Postoperative Harris Hip Score Research Articles

Direct superior approach versus posterolateral approach in mid-term clinical outcomes of total hip arthroplasty: a prospective randomized controlled study

PurposeThe aim of this study is to compare mid-term clinical outcome of direct superior approach (DSA) and posterolateral approach (PLA) in THA.MethodSeventy-eight patients who underwent THA from January 2021 to June 2021 were prospectively enrolled and randomly allocated into DSA group and PLA group. The surgical duration, incision length, total blood loss, ambulation time, visual analogue scale (VAS), patient satisfaction, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, postoperative leg length discrepancy (LLD), abduction angle, anteversion angle and complications were compared between the two groups.ResultsThirty three patients were randomized to the PLA group and 32 patients allocated to the DSA group. The average follow-up period was 39.8 months in DSA group and 40.1 months in PLA group. Compared with PLA group, DSA group had longer surgical duration ([124.1 ± 11.2] min vs. [103.3 ± 20.7] min), less total blood loss ([482.4 ± 236.1] ml vs. [680.2 ± 299.4] ml), shorter incision ([8.7 ± 1.9] cm vs. [15.6 ± 1.7] cm), and earlier ambulation time ([15.8 ± 4.0] h vs. [20.5 ± 3.5] h), with statistically significant differences (P < 0.0001). Furthermore, the DSA group had significantly lower WOMAC Scores compared to the PLA group at 1-year postoperatively (P = 0.011), and had significantly lower WOMAC Function Scores and WOMAC Stiffness Scores both at 1-year postoperatively and at the last follow-up. The anteversion angle of the cup in the DSA Group was significantly smaller than the PLA Group at postoperative day (POD) 3 and the last follow-up (P = 0.006 and P = 0.010, respectively). However, there was no difference in postoperative patient satisfaction, complication, LLD or HHS between the two groups.ConclusionDSA demonstrated benefits in terms of reduced blood loss, improved pain scores, shorter incisions, and earlier ambulation. These advantages support the use of DSA for promoting early recovery and better mid-term functional outcomes.Trial registrationThe study protocol was registered on Chinese Clinical Trial Register (ChiCTR) with the register number ChiCTR2000041186 (registration date: 2020/12/21).

Factors associated with poor hip flexion range of motion after total hip arthroplasty in patients with ankylosing spondylitis: a retrospective study on 538 consecutive hips

BackgroundThis study aimed to report the mid-term functional outcomes of total hip arthroplasty (THA) for the treatment of advanced hip involvement in ankylosing spondylitis (AS) and identify the factors associated with poor hip flexion range of motion (ROM) after THA in patients with AS.MethodsWe retrospectively investigated the mid-term functional outcomes in 313 AS patients (538 hips) who underwent primary THA from 2012 to 2017, with a mean follow-up of 7 years (range, 4–9 years). Postoperative functional outcomes were assessed by hip flexion ROM, Harris hip score (HHS), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The hips were divided into poor (≤ 90°) and good hip flexion ROM (> 90°) groups based on the degree of hip flexion ROM recorded at the most recent follow-up. We grouped factors related to postoperative hip flexion ROM into three categories: preoperative (or patient-related), intraoperative (or surgery-related), and postoperative factors. Multivariate logistic regression was performed to identify the independent factors associated with postoperative poor hip flexion ROM.ResultsThe overall flexion-extension ROM improved significantly with a median from 0° (0 ~ 120°) to 100° (30 ~ 130°) after THA (P < 0.001), and the mean HHS increased from 37 to 90 (P < 0.001). There were 102 hips (19%) with a hip flexion ROM of no more than 90°. The poor hip flexion ROM group had significantly lower postoperative HHS and WOMAC than the good hip flexion ROM group (85 ± 6 vs. 91 ± 4, P < 0.001; 63 ± 16 vs. 32 ± 16, P < 0.001). The result of multivariate logistic regression showed that male sex (odds ratio [OR] = 9.42, 95% confidence interval [CI], 1.23 to 72.03), bony ankylosis (OR = 3.02, 95%CI, 1.76 to 5.17), cup anteversion angle (OR = 0.96, 95%CI, 0.93 to 0.98), cup inclination angle (OR = 0.96, 95%CI, 0.93 to 0.99), American Society of Anesthesiologists (ASA) class III (OR = 6.23, 95%CI, 1.83 to 21.70), knee involvement (OR = 7.80, 95%CI, 2.75 to 22.16), and noise (OR = 0.45, 95%CI, 0.25 to 0.81) were independent factors associated with poor hip flexion ROM after THA in patients with AS.ConclusionNearly one out of the five hips in patients with AS have a poor hip flexion ROM after THA. Care has to be taken in acetabular component positioning during THA and its effect on the postoperative hip flexion function should be considered in the patients. The optimum treatment strategy is that THA should be performed before ankylosis in patients with AS.

