To examine the impact of frailty on 30-day outcomes of open reduction internal fixation (ORIF) alone or ORIF + total hip arthroplasty (THA) (fix-and-replace) for the treatment of acetabular fractures. . Retrospective Cohort. A total of 700 hospitals in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Included were patients aged 60 years or older undergoing ORIF ± THA for OTA/AO type 62 A-C fractures from 2015 to 2020. Preoperative frailty was assessed by the revised Risk Analysis Index (not frail: <21, prefrail: 21-30, frail: 31-40, severely frail: >40) and the 5-Item Modified Frailty Index factor. All outcome measures were in-hospital or within 30 days postoperatively, including the "favorable outcome," defined as no readmission, length of stay (LOS) < cohort median, and no major complication or death. There were 585 patients included [ORIF (88%): mean age-70.5 ± 14.2, sex-41.4% female; ORIF + THA (12%): mean age-77.0 ± 13.4; sex-65.7% female]. Frail patients (n = 353, 65.5%) were more likely to experience a complication [OR: 3.31, CI: (1.83-5.96)] and mortality (3.7% vs. 0.0%). ORIF + THA had higher association with postoperative transfusion [OR: 2.70, CI: (1.63-4.48)] but lower association with LOS >3 days [OR: 0.41, CI: (0.24-0.72)] and nonhome discharge [OR: 0.52, CI: (0.27-0.98)] than ORIF. Prefrail and frail patients undergoing ORIF + THA were more likely to achieve favorable outcomes than those nonfrail or severely frail [OR: 9.69, (3.40-27.57)]. Surgical intervention for acetabular fractures carried a 30-day complication risk of 12%-19% for frail patients. Frailty had similar predictability to age for early morbidity after surgery to treat acetabular fractures. Open reduction and internal fixation with the addition of an acute THA was associated with a higher rate of blood transfusion and shorter hospital LOS in frail patients with acetabular fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Total hip arthroplasty (THA) via the direct anterior approach (DAA) is favored for avoiding gluteal muscle disruption and promoting faster recovery. A known complication of DAA is greater trochanteric fracture (GTFX). This study compared patient-reported outcomes (PROs) between patients who sustained GTFX and those who did not following THA using DAA. A retrospective review was conducted of patients who underwent THA via DAA. Primary outcomes included Mental and Physical Patient-Reported Outcomes Measurement Information System scores, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and Forgotten Joint Score. Secondary outcomes included ambulation status, disposition, length of stay, complications, emergency department visits, and return to the operating room within 1 year. Patients without at least baseline and 6-month or 1-year PROs were excluded. Ninety-two THAs were analyzed; 13 patients (14%) sustained a GTFX. Baseline characteristics and preoperative PROs were similar between groups. At 6 months, the GTFX group had significantly lower HOOS JR scores (68.5 ± 18.1) compared to the non-GTFX group (79.8 ± 18.0; P = .0472). No significant differences in PROs were observed at 1-year. Two patients (15%) with GTFX and 2 (3%) without GTFX returned to the operating room (P = .0943). No other significant differences in secondary outcomes were noted. GTFX following THA via DAA are associated with worse HOOS JR scores at 6 months, suggesting a temporary delay in recovery. However, these differences resolve by 1 year, indicating GTFX may not impact long-term functional outcomes.

Increasing Patient Age and General Anesthesia are Risk Factors for Readmission after Same-Day Discharge in Total Hip Arthroplasty.

