Need For Total Hip Arthroplasty Research Articles

An in-depth analysis of young adults with osteonecrosis secondary to developmental dysplasia of the hip who underwent total hip arthroplasty

BackgroundPatients with osteonecrosis of the femoral head secondary to DDH frequently require total hip arthroplasty (THA), but it is not well understood which factors necessitate this requirement. We determined the incidence of THA in patients who have osteonecrosis secondary to DDH and factors associated with need for THA.MethodsWe included patients who received closed or open reductions between 1995 and 2005 with subsequent development of osteonecrosis. We determined osteonecrosis according to Bucholz and Ogden; osteoarthritis severity (Kellgren-Lawrence), subluxation (Shenton’s line); neck-shaft angle; and acetabular dysplasia (centre-edge and Sharp angles). We also recorded the number of operations of the hip in childhood and reviewed case notes of patients who received THA to describe clinical findings prior to THA. We assessed the association between radiographic variables and the need for THA using univariate logistic regression.ResultsOf 140 patients (169 hips), 22 patients received 24 THA (14%) at a mean age of 21.3 ± 3.7 years. Associated with the need for THA were grade III osteonecrosis (OR 4.25; 95% CI 1.70-10.77; p = 0.0019), grade IV osteoarthritis (21.8; 7.55–68.11; p < 0.0001) and subluxation (8.22; 2.91–29.53; p = 0.0003). All patients who required THA reported at least 2 of: severe pain including at night, stiffness, and reduced mobility. Acetabular dysplasia and number of previous operations were not associated with the need for THA.ConclusionsWe identified a 14% incidence of THA by age 34 years in patients with osteonecrosis secondary to DDH. Grade III osteonecrosis (global involvement femoral head and neck) was strongly associated with THA, emphasising the importance to avoid osteonecrosis when treating DDH.

Autological bone marrow concentrate for the treatment of early stages of femoral head avascular necrosis (literature review)

Relevance. In the treatment of the early stages of the femoral head osteonecrosis core decompression is widely used, which reduces intraosseous pressure and increases blood flow to the femoral head. To increase the efficiency of the core decompression the use of various bioadjuvants, including concentrate of autologous bone marrow cells is needed, the appropriateness of which is actively discussed.Purpose of the systematic review: evaluation of the effectiveness of autologous bone marrow cells in core decompression in the treatment of the early stages of the femoral head osteonecrosis according to the literature.Material and methods. Articles with clinical data in full text in English or Russian available in the Internet (PubMed and elibrary databases) were included in the study. Articles containing actual data on the stage of osteonecrosis, the number of femoral heads operated on, the use of autologous bone marrow cells as an adjunct to the core decompression of the femoral head, the number of ineffective surgical interventions after which total hip arthroplasty was required were included.Results. Sixteen original articles (2011–2022) were analyzed, and the results of 1135 femoral heads treatment (892 with autologous bone marrow cells, 243 without autologous bone marrow cells, control group) were evaluated. Patient follow-up periods ranged from 9 to 120 months, averaging 45 months. When using autologous bone marrow cells, the need for total hip arthroplasty was observed in 168 of 892 patients (18.8 %); when core decompression was used without autologous bone marrow cells, the rate of total hip arthroplasty was 27.2 % (p &gt; 0.05). Only 2 articles out of 16 authors did not consider autologous bone marrow cells to be reasonable in the core decompression of femoral head.Conclusion. The use of autologous bone marrow cells concentrate as a bioadjuvant in the core decompression slows the progression of osteonecrosis. According to the overwhelming number of authors, the core decompression using autologous bone marrow cells is highly effective, significantly reducing the intensity of pain syndrome and improving the function of the hip joint. The results will be more encouraging with the further development of regenerative medicine, which will provide new samples of cellular preparations for bone tissue structure restoration.

Statistical fragility analysis of reported outcomes associated with surgical management of acetabular labral pathology.