Comparison between in situ fixation and fixation after closed reduction in valgus impacted femoral neck fractures: A Multicenter Study.

The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 and above with valgus impacted femoral neck fractures using data from multiple centers. Design: Retrospective multicenter cohort study. Five tertiary-care university hospitals. Patients aged 50 and above, treated with operative fixation of valgus impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019. Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score (HHS), and Koval's grade were compared. The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50 to 95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs 26.7% of fixation after CR group, p = 0.002). Reoperation was required for 10.2% (7.5% of in situ fixation group vs 20% of fixation after CR group, p = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after CR group than in the in-situ fixation group (odds ratio = 4.757, p = 0.002 and odds ratio = 3.104, p = 0.023, respectively). At the two-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the two groups (p = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group (p = 0.027, 0.044, respectively). Postoperative EQ-5D and HHS scores showed no statistically significant differences between the two groups. In patients aged 50 years or older with valgus impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared to in-situ fixation. There was no significant difference in the incidence of ONFH in valgus impacted femoral neck fractures regardless of whether reduction was performed. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Total Hip Arthroplasty Using the Conjoined Tendon-Preserving Posterior Approach: The Modified Posterior Approach with a Minimum of 2-Year Follow-Up.

The conjoined tendon-preserving posterior (CPP) approach is a modified posterior approach for total hip arthroplasty (THA) that preserves the short external rotator muscles and most ischiofemoral ligaments. The objective of the present study was to compare the short-term clinical outcomes, complications, and imaging evaluations of CPP and posterior approaches in THA. This retrospective study included 83 patients from May 2018 to September 2021: 36 patients with 42 hips who underwent THA with the CPP approach (CPP group) and 47 patients with 60 hips who underwent THA with the standard posterior approach (PA group) with a minimum of 2 years of follow-up. Assessment tools included operative times, blood loss, preoperative and last follow-up Harris Hip Scores (HHS), postoperative complications, and implant placement angles between the groups. Statistical analysis was performed using chi-square tests and T-tests. The CPP approach had a significantly longer operative time and greater blood loss compared to the PA group. Preoperative and postoperative HHS were not significantly different between groups. Considering complications, the PA group had one case each of dislocation and infection, and the CPP group had two cases of sciatic nerve palsy, but the difference was not significant. Cup anteversion, inclination and stem anteversion were not significantly different between groups. Functional outcomes, complication rates, and implant placement angles were comparable with the posterior approach, and the CPP approach has the potential to reduce postoperative dislocations. However, careful attention should be paid to sciatic nerve palsy during early initiation of the CPP approach, and this study did not demonstrate that the CPP approach was clearly superior to the posterior approach.

Case–control Comparative Study of Porous Metal Augments versus Bone Graft in Management of Segmental Acetabular Defect in Hip Arthroplasty Procedures

Abstract Introduction: Acetabular bone loss represents a great challenge during hip arthroplasty procedures. This study aims at evaluating the efficacy and functional outcome of cost-friendly alternatives (autograft or allograft) when compared to the porous metal augments during reconstruction of acetabular defects in either complex primary or revision total hip replacement. Patients and Methods: This is a retrospective matched control study for evaluation of short and midterm results of metal augments versus bone graft during hip arthroplasty procedures. Inclusion criteria included adult patients who suffered from segmental acetabular defect and underwent hip arthroplasty procedure. The study included 34 cases divided into 2 groups. Group 1 cases were reconstructed with augment reconstruction. Group 2 was the control group which was reconstructed using graft reconstruction. Results: The mean age for Group 1 was 52.29 years (range: 30–68) and for Group 2 was 52.1 years, (range from 32 to 71 years). The mean follow-up period was 74.8 months in Group 1 (range: 66–85 months) and 71.5 months in Group 2 (range: 60–102 months). Both the groups included 13 males and 4 females. Group 1 had a mean postoperative Harris Hip Score (HHS) of 90.5 (range from 85 to 94), and Group 2 had a mean postoperative HHS of 88.7 (range from 80 to 94) with P = 0.236. Conclusion: Acetabular reconstruction using cost-friendly alternatives shows similar short-to-midterm results when compared to trabecular metal augments in a budget-conscious health setting.

