Standard Total Hip Arthroplasty Research Articles

Contemporary posterior surgical approach with standard cemented total hip arthroplasty for femoral neck fracture in patients of age 60 years and older: Still a safe option?

PurposeThe ideal operative treatment of displaced intracapsular femoral neck fractures in the active elderly is contentious. Recent literature favours a better outcome with the use of total hip arthroplasty (THA). Dislocation remains a major concern with THA, especially when a posterior approach is used. More recently, the concept of dual mobility cups is being promoted to avoid dislocations. The aim of the present study was to look at the outcomes of cemented THA utilising the posterior approach for these patients using a 28 ​mm (mm) femoral head. MethodsThis study retrospectively analysed the outcome of 108 primary cemented THA, performed by specialist hip surgeons, using a posterior approach with robust soft tissue repair in patients of age 60 years and older presenting with displaced intra capsular femoral neck fractures using a 28 ​mm head. ResultAt mean follow-up of 5.2 years (2.0–10.5 years), there were 2 dislocations (1.9%). One underwent manipulation under anaesthesia and the other had application of a posterior lip augmentation device. No other revisions were performed during the follow up period. The 30 day mortality was nil and no post-operative deep infections. Hundred patients (93%) at 1 year follow-up were independently mobilising. ConclusionsWith optimal patient selection, an excellent outcome can be achieved for patients with displaced femoral neck fractures using the standard cemented THA via the posterior approach with 28 ​mm head. A robust soft tissue repair and a specialist hip surgeon is recommended for this cohort of patients.

A propensity score-matched analysis on the impact of patient and surgical factors on early periprosthetic joint infection in minimally invasive anterolateral and transgluteal total hip arthroplasty.

Increased risk of periprosthetic joint infection (PJI) in minimally invasive (MIS) total hip arthroplasty (THA) is still debated. This study aimed to identify differences in surgical and patient-related risk factors for PJI between an MIS anterolateral approach and transgluteal-modified Hardinge approach. A retrospective cohort of 5315 THAs performed between 2006 and 2019 at a single institution was screened. Short stem THAs performed via an MIS anterolateral approach in the supine position and standard straight stem THAs performed via a transgluteal modified Hardinge approach were included. Propensity score matching was performed to control for selection bias. After matching, 1405 (34.3%) short stem THAs implanted via MIS anterolateral approach and 2687 (65.7%) straight stem THAs implanted via a transgluteal modified Hardinge approach were included. The risk of PJI due to patient-specific and surgical factors was retrospectively analyzed using chi-square test and multivariate regression analysis. PJI occurred in 1.1% in both MIS anterolateral and transgluteal approach (p = 0.823). Multivariate regression showed an increased infection risk for patients with a BMI between 35 and 39.99kg/m2 (OR 6.696; CI 1.799-24.923; p = 0.005), which could not be demonstrated for transgluteal approach (OR 0.900; CI 0.900-4.144; p = 0.93). A BMI ≥ 40kg/m2 (OR 14.150; CI 2.416-82.879; p = 0.003) was detected as a risk factor for PJI only in anterolateral approach. Increased operation time ≥ 121min showed a significantly increased risk for PJI in the general cohort (OR 6.989; CI1.286-37.972; p = 0.024). Minimally invasive anterolateral and transgluteal THA show a comparable rate of early PJI within the first year of index surgery. A BMI of ≥ 35kg/m2 was detected as a clear risk factor for infection in the anterolateral approach. Prolonged operation time ≥ 121min increases the risk of PJI regardless of approach.

PROMs in Total Hip Arthroplasty: A Comparison between Robotic Mako Assisted Versus Manual Technique

