Single Hip Research Articles

Can a single sensor measure hip range of motion in hip osteoarthritis patients?

Can a single sensor measure hip range of motion in hip osteoarthritis patients?

Osteoporosis should be evaluated by bone mineral density at the combination of the lumbar spine and ipsilateral femoral neck in female patients with knee osteoarthritis scheduled for knee arthroplasty: A retrospective observational study

BackgroundKnee arthroplasty is a well-established surgery with good clinical outcomes. However, periprosthetic fractures and aseptic loosening negatively impact clinical outcomes, and osteoporosis is one of the causes of such complication. Osteoporosis is usually evaluated by bone mineral density of the lumbar spine and hip using dual-energy X-ray absorptiometry (DXA). However, the prevalence of this disease in patients with knee osteoarthritis scheduled for knee arthroplasty may be underestimated due to differences in the measurement sites. This study aimed to determine the appropriate measurement site for DXA that would not miss osteoporosis in female patients with knee osteoarthritis undergoing knee arthroplasty. MethodsWe measured bone mineral density preoperatively in the consecutive 50 female patients with knee osteoarthritis scheduled for knee arthroplasty by dual-energy X-ray absorptiometry at five sites: the lumbar spine, bilateral-total hip, and femoral neck. We then compared the prevalence of osteoporosis among the four combinations of the lumbar spine and single hip site (ipsilateral or contralateral total hip or femoral neck). ResultsOsteoporosis prevalence in the combination of the lumbar spine and ipsilateral or contralateral total hip was 32%, and that in the combination of the lumbar spine and contralateral femoral neck was 44%. Notably, the disease's prevalence in the combination of the lumbar spine and ipsilateral femoral neck was 50%, which was significantly higher than that in the other combinations. ConclusionOsteoporosis should be evaluated by bone mineral density in the combination of the lumbar spine and ipsilateral femoral neck in female patients with knee osteoarthritis scheduled for knee arthroplasty.

939 A Comparison of the Short-Term Outcomes Following Robotic-Assisted and Computer-Navigated Total Knee Replacements

Abstract Aim Total knee replacements (TKR) remain as one of the most effective procedures for restoring quality of life. Computer-navigated TKR (CN-TKR) have been consistently used for the last two decades whereas robotic-assisted TKR (RA-TKR) have been recently introduced into practice. The primary outcome of this study was to compare the early outcomes following RA-TKR and CN-TKR. Method This retrospective, single-centre, cohort study identified all the patients who underwent a TKR in the Golden Jubilee National Hospital by a single primary hip and knee replacement surgeon between 12th January 2021 and 22nd April 2022. Results were analysed for statistical significance. Results 111 patients underwent a TKR between January 2021 and April 2022. 26 patients underwent a RA-TKR using Stryker’s MAKO SmartRobotics and 85 patients underwent CN-TKR using B. Braun’s OrthoPilot®. Patients who had an RA-TKR were younger, with the average being 64 compared to 69. They also had a greater ROM pre-operatively, with an additional 9 degrees of movement on average. However, post-operatively there was no difference in ROM. There was no change in the mean length of stay (LOS), operation length, blood loss, Oxford score, EQ5-D score, and Forgotten Joint Score. At the 6-week follow-up, 96% of RA-TKR patients were either satisfied or very satisfied compared to 91% of CN-TKR patients. Conclusions This study found no significant difference in short-term clinical outcomes between RA-TKR and CN-TKR. However, a small sample size and a relatively short time frame in which data was collected limits this study to some extent and further research is recommended.