Femoral neck fractures (FNF) in older adults are frequently managed with either total hip arthroplasty (THA) or hemiarthroplasty (HA). Despite improvements in surgical techniques, mortality rates after hip fracture surgery remain high. Identifying predictors of early mortality may enhance surgical decision-making, optimize perioperative management, and improve patient outcomes. The purpose of this study was to determine the short- and mid-term mortality rates after THA and HA for FNF, to identify clinical, demographic, and laboratory factors associated with 30-, 90-, and 180-day mortality, and to establish clinically relevant cutoff thresholds for significant continuous variables to stratify risk. We retrospectively reviewed 2379 consecutive patients treated for sub-capital FNF at a tertiary trauma center between [insert study years]. Of these, 831 underwent THA and 1548 underwent HA. Mortality was assessed at 30, 90, and 180 days postoperatively. Demographic, clinical, and laboratory parameters were analyzed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curve analysis was performed to identify optimal cutoff thresholds for significant continuous predictors. Among THA patients, mortality was 1.4% at 30 days, 3.4% at 90 days, and 5.1% at 180 days. Postoperative albumin ≤2.85g/dL predicted 30-day mortality, while C-reactive protein (CRP)>19.15mg/dL was independently associated with mortality at 90 and 180 days. Among HA patients, mortality was 6.6% at 30 days, 12.9% at 90 days, and 17.6% at 180 days. Predictors of 30-day mortality included white blood cell count (WBC)>14.48×109/L, albumin <3.55g/dL, and Charlson Comorbidity Index (CCI)>7.5. At 90 and 180 days, age >83.65 and>89.34 years, WBC >13.49×109/L, albumin <3.35-3.45g/dL, creatinine >1.08mg/dL, and CCI >6.5 were associated with higher mortality risk. This study identified several laboratory and clinical markers that predict short- and mid-term mortality following hip arthroplasty for FNF. Hypoalbuminemia, elevated inflammatory markers, renal dysfunction, and high comorbidity burden were consistent risk factors. Incorporating these parameters into preoperative assessment may improve patient selection, perioperative optimization, and shared decision-making. III.

Comparison of High-tensile Suture and 16-gauge Wire for Prophylactic Fixation in Total Hip Arthroplasty: A Biomechanical Study.

Three-Dimensional Pelvic Kinematics During Direct Anterior Approach Total Hip Arthroplasty on an Orthopaedic Table.

Three-Dimensional Hands-on Total Hip Arthroplasty Simulation After Surgically Treated Acetabular Fractures: A Technical Note on 8 Cases.

Technology-assisted total hip arthroplasty (THA)-including computer-navigated and robotic-assisted techniques-has emerged as a strategy to enhance component alignment and potentially improve postoperative outcomes. Although prior studies have described increasing utilization, contemporary trends and associated complication rates remain underexplored. A retrospective cohort study was conducted using a large national database to identify patients who underwent primary elective THA between 2010 and 2023. Patients were stratified into conventional vs technology-assisted THA groups, with the latter defined by the use of computer navigation or robotic assistance. Annual utilization trends were evaluated using linear regression, and 90-day postoperative complications were compared using multivariate logistic regression after adjusting for demographic, clinical, and regional factors. Among 1,062,597 patients undergoing primary elective THA, 4% received technology-assisted procedures. Utilization increased from 1.2% in 2010 to 12% in 2023-a 927% relative increase. Regional variation was notable, with highest utilization in the Northeast and the lowest in the Midwest. Technology-assisted THA was associated with lower odds of 90-day complications (5.36% vs 6.26%; adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.75-0.80), particularly reduced odds of dislocation (OR: 0.64; 95% CI: 0.60-0.69) and periprosthetic joint infection, though with higher odds of wound dehiscence (OR: 1.15; 95% CI: 1.07-1.23). Utilization of technology-assisted THA has increased substantially across the United States, accompanied by improved short-term outcomes, most notably decreased dislocation. These findings support the potential clinical benefits of surgical technology in THA, while underscoring the need for ongoing evaluation of long-term results.