Study Purpose: The purpose of this observational study is to evaluate the degree of satisfaction and improvement in quality of life through PROMs (Patient Related Outcome Measures), which were administered to patients who underwent Total Hip Arthroplasty (THA) by robotic-arm assisted technique (RIO®, MAKO Surgical Corporation). These data were then compared to a sample of patients operated on by standard manual technique. Both groups were operated on by the same surgical team, in the same hospital, and were subjected to the same recommendation and rehabilitation protocols. Surgeries were performed from November 2017 to March 2019 at a hospital in Asl Toscana Sudest. Endpoint of our study is to verify the rate of improvement – which is assumed to be stable one year after surgery – and how the satisfaction rate increases over time. Another aim is to determine – through the use of Forgotten Joint Score questionnaires and the satisfaction scale – whether there is a difference between arthroplasty operated on by standard manual technique vs robotic-assisted method one year after surgery. Method: Patients who undergone robotic-assisted surgery were evaluated before surgery, at discharge, 1, 4 and 12 months after surgery. 70 robotic-assisted THA patients were studied for a whole year, while 31 standard-technique THA patients were evaluated only 12 months after surgery. PROMs post-surgical evaluations occurred during follow-up visits by orthopedists and physiotherapists. Harris Hip Score (HHs), Oxford Hip score (OHS), EQol VAS (Dimension Visual Analogue Scale), LiKert satisfaction scales were used. Likert scale was administered only 4 and 12 months after (no significant results before this time). The Forgotten Joint Scale (FJS) and the satisfaction scale were administered 1 year after surgery both in robotic-assisted and standard manual THA patients (70 robotic-assisted THA vs 31 standard THA). They were operated on in the same period by the same surgical team, with the presence of a senior surgeon, and were subjected to the same rehabilitation protocols by the same team of physiotherapists.Results: 70 robotic-assisted THA were analyzed (30 l, 40r), with a mean age of 63, 76 years. The average hospital stay in acute care settings was 3.07 days. 40 patients then continued in the rehabilitation department after discharge for further 2.98 days. HHs scale gave a value of 54, 94±14, 71 before surgery and 98, 63±2, 54 one year after surgery. OHS scale reported a value of 21, 27±9, 24 before surgery and 47±2, 06 one year after surgery. The EqolVas scale had a value of 56, 23±20, 04 before surgery and 81, 25±15, 84 one year after. 4 months after surgery, the satisfaction rate was 4, 67±0, 61 and 12 months later was 4, 77±0, 54. The FJS scale in 70 robotic-operated patients had a value of 86, 24±21, 1 and it has been compared to a group of 31 standard-operated patients, whose values were 87, 02±16, 57 and P=0,86. 12 months after surgery, the satisfaction rate for robotic-operated patients was 4, 77±0, 54 and 4, 47±0, 83 and P<0, 05 for standard-operated patients, thus statistically significant. Conclusion: Patients undergoing hip arthroplasty surgery all have a high level of expectations and clinical outcomes are very satisfactory, while knee replacements have more limitations and less appreciable results. Some studies regarding THA report more favorable short-to-medium-term outcomes, fewer transfusions, and fewer days of hospital stay by the use of the roboticassisted technique, when compared to the standard manual surgery. Differences in function and quality of life after 1 year from the two types of surgery tend to decrease, although in our study the satisfaction rate of the robotic-assisted surgeries was statistically significant compared to the standard manual technique. Furthermore, it has been noticed that the rate of functional improvement, well-being, satisfaction and quality of life increases over time after surgery. At the first year of follow-up, no statistically significant differences are shown between the robotic-assisted and standard sample concerning the FJS scale.

Hip arthroplasty dislocation risk calculator: evaluation of one million primary implants and twenty-five thousand dislocations with deep learning artificial intelligence in a systematic review of reviews.

This paper aims to provide an overview of the possibility regarding the artificial intelligence application in orthopaedics to predict dislocation with a calculator according to the type of implant (hemiarthroplasty, standard total hip arthroplasty, dual mobility, constrained cups) after primary arthroplasty. Among 75 results for primary arthroplasties, 26 articles were reviews on dislocation after hemiarthroplasty, 40 after standard total hip arthroplasty, seven about primary dual-mobility arthroplasty (DM THA), and two reviews about constrained implants. Although our search method for systematic reviews covers ten years (2012-2022), none for dual mobility was published before 2016, showing a recent explosion of original articles on this subject. A total of 1,069,565 implants and 26,488 dislocations in primary arthroplasties are included in these 75 reviews. We used a supervised learning model in which models assign objects to groups as input and artificial neural network (ANN) with nodes, hidden layers, and output layers. We considered only four implant types as the input layer. We considered the patient's factors (indication for THA, demographics, spine surgery, and neurologic disease) as the second input values (hidden layer). We considered the implant position as the third input (hidden layer) property including head size, combined anteversion, or spinopelvic alignment. Surgery-related factors, approach, capsule repair, etc. were the fourth input values (hidden layer). The output was a post-operative dislocation or not within three months. The accuracy for predicting dislocation with this systematic review was 95%. Dislocation risk, based on the type of implant, was wide-ranging, from 0 to 3.9% (mean 0.31%) for the 3045 DM THA, from 0.2 to 1.2% (overall 0.91%) for the 457 constrained liners, from 1.76 to 4.2% (mean 2.1%) for 895,734 conventional total hip arthroplasties, and from 0.76 to 12.2% (mean 4.5%) for 170,329 hemiarthroplasties. In the conventional THA group, many factors increase the risk of dislocation according to the calculator, and only a few (big head, anterior approach) decrease the risk, but not very significantly. In the hemiarthroplasty group, many factors can increase the risk of dislocation until 30%, but none could decrease the risk. According to the calculator, the DM THA and the constrained liner markedly decreased the risk and were not affected by implant position, spine surgery, and spinopelvic position. To our knowledge, this study is the first to yield an implant-specific dislocation risk calculator that incorporates the patient's comorbidities, the position of components, and surgery factors affecting instability risk.