Paper 46: Modern Hip Arthroscopy for FAIS Delays the Natural History of Osteoarthritis in a Fourth of Patients: A 12-Year Follow-Up Analysis

Objectives: Little is known about the impact of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation. The purpose of this investigation was to (1) characterize the natural history of FAIS and (2) understand the impact of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of ten years. Methods: Between 2010-2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopist. Inclusion criteria were FAIS, primary unilateral hip arthroscopy (labral repair, femoroplasty, capsular closure), and minimum ten-year follow-up. The preoperative and minimum ten-year postoperative radiographs of patients were evaluated at each timepoint. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by two independent reviewers. Subgroup analyses were performed. Results: A total of 200 hips from 100 patients were available with 74% follow-up at a mean of 12.0 years were evaluated. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared to 28% (28/100) among operative hips (Table 1). At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time (Table 2). Modern hip arthroscopy conferred a relative risk reduction of 42% in osteoarthritis progression. Borderline dysplasia, age, preoperative Tönnis grade, and alpha angle > 65° were key risk factors in the radiographic progression of osteoarthritis. Conclusions: While the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history was favorably altered in a quarter of patients after arthroscopic correction (Figure 1). Modern hip arthroscopy indications and techniques represent a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Mixed patterns of impingement and instability that underwent arthroscopy were the fastest to degenerate.

Chemical neurolysis for the conservative treatment of hip fractures.

Aim: Hip fracture management is challenging when surgical risks outweigh benefits. Inadequate analgesia from conservative treatments prompted new procedures targeting hip capsule denervation. This study evaluates the efficacy and safety of single injection chemical hip neurolysis in the pericapsular nerve group plane.Materials & methods: In eligible patients, an ultrasound-guided diagnostic block was performed using 5ml of 2% lidocaine in the pericapsular nerve group plane. If positive, 6ml of 99.9% alcohol was administered.Results: From May 2022 to May 2023, five patients underwent hip neurolysis. None reported pain at day 5 or during follow-up. There were no adverse effects.Conclusion: Chemical neurolysis seems to provide effective and safe conservative treatment for hip fractures, offering reliable analgesia for nonsurgical candidates.

Multiple Joint Arthroplasty in Hip and Knee Osteoarthritis Patients: A National Longitudinal Cohort Study

BackgroundMany patients suffer from osteoarthritis (OA) in multiple joints, possibly resulting in multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (Cin) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients. MethodsPrimary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year Cin (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression. ResultsA total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year Cin for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year Cin for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small. ConclusionsThe 10-year Cin showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA.

Return to Cycling After Total Joint Arthroplasty

BackgroundAs total joint arthroplasty (TJA) candidates become younger, patients’ expectations continue to expand. We surveyed our patient population to determine rates of return to cycling after TJA so that we could provide more accurate counseling on performance and safety. MethodsAt our single institution, an online survey was generated and sent out to patients who had at least 3 months of follow-up. Patients were split into 4 categories based on surgery type: single total hip arthroplasty (THA), single total knee arthroplasty (TKA), multiple TJA, and revision TJA. ResultsA total of 1,029 surveys fit the inclusion criteria. The average age of the patient population was 69 years, with an average of 4.08 years from their time of most recent TJA surgery (maximum follow-up of 18.61 years). Nearly all those who were able to bike prior to surgery were able to return to cycling, with only 6% not being able to do so. There were 41.8% who returned to cycling less than 3 months after surgery. Most cyclists were able to return to their previous level. Patients who had a revision TJA had significantly lower rates of returning to cycling in comparison to single TKA, single THA, and multi-TJA (37.3%, 60.3%, 61.9%, and 60.3%, respectively, P < .005). Patients who never returned to cycling had higher revision rates in comparison to those who were able to get back on a bike (14.4 versus 9.2%, P = .01). ConclusionsA large proportion of patients who had prior cycling experience were able to return to bike riding within 3 to 6 months after TJA. Individuals who had revision TJA had lower rates of return to cycling in comparison to single TKA, single THA, and multi-TJA. Returning to cycling did not result in higher rates of revision.