Arthroscopic assisted versus open core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis.

Minimally invasive treatment options for osteonecrosis of the femoral head (ONFH) have been a prominent area of research in recent years. Arthroscopic-assisted treatments have been applied in the clinical management of ONFH; however, high-quality evidence verifying their effectiveness and safety is still lacking. To systematically assess the clinical efficacy and safety of arthroscopic-assisted core decompression (AACD) in treating ONFH. A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and the Chinese BioMedical Literature Database, from inception to June 25, 2024. We identified randomized controlled trials and non-randomized controlled studies on AACD for the treatment of ONFH based on predefined inclusion and exclusion criteria. A meta-analysis was performed using Review Manager 5.4.1 and Stata 17.0 software. The analyzed outcomes included operative time, intraoperative blood loss, length of hospital stay, postoperative femoral head collapse rate, Harris hip score, and postoperative complication rate. The Grades of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to assess the quality of evidence for the outcome indicators. A total of fourteen studies were included in this meta-analysis, comprising 1,063 patients-541 in the core decompression (CD) group and 522 in the AACD group. The meta-analysis revealed no significant differences between the two groups in terms of intraoperative blood loss, length of hospital stay, 12-month postoperative Harris hip score, or overall postoperative complication rate (P > 0.05). However, the AACD group had a longer operative time (MD = 31.19, 95% Cl: 5.32 to 57.07, P = 0.02) and a lower overall postoperative femoral head collapse rate (RR = 0.49, 95% Cl: 0.27 to 0.89, P = 0.02) compared with the CD group. Additionally, the AACD group showed significant improvements in Harris hip scores at 3 months (MD = 6.39, 95% Cl: 5.44 to 7.33, P < 0.00001), 6 months (MD = 7.56, 95% Cl: 6.63 to 8.49, P < 0.00001), ≥ 24 months (MD = 7.00, 95% Cl: 4.80 to 9.21, P < 0.00001), and at the last follow-up (MD = 6.89, 95% Cl: 5.30 to 8.48, P < 0.00001) compared to the CD group. The GRADE evidence assessment indicated that the overall postoperative complication rate was supported by moderate-quality evidence, while the evidence for operative time, intraoperative blood loss, postoperative femoral head collapse rate, and Harris hip score was of low quality. The evidence for length of hospital stay was deemed very low quality. This meta-analysis suggests that AACD is an effective and safe treatment for patients with ONFH. However, due to the limited quantity and quality of the included studies, these results should be interpreted with caution. Further high-quality studies are recommended to confirm these findings.

Postoperative Harris Hip Score Versus Harris Hip Score Difference in Hip Replacement: What to Report?

Reliable scientific information is crucial for assessing hip function and evaluating the success of hip surgery. The Harris Hip Score (HHS) is the most widely used tool for measuring hip function and, in particular, the outcomes of hip surgery. The aim of this study was to conduct a systematic review of the literature to identify randomized controlled trials (RCTs) that reported the HHS for hip replacement treatment groups and to test whether there was a substantial difference between reporting only the postoperative HHS or the HHS difference (HHSdiff). PubMed, CNKI, and Epistemonikos were searched until March 1, 2024. The risk of bias, level of evidence, and publication bias were assessed. As HHS is a continuous outcome, mean difference (MD) with 95% confidence intervals (CIs) was calculated using the Hartung-Knapp-Sidik-Jonkman method and a common-effect/random-effects model. The same approach was used for both postoperative HHS and HHSdiff. The effect of the two treatment groups studied (minimally invasive vs. conventional approach) on postoperative HHS was then compared with the effect of the two groups studied on the difference in HHS. A total of 41 RCTs, involving 3572 patients, with a low to high risk of bias and a low to moderate publication bias were included. The measured outcome parameters showed a low to moderate level of evidence. There was no relevant difference in the reporting of HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs, measured at 0-0.5, 3, 6, and 12 months postoperatively. The present study showed that there is no relevant difference between reporting of the HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs. Both methods of HHS reporting produced comparable results in an identical cohort of 3765 patients undergoing hip replacement surgery.

