Hip Replacement Research Articles

Hip Surgery is Not More Painful Than Spine Surgery in Children With Cerebral Palsy.

Posterior spinal fusion (PSF) and hip reconstruction are commonly indicated surgeries in children with cerebral palsy (CP), particularly those functioning at GMFCS levels IV and V. These are large and often painful procedures, and previous literature suggests that hip surgery is more painful than spine surgery in this patient population. The purpose of this study is to investigate pain scores and opioid use following hip and spine surgery in a large cohort of children with CP, including many patients who have undergone both types of surgery. A retrospective chart review was performed to identify children with CP who underwent hip reconstruction and/or PSF at a tertiary children's hospital between 2004 and 2022. Charts were reviewed for demographic data, pain scores, pain medication usage, duration of hospital stay, and complications. Data were collected for 200 patients (101 male, 99 female) who met inclusion criteria. Eighty-seven patients underwent hip reconstruction, 62 spinal fusion, and 51 both hip and spine surgery asynchronously. Median (interquartile range) age at the time of surgery was significantly older for spinal fusion compared with hip surgery [13.1 (4.9) vs. 8.1 (5.7) y, P <0.0001]. Length of stay was significantly longer after PSF, with a median of 6 (4) days compared with 2 (1) days after hip surgery ( P <0.0001). Both maximum and average daily pain scores were similar following hip and spine surgery, with the exception that average pain scores for hip surgery were slightly higher on postoperative day 1, hip=1.73 vs. spine=1.0 ( P <0.0001). The amount of opioids used, expressed as morphine milligram equivalents (MME)/kg were similar in the hip and spine surgery groups; however, it was significantly lower in the hip surgery group on postoperative day 0, hip=0.06 versus spine=0.17 ( P <0.0001). For the 51 patients who underwent both hip and spine surgery, the amount of opioids used mirrored that for the entire group (similar MME/kg, though only statistically significantly less on POD 0 and 3), and pain scores were not significantly different between the 2 groups except in 2 circumstances. The 2 exceptions in these 51 patients both demonstrated lower pain scores in patients after hip surgery, including lower maximum pain scores on POD 1 ( P =0.041), and lower average pain scores on POD3 ( P =0.043). This is the largest series to date comparing postoperative pain in children with CP after hip and spine surgery, including 51 of 200 patients who underwent both types of surgery. The results of this study demonstrate that hip surgery is not more painful than spine surgery in children with CP, and conflict with the traditional belief that hip surgery is more painful. This is important information for health care providers when counseling patients and families regarding these surgeries in children with CP. Level 3.

Using Digital Technology to Promote Patient Participation in the Rehabilitation Process in Hip Replacement: A Scoping Review.

The purpose of this scoping review was to identify and summarize how technology can promote patient participation in the rehabilitation process in hip replacement. We conducted a scoping review following the steps outlined by the Joanna Briggs Institute. The PRISMA Checklist (Preferred Reporting Items for Systematic reviews and Meta-Analyses) was utilized to systematically organize the gathered information. A thorough search of articles was performed on PubMed, Scopus, and CINAHL databases for all publications up to December 2022. Twenty articles were included in this study. Various technologies, such as mobile applications, Web sites, and platforms, offer interactive approaches to facilitate total hip replacement rehabilitation. The analyzed studies were based on the rehabilitation of total hip arthroplasty, which in most of them was developed in mobile applications and Web sites. The studies identified reflect trends in the application of digital health technologies to promote patient engagement in the rehabilitation process and provide risk monitoring and patient education.

