Total Hip Arthroplasty Research Articles

Fibroblast IRF7-mediated chondrocyte apoptosis affects the progression of collapse in steroid-induced osteonecrosis of the femoral head

PurposeThe objective of this study was to identify potential genes implicated in the “peri-collapse” synovium of osteonecrosis of the femoral head through coding gene sequencing and to further clarify their specific mechanisms via in vitro experiments.MethodsSteroid-induced osteonecrosis of the femoral head (SIONFH) (n = 3), femoral neck fracture (FNF) (n = 3), and hip osteoarthritis (HOA) (n = 3) Synovial tissue of the hip joint was collected in total hip arthroplasty. A cellular model of SIONFH constructed from rat synovial fibroblasts by lipopolysaccharide intervention. Lentiviral technology was used to construct a model for fibroblast knockout of the Irf7 gene. HE was used to compare the characteristics of synovial tissue damage, and immunofluorescence and immunohistochemistry were used to compare the expression levels of VIM, IRF7, and IFNα. PCR, WB, and IF were used to examine Irf7 knockdown efficiency, chondrocyte proliferation (Col2a1, Aggrecan, Sox9), cartilage matrix degradation (Mmp13), and apoptosis (Bcl2, Bax, and Caspase3) expression under co-culture conditions. Crystalline violet staining was used to observe the migration rate of fibroblasts, and flow cytometry was used to detect the apoptosis level of chondrocytes under co-culture conditions.ResultsTranscriptome sequencing of synovial tissue and fibroblasts ultimately screened for six differential genes, HOOK1, RNPC3, KCNA3, CD48, IRF7, SAMD9. Compared to FNF and HOA, synovial inflammatory cell recruitment and synovial hyperplasia were more pronounced in SIONFH. IF and IHC confirmed high expression of IRF7 and IFNα in the synovium of SIONFH. PCR and WB results suggested that fibroblasts highly expressed Irf7, Hook1, Rnpc3, Kcna3, Cd48, Samd9, Il-6, and Tnfα after lipopolysaccharide intervention, and the expression levels of Il-6 and Tnfα were significantly reduced after knockdown of Irf7 (P < 0.001). In the co-culture system, fibroblasts intervened with lipopolysaccharide significantly promoted chondrocyte apoptosis, the rate of cartilage matrix degradation, while inhibiting the level of chondrocyte proliferation, and this result was significantly reversed in Irf7 knockout fibroblasts. This was supported by flow cytometry results.ConclusionsIRF7, HOOK1, RNPC3, KCNA3, CD48, and SAMD9 as potential genes affecting the progression of SIONFH collapse. Irf7 mediates the fibroblast inflammatory response and affects the collapse process of SIONFH by influencing chondrocyte apoptosis. Thus, intervention in IRF7 holds promise as one of the key targets for reversing the collapse process of SIONFH.Graphical

Total hip arthroplasty, through the direct anterior approach, for a femoral neck fracture of ipsilateral transfemoral amputee: a case report

Total hip arthroplasty, through the direct anterior approach, for a femoral neck fracture of ipsilateral transfemoral amputee: a case report

Trabecular titanium acetabular cup in patients with medial femoral neck fracture: Survivorship analysis and clinical and radiological outcomes