THE EFFECT OF TRADITIONAL MAT EXERCISES VERSUS REFORMER PILATES AND HAMMOCK YOGA ON PAIN, ENDURANCE, BALANCE, DISABILITY, AND QUALITY OF LIFE IN INDIVIDUALS WHO HAD CHRONIC BACK PAIN

Objective: The aim of this study to examine the effects of traditional mat exercises, Reformer Pilates (RP) and Hammock Yoga (HY) approaches on pain, endurance, balance, disability, and quality of life of individuals who had Chronic low back pain (LBP). Method: 60 individuals who had Chronic LBP were participated and randomly attended into 3 groups as RP group (n=20, mean age:31.85±8.89 years), HY group (n=20, mean age:29.90±6.70 years), and mat group (n=20, mean age:30.40±8.21 years). All exercise training was applied twice a week for 4 weeks (45 minutes). The pain was evaluated with VAS and McGill, endurance was evaluated with plank tests and single leg hip bridge test, static balance was assessed with standing on single leg, and dynamic balance was assesed with the Star Excursion Balance Test. The Oswestry Disability Questionnaire and World Health Organization Quality of Life (WHOQOL-Bref) were used for disability and quality of life measurements, respectively. Results: Improvements were observed on a group basis in all evaluated parameters (p

Effect of hot isostatic pressing and heat treatment on the evolution of precipitated phase and mechanical properties of GH3230 superalloy fabricated via selective laser melting

In this paper, the microstructure and mechanical properties of SLM-GH3230 superalloy treated by different post treatments (single hot isostatic pressing and heat treatments after hot isostatic pressing) were studied. The micro-morphologies show that the grains along building direction after HIP + HT are mainly columnar grains, which is consistent to that after single HIP. The granular precipitates distribute intergranularly and intragranularly after HIP, but gradually re-dissolve into matrix with the increase of the temperature of the post HT processes. XRD and EDS analyses results indicate that the matrix mainly consists of austenitic γ phase and the granular precipitates are mainly M6C carbides enriched in W element. The average grain size decreases after HT compared to that after HIP, and the crystallographic orientation of grains tends to be more uniform. The Vickers hardness decreases after HIP and HIP + HT processes within a certain degree. According to tensile test results, the sample shows a better combination of strength and plastic performance under HIP+1250 °C/30 min processing, which can also be verified by the characteristic of the fracture morphology with more tearing dimples.

Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis.

Little is known about the effect of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation. To (1) characterize the natural history of FAIS and (2) understand the effect of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of 10 years. Cohort study; Level of evidence, 3. Between 2010 and 2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopic surgeon. Inclusion criteria were FAIS, bilateral radiographic findings of femoroacetabular impingement, primary unilateral hip arthroscopy (labral repair, femoroplasty, or capsular closure), and minimum 10-year follow-up. The preoperative and minimum 10-year postoperative radiographs of patients were evaluated at each time point. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by 2 independent reviewers. Subgroup analyses were performed. A total of 200 hips from 100 patients were evaluated at a mean follow-up of 12.0 years. Preoperatively, 98% and 99% of operative and nonoperative hips were evaluated as Tönnis grades 0 and 1, respectively; 5% of nonoperative hips had worse Tönnis grades than operative hips. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared with 28% (28/100) among operative hips. At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time. Modern hip arthroscopy was associated with a relative risk reduction of 42% in osteoarthritis progression. Impingement with borderline dysplasia, age, preoperative Tönnis grade, and alpha angle >65° were key risk factors in the radiographic progression of osteoarthritis. Although the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history may be favorably altered for 25% of patients whose Tönnis grade was better after undergoing arthroscopic correction. Modern hip arthroscopy indications and techniques represent a valid joint-preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Arthroscopy for mixed patterns of impingement and instability were the fastest to degenerate.

Powered single hip joint exoskeletons for gait rehabilitation: a systematic review and Meta-analysis.