Academic impact of French Hip & Knee Surgery Society (SFHG): A bibliometric analysis

IntroductionThe French Hip & Knee Surgery Society (SFHG) brings together French-speaking hip and knee expert surgeons. There has been an exponential growth of orthopaedic surgical activity over the last decade and hip and knee surgery clinical research has had a similar growth. Despite this, the SFHG's contribution to the orthopaedic literature remains poorly known. To answer this question, we conducted a bibliometric study using data from the national SIGAPS database between 2013 and 2022 to determine: (1) the number of publications produced by SFHG members, (2) the proportion of articles produced by SFHG members in relation to French orthopaedic production, (3) impact markers for articles produced by SFHG member surgeons, (4) collaboration networks between SFHG member surgeons. HypothesisThe number of articles produced by SFHG member surgeons will represent a significant proportion of French scientific output in orthopaedics. Material and methodThe analysis was carried out by cross-referencing the SFHG membership list with the French database of the “Système d'interrogation, de gestion, d'analyse des publications scientifiques” (SIGAPS) and the InCites platform. Among the 189 SFHG members, we identified a list of 183 SIGAPS identifiers in the national database, corresponding to 127 distinct individuals with publications over the period 2013–2022. Several indicators were studied: number of publications; SIGAPS score for the different WoS categories; number and percentage of publications in the top1% and top10%. ResultsOf SFHG's 189 members, 127 have been identified by the SIGAPS database as “publishers”. Over the last decade, 2306 articles have been published by SFHG members. The number of publications has risen steadily, from 203 publications in 2013 to 261 publications in 2022. All SIGAPS categories were represented. Most articles were published in rank D (n = 719; 31.2%) C (n = 552; 23.9%) and B (n = 549; 23.8%) journals. Authors were in first (n = 624) or last position (n = 730) in 58.7% of publications. Orthopaedics (1,639; 71.1%), Surgery (1,124; 48.7%) and Sports surgery (335; 14.5%) were the most frequently observed topics. Orthopaedics & Traumatology: Surgery & Research is the most popular journal for SFHG members' articles, with 655/2306 articles published over the last decade, representing a 32.2% market share. Of the 2160 publications indexed on the Web of Science, 1807 (83.7%) had a French corresponding author. 31 articles (1.4%) were in the Top 1% of most-cited articles worldwide, and 310 were in the Top 10% of most-cited articles worldwide (14.5%). DiscussionSFHG is a major player in orthopaedic research in France. In 2022, it accounted for 19% of the annual volume of French scientific publications in the field of orthopaedics and traumatology. Level of evidenceIV; Retrospective study without control group.

Clinical and Radiological Severity of Avascular Necrosis of the Femoral Head in Sickle Cell Disease Patients

Abstract Background: Sickle cell disease (SCD) has a high prevalence in Sub-Saharan Africa. Avascular necrosis (AVN) of the femoral head is a devastating complication of SCD. Early presentation and diagnosis can be treated with hip-preserving procedures, resulting in good outcomes. Late presentations will require more complicated treatment procedures, such as hip replacement. A good knowledge of the clinical presentation and severity of the disease will aid in early detection and clinical management. This study was designed to establish the age and sex distribution, severity, and stages of AVN in SCD patients at Korle-Bu Teaching Hospital. Materials and Methods: This was a cross-sectional study of SCD patients referred to the orthopaedic clinic with AVN of the femoral head. An evaluation form was used to assess the patient’s age, sex, genotype, and clinical symptoms. Hip X-rays were obtained to assess the severity of the disease. Chi-square tests were used to determine the association between demographic variables’ data and AVN. Results: Most patients were in the 31- to 50-year age group and presented with profound and limiting clinical features and advanced features on X-rays (stages 3 and 4 of the disease). There was a statistically significant association between the radiological stage of disease and clinical symptoms (limping, difficulty climbing stairs, and hip abduction). Conclusion: The patients mostly presented with severe disease both clinically and radiologically and will require complex surgical procedures including hip arthroplasties. Clinicians at primary care centres need to look out for early signs so that they can refer them for treatment.