BACKGROUND Clinical studies using Trabecular Titanium™ acetabular cups have shown promising short and medium-term results. This material, due to its macro and micro surface roughness, provides a substrate for osseointegration and enhances implant stability. However, there is a lack of evidence in the literature on the use of this material in patients with femoral neck fracture. AIM To evaluate the short-term clinical-functional and radiographic outcomes in patients with femoral neck fractures undergoing total hip arthroplasty (THA) with Trabecular Titanium™ acetabular cup implants. METHODS The study included 104 patients with medial femoral neck fractures who underwent THA between January 2020 and December 2020 with the Delta TT acetabular cup (Lima Corporate, Villanova di San Daniele del Friuli, Italy). The mean age of the patients was 69.57 ± 10.16 years (range: 36-85 years). The follow-up period ranged from a minimum of 3 to a maximum of 4 years. Three questionnaires (Harris Hip Score, Oxford Hip Score, and EQ5D) were administered along with radiographic evaluations. Statistical methods included the Student's t -test and one-way analysis of variance for comparisons (with significance set at 0.05), and the Kaplan-Meier curve for prosthetic implant survival. RESULTS The mean follow-up was 41.5 months. The Harris Hip Score (HHS) showed a mean increase of 2.74 points (mean HHS 88.52 at 6 months postoperatively and mean HHS 91.26 at the last follow-up) with statistical significance. Similarly, the Oxford Hip Score demonstrated a statistically significant difference between follow-up groups. However, the EQ5D did not show statistically significant differences among the three groups (preoperative, 6-month follow-up, and last follow-up). Revision surgery was required in 6 patients. According to Moore's criteria, 96% of the acetabular components were radiographically stable and well-integrated at the last follow-up. The Kaplan-Meier curve showed a 96% survival rate. CONCLUSION The clinical and radiographic results obtained in the short to medium term confirm the excellent performance of the Delta TT acetabular cup in terms of osseointegration, providing an optimal solution both for young patients with high functional recovery demands and for fragile patients requiring optimal stability of the acetabular component to reduce the risk of implant failure.

Case Report: Rheumatoid arthritis patient with hip joint infection and acetabular protrusion undergoing total hip arthroplasty: a case study and literature review

Case Report: Rheumatoid arthritis patient with hip joint infection and acetabular protrusion undergoing total hip arthroplasty: a case study and literature review

Investigation on the quality of life after anterior minimally invasive total hip arthroplasty: Commentary on recent findings

This editorial critically evaluated the recent study by Ishikura et al , which examined the impact of anterior minimally invasive total hip arthroplasty (MIS-THA) on postoperative quality of life, with a specific focus on the timeline and influencing factors for return to work and resumption of driving. Ishikura et al 's research demonstrated that anterior MIS-THA could shorten recovery time, reduce postoperative pain, and significantly enhance patients' quality of life and productivity. Their findings identified occupational type and work intensity as key determinants of postoperative recovery. By synthesizing evidence from multiple studies, this analysis systematically evaluated the clinical advantages of anterior MIS-THA—including reduced soft tissue trauma and accelerated functional recovery—while acknowledging its limitations, such as a steep surgical learning curve and early postoperative complication risks. The discussion emphasized the necessity of designing personalized rehabilitation protocols that accounted for patients' occupational demands. Notably, while current findings primarily derived from retrospective analyses, the article highlighted the need for prospective cohort studies to validate these observations. The commentary also addressed ongoing debates in the field, particularly the elevated complication rates associated with the direct anterior approach compared to posterior techniques, thereby underscoring the critical role of surgeon expertise in optimizing procedural safety. Collectively, this evaluation advanced our understanding of postoperative recovery dynamics in anterior MIS-THA and provides evidence-based insights to refine clinical rehabilitation frameworks.

Increased early complication rates following total hip arthroplasty in rheumatoid arthritis patients based on a Japanese nationwide medical claims database study

Although the rate of total hip arthroplasty (THA) is declining among rheumatoid arthritis (RA) patients, the complex etiology of RA and associated immunomodulatory therapies may contribute to elevated risks of postoperative complications. This study aimed to evaluate in-hospital complications following THA in RA patients compared to osteoarthritis (OA) patients using a Japanese nationwide database. This retrospective study analyzed data from the Diagnosis Procedure Combination database, including THA patients between December 2011 and March 2023. The RA and OA groups were matched in a one-to-three ratio using propensity scores, considering factors such as age, sex, and comorbidities. Multivariate logistic regression was conducted to assess independent risk factors for complications. Among 353,465 patients, 3,977 underwent THA for RA and 298,326 for OA. After matching, 3,951 RA and 11,853 OA patients were included. RA was an independent risk factor for dislocation (OR: 2.783, 95% CI 1.641–4.720) and reoperation (OR: 2.254, 95% CI 1.687–3.013). No significant differences were observed in infection, periprosthetic fracture, venous thromboembolism, or mortality. RA patients undergoing THA are at higher risk for dislocation and reoperation. These findings emphasize the need for careful surgical planning and implementation to improve outcomes in RA patients.