Acetabular revision is a challenging procedure, especially in patients with large defects. This study aimed to evaluate how the severity of acetabular bone loss influences reconstruction of the center of rotation (COR) and how the COR influences clinical outcomes and patient-reported outcome measures (PROMs). Patients who underwent acetabular revision at a tertiary hospital from January 2013 to December 2018 were included. Patients were grouped according to the Paprosky and Saleh classifications. To determine the COR, we applied the method described by Fessy. The Harris Hip Score (HHS), Western Ontario McMaster Arthritis Index (WOMAC) and Short Form 12 (SF-12) were used to determine clinical outcomes and PROMs at a median of 41 months of follow-up. A total of 117 acetabular revisions were performed. The Paprosky classification was I for 54 acetabular defects (46.15%); II for 36 acetabular defects (30.76%); and III for 27 acetabular defects (23.07%). The Saleh classification was as follows: I for 54 (46.15%); II for 26 (22.22%); III for 19 (16.23%); IV for 16 (13.67%) and V for 2 (1,7%) acetabular defects. The percentage of patients who achieved an appropriate COR was 60.1% according to the Fessy method. This method showed a statistically significant association between the severity of the acetabular defect and the ability to accurately reconstruct the center of rotation. Similarly, no differences were observed in patients' functional outcomes (HHS, WOMAC, and SF-12 scores) based on whether the hip center of rotation was restored. Likewise, no differences were found in complication rates regardless of COR restoration or the degree of bone loss. These findings suggest that, in complex acetabular revisions, prioritizing stable fixation and bone preservation rather than perfect anatomic restoration of the center of rotation does not adversely affect functional outcomes.

Risk factors for allogeneic transfusion in young adults undergoing simultaneous bilateral direct anterior total hip arthroplasty within an ERAS framework.

Clinical performance and durability of short taper-wedge femoral stems in direct anterior total hip arthroplasty: Insights from a five-year retrospective analysis.

Osteonecrosis of the femoral head (ONFH) is a progressive condition that often requires surgical intervention. Although treatment strategies have traditionally emphasized joint-preserving procedures in younger patients, advances in implant technology and perioperative management may have altered contemporary surgical decision-making. However, large-scale evidence describing temporal changes in surgical treatment patterns for ONFH is limited. Using the Japanese Diagnosis Procedure Combination (DPC) database, we conducted a nationwide retrospective cohort study of patients who underwent surgical treatment for ONFH between December 2012 and March 2023. Surgical procedures were categorized as total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA), proximal femoral osteotomy, pelvic osteotomy, or hip arthroscopy. Temporal trends in procedure selection were evaluated overall and by age group. Postoperative complications, including infection, deep vein thrombosis (DVT), pulmonary embolism, periprosthetic fracture, and in-hospital mortality, were compared between THA and BHA using univariate and multivariable logistic regression analyses. A total of 36,109 patients were included. THA was the most frequently performed procedure throughout the study period, with its proportion increasing from 72.6% in 2012 to 90.6% in 2022, while the use of BHA and joint-preserving osteotomy steadily declined. Among patients aged ≤ 20years, proximal femoral osteotomy predominated until 2020; thereafter, arthroplasty procedures accounted for more than half of all surgeries in this age group. Similar shifts toward THA were observed in patients aged 21-40years. In adjusted analyses, BHA was associated with a higher risk of postoperative infection and DVT, whereas THA was associated with a higher risk of periprosthetic fracture and in-hospital mortality. No significant differences were observed in dislocation or pulmonary embolism rates. Nationwide data demonstrate a substantial shift in surgical management of ONFH in Japan, with increasing use of THA and declining reliance on joint-preserving procedures, even among younger patients. While arthroplasty has become the dominant treatment modality, careful consideration of long-term outcomes, complication profiles, and patient age remains essential. Integration of large-scale administrative data with detailed clinical and imaging information may further refine optimal treatment strategies for ONFH.