Gait disorders and as a consequence, robotic rehabilitation techniques are becoming increasingly prevalent as the population ages. In the area of rehabilitation robotics, using lightweight single hip joint exoskeletons are of significance. Considering no prior systematic review article on clinical outcomes, we aim to systematically review powered hip exoskeletons in terms of gait parameters and metabolic expenditure effects. Three databases of PubMed, Scopus, and Web of science were searched for clinical articles comparing outcomes of gait rehabilitation using hip motorized exoskeleton with conventional methods, on patients with gait disorder or healthy individuals. Of total number of 37 reviewed articles, 14 trials were quantitatively analyzed. Analyses performed in terms of gait spatiotemporal parameters like speed (self-speed and maximum speed), step length, stride length, cadence, and oxygen consumption. Improved clinical outcomes of gait spatiotemporal parameters with hip joint exoskeletons are what our review's findings show. In terms of gait values, meta-analysis indicates that rehabilitation with single hip joint exoskeleton enhanced parameters of maximum speed by 0.13 m/s (0.10-0.17) and step length by 0.06 m (0.05-0.07). For the remaining investigated gait parameters, no statistically significant difference was observed. Regarding metabolic parameters, oxygen consumption was lower in individuals treated with hip exoskeleton (- 1.23 ml/min/kg; range - 2.13 to - 0.32). Although the analysis demonstrated improvement with just specific gait measures utilizing powered hip exoskeletons, the lack of improvement in all parameters is likely caused by the high patient condition heterogeneity among the evaluated articles. We also noted in patients who rehabilitated with the hip exoskeleton, the oxygen cost was lower. More randomized controlled trials are needed to verify both the short- and long-term clinical outcomes, including patient-reported measures. Level I (systematic review and meta-analysis).

The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis

Abstract Objectives Evidence for the comparative cost-effectiveness of intra-articular corticosteroid injection in people with hip osteoarthritis (OA) remains unclear. This study investigated the cost-effectiveness of best current treatment (BCT), comprising advice and education, with BCT plus a single ultrasound-guided intra-articular hip injection of 40 mg triamcinolone acetonide and 4 ml 1% lidocaine hydrochloride (BCT+US-T). Methods A trial-based cost–utility analysis of BCT+US-T compared with BCT was undertaken over 6 months. Patient-level cost data were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a UK National Health Service (NHS) perspective. Results BCT+US-T was associated with lower mean NHS costs (BCT+US-T minus BCT: −£161.6; 95% CI: −£583.95, £54.18) and small but significantly higher mean QALYs than BCT alone over 6 months (BCT+US-T minus BCT: 0.0487; 95% CI: 0.0091, 0.0886). In the base case, BCT+US-T was the most cost-effective and dominated BCT alone. Differences in total costs were driven by number of visits to NHS consultants, private physiotherapists and chiropractors, and hip surgery, which were more common with BCT alone than BCT+US-T. Conclusion Intra-articular corticosteroid injection plus BCT (BCT+US-T) for patients with hip OA results in lower costs and better outcomes, and is highly cost-effective, compared with BCT alone. Trial registration EudraCT: 2014-003412-37 (8 August 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (28 July 2015). Trial protocol Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0, doi: doi.org/10.1186/s12891-018-2153-0.

Single-stage bilateral conversion arthroplasty for hip fusion via direct anterior approach in a patient with severe ankylosing spondylitis and kyphoscoliosis: a case report

BackgroundSevere ankylosing spondylitis (AS) frequently involves hip joints and, occasionally, presents with concurrent spinal deformities, such as kyphoscoliosis, creating complex challenges for surgical management.Case presentationWe present a 26-year-old Persian male with a history of AS and severe kyphoscoliosis, leading to bilateral hip fusion and immobility. Following spinal deformity correction, a one-stage bilateral conversion to total hip arthroplasty (THA) was conducted through the direct anterior approach.ConclusionPrimary correction of spinal deformities allows for extended surgical procedures under general anesthesia. Single stage bilateral hip conversion arthroplasty via the direct anterior approach enhances postoperative mobilization, reduce the risk of re-ankylosis, and improve the overall quality of life for AS patients with this unique presentation.

Increased Rates of Late Periprosthetic Fractures in Larger Hydroxyapatite-Coated Cementless Stems: Are Collared Stems a Better Alternative for Total Hip Arthroplasty?