Comparison of Premium Technology Utilization in Total Hip Arthroplasty Between Safety-net Hospitals and Non-safety-net Hospitals.

The objective of our study was to investigate the association of safety-net hospital (SNH) status with the use of premium technologies in total hip arthroplasty (THA) using the American Academy of Orthopaedic Surgeons American Joint Replacement Registry. Premium technology was defined as having one or more of the following three characteristics: ceramic femoral head, dual mobility (DM) bearing, or surgery conducted with robotic assistance (RA). Patients of all ages were included and subdivided into ceramic femoral head, DM, and RA cohorts. SNH status (based on disproportionate share data), patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Multivariate regression analysis was conducted to analyze any notable associations. A total of 624,933 THAs between SNHs and non-SNHs were available for analysis. Based on the three different premium technology categories, there were 551,838 THAs for ceramic femoral head utilization analysis, 601,223 THAs for DM utilization analysis, and 199,250 THAs for RA utilization analysis. SNHs were associated with less use of DM and RA (odds ratio [OR] 0.53 P < 0.0001, 0.39 P < 0.0001, respectively). No difference was observed in ceramic femoral head utilization between SNHs and non-SNHs. Patient age was significantly associated with less utilization of all three premium THA technologies (ceramic: OR 0.43 P < 0.0001; DM: OR 0.93 P < 0.0001, RA: OR 0.89 P < 0.001). Teaching hospitals were significantly associated with increased utilization of premium THA technologies (ceramic: OR 1.23 P < 0.0001, DM: OR 1.62 P < 0.0001, RA: OR 5.33 P < 0.001). Premium THA technologies are becoming increasingly used across the US healthcare system; however, that growth is not equal in hospitals with marginalized patient populations. The utilization of ceramic femoral heads is becoming increasingly common across healthcare systems suggesting that ceramic femoral heads may no longer be considered premium technology but rather standard THA care. Level III.

Surgical Approaches in Primary Total Hip Arthroplasty: Systematic Review of Randomized Controlled Trials

AbstractThe aim of this study was to provide an overview of randomized controlled trials (RCTs) of surgical approaches in primary total hip arthroplasty (THA), summarizing the available high-quality evidence. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we performed the electronic searches in January 2021. We searched the Cochrane Central Register of Controlled Trials (2021, Issue 1), Ovid MEDLINE (including e-pub ahead of print, in-process, and other non-indexed citations, Ovid MEDLINE Daily, Ovid MEDLINE and Versions) (1946–January 20, 2021), and Embase (1980–January 20, 2021). We limited our search to English language literature. We excluded nonrandomized trials, trials on neck of femur fractures or revision surgery, systematic reviews, and meta-analyses. Trials that met our inclusion criteria were assessed using a binary outcome measure of whether they reported statistically significant findings. These were then classified according to the intervention groups. A total of 72 RCTs met the inclusion criteria. The total number of patients in those trials was 6,728. Only five RCTs (5.9%) reported significant differences between the intervention and the control groups. The largest subgroup of trials was minimally invasive versus standard techniques (18 RCTs) with no significant differences. Standard (lateral, posterior) approaches were compared in 23 RCTs with only 1 RCT reporting significant differences. Thirteen RCTs evaluated mini-incisions, with only 1 RCT reporting significant differences, and the remaining 18 RCTs evaluated variations of surgical approaches and interventions, with 3 RCTs reporting significant differences. The evidence reviewed indicates that for the vast majority of patients, a standard THA approach familiar to the surgeon leads to comparable outcomes. Level of evidence is II.