The purpose of this study was to analyse the robustness of comparative research that evaluated arthroscopic labral reconstruction versus other surgical management of labral pathology. Key measures of statistical fragility include the fragility index and fragility quotient.ß. 12 comparative studies that evaluated the use of arthroscopic labral reconstruction were included in this study. Particular attention was placed on evaluating trends, either statistically significant or not, of functional improvement, complication rates, need for total hip arthroplasty (THA) and revision rates with associated p-values. The analysis involved in this study was the Fragility Index, which is the median number of events required to change the statistical significance of a particular outcome, thus changing the study conclusions. Fragility quotient was calculated for each study as the fragility index divided by sample size. Of the 12 studies that were included for analysis, there were a total of 25 reported outcomes, 8 of which were statistically significant (p < 0.05). The statistical fragility for the significant outcomes were 2.5 (interquartile range [IQR]: 1.5-3.5), whereas the median statistical fragility for insignificant results was 6 (IQR 4-9). The overall fragility index was 4 (IQR 3-7). The median of fragility quotients was 0.04 (IQR 0.01-0.07). This study demonstrated that comparative research regarding arthroscopic techniques of labral reconstruction may not be as statistically stable as previously hoped. In many of the reported outcomes, particularly the ones that were statistically significant, only a small percentage of event changes was required to change the significance of the study conclusions. This fragility is worrisome, since clinical decisions that rely on these reported outcomes may have a significant impact on long-term patient outcomes. It is, therefore, crucial to optimise patient outcomes by incorporating past literature and reported outcomes.

Modified Lightbulb Non-Vascularized Bone Grafting Technique for Osteonecrosis of the Femoral Head.

Multiple techniques for non-vascularized bone grafting for the treatment of femoral head osteonecrosis have been proposed with varying degrees of success. The success of these procedures may be improved with the use of ancillary growth and differentiation factors. The trephine (Phemister) technique allows for limited decompression of the femoral head through two percutaneous tunnels, while the direct approach through the femoral head ("trapdoor" technique) may result in damage to the articular cartilage. Herein we provide our modified "lightbulb" technique to decompress the femoral head through a window at the femoral head-neck junction that provides excellent, direct access to the osteonecrotic lesion. Adjuvant, non-vascularized bone graft, comprised of bone marrow aspiration concentrate (BMAC) and open matrix bone graft (MagnetOs Flex Matrix, Kuros Bioscience, Bilthoven, Netherlands) is a unique fibrillar and flexible structure that provides bone induction and further structural support to create a favorable environment for bone formation and healing. This is a straight-forward, hip-preserving, surgical technique that may be used for symptomatic management to delay, or potentially obviate, the need for total hip arthroplasty in patients who have medium- to large-sized or early-collapse lesions of the femoral head.

Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain, especially in young patients. When left untreated, it has been demonstrated to be a risk factor for the onset or progression of osteoarthritis (OA) and has been identified as one of the main contributors leading to the need for total hip arthroplasty (THA) at a young age. While the short-term therapeutic potential of hip arthroscopy is widely recognized, little is known regarding its potential mid- to long-term preventive effect on the progression of hip OA. Purpose: To (1) report clinical outcomes of arthroscopically treated FAI syndrome with a minimum 5-year follow-up and compare the results to a cohort with FAI treated nonsurgically and (2) determine the influence of hip arthroscopy on the onset and progression of hip OA in patients diagnosed with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who had hip pain and were diagnosed with FAI were included. Exclusion criteria were (1) previous or concomitant hip surgery, (2) <5 years of follow-up, and (3) insufficient radiographs. Patients treated with hip arthroscopy were compared with a cohort of patients with FAI who were treated nonsurgically. Kaplan-Meier estimates of failure (defined as conversion to THA) were performed. Bivariate analysis and Cox regression were used to identify factors associated with inferior clinical and radiographic outcomes. Results: A total of 957 patients (650 female, 307 male; 1114 hips) (mean age, 28.03 ± 8.9 years [range, 6.5-41.0 years]) with FAI were included. A total of 132 hips underwent hip arthroscopy and 982 hips were nonoperatively treated. The mean follow-up was 12.5 ± 4.7 years (range, 5.0-23.4 years). At the final follow-up, the rate of OA progression was 26.5% in the operative group and 35.2% in the nonoperative cohort (P < .01). Conversion to THA was performed in 6.8% of the surgical patients and 10.5% of the initially nonsurgical patients (P = .19). Additionally, there was no significant difference in the risk of failure between the operatively and nonoperatively treated patients. Male sex, increased age at initial diagnosis, presence of cam morphology, and increased initial Tönnis grade were risk factors for failure (male sex: hazard ratio [HR], 2.3; P < .01; per year of increased age: HR, 1.1; P < .01; presence of cam: HR, 3.5; P < .01; per Tönnis grade: HR, 4.0; P < .01). Conclusion: At a mean follow-up of nearly 13 years, 7% of patients of the surgical group experienced progression to THA, compared with 11% of the nonoperative control group. While most of the operative group showed little to no OA at final follow-up, moderate OA (Tönnis grade 2) was present in 12% of the cohort compared with 22% of nonsurgical patients. Increased age at diagnosis, male sex, presence of a cam morphology, and presence of initial arthritic joint changes were found to be risk factors for failure. The results of this study demonstrated evidence for a preventive effect of hip arthroscopy on the development and progression of OA in young patients with FAI at mid- to long-term follow-up.

The Implications of Obesity on Total Hip Arthroplasties: A Literature Review of the Associated Complications

Introduction: Obesity is a global pandemic and public health crisis associated with a wide range of comorbidities, including osteoarthritis, leading to a significantly younger age at the time of primary total hip arthroplasty (THA) and an increased rate of complications compared to nonobese individuals. As our population continues to get older, combined with an increasing rate of obesity, an increased rate of consultations for total hip arthroplasty is expected. This has led to concerns regarding the implications of obesity on the need for THA itself and the associated complications, especially for arthroplasty surgeons. Unfortunately, few articles provide an all-encompassing review of different complications surrounding obesity within orthopedic surgery, and even fewer around total hip arthroplasty. This literature review aims to provide a comprehensive review of the implications obesity has on total hip arthroplasties, its associated complications, and how we can potentially modify these risks. Methods: Sources and research articles were identified by searching the databases of PubMed, Google Scholar, and the National Center for Biotechnology Information (NCBI) from 2000 to July 2022. Our search used the specific terms located within the abstract/title, including: “total hip arthroplasty” AND “complications,” AND “obesity, OR obese.” Inclusion criteria for research articles were the English language and peer-reviewed articles published from inception to July 2022. Articles not directly examining the effect of obesity on the incidence of complications following primary THA were excluded. Studies with outcomes of interest included the incidence of postoperative complications, primary THA in obese patients, and clinical outcome measures. A total of 265 studies were identified upon initial search. Thirty-one articles were selected for reference in this literature review. Results: Obese patients undergo primary THA at an earlier age and experience an increased duration of surgery, higher rates of infection, dislocation, periprosthetic fractures, and venous thromboembolism compared to nonobese patients. The role of pre-operative bariatric surgery before total hip arthroplasty has failed to show reductions in complication rates. Harris Hip Scores are lower in obese patients pre-operatively and post-operatively, but the degree of improvement following THA is similar compared to nonobese patients. Long-term survival of total hip prostheses is similar when compared to nonobese patients. Conclusion: Current literature strongly suggests increased complication rates in obese patients who undergo THA. This phenomenon is not solely due to biomechanical forces and is multifactorial, including inflammatory and genetic predispositions, which need further study. The decision to perform THA on obese patients should not solely be based on BMI. Other factors, such as management of comorbidities, surgical exposure, and nursing care, should be considered when deciding on surgical candidacy.