BackgroundCementless hip stems are widely used for total hip arthroplasty (THA) and have demonstrated excellent survivorship. This study aimed to investigate the effects of stem size and calcar collars on rates of revision due to periprosthetic fracture. MethodsAll primary THA procedures recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from September 1999 to December 2021 for a diagnosis of osteoarthritis using a single cementless hip stem with modern bearings were included. The primary outcome measure was revision due to periprosthetic fracture. Stems were divided into 2 groups for comparison, large (size 14 to 20) and small-medium (6 to 13). A subanalysis was performed for collared stems. A total of 59,518 primary THA procedures were included. ResultsThe cumulative percent revision for periprosthetic fracture was significantly higher for large stems compared to small-medium stems (hazard ratio [HR] = 1.57 [95% confidence interval {CI} 1.18, 2.09] P = .002). Furthermore, collared stems had significantly lower revision rates due to late periprosthetic fracture compared to collarless variants (2 week + HR = 4.55 [95% CI 3.23, 6.42], P < .001). Large collarless stems were found to have greater revision rates due to fracture compared to small-medium collarless stems (HR = 1.55 [95% CI 1.13, 2.12] P = .006), but no difference was found between collared groups (HR = 1.37 [95% CI 0.68, 2.78] P = .382). ConclusionLarge cementless hip stems have a higher rate of revision due to periprosthetic fracture compared to small-medium stems. Using a collared stem reduces the rate of periprosthetic fracture.

Etiology and Exercise Treatment of Patellofemoral Pain Syndrome

Objective: As a result of peripatellar pain or anatomical or biomechanical anomalies in the anterior knee, patellofemoral pain syndrome (PFPS) is a knee injury that can be made worse by weight-bearing activities like climbing and descending stairs. According to long-term follow-up studies, patellofemoral arthritis may eventually develop in 45% of PFPS patients who do not receive prompt and efficient treatment in the early stages, causing irreparable harm that may significantly impair the patient's quality of life. In order to prevent injuries, enhance daily life activities and athletes' sporting performance, it is important that we understand the mechanism and exercise treatment of PFPS. Methods: We reviewed the China Knowledge Network (CNKI) and PubMed life science database, searched for the terms "patellofemoral pain syndrome," "patellar tenderness," "running knee," and "anterior knee pain," and summarized the pertinent research. Results: Its cause is still unknown, and its etiology is complicated, with the main contributing factors being poor lower extremity function, decreased muscle strength, lack of flexibility, and impaired neuromuscular control. The majority of exercise therapy currently performed includes training the hip, knee, core, retraining the gait, and blood flow restriction training. The impact of the condition may depend on quick and efficient interventions. Conclusion: Exercise therapy had the strongest evidence base, particularly for the positive effects of either single hip or knee muscle strength training or a combination of the two, according to systematic evaluations that came to conclusions about the effectiveness of interventions. However, there was insufficient evidence to determine the ideal form of training and long-term effects. Contrarily, there is still scant evidence to support interventions such as gait retraining, blood flow restriction training, and core stability training. When it comes to selecting a course of treatment, a combination of treatments is typically advised and chosen in accordance with the precise evaluation of the patient's condition.

Comparative Study of Pre-operative, Operative, and Post-operative Parameters of Single and Staged Bilateral Total Hip Replacement

Objectives Total Hip replacement (THR) is now emerging as the most successful surgery that can drastically improve the quality of life of an arthritis patient. Bilateral (B/L) hip involvement is seen in many cases where there is a treatment option of operation on both hips in a single operation under single anesthesia or a staged operation. The present study aims to compare the pre-operative, operative, and post-operative parameters of single operation Bilateral Total Hip Replacement (B/L THR) and staged B/L THR (two operations in stages; second operation done after 6–7 days). Material and Methods 97 B/L THR cases were included in a retrospective cohort study operated Delete conducted 2017–2021 under a single surgeon in a tertiary care hospital. The age, sex, and Body Mass Index (BMI) - matched cases were divided into Group 1-single B/L THR and Group 2-staged B/L THR. The patients were assessed on blood loss during surgery and post-surgery up to 24 h, time to reach visual pain analog score of baseline 3, pre and post-operative Harris Hip score, post-operative hemoglobin (Hb) level, infection, dislocation, deep vein thrombosis and duration of hospital stay. Results Thirty-seven cases of Group 1 Single B/L THR and 60 cases of Group 2-Staged B/L THR were analyzed. The time taken for pain to decrease was more in Single B/L THR which was statistically significant. Even though the intra-operative and post operative blood loss was not statistically significant, still more number of cases showed greater blood loss in Staged B/L THR. The pre-operative and post-operative hip functionality outcome was statistically same in both groups. Complications like deep vein thrombosis (DVT) showed lower incidence in Single B/L THR; and equal incidence of infection in both groups. The duration of hospital stay was more in Staged B/L THR. The statistical significance of longer duration of pain in Staged B/L THR can be explained on basis of two injuries inflicted by two operations 6–7 days apart. Harris Hip score for assessing hip functionality did not show statistical significance indicating that both single and staged show similar improvement of hip function. Lower incidence of DVT in Staged B/L THR can be attributed to early mobilization and physiotherapy. Conclusion On the basis of the above study, we conclude that Single B/L THR is feasible, safe and cost-effective with similar functional outcomes and early return to the society. Therefore, it should be encouraged in tertiary care hospitals.