Impact of Sarcopenia and Functional Relationships Between Balance and Gait After Total Hip Arthroplasty

Impact of Sarcopenia and Functional Relationships Between Balance and Gait After Total Hip Arthroplasty

Age/BMI is a strong predictor of 30-day mortality and morbidity following total hip arthroplasty

Age/BMI is a strong predictor of 30-day mortality and morbidity following total hip arthroplasty

In Silico Evaluation of the Primary Stability of Acetabular Revision Cups: Standard vs. Locking Screws.

Given the increasing complexity of revision total hip arthroplasty, ensuring optimal stability of acetabular revision cups (ACs) is crucial, especially in cases of bone stock loss. In this study, the primary stability of ACs was investigated by modeling various configurations of screw placements, including all standard, all locking, and mixed setups, under different load scenarios. Finite element models were implemented to evaluate the stress distribution and micromotions at the bone-prosthesis interface, simulating three primary load cases: 'walking', 'stairs-down', and 'stand-up'. The results indicated that the 'stairs-down'; load case generated the highest von Mises stresses and sliding distances, marking it as the most critical load scenario. Configurations using all standard screws showed higher peak stresses and reduced stable areas, compared to those utilizing locking screws. While the locking screws provided a stiffer connection, the mixed screw configuration offered a balanced performance by combining the compression benefits of standard screws with the rigid fixation of locking screws. Configurations with a single standard screw complemented by locking screws showed enhanced stability, suggesting this combination could be advantageous in clinical applications. This study underscores the importance of screw type and placement in ensuring the primary stability of ACs. Locking screws are recommended for use when feasible. For ACs allowing both screw types, a mixed configuration starting with a standard compression screw followed by locking screws appears optimal. Future research should further explore various combinations of screw geometries and lengths to refine these findings and enhance surgical outcomes in acetabular revisions.

Comparing general and regional anesthesia in patients undergoing primary total hip arthroplasty: analysis of national health insurance data in Korea

Comparing general and regional anesthesia in patients undergoing primary total hip arthroplasty: analysis of national health insurance data in Korea

The Choice of Hip Arthroplasty: HRA or THA? Revealed by Meta-Analysis.

Total hip arthroplasty (THA) is the gold standard for end-stage hip arthrosis, while hip resurfacing arthroplasty (HRA) is considered a more bone-conserving alternative. This meta-analysis aimed to compare the safety and clinical efficacy of HRA and THA. The databases of PubMed, EMBASE, Cochrane Library, and CNKI were searched for RCTs comparing HRA and THA in treating hip arthrosis from database initiation to April 2024. Inclusion and exclusion criteria were defined, and data extraction, quality evaluation, and risk bias assessment were performed. A meta-analysis was conducted using appropriate RevManv5.4 and Stata v14.0 software. Twenty RCTs from six countries were included. HRA had a similar revision rate, function scores (WOMAC, HSS, OHS, UCLA activity score, EQ-D, EQ-5D VAS), and blood levels of cobalt and chromium compared to THA. HRA had fewer complications and less blood loss but required more operating time. HRA is a safe and effective alternative to THA, with similar revision and functional outcomes, less blood loss, and is particularly suitable for young male patients with a demand for high-level activities.