Hip arthroplasty following failure of internal fixation in intertrochanteric femoral fractures: classification decision-making for femoral stem selection and clinical validation

AimsFollowing Failed Internal Fixation of Intertrochanteric Fractures (FIF-ITF), the choice of treatment remains a clinical challenge. This study introduces a novel classification system to guide the selection of femoral prostheses in hip arthroplasty (HA) and validates its clinical efficacy.MethodsRetrospectively, we analyzed 108 cases from three university-affiliated hospitals between December 2012 and February 2023 involving patients who underwent hip arthroplasty due to Failed Internal Fixation of Intertrochanteric Fractures (FIF-ITF). Patients were classified into three categories based on fracture healing, proximal femoral support, and the severity of femoral cortical defects, with subtypes identified. Surgical outcomes and complication rates were compared between the Classification-based Decision Group and the Non-classification Decision Group.ResultsThe Classification-based Decision Group did not differ significantly from the Non-classification Decision Group in operation time, blood loss, or the use of cemented stems. However, the classification system markedly reduced the risk of periprosthetic fractures intraoperatively from 22.5 to 4.4% and postoperatively from 10 to 1.4%. The Classification-based Decision Group also demonstrated higher postoperative Harris Hip Score (HHS) and Visual Analog Scale (VAS) scores.ConclusionThe proposed classification system serves as an innovative clinical tool for femoral prosthesis selection in hip arthroplasty post-FIF-ITF, effectively reducing complications and enhancing hip function in the Classification-based Decision Group, underscoring its significant clinical utility.

Treatment Outcomes of Total Hip Arthroplasty Following Hip Joint Gunshot and Shell Fragment Injuries: Insights From a Single-Center Retrospective Study in Yemen.

Background Gunshot injuries to the hip joint are uncommon extremity injuries. The management outcomes of total hip arthroplasty for such injuries are inadequately documented and lack comprehensive treatment protocols. The purpose of this study was to evaluate the outcomes and complications associated with total hip arthroplasty following gunshot and shell fragment injury incidents in a resource-limited setting. Materials and methods A retrospective study of 10 patients diagnosed with hip joint gunshot and shell fragment injuries and who underwent total hip arthroplasty was conducted between November 2020 and November 2023 at the 48 Model Hospital in Sana'a, Yemen. Clinical demographic data, hip joint injury characteristics, management, complications, and outcomes were collected and analyzed. The primary end measure was the Harris Hip Score (HHS), which was calculated both before and after surgery, and the secondary outcome was the variables associated with complications. Result The mean age was 30.2 ± 10.7 years (range: 20-49 years). The mechanism of injury was bullets in six (60.0%) patients and shell fragments in four (40.0%). The most common previous surgery was wound debridement in eight (80.0%) patients. The mean time between fracture and total hip arthroplasty was 16.7 ± 7.5 months. The mean preoperative and postoperative HHS was 32.1 ± 8 and 69.2 ± 16.7 points, respectively. The postoperative HHS improved significantly, with a mean difference of 37.08 points (95% CI: 24.30-49.85, p = 0.002). Complications occurred in two patients (20.0%), including heterotopic ossification in one patient and surgical site infection in one. Within a mean follow-up time of 31.9 ± 11.8 months, the functional result showed poor functional outcomes in four (40.0%) patients, fair in three (30.0%), excellent in two (20.0%), and good in one (10.0%). Factors associated with postoperative complications were older age (p = 0.049), previous abdominal surgery with intestinal repair (p = 0.022), and shorter time to arthroplasty (p = 0.029). Conclusion In this study, total hip arthroplasty was a highly effective therapy for posttraumatic arthritis induced by bullets or shell fragments, lowering discomfort and increasing function, allowing younger patients to lead normal lives. Moreover, post-arthroplasty complications were found to be more common in patients aged older, who had previous abdominal surgery with intestinal repair, and those who underwent arthroplasty earlier.

Extended Trochanteric Osteotomy Does Not Compromise Functional and Radiographic Outcomes of Femoral Stem Revisions with the Use of an Uncemented Modular Conical Stem.