Diagnosis and treatment of 10 cases of idiopathic chondrolysis of the hip.

To analyze the clinical characteristics, X-ray and magnetic resonance imaging manifestations, and treatment efficacy of idiopathic chondrolysis of the hip. Ten patients with idiopathic chondrolysis of the hip treated at our hospital from September 2013 to April 2022 were collected, and their clinical features, X-ray and magnetic resonance imaging manifestations, and treatment outcomes were analyzed. Their main clinical features included single hip pain, claudication gait, and pelvic tilt, without specific clinical symptoms and signs. Laboratory tests such as blood analysis, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, autoimmune test, coagulation function, interferon release test for tuberculosis infection, and tuberculosis antibody test were normal. In the late stage, the imaging shows degeneration or ankylosis of the joint. The disease progresses rapidly, and joint degeneration can occur in adolescence without effective treatment. Herein, seven patients were treated with recombinant human tumor necrosis factor receptor-antibody type II fusion protein. Among them, four (according to Camarnat magnetic resonance imaging classification, three were Stage I and one was Stage II) showed improved symptoms and function, while two (Stage III) had progressed. One patient (Stage I) who received recombinant human tumor necrosis factor receptor had no significant relief of symptoms, for whom anterior capsular release surgery significantly improved the hip joint motion. Of the four patients who underwent hip release surgery, three showed progression. Idiopathic chondrolysis of the hip has no specific clinical and laboratory tests and a high misdiagnosis rate. Thus, early magnetic resonance imaging is a critical reference for diagnosis. We recommend that patients with magnetic resonance imaging Stage II or earlier be actively treated with recombinant human tumor necrosis factor receptor and start treatment as early as possible. In the third stage, the treatment effect is mediocre, and the narrowed hip space is difficult to change.

Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study

PurposeUni- or bilateral hip osteoarthritis is a common disease generating pain, stiffness, and functional disabilities. Changes in the normal walking with higher energy expenditures are observed. Facing a cruel lack of biomechanical data, we decided to analyse the impact on the walking of single and simultaneous bilateral total hip arthroplasties (THA).MethodWe conducted a prospective monocentric study, comparing two matched groups of 15 patients able to walk with symptomatic isolated uni- (group 1) or bilateral HO (group 2) and treated respectively by unilateral THA (UTHA) or simultaneous bilateral THA (SBTHA). Surgery was performed by a single surgeon with a direct anterior approach and approved by local ethical committee. Walking was assessed by a « 3D Gait analysis motion» pre and at 6 months post operatively.ResultIn the UTHA group, recovery, i.e., efficiency of locomotor mechanism (p < 0.001) and pelvis sagittal balance (p = 0.031) improved, while external and total work (p = 0.010) decreased post operatively. In the SBTHA group, speed (p = 0.035), step length (p = 0.046), range of motion of knee sagittal stance (p = 0.009) and hip frontal (p = 0.031), and internal work are significatively higher (p < 0.001) post operatively.ConclusionsThis original study attests that THA has a positive impact on walking and energetics outcome in UTHA and SBTHA.

An in vitro methodology for experimental simulation on the natural hip joint.