Evaluating the necessity of pre-transfusion testing in primary total hip arthroplasty: a systematic review and meta-analysis

Introduction: The unnecessary over-ordering of routine pre-transfusion tests (blood typing, screening, and cross-matching) for surgical cases results in substantial avoidable costs and imposes an undue burden on transfusion services. This study specifically focuses on conducting a systematic review of the literature to assess the necessity of routine pre-transfusion tests before total hip arthroplasty (THA) and aims to provide a comprehensive summary of the outcomes associated with this practice. Methods: A systematic review and meta-analysis were conducted to analyse the study’s characteristics, assess the prevalence of over-ordering, defined as ordering more routine pre-transfusion tests than clinically necessary, examine transfusion rates, and evaluate potential cost savings to the healthcare system. Results: The study included 12,178 patients. Pooled results revealed an 88.1% over-ordering pre-transfusion test rate (95% CI, 0.80–0.96; p &lt; 0.001) among patients undergoing primary THA. The pooled prevalence of hospital transfusion rate was 11.9%, with a percentage of intraoperative transfusion of 0.4% (95% CI, 0.001–0.007; p = 0.007). There were statistically significant differences in preoperative haemoglobin (Hb) levels between patients not requiring 14.1 g/dl (95% CI, 13.2–14.9; p &lt; 0.001) and those needing transfusion 11.9 g/dl (95% CI, 10.9–12.9; p &lt; 0.001) ( p &lt; 0.001). The per-patient total cost savings ranged from 2.10 to 191.27 dollars. Conclusions: Our findings indicate that routine pretransfusion testing for all patients undergoing primary THA may be unnecessary. We recommend restricting pre-transfusion test orders to patients with preoperative haemoglobin levels below 12 g/dl specifically in the context of unilateral primary THA, always considering individual patient and surgical risk factors. This focused approach has the potential to yield substantial cost savings for healthcare systems and transfusion services by mitigating the unnecessary over-ordering of pre-transfusion tests associated with these surgical procedures.

Enhancing the accuracy of cup placement in total hip arthroplasty using CT-based navigation by a trainee surgeon: a retrospective cohort study

BackgroundThe learning curve of total hip arthroplasty (THA) using the anterior approach in the supine position is considered to be long owing to limited surgical field visualization. This study aimed to investigate the learning curve of a trainee’s cup placement using computed tomography (CT)-based navigation, focusing on identifying the number of cases required to achieve proficiency.MethodsThis retrospective cohort study included 112 hips that underwent total hip arthroplasty using CT-based navigation via anterolateral approach in the supine position by a trainee surgeon who had performed fewer than 20 prior THA cases. The absolute differences in cup alignment between postoperative measurements and intraoperative records, and differences in three-dimensional position between postoperative measurements and preoperative plan were assessed using the Mann–Whitney U test. A receiver operating characteristic (ROC) curve was used to determine the cutoff point for achieving accuracy.ResultsThe absolute differences were 2.4°±2.5° (inclination) and 2.4°±2.0° (anteversion), and 1.5 mm ± 1.3 mm (coronal plane) and 1.4 mm ± 1.2 mm (axial plane). The ROC curve identified 20 cases as the cutoff point for proficiency, with significant improvement in cup inclination accuracy. Multivariate analysis revealed that the first 20 cases (odds ratio, 10.4; 95% confidence interval, 3.1−34.5) were a predictive risk factor for inaccurate cup alignment. No cup revisions or dislocations occurred.ConclusionsThis is the first study to identify the learning curve of cup placement using CT-based navigation via an anterior approach by an inexperienced trainee surgeon. Proficiency in cup placement was achieved after 20 cases using CT-based navigation.

Should the lumbar or femoral neck young adult mean percentage be measured in patients with distal radius fractures? A case-control study.

In the 2015 guidelines for the prevention and treatment of osteoporosis in Japan, the young adult mean percentage (%YAM) of the lumbar spine or femoral neck is required to diagnose osteoporosis in patients with distal radius fracture (DRF). When the %YAM of multiple locations is measured, the lower %YAM is adopted for the diagnosis. If the area with a lower %YAM is known, bone mineral densitometry tests may only need to be performed at one site. This study aimed to compare the lumbar and femoral neck %YAMs of patients with DRFs to find out the lower %YAM site. We retrospectively compared the %YAM of the lumbar and femoral neck of patients with DRFs who underwent open reduction and internal fixation (ORIF) between April 2018 and March 2023. We also measured the lumbar and femoral neck %YAM of patients with hip fractures (HFs) treated by ORIF, bipolar hemiarthroplasty, or total hip arthroplasty. The %YAM of the femoral neck was significantly lower than that of the lumbar region in the DRF group. In the HF group, the lumbar %YAM was significantly higher than that of the femoral neck. In patients with DRFs, the %YAM of the femoral neck was significantly lower than the lumbar %YAM. The lumbar %YAM appears to be less reliable than the %YAM of the femoral neck because of the lumbar degenerative changes. Therefore, we believe that the %YAM of the femoral neck should be measured first if osteoporosis is suspected in patients with DRF. Case-control study.