Protein-metal interactions due to fretting corrosion at the taper junction of hip implants: An in vitro investigation using Raman spectroscopy

Modular hip implants are a clinically successful and widely used treatment for patients with arthritis. Despite ongoing retrieval studies the understanding of the fundamental physico-chemical mechanisms of friction and wear within the head-taper interface is still limited. Here, we Raman-spectroscopically analyze structural features of the biotribological material which is formed within the taper joint between Ti6Al4V and low-carbon cobalt alloy or high-nitrogen steel surfaces in in vitro gross-slip fretting corrosion tests with bovine calf serum. As a function of the fretting duration, we investigate short and long aliphatic chains and their adsorption behavior on the cobalt- and steel-type surfaces. Using the intensity and frequency shifts of the amide I and III Raman bands, we furthermore identify progressive protein folding and unfolding including the secondary structures of α-helix, β-sheet, and random-coil configuration as well as the formation of proteinaceous clusters depending on the hydrophilicity of the metallic surfaces. We additionally find a mixture of chromates and iron oxides with tryptophan and tyrosine at the worn cobalt alloy and high-nitrogen steel surfaces, respectively. Also, for long fretting duration, sp2 hybridized amorphous carbon is formed due to fretting-induced cleavage of proteins. Statement of significanceDespite efforts enhancing the biomedical tribology of hip implants, the impact of the organic environment on friction and wear at the femoral head-stem taper interface is limitedly understood. Using Raman spectroscopy we resolve structural changes within the biotribological material agglomerated at biomedical-grade metal alloys due to metal-organic interactions during in vitro fretting corrosion tests. Adsorption of short and long aliphatic chains, progressive protein (un)folding and proteinaceous cluster formation depend to a distinguishable extent on the fretting duration and type of alloy. Chromates and iron oxides are mixed with tryptophan and tyrosine, and amorphous carbon is formed resulting from a fretting-induced cleavage of serum proteins. Such information spectroscopically gleaned from biotribological material are vital to improve the design and performance of taper junctions.

Prostate magnetic resonance imaging (MRI) in patients with hip implants-presetting a protocol using a phantom.

Metal structures are a source of artifacts that significantly complicate the interpretation of magnetic resonance imaging (MRI). The use of prostate MRI as a preliminary test in men with a suspicion on prostate cancer leads to an increased use of the test. The aim of this study was to solve a clinically significant problem: to ensure the reduction of artifacts from metal hip implants during prostate MRI. Another goal was to evaluate the impact of artifact reduction methods on quantitative measurements. The prostate gland (PG) phantom model was a cylinder filled with an aqueous solution of polyvinylpyrrolidone at the concentrations of 40%, 30%, and 20% [central zone (CZ), peripheral zone (PZ), and "lesion", respectively]. Phantom MRI study was conducted on Philips Ingenia 1.5T and Philips Ingenia 3T scanners. For 1.5 T, the reduction in the influence of artifacts inside region of interest (ROI) was observed, expressed in a decrease in the average apparent diffusion coefficient (ADC) (CZ, PZ, "lesion") for the manual artifact reduction (MAR) and ZOOM (title of software artifact reduction) techniques compared to the standard method. For 3T this effect was not detected. The same ADC results were obtained for Standard and MAR techniques, and increased ADC values for ZOOM. Despite the fact that the spread of ADC values on 3.0T scanners was minimal, there was a significant deviation of ADC values from the reference ones (up to 30.4%). Therefore, it is necessary to use a correction coefficient in the ADC calculation for the 3.0 T device. In the presented clinical case, high-quality tomograms were obtained without any artifacts, despite the presence of two hip replacement devices in the scanning area. The accurate prostate MRI in the presence of implants is essential for an accurate diagnosis. This approach allows to reduce artifacts from hip implants, to visualize PG and periprostatic tissue in the best way, and to detect malignant and benign changes.

Influencia de la temperatura y humedad ambiental en la incidencia de infecciones de prótesis articulares

BackgroundProsthetic Joint Infection (PJI) are associated with significant morbidity and mortality, underscoring the importance of identifying the related risk factors. The objective of the present study was to evaluate whether environmental factors were correlated with an increase in PJI. Material and methodRetrospective cohort study of 1847 consecutive hip and knee prosthesis surgeries performed at a single center over a 10-year period. All patients who underwent surgery during this period were included, with a minimum follow-up of 2 years. The association between infection cases and environmental temperature and humidity was analyzed for both the day of surgical intervention and the week following the procedure. ResultsSixty-three cases of infection (3.4%) were identified. No statistically significant differences were observed in the infection rate according to the month (p=0.13) or season (p=0.42) in which the surgery was performed. Furthermore, no significant association was found between the incidence of PJI and the average temperature or humidity on the day or week following the prosthesis implantation. ConclusionsEnvironmental temperature and humidity do not influence the incidence of PJI in regions with an oceanic climate. The increase in PJI according to environmental conditions is primarily observed in large-scale studies based on national registries.

Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research.

Opioids remain the mainstay of post-surgical pain management; however, concerns regarding addiction and side effects necessitate the exploration of alternatives. This narrative review highlights the potential of nerve blocks as a safe and effective strategy for post-surgical pain control. This review explores the use of various nerve block techniques tailored to specific surgical procedures. These include nerve blocks for abdominal surgeries; fascial plane blocks for chest surgeries; nerve blocks for arm surgeries; and nerve blocks for lower limb surgery including; femoral, hip, and knee surgeries. By targeting specific nerves, these blocks can provide targeted pain relief without the negative side effects associated with opioids. Emerging evidence suggests that nerve blocks can be as effective as opioids in managing pain, while potentially offering additional benefits such as faster recovery, improved patient satisfaction, and reduced reliance on opioids. However, the effectiveness of nerve blocks varies depending on type of surgery, and in individual patients. Rebound pain, which temporary increase in pain after a block wears off, can occur. In addition, some techniques require specialized guidance for accurate placement. In conclusion, nerve blocks show great promise as effective alternatives for managing post-surgical pain. They can reduce the need for opioids and their side effects, leading to better patient outcomes and satisfaction. Future studies should assess the long-term impacts of specific nerve blocks on mortality rates, cost-effectiveness, and their incorporation into multimodal pain management approaches to further enhance post-surgical care.

Updates on Evidence-Based Controversies for Outpatient Joint Arthroplasties

Total joint arthroplasty in the outpatient setting is becoming more common and is a topic of notable debate and discussion in orthopaedic surgery. Rapid changes in technology, surgical techniques, and policies surrounding hip and knee arthroplasty surgeries are making successful same-day surgery possible. In response to these changes, this comprehensive review examines the most recent developments and controversies based on the published literature within the past five years. Critical issues surrounding outpatient joint arthroplasty include debates on surgical techniques, proper patient selection, anesthesia techniques, perioperative pain management, discharge readiness, and complications. Evolving consensus statements and guidelines emphasize the need for ongoing research and multidisciplinary cooperation to ensure the best outcomes and patient safety.

Seasonal variation in newborn hip dysplasia: Unraveling the impact of weather on hip development

BackgroundBabies born in winter have greater incidence of developmental dysplasia of the hip (DDH) and related surgeries. How weather conditions impact hip development and how screening program reacts weather issue remain unknown. This study tests a hypothesis that winter born babies have more newborn acetabular dysplasia and laxity that is responsible of later DDH. MethodsRetrospective data from newborns who had hip ultrasonography in the first 3 days of life were analyzed. The Graf type IIc, III, IV (shallow acetabulum) and type D (laxity) were classified as abnormal. The association and risks of an abnormal hip were analyzed with gender, gestational age, fetal presentation, parity and external temperature of birth month and the last 3 months before birth using the Pearson chi-square test and logistic regression. ResultsA total of 10962 newborns participated in hip ultrasound exams voluntarily in nurseries from 2016 to 2022. Distribution of babies with Graf type I, IIa, IIc, D, III/IV hips were 88.8%, 10%, 0.5%, 0.6%, and 0.1%, respectively. Female was the most significant factor for congenital shallow acetabulum (3.8x) and hip laxity (4x) compared to male (p <0.001). Preterm babies had a borderline lower risk of abnormal hips (0.4x, p = 0.05). Winter season is not associated with newborn abnormal hips (p = 0.36, statistical power = 80%), but a positive correlation was noted between external temperature and incidence of abnormal hips (r = 0.62, p = 0.03). Cold weather does not have a direct internal effect in acetabular dysplasia or hip laxity at birth. ConclusionsBabies who were born in winter were not associated with acetabular dysplasia and hip laxity at birth but had greater risks of late-diagnosed DDH and surgeries. The postnatal effects from weather should be addressed by a public awareness campaign, and hip screening may not be limited on the neonatal stage. Level of evidencelevel III, diagnostic