Background: Stem revisions in revision total hip arthroplasty (THA) with proximal bone stock loss may be dealt with utilizing modular, uncemented conical stems. During stem extraction, surgeons may resort to extended trochanteric osteotomy (ETO). However, ETO is associated with extensive blood loss and infections. This study compared the clinical outcomes, radiographic results and complications in THA revisions utilizing conical modular stem with and without ETO. Methods: Patients who underwent revision THA with or without ETO were assessed retrospectively. The minimal follow-up was 3 years. The functional evaluation included Harris Hip Score (HHS) and Short Form 36 (SF-36) as well as Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Numerical Rating Scale for pain assessment. The radiographic evaluation comprised bone defect assessment, osteotomy healing, stem migration and position, presence of radiolucent lines and stress shielding. Results: In total, 73 patients (80 hips) were included in the final analysis. The ETO group comprised 48 hips, and the no-ETO group comprised 32 hips. In the ETO group, pre-operative WOMAC scores were lower than in the no-ETO group (p = 0.012). No significant differences were found in terms of post-operative HHS, WOMAC, and NRS scores between groups, except worse results were found in the case of claw plate implantation. Patients in the no-ETO group exhibited better results in SF-36 than in the ETO-group. Osteotomy non-union was observed in four hips (9.5%). Stam varus/valgus position was within ±1.5 degrees (85.9%). Conclusions: ETO does not adversely impact outcomes in patients undergoing femoral stem revisions with modular conical stems. The invasive nature of these procedures prompts careful consideration in each case individually.

Comparative postoperative prognosis of ceramic-on-ceramic and ceramic-on-polyethylene for total hip arthroplasty: an updated systematic review and meta-analysis.

To compare the clinical outcomes between ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) bearing surfaces in patients undergoing total hip arthroplasty (THA) through a pooled analysis and evidence update. We performed a systematic literature search using PubMed, Embase, Cochrane Library and Web of Science up to March 2023 for studies that compared the bearing surfaces of CoC and CoP in patients undergoing THA. The primary outcomes were the incidence of common postoperative complications and the rate of postoperative revision. The secondary outcome was the Harris Hip Score. A total of 10 eligible studies involving 1,946 patients (1.192 CoC-THA versus 906 CoP-THA) were included in the evidence synthesis. Pooled analysis showed no significant difference in the rates of common postoperative complications (dislocation, deep vein thrombosis, infection, wear debris or osteolysis) and of revision. After eliminating heterogeneity, the postoperative Harris Hip Score was higher in the CoC group than in the CoP group. However, the strength of evidence was moderate for the Harris Hip Score. CoC articulations are more commonly used in younger, healthier, and more active patients. While the performance of conventional polyethylene is indeed inferior to highly cross-linked polyethylene, there is currently a lack of sufficient research comparing the outcomes between highly cross-linked polyethylene and CoC bearing surfaces. This area should be a focal point for future research, and it is hoped that more relevant articles will emerge. Given the limited number of studies included, the heterogeneity and potential bias of those included in the analysis, orthopaedic surgeons should select a THA material based on their experience and patient-specific factors, and large multicentre clinical trials with >15 years of follow-up are needed to provide more evidence on the optimal bearing surface for initial THA.

The medullary cavity morphology of the proximal femur influences the fixation pattern of the rectangular tapered short stem in total hip arthroplasty.

This study aimed to evaluate differences in the pattern of fixation with a rectangular tapered short stem (Fitmore stem) due to proximal femoral medullary cavity morphology based on periprosthetic bone mineral density (BMD) and radiological findings. We analyzed 105 consecutive patients (Dorr type A, 18; Dorr type B, 66; Dorr type C, 21) who underwent total hip arthroplasty using a Fitmore stem. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry from 1 to 24months postoperatively and radiological analysis was performed. Clinical outcomes were evaluated using the Harris hip score (HHS) and the University of California Los Angeles (UCLA) activity score preoperatively and 24months postoperatively. At 24months postoperatively, Dorr type C had significantly decreased BMD changes in Gruen zones 2, 6, and 7 compared to Dorr types A and B, and conversely, significantly increased BMD changes in zone 4 (p < 0.05). Dorr type C had significantly greater subsidence than the other types (p < 0.01) and significantly higher cortical hypertrophy in zone 3 (p < 0.01). Stress shielding was not significantly different between Dorr types. The preoperative and postoperative HHS and UCLA activity scores showed no significant differences between the Dorr types. In Dorr type C, BMD significantly decreased in the proximal femur with a rectangular tapered short stem, suggesting that the stem was fixed at the distal part. Careful observation of this prosthesis over time is needed in patients with Dorr type C.

Intraoperative application of three-dimensional printed guides in total hip arthroplasty: A systematic review.