The effect of sintering temperature holding time on physical and mechanical behaviours of alumina ceramic prepared for total hip-joint arthroplasty application

ABSTRACT Alumina-based ceramics with the magnesia and titania addition were prepared in this research to study the effect of α-alumina sintering temperature and the temperature holding time of ceramic alumina (Al2O3). Technical alumina, 96% and 98.9% purity, is used as raw material. Spherical samples are formed in moulds under various applied pressures. They were then sintered in an oven to a temperature of 1500ºC. This sintering temperature is set below the alumina sintering temperature (1700ºC). The ceramic physical and mechanical parameters were investigated, including porosity, density observations, hardness testing, and microstructure before and after mechanical testing. After sintering, further research was conducted to determine the magnesia and titania addition impact on the ceramic hardness and to determine the effect of delaying the sintering temperature time during the sintering process. Material test results that consider the effect of temperature holding time on physical and mechanical properties show that the average density of ceramics increases from 2.96 kg/m3 at a holding time temperature of 4 hours to 3.25 kg/m3 at a holding time temperature of 12 hours. The results of the microstructure investigation of neck formation which began when the temperature reaches 1500ºC show that neck dilatation increases with increasing temperature holding time.

In-Hospital Pain and Opioid Consumption After Primary Total Knee Arthroplasty Compared to Primary Total Hip Arthroplasty: Results from 7330 Patients Treated in a Fast-Track Setting.

Differences in in-hospital pain and consumption of opioids after primary total hip arthroplasty (THA) and knee arthroplasty (TKA) have been rarely studied in a setting where the patient course is otherwise similar. The aim of this study was to compare early pain intensity and opioid usage between patients who have undergone THA and TKA to identify potential implications for outpatient surgery. This institutional register study included 4655 patients receiving THA and 2675 patients receiving TKA. Pain at rest and during mobilization were collected once preoperatively, and postoperatively at five time-points, twice on the Day of surgery, once each on day 1 and day 2 after surgery, and at discharge, on a numeric rating scale (NRS) 0-10. Rescue opioids in oral morphine-equivalent doses (MME) were consecutively registered. Postoperative mobilization was registered twice daily. Overall mean pain were 2.0 (Cl 2.0-2.0) after THA and 2.3 (Cl 2.3-2.4) after TKA at rest, and 3.3 (Cl 3.3-3.3) and 3.7 (Cl 3.7-3.8) during mobilization, respectively. Patients undergoing TKA had a transient increase in pain intensity the day after surgery, whereas patients undergoing THA had improved pain levels. Outpatient criteria for pain (NRS<5 during mobilization) were feasible for 37% of THA and 35% of TKA. Total median MME was 30.0 (0-573) after THA and 52.5 (0-390) after TKA. Patients undergoing TKA were less mobilized during hospitalization. A comparable number of THA and TKA cases were eligible for same-day discharge based on outpatient discharge criteria for pain. Patients receiving TKA can expect an increase in pain intensity and opioid needs on the day after surgery.

A joint effort: Evaluating the quality and readability of online resources relating to total hip arthroplasty.

A joint effort: Evaluating the quality and readability of online resources relating to total hip arthroplasty.

High subsidence rate in primary total hip arthroplasty with a taper wedge stem featuring a three-dimensionally printed porous structure.