Prognostic role of affected side of the sacroiliac joint in pain recurrence after total hip arthroplasty with prior manual correction of iliosacral dislocation: prospective randomized clinical study.

Degenerative changes in the hip joint as indications for operative treatment are observed in more than a third of the population over the age 50. In most cases, the development of a degenerative process in the hip joint is accompanied by changes in the sacroiliac joint. To improve the quality of life, relieve pain, and improve the clinical outcomes of rehabilitation after total hip arthroplasty (THA), an integrated approach should be chosen. Eighty-four patients were enrolled in a prospective randomized study, between 2017 and 2020. The patients were randomly (with the use of computer) divided into two groups (42 to group I, 42 to group II). The first group of patients underwent surgery using a new technique that included intra-operative manual correction of iliosacral dislocation of the sacroiliac joint, whilst the second group of patients underwent THA according to the standard protocol. All groups of patients underwent THA. Clinical treatment outcomes were assessed with the use of the Visual Analogue Scale (VAS) and the Harris Hip Score (HHS). Kaplan-Meier estimator was constructed to determine the differences in the probability of recurrence of pain syndrome depending on the side of the dislocated sacroiliac joint. NCT04673747 (ClinicalTrials.gov identifier). There was a significant pain relief and an improvement in the quality of life of patients who underwent intra-operative manual correction of sacroiliac joint dislocation compared with the group of patients who underwent standard THA. The use of intra-operative manual correction of sacroiliac joint dislocation can lead to a pronounced improvement in the quality of life of patients, pain decrease, and an improvement in rehabilitation of patients after performing THA. According to the analysis of statistical data, a potential risk factor for recurrence of pain, is the presence of dislocation on the contralateral side from the operated joint.

Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants.

The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations.

Can robotic technology mitigate the learning curve of total hip arthroplasty?

AimsTraditionally, acetabular component insertion during total hip arthroplasty (THA) is visually assisted in the posterior approach and fluoroscopically assisted in the anterior approach. The present study examined the accuracy of a new surgeon during anterior (NSA) and posterior (NSP) THA using robotic arm-assisted technology compared to two experienced surgeons using traditional methods.MethodsProspectively collected data was reviewed for 120 patients at two institutions. Data were collected on the first 30 anterior approach and the first 30 posterior approach surgeries performed by a newly graduated arthroplasty surgeon (all using robotic arm-assisted technology) and was compared to standard THA by an experienced anterior (SSA) and posterior surgeon (SSP). Acetabular component inclination, version, and leg length were calculated postoperatively and differences calculated based on postoperative film measurement.ResultsDemographic data were similar between groups with the exception of BMI being lower in the NSA group (27.98 vs 25.2; p = 0.005). Operating time and total time in operating room (TTOR) was lower in the SSA (p < 0.001) and TTOR was higher in the NSP group (p = 0.014). Planned versus postoperative leg length discrepancy were similar among both anterior and posterior surgeries (p > 0.104). Planned versus postoperative abduction and anteversion were similar among the NSA and SSA (p > 0.425), whereas planned versus postoperative abduction and anteversion were lower in the NSP (p < 0.001). Outliers > 10 mm from planned leg length were present in one case of the SSP and NSP, with none in the anterior groups. There were no outliers > 10° in anterior or posterior for abduction in all surgeons. The SSP had six outliers > 10° in anteversion while the NSP had none (p = 0.004); the SSA had no outliers for anteversion while the NSA had one (p = 0.500).ConclusionRobotic arm-assisted technology allowed a newly trained surgeon to produce similarly accurate results and outcomes as experienced surgeons in anterior and posterior hip arthroplasty.Cite this article: Bone Jt Open 2021;2(6):365–370.

Giant Cell Tumor of the Femoral Head: A Case Report and Review of the Literature

IntroductionGiant cell tumors (GCTs) of the bone are uncommon primary bone neoplasms that occur mainly in the epiphysis of long bones. GCT of the femoral head is rarely encountered.Case ReportWe report a rare case of GCT of the femoral head in a 20-year-old female. The patient presented with pathological fracture. The patient underwent total hip arthroplasty (THA). The aim of this paper is to present a case study with pathological fracture of the femoral head and to report the results of a literature review.ConclusionThe treatment of choice for GCT of the proximal femur is a hip arthroplasty with either a standard THA for small confined tumors or endoprosthesis insertion for more extensive tumors. Joint preserving procedures have a high revision rate (47.06%). Denosumab has been tried as a neoadjuvant treatment with some success in certain cases.

