB (1.05) groups compared to the control group (2.15) (p&lt;0.001). Tramadol consumption in the first 12 h was significantly lower in the ESPB (52.3 mg) and QLB (50.1 mg) groups compared to the control group (135.20 mg) (p&lt;0.001). PONV was absent in 60% of ESPB and 63% of QLB patients, compared to only 33% in the control group (p=0.038). Conclusion: Lumbar-ESPB and QLB-t blocks effectively reduce post-operative pain and analgesic requirements in THR surgeries, showing comparable benefits. Both techniques also lower the incidence of PONV.

Combined Lumbar and Sacral Plexus Block in an Elderly Patient with Coronary Artery Disease for Unilateral Total Hip Replacement as a Sole Anaesthetic

Combined Lumbar and Sacral Plexus Block in an Elderly Patient with Coronary Artery Disease for Unilateral Total Hip Replacement as a Sole Anaesthetic

Evaluation of three acetabular measurement methods for total hip replacement in dogs.

To compare three measurement methods for acetabular sizing and evaluate the influence of osteoarthritis (OA) on the accuracy of measurements. Observational study. Radiographic images of 73 hip joints from 60 dogs with cementless cups. Radiographs were anonymized and measured independently by three observers. One observer measured 12 sets of radiographs three times. A best-fit acetabular circle (AC) and cranial-caudal acetabular line (AL) were measured on ventral-dorsal (VD) radiographic view and open leg lateral (OLL) view. A best-fit femoral head circle (FHC) was measured on VD, OLL, and craniocaudal horizontal beam (CCHB) views. Two observers scored the OA in each hip joint. Intra- and interobserver consistency and repeatability and bias relative to implanted cup size were calculated and analyzed. Intraobserver consistency and repeatability were excellent for all measurements. Interobserver consistency was excellent (ICC > 0.9) for ACVD and ACOLL and was good (0.75 < ICC ≤ 0.9) for all other methods. Bias was small for AC and AL measurements (range, -0.46 to 0.45 mm) and large for FHC measurements (-3.58 to -2.42 mm). OA score significantly influenced bias for all acetabular measurement methods (p < 0.05). All acetabular measurement methods were highly consistent within an observer. Interobserver consistency was highest for ACVD and ACOLL. FHC measurements underestimated cup size. Higher OA scores decreased the accuracy of all acetabular measurement methods. Superimposing a circle on the acetabulum seen on VD radiographic view accurately measures the acetabulum before cementless cup placement.

The accuracy and efficiency of design and development of 3D printed integral anatomical acetabular prosthesis in total hip arthroplasty for Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip

Objective: To compare the accuracy and efficiency between the model development method and the software development method, which design and develop 3D printed integral anatomical acetabular prosthesis to be used in total hip arthroplasty(THA) for patients with Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip(DDH). Methods: Fifteen patients with end-stage hip osteoarthritis due to Crowe type Ⅱ and Ⅲ DDH who underwent THA in the Orthopedics Department of the First Affiliated Hospital of Bengbu Medical College between January 2015 and June 2023 were selected in this study retrospectively. There were 1 male (1 hip) and 14 females (17 hips) with a mean age of (55.1±9.1) years. There were 12 hips with Crowe type Ⅱ, 6 hips with Crowe type Ⅲ. The preoperative pelvis three-dimensional CT data in those patients were used to design integral anatomical acetabular prosthesis. The model development group used 3D printing technology to print life-size pelvis models. The acetabulum was reamed and the acetabulum cup was inserted into the socket according to conventional THA procedures. The bone defect above the acetabulum cup was filled with bone wax. The Mimics and 3-matic software were used to simulate the THA procedures, design and install the integrated anatomical acetabular prosthesis in the software development group. The operation time, the size of the acetabular cup, the volume and surface area of the acetabulum bone defect, the acetabular cup's inclination and anteversion, the horizontal distance and the vertical distance of hip rotation center were compared between the two methods. Results: The study in the two groups were all based on the data of 18 hips in the 15 patients. The horizontal and vertical distances of rotation center in the model development group and software development group was (32.08±1.80) mm, (32.17±2.40) mm and (14.36±1.53) mm, (15.11±1.45) mm, respectively (both P>0.05). The cup size in model development group was (48.56±1.15)mm, and it was (48.77±1.22) mm in the software group (P=0.160). The anteversion and inclination of the acetabular cup in the model and software groups were 23.79°±6.31°, 30.49°±11.03° and 15.17°±0.52°, 40.24°±0.58°, respectively (both P<0.01). The volume and surface area of the acetabulum bone defect in the model development group was (5.06±2.86) mm3 and (8.31±2.21) mm2, respectively, while it was (4.01±2.56)mm3 and (6.83±2.71) mm2, respectively, in the software development group (both P<0.05). The work time in the model development group was (24.43±0.68) h and (0.47±0.12) h in the software development group, respectively (P<0.001). Conclusion: Compared with the 3D printing model development method, the application of Mimics and 3-matic software to design and develop integrated anatomical acetabular prosthesis in total hip arthroplasty for Crowe type Ⅱ and Ⅲ DDH show advantages of convenience, high efficiency and more accuracy.