Femoral stem subsidence (FSS) following total hip arthroplasty (THA) can lead to complications such as aseptic loosening and early implant failure. This study evaluated the subsidence and clinical outcomes of the GS-Taper stem, a taper wedge stem using a three-dimensional (3D)-printed porous structure, in primary THA cases. This retrospective analysis was conducted in 112 hips that underwent THA using the GS-Taper stem between October 2020 and May 2023, with follow-up at 1 year postoperatively. The primary outcome was the evaluation of FSS and its relationship with neck length, canal fill ratio, and stem alignment. Secondary outcomes included clinical scores assessed using the modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles activity scores, as well as radiographic findings such as periprosthetic bone reactions, including stress shielding, radiolucent lines, and spot welds. The mean subsidence at 1 year postoperatively was 3.4 ± 3.0mm, with 55 hips showing subsidence ≥ 3mm (FSS group) and 57 hips showing subsidence < 3mm (non-FSS group). The FSS group demonstrated significantly shorter neck length, lower canal fill ratio, valgus positioning, and a higher proportion of medial gaps compared to the non-FSS group. Radiographic analysis revealed increased radiolucent lines and stress shielding in Gruen zone 1 in the FSS group. The FSS group had significantly worse clinical outcomes and a higher incidence of thigh pain than the non-FSS group. The GS-Taper stem exhibited a high rate of subsidence, potentially due to its 3D-printed porous structure and micro-spike configuration. These findings highlight the need for design modifications to improve initial stability and biological fixation.

Association between adherence to patient blood management recommendations and postoperative complications in hip and knee arthroplasty.

Patient blood management (PBM) is a set of evidence-based practices that reduces the need for blood transfusions. However, its impact on relevant clinical outcomes remains unclear. We evaluated the association between adherence to guideline-recommended PBM care and 30-day postoperative complications in patients undergoing primary total knee and hip arthroplasty. Secondary outcomes included the length of hospital stay and red blood cell utilization. This was a retrospective, multicenter cohort study including patients from 43 hospitals. The PBM clinical pathway comprised nine major guideline-recommended interventions, and adherence was assessed using a composite quality indicator. Multilevel multivariable regression models were used to evaluate the associations between PBM adherence and outcomes at the patient level while accounting for hospital characteristics and hospital variation. A total of 30926 patients who underwent primary total knee or hip arthroplasty between 2016 and 2022 at 43 hospitals were included. Of these, 1335 (4.3%) had 30-day postoperative complications. The median adherence to the PBM clinical pathway was 60.%. Higher PBM adherence was associated with fewer 30-day postoperative complications (adjusted odds ratio, 0.43; 95% confidence interval (CI) 0.32 to 0.58; p < 0.001), including 65% lower odds of major adverse cardiac events and 45% lower odds of infection. Additionally, higher adherence was associated with shorter hospital stays (adjusted incidence rate ratio, 0.77; 95% CI 0.76 to 0.79; p < 0.001) and reduced transfusion rates (adjusted odds ratio, 0.11; 95% CI 0.09 to 0.14; p < 0.001). Sensitivity analyses confirmed these associations. Adherence to the PBM clinical pathway was associated with improved outcomes. While causality cannot be established, these findings support the potential effectiveness of PBM in reducing postoperative complications and its efficiency in shortening hospital stays, beyond minimizing blood transfusions, in patients undergoing knee and hip arthroplasty.

Next-Generation Sequencing in Periprosthetic Joint Infections

Abstract Periprosthetic joint infection (PJI) is 1 of the most dreaded complications following total hip arthroplasty and total knee arthroplasty. Early diagnosis and optimal treatment are critical for managing PJI, and accurate detection of causative pathogens may be aided by recently available nucleic acid–based diagnostics. Next-generation sequencing (NGS) has demonstrated particular value in culture-negative PJI cases and in detection of atypical organisms. The use of NGS can provide substantial benefits to antimicrobial stewardship in PJI treatment. NGS facilitates earlier and more effective treatment interventions for PJI patients by enabling the rapid and precise identification of pathogens. This technology is especially crucial for detecting rare, novel, or polymicrobial infections, which traditional diagnostic methods often fail to identify.