The advantages of artificial intelligence-assisted total hip arthroplasty: A randomized controlled trial followed by 12 months

The advantages of artificial intelligence-assisted total hip arthroplasty: A randomized controlled trial followed by 12 months

Tratamiento quirúrgico de fractura subcapital de cadera no desplazada: Femoral Neck System vs. tornillos canulados. Estudio comparativo

ObjectiveThe objective of this study is to compare the outcomes of using the Femoral Neck System (FNS) (DePuy Synthes®) versus the use of cannulated screws (CS) in the surgical treatment of non-displaced subcapital hip fractures. Materials and methodsA retrospective cohort study was conducted on non-displaced subcapital hip fractures treated with CS or FNS between 2020 and 2023, with a minimum follow-up of one year. A total of 28 patients were included, 14 treated with CS and 14 with FNS. Demographic, radiological, clinical, and functional variables were analyzed. ResultsIn the CS group, 64% were male, with a mean age of 66.5 years (SD 14.9) and an average follow-up of 22 months (range, 12-36 months). In the FNS group, 57% were male, with a median age of 60.8 years (SD 13.78) and an average follow-up of 16 months (range, 12-24 months).Regarding functional outcomes, no significant differences were found between FNS and CS in the Harris scale: 94.21±11.55 for FNS and 96.50±6.9 for CS (p=0.618).The total postoperative complications (FNS/CS) were 7.1% versus 43%, and implant failure with conversion to total hip replacement was 0% versus 43%, both significantly higher in the CS group (p=0.047; p=0.016, respectively). The FNS also presented a lower rate of avascular necrosis (0% versus 11.1%, p=0.391) and nonunion (0% versus 20%, p=0.163), although these differences did not reach statistical significance. ConclusionsAlthough both treatment methods, cannulated screws and the FNS, showed similar short-term functional outcomes in the management of undisplaced subcapital femoral fractures, the FNS demonstrated a significantly lower rate of complications and reoperations. These results suggest that the FNS could be considered a safer and more effective option compared to cannulated screws.

Exploring the Association Between Surgical Out-of-Pocket Costs and Healthcare Quality Outcomes: A Retrospective Cohort Study

ObjectivesRising out-of-pocket (OOP) costs paid by healthcare consumers can inhibit access to necessary healthcare. Yet, it is unclear if higher OOP payments are associated with better care quality. This study aimed to identify the individual and socio-contextual predictors of OOP costs and to explore the association between OOP costs and quality of care outcomes for 4 surgical procedures. MethodsA retrospective cohort analysis was conducted using data from Medibank Private health insurance members aged ≥18 years who underwent hip replacement, knee replacement, cholecystectomy, and radical prostatectomy during 2015 to 2020 across >300 hospitals in Australia. Healthcare quality outcomes investigated were hospital-acquired complications, unplanned intensive care unit admissions, prolonged length of stay, and readmissions within 28 days. Socio-contextual determinants of OOP costs examined were patient demographics, socioeconomic status, health insurance, and procedure complexity. Generalized linear mixed modeling examined the risk of each outcome, adjusting for covariates and considering patient clustering within surgeons and hospitals. ResultsPatients were more likely to pay OOP costs if they were aged 65 to 74 years compared with aged 18 to 44 years for all 4 surgical procedures. No association between OOP payments and the risk of hospital-acquired complications, intensive care unit admission, or hospital readmission was identified. Patients who paid OOP costs were less likely to have a prolonged length of stay for all 4 procedure types. ConclusionsHigher OOP payments were not linked to improved care quality except for shorter hospital stays. Greater transparency on OOP costs is needed to inform consumer decisions.