Dual Mobility hip replacement in hip fractures offer functional equivalence and a stability advantage - A case-controlled study.

BackgroundHip fracture is a common and serious injury in the elderly. Hip arthroplasty is the most frequently performed procedure for patients with an intracapsular hip fracture. The majority of national guidelines recommend total hip arthroplasty (THA) for more active patients. Literature indicates significant stability advantages for dual mobility (DM) acetabular components in non-emergent scenarios. Evidence supporting the use of DM in hip fracture patients is limited. AimWe set out to ascertain if DM implants offer stability and/or functional advantages over standard THA in patients with hip fracture. MethodsWe utilised our local National Hip Fracture Database to identify all patients undergoing either a standard or DM THA for hip fracture (n=477) We matched cohorts based on age, AMTS, mobility status pre-operatively, gender, ASA and source of admission. Our primary outcome of interest was functional status using the oxford hip score (OHS). Secondary outcome measures included dislocation, fracture and deep infection requiring further surgery. Results62 patient pairs were available for this study. Mean OHS for DM THA was 41.5 and for standard THA this was 42.7 (p=0.58). There were 4 dislocations in the standard THA group and 0 with DM THA. No difference was seen with infection or peri-prosthetic fracture. ConclusionThis study demonstrates functional equivalence between DM and standard THA. In addition it shows a trend towards less dislocation with DM THA. Cost savings from less instability may outweigh initial prosthesis costs. This study suggests a suitably powered RCT using instability as the primary outcome measure is indicated.

Functional navigation in hip resurfacing.

Acetabular malpositioning in total hip arthroplasty (THA) can result in edge loading, leading to increased wear, pseudotumours and bearing failure. Historically Lewinnek's safe zone has been the goal for optimal THA cup positioning; however, research indicates that one generic safe zone is not ideal. In hip resurfacing (HR) there is a lack of data regarding optimal position, and studies indicate that edge loading is related to increased inclination. We used a functional positioning protocol to produce patient-specific (PS) dynamic analyses, identifying individual functional ideal acetabular zones. We hypothesized that identifying and implanting into PS functional ideal zones would result in decreased edge loading and improved clinical outcomes. Fifteen adept HRs were implanted using a PS functional positioning protocol. As plans were created for standard THA acetabular position, adjustments were made intra-operatively. Dynamic post-operative analyses showed 80% of implants were appropriately positioned. The remaining 20% had edge loading, where implants had inclination ≤5° of planned positioning and 10° of planned anteversion. 60% were ≤10° of planned inclination and anteversion. No pre-operative planned positions were within 'Lewinneks's zone', indicating its questionable relevance, especially in HR. A total of 20% of patients developed pain; however, at 1 year post-operatively all patients recorded improved Oxford hip scores. This study confirms that functional positioning in HR consistently results in improved precision and accuracy in achieving the functional acetabular ideal zone, leading to improved clinical outcomes and prevention of edge loading.

Metaphyseal anchoring short stem hip arthroplasty provides a more physiological load transfer: a comparative finite element analysis study

BackgroundShort stem total hip arthroplasty (SHA) preserves femoral bone stock and is supposed to provide a more natural load transfer compared to standard stem total hip arthroplasty (THA). As comparative biomechanical reference data are rare we used a finite element analysis (FEA) approach to compare cortical load transfer after implantations of a metaphyseal anchoring short and standard stem in native biomechanical femora.MethodsThe subject specific finite element models of biomechanical femora, one native and two with implanted metaphyseal anchoring SHA (Metha, B. Braun Aesculap) and standard THA (CLS, Zimmer-Biomet), were generated from computed tomography datasets. The loading configuration was performed with an axial force of 1400 N. Von Mises stress was used to investigate the change of cortical stress distribution.ResultsCompared to the native femur, a considerable reduction of cortical stress was recorded after implantation of SHA and standard THA. The SHA showed less reduction proximally with a significant higher metaphyseal cortical stress compared to standard THA. Moreover, the highest peak stresses were observed metaphyseal for the SHA stem while for the standard THA high stress pattern was observed more distally.ConclusionsBoth, short and standard THA, cause unloading of the proximal femur. However, the metaphyseal anchoring SHA features a clearly favorable pattern in terms of a lower reduction proximally and improved metaphyseal loading, while standard THA shows a higher proximal unloading and more distal load transfer. These load patterns implicate a reduced stress shielding proximally for metaphyseal anchoring SHA stems and might be able to translate in a better bone preservation.