Different hip pathologies can cause geometric variation of the acetabulum and femoral head. These variations have been considered as an underlying mechanism that affects the tribology of the natural hip joint and changes the stress distribution on the articular surface, potentially leading to joint degradation. To improve understanding of the damage mechanisms and abnormal mechanics of the hip joint, a reliable in-vitro methodology that represents the in vivo mechanical environment is needed where the position of the joint, the congruency of the bones and the loading and motion conditions are clinically relevant and can be modified in a controlled environment. An in vitro simulation methodology was developed and used to assess the effect of loading on a natural hip joint. Porcine hips were dissected and mounted in a single station hip simulator and tested under different loading scenarios. The loading and motion cycle consisted of a simplified gait cycle and three peak axial loading conditions were assessed (Normal, Overload and Overload Plus). Joints were lubricated with Ringer’s solution and tests were conducted for 4 hours. Photographs were taken and compared to characterise cartilage surface and labral tissue pre, during and post simulation. The results showed no evidence of damage to samples tested under normal loading conditions, whereas the samples tested under overload and overload plus conditions exhibited different severities of tears and detachment of the labrum at the antero-superior region. The location and severity of damage was consistent for samples tested under the same conditions; supporting the use of this methodology to investigate further effects of altered loading and motion on natural tissue.

Paper 45: Preoperative MRI Offers Minimal Clinical Utility, Delays Access to Hip Arthroscopy, and Lacks Cost-Effectiveness in Patients Aged 40 or Under with Classic Femoroacetabular Impingement Syndrome: A Retrospective 5-Year Analysis

Objectives: Background:The volume of hip arthroscopy for femoroacetabular impingement syndrome(FAIS) has dramatically risen, and data increasingly supports early intervention from symptom onset. In an increasingly value-conscious environment, the practice of routinely acquiring preoperative MRIs for primary hip arthroscopy patients in the setting of FAIS defined by concordant history, physical exam, and radiographs may offer questionable clinical utility, waste healthcare resources, and negatively impact patient outcomes by delaying access to care.Hypothesis/Purpose:The primary purpose of the present study was to determine whether preoperative MRI provided clinical utility for patients aged 40 or under with FAIS undergoing primary hip arthroscopy. A secondary purpose was to quantify the delay in care due to ordering the preoperative MRI.Methods:A cohort of 1,786 consecutive patients who underwent hip arthroscopy between August 27, 2015, and December 31, 2020, were reviewed from the practice of a single fellowship-trained hip arthroscopist at a quaternary referral center. Our inclusion criteria were as follows: primary hip arthroscopy for FAIS and age 40 years or under. Patients were excluded if they presented to the office already with an MRI, had a contraindication to undergo MRI, elected to reattempt a second round of conservative management, or underwent a concomitant periacetabular osteotomy. The interpretation of the preoperative MRI was subsequently compared to the in-office evaluation, consisting of history, physical exam, and plain radiographs, as well as the intraoperative findings at the time of hip arthroscopy to assess for agreement. In addition to baseline demographic data, time from initial office evaluation to MRI completion and time from MRI to hip arthroscopy were recorded.Results:A total of 198 patients met the criteria for evaluation, 70% of which were female. Mean BMI and age were 25.6 and 24.8, respectively. All 198 patients had MRI findings demonstrating anterosuperior labral tears that were again re-demonstrated and repaired intraoperatively during hip arthroscopy. Of the three patients with questionable articular cartilage pathology noted on MRI, none required surgical treatment or reoperations to address cartilage pathology. No patients underwent primary labral reconstruction. The mean time from in-office FAIS diagnosis to noncontrast MRI acquisition was 15.0 days. The mean time from MRI to hip arthroscopy was 73.0 days.Conclusions:Preoperative MRI for patients with FAIS aged 40 or under undergoing primary hip arthroscopy provides little to no actionable clinical information with respect to the labrum or cartilage and may in turn negatively impact outcomes by delaying access to care unnecessarily by at least two weeks. Whether driven by practice dogma from referring physicians or arbitrary insurance preauthorization standards, the necessity of routine preoperative MRI in the young hip population with FAIS indicated for primary hip arthroscopy should be challenged by all relevant stakeholders from both clinical and value-based perspectives.FAIS. Time from initial visit to MRI and MRI to procedure.Table 1.Demographic data for cohort of included patients