Acetabular component positioning in total hip arthroplasty (THA) is of key importance to ensure satisfactory post-operative outcomes and to minimize the risk of complications. The majority of acetabular components are aligned freehand, without the use of navigation methods. Patient specific instruments (PSI) and three-dimensional (3D) printing of THA placement guides are increasingly used in primary THA to ensure optimal positioning. To summarize the literature on 3D printing in THA and how they improve acetabular component alignment. PubMed was used to identify and access scientific studies reporting on different 3D printing methods used in THA. Eight studies with 236 hips in 228 patients were included. The studies could be divided into two main categories; 3D printed models and 3D printed guides. 3D printing in THA helped improve preoperative cup size planning and post-operative Harris hip scores between intervention and control groups (P = 0.019, P = 0.009). Otherwise, outcome measures were heterogeneous and thus difficult to compare. The overarching consensus between the studies is that the use of 3D guidance tools can assist in improving THA cup positioning and reduce the need for revision THA and the associated costs. The implementation of 3D printing and PSI for primary THA can significantly improve the positioning accuracy of the acetabular cup component and reduce the number of complications caused by malpositioning.

Analysis of kinematic changes of hip joint after total hip arthroplasty

To analyze the kinematic changes of the hip joint after total hip arthroplasty (THA) through three-dimensional gait analysis. Patients with hip joint diseases admitted between October 2022 and June 2023 were selected as the subjects. The patients who met the selective criteria were finally included in the THA group. The healthy volunteers matched with the THA group in the same age were included as the control group. Baseline data including age, gender, body mass index (BMI), and laterality were compared between the two groups. The Harris hip score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were recorded preoperatively and at last follow-up in the THA group. Three-dimensional motion capture system was utilized to collect spatiotemporal parameters and kinematic data during walking, including stride length, cadence, and maximum/minimum values, range of motion (ROM) in hip joint abduction/adduction, external/internal rotation, and flexion/extension, as well as gait scores. Differences between the two groups were analyzed. Additionally, the correlation between gait scores and postoperative HHS and WOMAC scores were analyzed in the THA group. Finally, the kinematic data of each degree of freedom (DOF) were fitted into a gait diagram, and the dynamic changes of the 3-DOF of the hip joint during the gait cycle were quantitatively analyzed. There was no significant difference in gender, age, laterality, and BMI between the two groups ( n=20, P>0.05). The mean follow-up time in the THA group was 9.9 months (range, 6-12 months). The HHS and WOMAC scores at last follow-up in the THA group showed significant improvement when compared with preoperative scores ( P<0.05). Gait scores were positively correlated with postoperative HHS score ( r=0.585, P=0.007) and negatively correlated with WOMAC score ( r=-0.619, P=0.004). There was no significant difference in stride length and cadence between the THA and control groups ( P>0.05), but gait score was significantly lower in the THA group than in the control group ( P<0.05). There was no significant difference in maximum and minimum values of flexion/extension, external/internal rotation, and abduction/adduction between the two groups ( P>0.05); however, ROM in the THA group was significantly lower than that in the control group ( P<0.05). There were significant differences between the two groups of flexion/extension in multiple phases of the gait cycle ( P<0.05). Early post-THA hip joint kinematics exhibit relative adduction, external rotation, and flexion during the gait cycle compared to normal individuals, with incomplete recovery of kinematic parameters in three degrees of freedom. Significant differences in flexion are observed at multiple phases of the gait cycle compared to normal individuals.

To further incorporate computer-aided designs to improve preoperative planning in total hip arthroplasty: a cohort study.

Hip replacement surgeries are increasing in demand, requiring rigorous improvements to a mature surgical protocol. Postoperative patient dissatisfaction mainly stems from postoperative complications resulting from the inappropriate selection of prostheses to meet the needs of each patient. This results in prosthesis loosening, hospital-related fractures, and postoperative complex pain, which can all be attributed to inappropriate sizing. In this study, we aimed to further explore the intraoperative and postoperative benefits of incorporating computer-aided design (CAD) in preoperative planning for total hip arthroplasty (THA). A total of 62 patients requiring total hip replacement surgery from January 2021 to December 2021 were collected and randomly divided into a preoperative computer-aided simulated group and a conventional x-ray interpretation group. The accuracy of implant size selection (femoral and acetabular implant) between the preoperative planning and surgical procedure of the two groups was compared. Patient parameters, perioperative Harris hip scores, operative time (skin-to-skin time), surgical blood loss, and postoperative hospital stay were recorded, and the differences between the two groups were statistically compared using a single sample t-test. All patients in the study were successfully operated on and achieved good postoperative functional recovery. With CAD, the selection of the most suitable-sized prosthesis was significantly more accurate compared to the control group (accuracy of the acetabular component between the CAD/control: 80.6%/61.3%, and accuracy of the femoral component: 83.9%/67.7%). Intraoperative blood loss (177.4/231.0 ml, P = 0.002), operation time (84.2 ± 19.8 min/100.3 ± 25.9 min, P = 0.008), duration of hospital stay (6.5 ± 3/9.1 ± 3.9 days, P = 0.003), and postoperative Harris hip score (81.9 ± 6.5/74.7 ± 11.1, P = 0.003) were compared to the control group and showed statistical significance. Incorporating CAD into the preoperative planning of total hip arthroplasty can effectively guide the selection of the most suitable-sized prosthesis, reduce intraoperative blood loss, and promote short-term functional recovery after THA.