Periprosthetic femur fractures (PFFs) are a leading cause of revision following primary total hip arthroplasty. Although triple-tapered, noncemented, collared stems have been associated with a lower incidence of PFFs, most studies are from single institutions. The purpose of this work was to investigate PFF incidence and early device survivorship of a modern-designed, noncemented, collared stem as reported in the American Joint Replacement Registry (AJRR). All primary total hip arthroplasty cases in patients older than 65 years from January 2021 to December 2024, submitted to AJRR as of September 2024, with Medicare data, were queried in this 2-year analysis. Data were stratified into three treatment cohorts: a recently introduced noncemented collared stem, aggregated noncemented collarless stems, and aggregated cemented stems in the US market. This analysis included 8,432 noncemented collared stems, 74,300 noncemented collarless stems, and 9,293 cemented stems. Cumulative 2-year revision and PPF incidence were determined per International Classification of Diseases 9 and 10 codes. The AJRR data were linked to Medicare claims data through a unique identifier provided by the Research Data Assistance Center (ResDAC). The noncemented collared stem had the lowest all-cause 2-year revision incidence of 1.32% compared with cemented (2.02%) and noncemented collarless (2.22%) cohorts ( P < 0.001). The 2-year PFF incidence was equivalent between the noncemented collared (0.19%) and cemented (0.20%) cohort ( P = 0.99). The 2-year PPF incidence was markedly lower for the noncemented collared cohort than the noncemented collarless cohort (0.19% vs. 0.65%, P < 0.001). In this large retrospective AJRR cohort, markedly lower 2-year all-cause revision were observed with a modern, triple-tapered, noncemented, collared stem compared with noncemented, collarless stems. Notably, the incidence of PFF with this noncemented, collared stem was threefold lower than all noncemented, collarless stems and equivalent to all cemented stem designs.

Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in theelderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment. Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: totalarthroplasty,partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age. The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45-54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively. Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years. Level of evidence level 1, population-based study.

Ceramic-on-ceramic bearings are widely used in total hip arthroplasty (THA); although rare, ceramic femoral head fracture represents a serious complication. This event typically occurs early or after trauma, whereas atraumatic late-onset fractures confined to the femoral head component are exceedingly uncommon. A 73-year-old patient developed sudden-onset hip pain and functional impairment 11 years after a primary ceramic-on-ceramic THA. The patient denied any preceding trauma. Radiographs demonstrated multiple ceramic fragments without clear identification of the donor site; intraoperative inspection confirmed a fractured femoral head with an intact liner. Revision surgery was performed with complete removal of ceramic debris and exchange to a new ceramic femoral head using a taper adapter while preserving the well-fixed stem. The postoperative course was uneventful, and the patient regained satisfactory function at follow-up. This case represents an exceedingly rare late atraumatic fragmentation of a ceramic femoral head in a ceramic-on-ceramic THA, with successful stem-preserving revision despite extensive intra-articular ceramic debris. Orthopedic surgeons and musculoskeletal radiologists should remain vigilant for this possibility in patients presenting with acute hip symptoms years after implantation. Prompt recognition and revision surgery are essential to achieve favorable outcomes.

Bone cement continues to be part of the fixation strategy for a large proportion of all total hip arthroplasties (THAs) in the UK and other countries. The aim of this study was to investigate the association between specific commercially available bone cement formulations and the risk of revision surgery after primary elective THA. This was a population-based cohort study using data from the National Joint Registry from 1 April 2003 to 31 December 2024. All consenting patients having a cemented, hybrid, or reverse hybrid primary THA for osteoarthritis were included. Multilevel over-dispersed piecewise Poisson models were used to compare the rate of revision surgery by cement type adjusted for implant type, age, sex, and American Society of Anesthesiologists grade. A total of 515,433 procedures were included, mean patient age was 71.31 years (SD 9.5), and 63% (n = 324,962) were female. In total, 21 different cement types were used. Compared to Heraeus Medical Palacos R+G high-viscosity (68.2% of all procedures), we did not observe a different incidence rate ratio for most cement types commonly used in contemporaneous practice. However, DePuy CMW3 medium viscosity with gentamicin (incidence rate ratio (IRR) 2.21 (95% CI 1.75 to 2.75)), DePuy CMW1 high viscosity with gentamicin (IRR 1.27 (95% CI 1.08 to 1.49)), Schering-Plough HMP low viscosity with gentamicin (IRR 1.78 (95% CI 1.06 to 2.96)), Biomet Optipac Refobacin R medium viscosity with gentamicin (IRR 1.36 (95% CI 1.07 to 1.72)), and Stryker Simplex medium viscosity (IRR 1.24 (95% CI 1.04 to 1.47)) were associated with a significantly increased rate of revision surgery. Most cement types in contemporaneous practice have similar incidence rate ratios of revision to the reference cement (Heraeus Medical Palacos R+G high viscosity), but five cement types were associated with a significantly higher rate of revision. Vigilance is required as new cements are introduced into the market.