The incidence of postoperative periprosthetic femoral fracture following total hip replacement: An analysis of UK National Joint Registry and Hospital Episodes statistics data.

Postoperative periprosthetic femoral fracture (POPFF) after total hip replacement (THR) requires complex surgery and is associated with a high morbidity, mortality, and cost. Although the United Kingdom based National Joint Registry (NJR) captures over 95% of THRs treated with revision, before June 2023 it did not capture POPFF treated with fixation. We aimed to estimate the incidence and epidemiology of POPFF treated with either surgery in England. We performed a retrospective analysis of a mandatory, prospective database (NJR) linked to Hospital Episode Statistics (HES). All linkable primary THRs between 01/01/2004 and 31/12/2020 were included. Revision or fixation of POPFF were identified using a combination of procedural and diagnosis codes. We identified 809,832 THRs representing 5,542,332 prosthesis years at risk. A total of 5,100 POPFF were identified that had been surgically treated by revision, fixation, or both, and 2,831 of these fractures were treated with fixation alone, meaning 56% were not represented with revision data alone. The incidence of POPFF needing surgery was 0.92 (95% CI 0.90, 0.95) per 1,000 prostheses years. This incidence was higher in patients over the age of 70 at the time of primary THR (1.31 [95% CI 1.26, 1.35] per 1,000 prostheses years) and for patients who underwent THR for hip fracture (2.19 [95% CI 1.97, 2.42] per 1,000 prostheses years). This incidence appears to be increasing year on year. The cumulative probability of sustaining a POPFF within 10 years of THR was 1% and over 15% of patients died within 1 year of surgery for a POPFF. To date, the incidence of POPFF may have been underestimated with over 50% of cases missed if the case identification in this study is correct. After including these cases, we observed that POPFF is the largest reason for major reoperation following THR and patients sustaining these injuries have a high risk of death. The prevention and treatment of POPFF and requires further resource allocation and research.

Functional outcomes of total hip replacement by a posterior surgical approach

Functional outcomes of total hip replacement by a posterior surgical approach

Evaluation of Functional Hip Score after Total Hip Replacement in Cases of Bilateral Fused Hips: A Case Series Study

Evaluation of Functional Hip Score after Total Hip Replacement in Cases of Bilateral Fused Hips: A Case Series Study

Association Between Hip Translation and Hip Rotation and Anatomy: A Pilot Quasi-static MRI Study.

There is little known about translation of the hip and the relationship with hip rotation and morphology in asymptomatic patients. (1) Femoral head would exhibit significant translations in asymptomatic hips, (2) femoral head translations would correlate to femoral rotations, and (3) range of femoral head translations would correlate to hip morphology. Cross-sectional study; Level of evidence, 3. A total of 11 individuals (age, 23-47 years; 64% female) with asymptomatic hips underwent hip magnetic resonance imaging (MRI) in the following postures: neutral (supine), midflexion, maximum-flexion, internal rotation, internal rotation + midflexion, internal rotation + maximum-flexion, adduction, flexion-abduction-external rotation (FABER), extension, and lateral abduction. All rotations were passive. MRI-generated 3-dimensional hip models were used to quantify femoral rotations and translations. Femoral head diameter, acetabular diameter, lateral center-edge angle, alpha angle, femoral anteversion, acetabular version and inclination, and neck-shaft angle were measured from MRI. A t test was used if measured translations were statistically significant. Linear regression was used to assess the associations between translation and rotation. Pearson correlation was used to assess the relationships between hip anatomy and range of femoral head translations. In all tested positions, the femoral head translated anteriorly by 2 ± 1 mm (maximum 5 mm, P < .001), posteriorly by 1 ± 1 mm (maximum 6 mm, P < .001), superiorly by 2 ± 2 mm (maximum 7 mm, P < .001), inferiorly by 2 ± 2 mm (maximum 6 mm, P < .001), laterally by 1 ± 1 mm (maximum 4 mm, P < .001), and medially by 2 ± 1 mm (maximum 5 mm, P < .001), relative to the rested supine position. Femoral flexion was associated with posterior translation of the femoral head (P = .038). Femoral abduction was associated with medial translation of the femoral head (P = .042). Higher femoral anteversion and smaller alpha angle were associated with a higher total magnitude of femoral head translation in the anterior-posterior direction (P < .04). Smaller femoral anteversion, higher acetabular inclination, smaller lateral center-edge angle, and lower neck-shaft angle were associated with a higher total magnitude of femoral head translation in the superior-inferior direction (P ≤ .03). Our study demonstrated that, during passive physiologic movement, asymptomatic hips on average translated up to 2 mm (with up to 7 mm maximum translation in some positions), which is potentially related to hip rotations and morphology. Further investigations are warranted to understand the normal and pathologic hip translations and their impact on hip function (ie, instability and impingement).