Recovery of muscular tissue and functional results of patients treated with a gluteus maximus flap transfer due to chronic abductor deficiency after total hip arthroplasty.

To evaluate the function of the abductor mechanism after a gluteus maximus flap transfer due to a degeneration of the muscles after hip arthroplasty, we analyzed the post-operative functional outcome as well as radiographic effects in muscle tissue. This present study included six consecutive patients operatively treated with a gluteus maximus flap due to chronic gluteal deficiency after total hip arthroplasty. All patients presented a preoperative severe limp, hip abductor deficiency and a history of conservative treatment without the relief of symptoms. MRI scans were performed pre- and postoperatively to evaluate the muscle volume and grade of degeneration of the abductor mechanism. For clinical evaluation, the Harris hip score (HHS) was applied pre- and postoperatively. Moreover, the intensity of pain, the Trendelenburg sign, the internal rotation lag sign and the abductor muscle force were measured before and after surgery. Overall, the evaluation of the Magnetic Resonance Imaging (MRI) showed no significant changes in total muscle volume during the follow-up period. Separate measurements presented a significant growth of muscle volume for the gluteus minimus and tensor fascia lata compared to preoperative imaging during the follow-up period. The amount of fat volume decreased for all the measured muscles with statistical significance for the gluteus minimus, the gluteus medius and the tensor fascia lata. No further muscle degeneration and no flap necrosis were measured. The postoperative HHS results were not statistically significant compared to the preoperative results. Besides fair clinical results, the radiological measurements indicate that the flap transfer enables functional muscular tissue recovery and prevents further degeneration. Given these conditions, the gluteus maximus muscle flap transfer represents a viable treatment option for patients with chronic gluteal deficiency in selected patients.

Total Hip Arthroplasty Combined with Proximal Femoral Reconstruction Effectively Treats Severe Hip Deformities: A Novel Osteotomy Technique.

Total hip arthroplasty (THA) combined with proximal femoral reconstruction is a novel osteotomy technique developed to address severe hip deformities. There is a paucity of robust clinical and radiological evidence regarding the outcomes of this novel osteotomy technique. This study aimed to evaluate the clinical and radiological outcomes of THA combined with proximal femoral reconstruction during the early follow-up. This is a retrospective case series of 63 hips who underwent THA combined with proximal femoral reconstruction at a single institution between January 2020 and July 2023. The mean age of patients was 39.6 ± 12.6 years. The mean follow-up was 25.6 ± 3.8 months. Surgical characteristics and perioperative variables were evaluated to assess the efficacy of this technique. Harris hip score (HHS) was utilized to evaluate hip function. Leg length discrepancy (LLD) was evaluated in X-ray. The incidence of major adverse events including deep vein thrombosis (DVT), osteolysis, nonunion of the osteotomy, intraoperative femoral fracture, and infection was also evaluated. Paired-samples t-test was used to compare preoperative and postoperative HHS and LLD. The mean operative time was 125.1 min. The mean size of the acetabular components used was 45.2 mm, and the stem size was 7.5. The primary friction interface was ceramic-on-ceramic, accounting for 92.1% of cases. The average length of hospital stay was 8.5 days. The mean cost of treatment was 46,296.0 Yuan. There was a significant improvement in postoperative HHS (p < 0.001) and LLD (p < 0.001) compared to preoperative values. The incidence of deep venous thrombosis was 4.8%; osteolysis rates for the cup and stem were 4.8% and 6.4%, respectively. The non-union and dislocation rates were 1.6% and 3.2%, respectively. There was no incidence of postoperative infection. The novel osteotomy surgical procedure yields reliable and impressive clinical and radiological outcomes, with minimal complications. We advocate for its use in complex primary THA cases involving severe proximal femoral deformities.