Age is predictive of higher rate of conversion to total hip arthroplasty after core decompression for osteonecrosis of the hip

BackgroundCore decompression may be performed for early osteonecrosis with a goal of improving symptoms and potentially delaying the need for total hip arthroplasty. The effectiveness and complication rate of this procedure is not well understood given the relatively rare nature of hip osteonecrosis. PurposeThe purpose of this study is to determine time to total hip arthroplasty (THA) after core compression, assess predictors of early conversion to THA, and to examine complications after hip core decompressions. MethodsUsing Current Procedural Terminology (CPT) codes, we queried the Mariner PearlDiver dataset for patients who underwent hip core decompression. Patient demographics were recorded and subsequent THA conversion within 2 years after surgery were tracked. Patient demographic factors, including age, sex, obesity, diabetes, prior fractures, steroid use, tobacco use, or alcohol use, were evaluated as possible predictors of early conversion to THA. International Classification of Diseases (ICD) codes were used to identify complications at 90 days after core decompression. Multiple linear regression was used to test if the patient demographics significantly predicted conversion to THA and complications after core decompression. ResultsBetween 2010 and 2020, 555 patients underwent hip core decompression. Within 2 years of core decompression, 226 patients converted to THA (40.7%). Age was the only significant risk factor for conversion to THA. The highest proportion of patients (61.1%, 138/226) who converted to THA were between age 40–59. The 90-day complication rate was 2.9% (16/555). The most common complication was femoral neck fracture (11/16 of all complications). DiscussionThere is a high failure rate following core decompression for hip osteonecrosis with over one third of patients converting to THA within 2 years. Age was the only variable predictive of conversion to THA. The overall complication rate after core decompression is low at 90 days. ConclusionPatients should be counseled regarding the risk of early conversion to THA if over 40 and the potential risk of femoral neck fracture.

Total Hip Arthroplasty in Nonagenarians - A National In-Patient Sample-Based Study of Perioperative Complications.

Nonagenarians are a rapidly expanding population in the United States. These patients are met with increasing rates of hip arthritis, necessitating the need for total hip arthroplasty (THA). However, there is currently limited information on hospitalization information and perioperative complications in this population. Methods: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016-2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THAs who were categorized as nonagenarians, and those who were not. The NIS database identified 309 100 patients who underwent THAs from 2016-2019. Of those, 1864 patients (.6%) were nonagenarian, while the remaining 307 236 patients were included under the non-nonagenarian category (control). The mean age in the nonagenarian group was 90years compared to the control group which had a mean age of 65.8years. There was an increased incidence of mortality rate (nonagenarian group .2%, control group .03%, P < .001), myocardial infarction (MI) (nonagenarian group .1%, control group .02%, P = .01), acute renal failure (ARF) (nonagenarian group 5.4%, control group 1.6%, P < .001), blood anemia post-operatively (nonagenarian group 28.9%, control group 17.2%, P < .001), and deep vein thrombosis (DVT) (nonagenarian group .48%, control group .07%, P < .001) in the nonagenarian group. The COC for the nonagenarian group was higher than that in the control group (P < .001). The mean LOS was longer in the nonagenarian group (3.1days) in comparison to the control group (1.96days) (P < .001). Nonagenarians had significantly higher rates of both orthopedics and medical complications than the younger patients undergoing THAs. In addition, the nonagenarian group incurred higher COC. This information is useful for the providers to make informed decisions regarding patient care and resource utilization for nonagenarian patients undergoing THAs.

One in five patients require conversion to arthroplasty after non-vascularized bone grafts in patients with osteonecrosis of the femoral head: a systematic review