Recent years have seen increased interest in tissue-sparing approaches for total hip arthroplasty (THA), which has led to innovations in implant design. Short cementless femoral components have gained traction, and the inclusion of a medial calcar collar to improve stability may offset the risk of fracture. The aim of this current study is to report short-term outcomes and survivorship for a novel design of femoral component across four non-designer centres. All patients undergoing primary THA across four centres from July 2020 to January 2025 were eligible for inclusion. Data were collected prospectively in a national arthroplasty register, with planned routine follow-up at six months and two years. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS) and EuroQol five-dimension questionnaire (EQ-5D) score. A total of 517 components in 489 patients were included in the dataset: three patients (0.6%) died by final follow-up, and of the remaining 514 components, 512 components (99.6%) remain in situ. For the two patients (0.4%) undergoing revision surgery, indications for revision were periprosthetic fracture (PPF) and large postoperative haematoma. PPF affected four patients (0.8%) in total: two intraoperative events were managed with cables, and one Vancouver C fracture was managed with plate and screw fixation. The mean preoperative OHS was 17 (95% CI 16.3 to 17.7) with a mean postoperative score of 40.7 (95% CI 39.7 to 41.5), and mean preoperative EQ-5D score was 0.36 (95% CI 0.34 to 0.38), with a mean postoperative score of 0.80 (95% CI 0.78 to 0.82). This novel femoral component demonstrates excellent functional outcomes which are reproducible across multiple surgeons in non-designer centres, with low rates of revision surgery and PPF.