A new seven-axis robotic-assisted total hip arthroplasty system improves component positioning: a prospective, randomized, multicenter study

This study compared the radiologic and clinical outcomes of a new seven-axis robotic-assisted total hip arthroplasty (THA) and conventional THA. Hundred and four patients were randomly assigned to two groups—the robotic-assisted THA group (RAS group) and the conventional THA group (CON group). The preoperative and postoperative Harris Hip score (HHS), acetabular inclination, anteversion, femoral offset, and leg length discrepancy (LLD) were compared. During the follow-up, no patients had any complications that could be associated with the use of the robot. The proportion of acetabular cups in the safety zone was significantly higher in the RAS group than that in the CON group. The two groups had significantly different mean absolute difference of inclination and anteversion. There was no significant difference in the postoperative HHSs, changes in HHSs, femoral offset, and lower limb length between the two groups. The seven-axis robotic-assisted THA system is safe and effective, and leads to better acetabulum cup positioning compared to conventional THA. The improvements observed in the HHS, LLD, and femoral offset in the RAS group were similar to those in the CON group.Clinical trial registration time: 19/05/2022.Clinical trial registration number: ChiCTR2200060115.

FUNCTIONAL OUTCOME OF UNCEMENTED TOTAL HIP ARTHROPLASTY IN POST-TRAUMATIC AVASCULAR NECROSIS OF FEMORAL HEAD IN YOUNG PATIENTS

Objective: To determine the frequency of different outcomes of uncemented total hip replacement in young patients with avascular necrosis due to traumatic cause Materials and Methods: This study was done in Khyber Teaching Hospital Peshawar, Pakistan from March 2022 to January 2024. 96 patients of the younger age group (20-45 years) consisting of both genders with uncemented total hip arthroplasty for AVN femoral head due to traumatic cause, were studied. Age, gender, side of hip affected by AVN, and pre-operative Harris Hip Score were noted. Functional outcomes of uncemented THA were determined in terms of improvement in postoperative Harris hip score was documented at 3 months postoperatively. Results: A total of 96 patients, 80 (83.33%) men and 16 (16.67%) women underwent uncemented total hip arthroplasty. The age ranged from 20 to 45 years, with a mean of 40±7.02 years. Reasons for osteonecrosis included femoral neck fracture (50%), hip dislocation (36.46%), and acetabular fracture (13.54%). After 3 months of surgery, the Harris hip score improved and was excellent in 86.46% of patients, good in 8.33% of patients, fair in 5.2% of patients and none of the patients had poor scores. Conclusion: The cementless hip prosthesis for the treatment of post-traumatic avascular necrosis of the femoral head in active and young individuals is a very good option. The results of cementless hip arthroplasties are good and encouraging in terms of functional outcome postoperatively. Keyword: Harris Hip Score; Uncemented Total Hip Arthroplasty; Avascular Necrosis Hip

Distal Locking of Proximal Femoral Nails in Intertrochanteric Fractures: A Comparison of Taloned and Static Locking Systems

Background: The necessity of distal locking in proximal femoral nails (PFNs) used in intertrochanteric fracture surgery is still controversial. However, the newly designed talon distalfix PFN differs from other PFN systems with its taloned distal locking (TDL) mechanism. Aim: To compare the radiologic and functional results of this newly designed TDL system and the static distal locking (SDL) system. Methods: Between January 2018 and December 2021, 142 patients over the age of 65 who underwent PFN surgery for intertrochanteric fractures in our department and underwent SDL or TDL as the distal locking mechanism were analyzed. The patients were divided into two groups as SDL and TDL according to the type of distal locking applied. Demographic variables and intraoperative data (operative time, intraoperative bleeding amount, and fluoroscopy time) were recorded. Harris hip score and Visual Analog Scale (VAS) score results were recorded to evaluate postoperative functional outcomes. Union time and all postoperative complications were recorded. Results: Of a total of 142 patients with a mean age of 77.51 ± 11.67 years, 79 underwent SDL and 63 underwent TDL. Operative time, intraoperative bleeding amount, and fluoroscopy time were significantly reduced in patients who underwent TDL compared to those who underwent SDL. The union times were found to be significantly shorter in TDL patients. There was no significant difference between the groups in terms of postoperative Harris hip score and VAS score results and complications. Conclusions: This clinical study confirms that TDL is as effective and safe as SDL. In addition, TDL has been shown to have advantages over SDL with shorter operative time, less bleeding amount, and less fluoroscopy time.