BackgroundNon-vascularized bone grafting (NVBG) has demonstrated to treat osteonecrosis of the femoral head (ONFH). There are a number of articles updating the use of NVBG to treat the ONFH, but the percentage of patients subsequently undergoing a total hip arthroplasty (THA) is controversial.MethodsSeveral electronic databases, including PubMed, Embase, Web of Science, and Cochrane databases, were searched to find studies using NVBG to treat ONFH. The pooled rate and 95% confidence interval (CI) were used to assess the conversion rate to THA after NVBG. In addition, we performed subgroup, sensitivity, and publication bias analysis.ResultsA total of 37 studies describing 2599 hips were included. The mean weighted follow-up time was 50.5 months and the mean age at surgery was 36.3 years. The conversion rate to THA after NVBG was 21% (95%CI: 17% to 25%), and subgroup analyzes indicated lightbulb, trapdoor and Phemister techniques incidences with THA of 15%, 19%, and 24%, respectively.ConclusionsThis study preliminarily obtained the general trend of the survival rate of NVBG patients, but these results should be interpreted cautiously. Pooled results from 2599 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 21% of patients underwent a THA following NVBG. NVBG treatment for patient with ONFH appears to defer or at least delay the need for THA.

Cost and Early Complication Analysis Following Total Hip Arthroplasty in Parkinson's Disease Patients: A Propensity-matched Database Study.

Parkinson's Disease is a well-known neuromuscular disorder, which affects the stability and gait of elderly patients. With the progressive increase in the life span of patients with PD, the problem of degenerative arthritis and the consequent need for total hip arthroplasty (THA) in this cohort are rising. There is paucity of data in the existing literature regarding the healthcare costs and overall outcome following THA in PD patients. The current study was planned to assess the hospital expenditure, details regarding hospital stay, and complication rates for patients with PD, who underwent THA. We investigated the National Inpatient Sample data to identify PD patients, who underwent hip arthroplasty from 2016 to 2019. Using propensity score, PD patients were matched 1:1 to patients without PD by age, gender, non-elective admission, tobacco use, diabetes, and obesity. Chi-square and T-tests were used for analyzing categorical and non-categorical variables, respectively (Fischer-Exact test was employed for values<5). Overall, 367,890 (1927 patients with PD) THAs were performed between 2016 and 2019. Before matching, PD group had significantly greater proportion of older patients, males, and non-elective admissions for THA (P<0.001). After matching, PD group had higher total hospital costs, longer hospital stay, greater blood loss anemia, and prosthetic dislocation (P<0.001). The in-hospital mortality was similar between the two groups. Patients with PD undergoing THA required greater proportion of emergent hospital admissions. Based on our study, the diagnosis of PD showed significant association with greater cost of care, longer hospital stay, and higher post-operative complications.

The effect of suprainguinal fascia iliaca blocks on morphine use after total hip arthroplasty: a retrospective cohort study

Background: Good pain control after total hip arthroplasty improves patient outcomes. Fascia iliaca blocks are used as part of multimodal pain management. Objectives: We compared patient-controlled intravenous (PCIA) morphine use between patients with pre- operatively placed suprainguinal fascia iliaca compartment block (SFICB), using 40 ml ropivacaine 0.375%, and a control group (NB). Design and setting: Retrospective, single-centre cohort study. Methods: A database of the Imeldaziekenhuis in Bonheiden, Belgium was analysed. This database contained data of total hip arthroplasties performed between April 29 2019 and May 7 2021. Inclusion criteria were age &gt;18 years and undergoing an elective total hip arthroplasty. The exclusion criterium was incomplete data registration. 277 patients were included in the study, 203 patients in the SFICB group and 74 in the NB group. A retrospective comparison between these two groups was performed. Main outcome measures: The primary endpoint was PCIA morphine use at 24 hours. Secondary endpoints were PCIA morphine use between 24 and 48 hours, Numeric Rating Scale pain scores, peroperative sufentanil use, postoperative piritramide consumption and nausea. Results: The median dose of PCIA morphine at 24 hours was 5 [2 to 9] mg in the SFICB group compared to 9.5 [5 to 15.75] mg in the NB group (P=0.000034). Lower pain scores at 48 hours (P=0.0003) and peroperative sufentanil consumption (P=0.015) were reported in the SFICB group. The median NRS pain score (P=0.02) and intravenous piritramide consumption (P=0.014) on the recovery ward were significantly higher in the SFICB group than in the NB group. No difference was reported for PCIA morphine use between 24 and 48 hours, pain score at 24 hours and nausea. Conclusions: Preoperative suprainguinal fascia iliaca block leads to less PCIA morphine consumption the first 24 hours, lower NRS pain scores at 48 hours and lower peroperative opioid need for total hip arthroplasty.