Stand up! Are normal weight-bearing forces sufficient for a 12/14 Morse taper locking in total hip arthroplasty?

The aim of this study was to investigate total hip arthroplasty (THA) Morse taper pull-off strengths after impaction prior to cyclical loading compared to cyclical loading alone. The practical relevance of the experiment is to provide a perspective on what may be clinically satisfactory taper assembly given the spectrum of head tapping patterns used by surgeons, as well as compare traditional impaction performed in standard THA with alternate methods of taper engagement such as 'in situ assembly' used in micro-invasive techniques. 36 taper constructs utilising a combination of cobalt-chrome alloy and ceramic-titanium alloy junctions were investigated in vitro in wet and dry conditions with cyclical loading of the constructs. Taper disengagement strengths with and without impaction were compared. Secondary investigation of the surface roughness of the heads and tapers was also assessed. An impaction to a wet taper resulted in a greater pull off force compared to a dry taper with a CoCr head and taper combination. Impacting the head and dryness of the taper did not affect pull off forces of a ceramic femoral head on titanium taper. Pulling a head off a taper significantly alters the head surface roughness. Impaction of a taper does not provide any benefit over cyclical loading of a taper assembly alone for pull-off strength.

Trochanteric pain and total hip arthroplasty: a systematic review of the literature

Background:Total hip arthroplasty (THA) is one of the most common surgical procedures. Although THA surgeries are typically very successful, between 3% and 17% of all patients experience trochanteric pain after surgery. There is little high-quality evidence on this disorder, especially after total hip arthroplasty. The purposes of this review were to describe the prevalence, treatments, prognosis, risk factors, and diagnostic methods available for trochanteric pain among preoperative or postoperative primary THA patients.Methods:The authors conducted a systematic review of trochanteric pain among THA patients. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched to identify relevant articles. Two reviewers systematically screened studies and extracted data independently in duplicate. This study presents descriptive statistics and pooled prevalence of trochanteric pain.Results:We included 36 studies with 7826 patients (mean age of 62 yr, 59% female). The prevalence of trochanteric pain was reported in 25 studies, with a mean prevalence of 3.8% (95% CI 3.3% to 4.4%). Methods of treatment for trochanteric pain included corticosteroid injections, bursectomy, and iliotibial (IT) band lengthening. Risk factors for trochanteric pain were inconsistently reported, but those most commonly listed were female gender and postoperative leg-length discrepancy.Conclusions:Approximately one in 25 patients who has undergone standard THA experiences postoperative trochanteric pain. With low certainty, the results of this review suggest the surgical approach may not influence incidence of trochanteric pain. The heterogeneity in both diagnostic modalities reported and in treatment options suggests that further prospective research is required to better inform treatment decisions for this common condition.Level of Evidence:Level III.

Return to sports after hip resurfacing versus total hip arthroplasty: a mid-term case control study.

Hip resurfacing (HR) is an alternative to conventional total hip arthroplasty (THA) for the treatment of osteoarthritis (OA) in very active, young male patients. However, there is no study in the literature that has proven its benefits for high-impact sport over standard primary THA. The aim of the current study was to investigate the return to sport and function level of male patients after THA vs. HR. This prospective study is based on a telephone questionnaire for general health and sports activities. 40 HRs were matched with 40 THAs based on preoperative University of California Arthroplasty Score (UCLA), BMI, age at time of surgery and age at follow-up. The mean follow-up period was 56months (range 24-87months). HR patients showed a significantly higher High-activity arthroplasty score (HAAS) (14.9 vs. 12.9, p < 0.001) and Lower extremity activity scale (LEAS) (15.9 vs. 14.1, p < 0.001) and reached significantly higher values in the Hip cycle score (HCS) (44.7 vs. 35.7 p = 0.037) and Impact score (IS) (40.9 vs. 29.6, p < 0.002) than THA patients. No significant differences were found in the HOOS function section (91.4 vs. 90.3, p = 0.803) and the Pain numeric rating scale (NRS)-11 (0.6 vs. 0.9 p = 0.169). Patients with HR had a slightly higher Harris hip score (HHS) (97.8 vs. 95.6, p = 0.015) CONCLUSION: The current study suggests that young male patients are able to engage in higher activity levels after HR compared to standard THA.