Timely Hip Surgery Access in Children With Cerebral Palsy: Unaffected by Social Disadvantage at a Large Urban Safety Net Hospital.

Socioeconomic disadvantage has been shown to limit timely access to pediatric orthopaedic care and can result in poor surgical outcomes. Insurance coverage has often served as a proxy for socioeconomic status; however, area deprivation index (ADI) and child opportunity index (COI) are more comprehensive measures of social determinants of health (SDOH). The treatment of hip displacement in children with cerebral palsy (CP) requires early radiographic identification and continuous surveillance, which may be impacted by SDOH. This study seeks to evaluate the influence of insurance, ADI, and COI on preoperative Reimer migration percentage and need for pelvic osteotomy during varus derotation osteotomy (VDRO) in children with CP. This retrospective cohort study examined 219 patients with CP who underwent VDRO surgery for hip subluxation or dislocation at a tertiary referral center (135 male, mean age 7.9y, SD: 2.9, range: 2.4 to 17.2; 17 GMFCS II, 21 GMFCS III, 89 GMFCS IV, 92 GMFCS V) from 2004 to 2022. Imaging and clinical documentation for patients with CP and hip displacement, age <18 years with ≥1 year of follow-up, treated with VDRO were reviewed. GMFCS level, preoperative Reimer migration percentages (MP), surgical details, and demographic and socioeconomic data were collected, and addresses were used to determine ADI (2018 version) and COI (2.0 database). The relationship of ADI, COI, and insurance type to preoperative Reimer MP of the more displaced hip and the need for pelvic osteotomy were analyzed with linear regressions and logistic regressions. The mean preoperative Reimer MP was 64.4% (SD: 25.0, range: 0 to 100). As expected, patients functioning at higher GMFCS levels presented with greater Reimer MPs. The average Reimer MP was 34.0 for GMFCS II, 44.2 for GMFCS III, 64.6 for GMFCS IV, and 74.5 for GMFCS V (P<0.01). The mean ADI state decile (1 to 10 scale) and COI (1 to 100 scale) for the cohort were 5.6 (SD: 2.2, range: 1 to 10) and 37.2 (SD: 28.1, range: 4 to 100), respectively. ADI (P=0.77), COI (P=0.30), and insurance type (P=0.78) were not related to preoperative Reimer MP. However, patients with lower ADIs (OR 0.83, 95% CI [0.70, 0.99], P=0.04) and higher COIs (OR 1.01, 95% CI [1.00, 1.03], P=0.03) underwent pelvic osteotomies at a higher rate. ADI, COI, and insurance type were not related to preoperative Reimer MP. Interestingly, greater social disadvantage was associated with a lower frequency of pelvic osteotomy at the time of VDRO. Our data demonstrate that at our institution, greater social disadvantage does not result in limited access to timely orthopaedic care for children with CP. This is likely due to adequate governmental insurance coverage for children with neuromuscular disorders in this state and the active involvement of pediatric orthopaedic surgeons in government-sponsored clinics, including ongoing hip screening programs for children with CP. These results provide hope that healthcare disparities can potentially be mitigated.

Hip Arthroscopy for Femoroacetabular Impingement Syndrome in High-Level Athletes: A 10-Year Follow-up.

Arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) has previously been reported to have favorable short-term results in high-level athletes. Less is known about long-term outcomes. To report outcomes 10 years after hip arthroscopy for FAIS in high-level athletes using validated patient-reported outcome measures (PROMs). Case series; Level of evidence, 4. Patients who underwent hip arthroscopy between November 2011 and January 2013 were included in a local hip arthroscopy registry and completed preoperative PROMs. At 10-year follow-up, the same PROMs were completed. Inclusion criteria were age <40 years at time of surgery, no prior hip surgeries, and a pre-symptomatic Hip Sports Activity Scale (HSAS) level of 7 or 8. The exclusion criterion was total hip arthroplasty at follow-up. The PROMs included the international Hip Outcome Tool-12 items (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), visual analog scale (VAS) for overall hip function, European Quality of Life-5 Dimensions questionnaire (EQ-5D) and European Quality of Life-visual analog scale (EQ-VAS), HSAS, and a single question on patient satisfaction. The rates of patients achieving minimal important change and reporting Patient Acceptable Symptom State (PASS) were reported for HAGOS and iHOT-12. For iHOT-12, preoperative results were compared with 1, 5, and 10-year follow-ups. A total of 45 patients (34 men, 11 women; 70 hips; mean age 24.4 years at time of surgery) were included, with 77 patients eligible for inclusion. Significant improvements (P < .001) were seen at 10-year follow-up in all HAGOS subscales: Symptoms, Pain, Daily Activity, Sports, Physical Activity, Quality of Life (50.3 vs 78.6, 59.2 vs 86.8, 65.9 vs 88.8, 37.1 vs 81.1, 24.4 vs 81.1, 32.1 vs 79.3), iHOT-12 (40.1 vs 81.6), EQ-5D (0.59 vs 0.89), EQ-VAS (65.6 vs 80.4), and VAS for overall hip function (48 vs 79). For iHOT-12, the largest change was seen between preoperative and 1-year follow-up values, with consistent results over time. There was no statistically significant difference between HSAS levels preoperatively and at 10-year follow-up (HSAS level 4), with 24% of patients reporting a HSAS level 7 or 8 at the follow-up. Of the patients, 93% reported satisfaction with the surgery. PASS was achieved in 82% for iHOT-12, with a range of 76% to 91% for HAGOS subscales. Furthermore, 93% exceeded the minimal important change for iHOT-12, and a range of 67% to 84% for HAGOS. In a high-level athletic population, significant improvements in long-term outcomes are reported after hip arthroscopy for FAIS, with patients reporting a high satisfaction rate. The results also show that the largest improvement occurs within the first postoperative year, with results being maintained for 10 years.

Statistical models and implant customization in hip arthroplasty: Seeking patient satisfaction through design

ObjectivesThis study conducts a systematic literature review to explore the role of statistical models and methods in the design of orthopedic implants, with a specific focus on hip arthroplasty. Through a comprehensive analysis of the scientific literature, it aims to understand the relevance and applicability of these models in implant development and research trends in the field of design. MethodsData analysis and co-occurrence mapping techniques were employed to investigate the statistical models used as predictors of satisfaction in hip arthroplasty and in implant design. This approach facilitated a detailed and objective assessment of existing literature, revealing key trends and identifying gaps in current knowledge. Key findingsThe review's findings underscore a burgeoning interest in implant customization, with a significant emphasis on leveraging statistical techniques for optimal design. The logistic model methodology was applied to analyze a survey of hip surgery specialists, revealing that the physician's age does not influence the decision to use a customized implant. Furthermore, the review highlighted a knowledge gap at the intersection of statistics and design discipline concerning implant customization. SignificanceDespite the recognized importance of customization in implant design, there remains a dearth of contributions from the design discipline perspective in the existing literature, indicating substantial room for improvement and the need for interdisciplinary integration. ConclusionThe integration of statistical methods in implant design is crucial, emphasizing the need for multidisciplinary approaches and customization to enhance patient satisfaction. This study provides a foundation for future research that could transform the field of hip arthroplasty through more personalized and effective solutions.