Efficacy of necrosis decompression techniques in the treatment of early stages of avascular necrosis of the femoral head

BACKGROUND: There is no consensus on the methods of surgical treatment of early stages of avascular necrosis (AVN) of the femoral head. Decompression of the necrotic zone in different variations is the most widely used, but the effectiveness of it is debated.&#x0D; AIM: We evaluated the effectiveness of classic decompression of the necrotic zone and decompression using a percutaneous expandable reamer combined with bone graft.&#x0D; MATERIAL AND METHODS: Fifty patients were included in our study. The inclusion criteria were decompression of the necrotic zone in AVN of the femoral head at stages III and the possibility of assessing the effectiveness of surgical treatment after 12 months. Depending on the method of decompression, the patients were divided into two groups. Group 1 included 25 patients who underwent decompression using a percutaneous expandable reamer combined with bone graft. Group 2 consisted of patients who underwent classic decompression of the necrosis area. The groups were comparable in all major clinical characteristics. The efficacy of surgical interventions was assessed after 12 months by comparing pre- and postoperative assessment of the functional state of the hip joint using the Harris Hip Score and the intensity of pain syndrome using the visual analog score (VAS). The main criterion for ineffectiveness of AVN decompression of the femoral head was the need for total hip arthroplasty.&#x0D; RESULTS: Twelve months after surgical treatment of femoral head AVN, group 1 patients average Harris Hip Score was 63.9, group 2 patients average Harris Hip Score was 74.1 (versus 59.1 and 63.9 before surgery, respectively); VAS was 2.7 in both groups (versus 5.5 and 4.8 before surgery, respectively). Three patients (12%) from group 1 and four patients (16%) from group 2 underwent total hip arthroplasty, to persisting pain syndrome and progression of osteonecrosis of the femoral head to the subchondral fracture stage. The differences between the groups were statistically insignificant.&#x0D; CONCLUSION: Decompression of the necrosis zone is an effective method of treatment of stages I and II of AVN of the femoral head, significantly reducing the intensity of pain syndrome and slightly improving the functional characteristics of the hip joint. Studies in this direction should be continued with the involvement of more profiled patients and with the analysis of the effectiveness of other joint-preserving surgical techniques.

Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis.

Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes.

Clinical results of free vascularized fibula graft in the management of precollapse osteonecrosis of the femoral head: A retrospective clinical study.

This study aimed to evaluate clinical results, femoral head survival, and the need for total hip arthroplasty (THA) in patients with precollapse osteonecrosis of the femoral head (OFH) (Steinberg stage II and III) treated by free vascularized fibula graft (FVFG) application. We retrospectively reviewed 54 hips of 47 patients (39 males, eight females; mean age 36 ± 14 years) who underwent FVFG due to OFH, with at least two years of follow-up. The patient data, including Harris Hip Score (HHS), Visual Analogue Scale (VAS), and conversion to THA, were documented. The right hip of 26 patients and the left hip of 28 patients were involved. Bilateral FVFG surgery was performed on seven patients due to bilateral OFH. The mean follow-up time was 5.5 (range 2-14) years. Survival of the femoral head was observed in 39 hips (72.2%), while the femoral head collapse was observed in 15 femoral heads (27.8%). The mean preoperative HHS increased from 46.5 (range=12-85) to 86.5 (range=33-100) postoperatively (P < 0.001). The mean preoperative VAS score improved from 8.2 (range=2-10) to 1.3 (range=0-10) postoperatively (P < 0.001). THA was performed on seven hips at a mean follow-up time of 1.8 years (range=0.7-3.3). There was no significant difference in the collapse rate between unilateral or bilateral OFH (P=0.175). A higher survival rate was observed in the Steinberg stage II femoral head patients compared to the stage III femoral head (P=0.021). This study has shown that FVFG surgery can be a good option for managing patients with Steinberg stage II and III precollapse OFH to prevent femoral head collapse and joint function. Level IV, Therapeutic Study.