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review.

The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table (n = 4402) and 100.1 ± 32.6 minutes for traction table (n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard (n = 2992) and 531.7 ± 364.3 mL for traction table (n = 2675). Intra-operative fracture rate was 1.3% for standard table (n = 3940) and 1.7% for traction table (n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.

Anterior acetabular retractors and the femoral neurovascular bundle in anterior total hip arthroplasty: a cadaveric study.

The direct anterior approach for primary total hip arthroplasty (THA) has become increasingly popular in recent years. Nerve compression or traction with a retractor is a common cause of nerve injury in this approach. The purpose of this cadaveric study was to evaluate the anatomic relationship of the femoral neurovascular bundle to the anterior acetabular retractor during direct anterior approach THA. Eleven fresh-frozen cadavers underwent a standard direct anterior THA, with placement of an anterior acetabular retractor in the usual fashion between the iliopsoas and acetabulum for visualization during acetabular preparation. Careful dissection of the femoral triangle was performed, and the distances from the anterior retractor tip to the femoral nerve, artery, and vein were recorded and analyzed as mean distance ± standard deviation. In all 11 cadavers, the retractor tip was medial to the femoral nerve. The mean distance from retractor tip to femoral artery and vein was 5.9mm (SD = 5.5, range 0-20) and 12.6mm (SD 0.7, range 0-35), respectively. Surgeons should be aware of the proximity of the neurovascular structures in relation to the anterior acetabular retractor in the direct anterior approach, taking care to avoid perforating the iliopsoas muscle during retractor insertion and limit excessive traction to prevent nerve injury.

Short stems reproduce femoral offset better than standard stems in total hip arthroplasty: a case-control study

In total hip arthroplasty (THA), altering the original offset can lead to poor outcome or even complications or revision when the changes are too great. The aim of the present study was to compare femoral offset between short and standard stems. The hypothesis was that the short stems studied provide better control of post-operative femoral offset. We retrospectively reviewed 100 consecutive THAs using uncemented optimys™ short stems (Mathys, Bettlach, Switzerland), matched to 100 standard stem THAs performed during the same period. The primary endpoint was femoral offset; secondary endpoints were the limb length and cervico-diaphyseal angle. The mean femoral offset increased by 6.0 ± 7.2mm overall (p < 0.0001), 4.7 ± 6.7mm in the short-stem group (p < 0.0001), and 7.2 ± 7.5mm in the standard stem group (p < 0.0001), with a significant inter-group difference (p = 0.0152). Limb length showed no significant inter-group difference (p = 0.8425). Cervico-diaphyseal angle was increased by surgery overall, and more by standard than by short stems (p < 0.05). Measurement of femoral offset revealed significant lateralization. It is critical that offset should be maintained in THA. The technique we use increases femoral offset, but the present study showed less increase using short than standard stems. These findings must be borne in mind to achieve good clinical outcome.

Mortality after hip resurfacing versus total hip arthroplasty in young patients: a single surgeon experience.

The aims of this study were to investigate the following questions: (I) what are the mortality rates in patients age 55 years and younger who underwent a hip resurfacing arthroplasty (HRA) versus a standard total hip arthroplasty (THA)? (II) is the type of operation independently associated with mortality? The database of a single high-volume surgeon was reviewed for patient's age 55 years and younger who underwent a hip arthroplasty between 2002 and 2010. This yielded 505 HRA patients and 124 THA patients. Chi-square analysis was performed to identify a 5-year mortality rate difference between the two cohorts. Multivariable Cox-Regression analyses were used to determine whether the type of operation was independently associated with mortality. There were 8 mortalities (1.6%) in the HRA cohort and 11 (8.9%) in the THA cohort, a statistically significant difference (P<0.001) on univariate analysis. Low mortality rates produced underpowered multivariate models. We have demonstrated that patients age 55 and younger who undergo HRA have a significantly lower mortality rate than those undergoing THA. This is consistent with multiple previously published large database studies.