Periprosthetic joint infection (PJI) is the most common reason for revision total knee arthroplasty (TKA). Recent evidence has demonstrated that patients who develop PJI within 1 year following total hip arthroplasty have a significantly elevated risk of mortality within 10 years. Thus, the aim of this study was to compare long-term mortality rates between patients who did and did not develop PJI within 1 year following the index TKA. This was a retrospective population-level database study. All eligible participants interacted with a single-payer public health-care system. The primary outcome measure was mortality at 10 years following index TKA; 1- and 5-year mortality were also compared. Mortality was compared for propensity-score-matched groups. Of the total of 263,204 patients who underwent primary TKA in the study period (mean age and standard deviation, 67.9 ± 9.3 years), 1,228 (0.5%) subsequently developed PJI within 1 year. Across the entire sample, patients who developed PJI within 1 year following the index TKA were more likely to be male, have frailty, and have a Charlson-Deyo score of >0; they also had significantly higher rates of congestive heart failure and chronic obstructive pulmonary disease compared with those who did not develop PJI within 1 year. A total of 1,202 patients who developed PJI within 1 year of the index TKA were matched to 1,202 patients who did not develop PJI within 1 year of the index TKA, with standardized differences of <0.10 for all covariates, indicating a robust match. After matching, TKA recipients who developed PJI in the first year had a significantly higher 10-year mortality rate (7.2% [86] versus 1.6% [19]; absolute risk difference = 5.45% [95% confidence interval (CI) = 3.41% to 7.74%]; hazard ratio = 4.66 [95% CI = 2.84 to 7.66]). Patients who developed PJI within 1 year following TKA were at significantly higher risk for mortality at 10 years post-TKA compared with those who did not develop PJI within 1 year following TKA. The etiological factors leading to this increased risk remain unclear and warrant further investigation alongside efforts to further the prevention, diagnosis, and management of PJI. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Aseptic loosening and intraoperative periprosthetic fractures (IOPPFs) are major complications in uncemented total hip arthroplasty (THA). Computational models for assessing primary stability and IOPPF risk preoperatively are limited. This study developed a patient-specific finite element analysis (FEA) framework that replicates stepwise broaching and implantation in uncemented THA, enabling primary stability assessment and providing a foundation for future IOPPF research. A FEA framework was developed using patient-specific femoral geometries and heterogeneous material properties to simulate stepwise broaching and implantation along a defined insertion path. Primary stability was assessed via micromotion under physiological loading. Four case studies were performed to (a) demonstrate the framework using three cadaveric femurs, (b) validate the framework against experimental strain measurements obtained via digital volume correlation (DVC), (c) compare predicted outcomes with a literature-based volumetric expansion model, and (d) assess sensitivity to variations in bone material property models. Average post-implantation von-Mises stress ranged from 9.87 to 14.77MPa, with each broach increasing stress and indicating progressive bone compaction. Primary stability, assessed via bone-implant micromotion (29.10-78.04µm), remained well below the 150µm threshold, considered favourable for osseointegration. The proposed framework showed closer agreement with experimental DVC strains and compared to the volumetric-expansion model, halved the prediction error. The analysis also demonstrated limited sensitivity to variations in E-ρ models. The proposed FEA method replicates stepwise broaching and implantation in uncemented THA, enabling patient-specific assessment of bone-implant interactions and primary stability, and providing a foundation for preoperative tools to evaluate IOPPF and aseptic loosening risk and guide tailored femoral implant selection.

Data on midterm outcomes in patients with borderline hip dysplasia (BHD) based on sex differences after hip arthroscopy are scarce. To report sex-based differences in patient-reported outcome measures (PROMs), clinical benefit, and survivorship in patients with BHD who underwent hip arthroscopy at a minimum 5-year follow-up. Cohort study; Level of evidence, 3. Data were retrospectively reviewed for all patients with BHD who underwent primary hip arthroscopy with a lateral center-edge angle (LCEA) between 18° and 25° from 2008 to 2018. The exclusion criteria were as follows: LCEA <18º or >25º, previous ipsilateral hip surgery or conditions, and Tönnis grade >1. The modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain and patient satisfaction were reported. Clinical benefit was assessed via minimal clinically important difference (MCID), the patient acceptable symptomatic state (PASS), and the maximum outcome improvement (MOI). Survivorship was defined as nonconversion to total hip arthroplasty. A sex-based propensity-matched comparison was made in a 1-to-1 ratio based on age, body mass index (BMI), and Tönnis grade. Propensity-score matching created a cohort of 152 hips, 76 per group. Significant and comparable improvements in all PROMs were observed at a minimum 5-year follow-up, with high achievement rates for the MCID, PASS, and MOI in both groups. However, improvements were significantly higher for women for MCID for the mHHS (86.8% vs 69.7%; P = .0105), MCID for the NAHS (88.2% vs 61.8%; P = .0002), MCID for the VAS for pain (84.2% vs 64.5%; P = .005), PASS for the mHHS (90.8% vs 78.9%; P = .041), and MOI for the NAHS (77.6% vs 55.3%; P = .0057). Survivorship was similar for men (94.74%) and women (89.47%) (P = .229). At a minimum 5-year follow-up, a propensity-matched comparison of female and male patients with BHD who underwent primary hip arthroscopy demonstrated significant improvement and comparable PROMs and survivorship. Clinical benefit was significantly higher in women, as evidenced by higher achievement rates on the MCID, PASS, and MOI.