Development and Validation of an Artificial Intelligence Preoperative Planning System for Total Hip Arthroplasty.

BackgroundAccurate preoperative planning is essential for successful total hip arthroplasty (THA). However, the requirements of time, manpower, and complex workflow for accurate planning have limited its application. This study aims to develop a comprehensive artificial intelligent preoperative planning system for THA (AIHIP) and validate its accuracy in clinical performance.MethodsOver 1.2 million CT images from 3,000 patients were included to develop an artificial intelligence preoperative planning system (AIHIP). Deep learning algorithms were developed to facilitate automatic image segmentation, image correction, recognition of preoperative deformities and postoperative simulations. A prospective study including 120 patients was conducted to validate the accuracy, clinical outcome and radiographic outcome.ResultsThe comprehensive workflow was integrated into the AIHIP software. Deep learning algorithms achieved an optimal Dice similarity coefficient (DSC) of 0.973 and loss of 0.012 at an average time of 1.86 ± 0.12 min for each case, compared with 185.40 ± 21.76 min for the manual workflow. In clinical validation, AIHIP was significantly more accurate than X-ray-based planning in predicting the component size with more high offset stems used.ConclusionThe use of AIHIP significantly reduced the time and manpower required to conduct detailed preoperative plans while being more accurate than traditional planning method. It has potential in assisting surgeons, especially beginners facing the fast-growing need for total hip arthroplasty with easy accessibility.

A Patient and Public Involvement Study to Explore the Need for Further Research into the Experience of Younger Patients Undergoing Total Hip Arthroplasty.

Background: Total Hip Arthroplasty (THA) is one of the most commonly performed operations in orthopaedics. It is an operation usually performed in older patients, however the need for THA in younger patients is increasing. There is a lack of literature examining whether current recovery pathways address the specific needs of younger patients. Public and Patient Involvement (PPI) is a core aspect of good research practice and is recommended throughout the research process, including the formulation and refinement of pertinent research questions. Therefore, the explicit aim of this PPI study was to collect qualitative data from patients on the feasibility and requirement for further research into the experience of younger hip arthroplasty patients. Methods: Qualitative data was collected via an online questionnaire that was advertised on social media, requesting the input of anybody who had experienced a lower limb musculoskeletal injury or condition before the age of 50. The survey asked the respondents to describe their experiences and reflect on their priorities and goals throughout their recovery. Results: There were 71 respondents, of which 90% were female, with an average age of 43. Qualitative responses identified many concerns that were issues that could be translated across all patient ages. However, other priorities were raised that are not always recognised as important when measuring successful outcomes after a THA. Furthermore, many respondents described not feeling listened to by clinicians or treatment options not being sufficiently addressed and explored. Multiple respondents reported being told they were too young to have anything serious or that nothing could be done until they were older. Conclusions: The responses to the survey indicate that current care pathways are not fulfilling the needs and priorities in younger patients. Further research is required to explore these priorities and goals in more depth in order to understand how healthcare professionals can address them.

Core decompression and bone marrow aspirate concentrate injection for Avascular Necrosis (AVN) of the femoral head: A scoping review

BackgroundVarious joint preserving treatments are available for use in Avascular Necrosis of the femoral head. Most of these are effective in the pre-collapse stage of the disease. This review aimed to evaluate the effectiveness of core decompression and Bone Marrow Aspirate Concentrate in various stages of AVN, in modifying the progression of the disease and the need for hip replacement. Material and methodsThe Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews reporting guidelines were followed. The literature search was conducted from inception till 2nd May 2021, on the PUBMED, SCOPUS, and Google Scholar search engines, using “bone marrow aspirate concentrate osteonecrosis femur” and “bmac osteonecrosis femur” as the keywords. In all these studies, Core Decompression with Bone marrow Aspirate concentrate was performed. The evaluation was done based on the progression of osteonecrosis, improvement in functional outcomes and the conversion to total hip arthroplasty. ResultsWe have analyzed 612 hips from11 studies, based on our inclusion and exclusion criteria. The mean age of the patients was 38.27 years. There was a predominance of males. The grade of AVN ranged from grade 1 to 4. The average follow-up period of the cases ranged from 2 to 12 years (average: 4.38 years). The functional scores were improved in the majority of cases. Radiographic progression occurred in 23.5% of hips, and the Total Hip Arthroplasty was performed in 14.9% of hips. ConclusionsCore decompression with Bone Marrow Aspirate Concentrate in pre-collapse stages of the disease is beneficial in improving the functions scores and for reducing the radiological progression of the disease and need for total hip arthroplasty, in the majority of cases.

Common musculoskeletal disorders in chronic liver disease patients

Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.

Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course

BackgroundTo determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH).MethodsWe identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling.ResultsKaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8–83.4%) and the natural course group (72.2, 95% confidence interval 64.8–79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05).ConclusionsMultiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH.Trial registrationThe trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000035180) dated 2 August 2020.

Is arthroplasty inevitable after Ilizarov hip reconstruction of unstable hip joints in adolescents and young adults? Long-Term Evaluation of 136 Cases

Introduction Whereas hip joint destroying trauma and diseases are difficult situations, the problem is more complex when it is complicated by hip instability. This could be a sequel of several hip affections such as trauma, septic or tuberculous arthritis, neglected developmental dysplasia of the hip, postoperative conditions, and neurologic pathologies (cerebral palsy, myelomeningocele, poliomyelitis). Purpose The purpose of this study is to evaluate long-term radiographic and clinical outcomes of the Ilizarov hip reconstruction for the treatment of painful and unstable hips in adolescents and young adults. Materials and methods The study included 136 patients with an average age of 18.3 years (range, 6 to 34 years); 75 patients were males (55.1%) and 61 females (44.9%). The primary causes of the hip instability were untreated or unsuccessfully treated cases of septic arthritis (40 cases; 29.4 %), congenital hip dislocation (28 cases; 20.6 %), paralytic hip dislocation (36 cases; 26.5 %), proximal femoral focal deficiency (14 cases; 10.3 %), neglected fracture of the femoral neck (10 cases; 7.4 %), osteoarthritis (6 cases; 4.4 %), and tuberculous hip arthritis (2 cases; 1.5 %). The intervention consisted in the performance of two osteotomies (proximal and distal) of the femur with pelviс support and placement of the Ilizarov apparatus of a specific assembly. Results The external fixation period ranged from 4 to 12 months (6.5 months on average). Patients were followed up for an average of 17.4 years (range, 5 to 27 years). Multiple clinical parameters at final follow-ups showed significant improvement, including pain relief, pain-free walking distance, lameness, hip flexion and abduction, hip contracture, and lumbar lordosis. Functionally, the mean Harris Hip Score improved with a statistically significant difference from 48 points (range, 35–65) before surgery to 83 points (range 70–90) after surgery. The pain disappeared in all patients, with the exception of six cases of pain in the early postoperative period. In all cases, supportive walking aids were no longer necessary, with the exception of two cases of persistent pain by physical activities. Walking ability and painless walking distance improved in all patients from an average of 35 m (range, 10 to 50 m) before surgery to 1,150 m (range, 1,000 to 1,500 m) after surgery, showing significant difference. Conclusion Ilizarov pelvic support osteotomy provided a multi-purpose solution to the complex challenging problem of hip instability in adolescents and young adults with variable primary etiologies. The improvements in the hip motion, mechanical axis, and correction of limb-length discrepancy lead to good functional outcomes over a long-term follow-up. This treatment modality might avoid or postpone the need for total hip arthroplasty for several years.