Waiting times for arthroplasty surgery in Northern Ireland are among the longest in the National Health Service, which have been further lengthened by the onset of the SARS-CoV-19 global pandemic in March 2020. The Department of Health (DoH) in Northern Ireland has announced a new Elective Care Framework (ECF), with the framework proposing that by March 2026 no patient will wait more than 52 weeks for inpatient/day case treatment. We aimed to assess the feasibility of achieving this with reference to
Eliminating pain and restoring physical activity are the main goals of
Objectives. There are few reports on
Background: The few reported results of
Aseptic loosening is the most frequent cause of implant failure in
Introduction: Physical activity is a major outcome in
Musculoskeletal loading plays an important role in the primary stability of THA. There are about 210,000 primary THA interventions p.a. in Germany. Consideration of biomechanical aspects during computer-assisted orthopaedic surgery is recommendable in order to obtain satisfactory long-term results. For this purpose simulation of the pre- and post-operative magnitude of the resultant hip joint force R and its orientation is of interest. By means of simple 2D-models (Pauwels, Debrunner, Blumentritt) or more complex 3D-models (Iglič), the magnitude and orientation of R can be computed patient-individually depending on their geometrical and anthropometrical parameters. In the context of developing a planning module for computer-assisted THA, the objective of this study was to evaluate the mathematical models. Therefore, mathematical model computations were directly compared to in-vivo measurements obtained from instrumented hip implants. With patient-specific parameters the magnitude and orientation of R were model-based computed for three patients (EBL, HSR, KWR) of the OrthoLoad-database. Their patient-specific parameters were acquired from the original patient X-rays. Subsequently, the computational results were compared with the corresponding in-vivo telemetric measurements published in the OrthoLoad-database. To obtain the maximum hip joint load, the static single-leg-stance was considered. A reference value for each patient for the maximum hip load under static conditions was calculated from OrthoLoad-data and related to the respective body weights (BW). On average there are large deviations of the results for the magnitude (Ø=147%) and orientation (Ø=14.35° too low) of R obtained by using Blumentritt's model from the in-vivo results/measurements. The differences might be partly explained by the supplemental load of 20% BW within Blumentritt's model which is added to the input parameter BW in order to consider dynamic gait influences. Such a dynamic supplemental load is not applied within the other static single-leg-stance models. Blumentritt's model assumptions have to be carefully reviewed due to the deviations from the in-vivo measurement data. Iglič's 3D-model calculates the magnitude (Ø17%) and the orientation (Ø49%) of R slightly too low. For the magnitude one explanation could be that his model considers nine individual 3D-sets of muscle origins and insertion points taken from literature. This is different from other mathematical models. The patient-individual muscle origin and insertion points should be used. Pauwels and Debrunner's models showed the best results. They are in the same range compared to in-vivo data. Pauwels's model calculates the magnitude (Ø5%) and the orientation (Ø28%) of R slightly higher. Debrunner's model calculates the magnitude (Ø1%) and the orientation (Ø14%) of R slightly lower. In conclusion, for the orientation of R, all the computational results showed variations which tend to depend on the used model. There are limitations coming along with our study: as our previous studies showed, an unambiguous identification of most landmarks in an X-ray (2D) image is hardly possible. Among the study limitations there is the fact that the OrthoLoad-database currently offers only three datasets for direct comparison of static single leg stance with in-vivo measurement data of the same patient. Our ongoing work is focusing on further validation of the different mathematical models.
Introduction. The goal of joint-preserving surgery for the treatment of osteonecrosis of the femoral head (ONFH) is to delay or prevent osteoarthritic development. Bone marrow is a source of osteogenic progenitors that are key elements in the process of bone formation and fracture healing. We established an easy-to-use method using a conventional manual blood bag centrifugation technique traditionally used for extracting buffy coats, for concentration of nucleated cells and platelets from clinical bone marrow aspirates to obtain osteogenic progenitors and growth factors. However, it is unclear whether the surgical goals are really achieved and if so in which patients. The purpose of this study was to identify demographic, clinical, and radiographic factors predicting
To analyze the treatment results of late instability and dislocation of the hip following total hip arthroplasty. The study refers to 16 patients from 42 to 71 years old when had primary THA. The mean time of late dislocation was 9,5 years and the revision mean time was 11 years following THA. In most patients extensive polyethylene wear was documented, in 12 patients the cup or the polyethylene insert on a stable metal implant was revised and in 4 patients new polytethylene cemented insert was placed in a stable metal implant. In all cases exchange of the femoral component metal head took place. During follow up and re-evaluation 2–7 years after the revision there were 13 patients (81.25 %) with a stable THA and good function. Instability remained in three patients, which in 2 was resolved with re-revision of the cup whereas in the third (over aged) a special abduction brace was applied. Late hip dislocation 5 or more years after THA occurs mainly due to extensive polyethylene wear and in contrast with early dislocation requires more often surgical intervention. The main cause of late hip dislocation was the extensive polyethylene wear, which in three cases was associated with prosthesis mal-orientation at primary implantation and in lots of cases with age-related neuromuscular deficit. The treatment of late instability with repetitive dislocations requires surgical intervention. The revision might need exchange of cup or polyethylene insert on a stable metal implant or new polytethylene cemented insert on a stable metal implant.
Patient medical comorbidities are well-established risk modifiers of THA patient outcomes. Patient's mental state preoperatively may influence postoperative functional outcomes though just like any medical comorbidity. This study sought to determine if patient confidence in attaining post-operative functional goals was associated with objective and subjective outcomes following THA. Patients undergoing primary or revision THA at a single institution between 2008 and 2010 were administered a questionnaire consisting of demographics, body mass index, Hip Dysfunction Osteoarthritis and Outcomes Score (HOOS), SF-12 scores, the level of functionality they hoped to gain postoperatively and their confidence in attaining that goal (0–10 scale) preoperatively and postoperatively at last follow-up (minimum 12 months). Measured outcomes included length of stay, 30-day readmission, HOOS, and SF-12 physical component scores. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models that were adjusted for all variables, including baseline mental and functional scores.Introduction:
Methods:
Subluxation and dislocation are frequently cited reasons for THA revision. For patients who cannot accommodate a larger femoral head, an offset liner may enhance stability. However, this change in biomechanics may impact the mechanical performance of the bearing surface. To our knowledge, no studies have compared wear rates of offset and neutral liners. Herein we radiographically compare the in-vivo wear performance of 0mm and 4mm offset acetabular liners. Two cohorts of 40 individuals (0mm, 4mm offset highly crosslinked acetabular liners, respectively) were selected from a single surgeon's consecutive caseload. All patients received the same THA system via the posterior approach. AP radiographs were taken at 6-week (‘pre’) and 5-year (‘post’) postoperative appointments. Patients with poor radiograph quality were excluded (n0mm=5, n4mm=4). Linear and volumetric wear were quantified according to Patent US5610966A. Briefly, images were processed in computer aided design (CAD) software. Differences in vector length between the center of the femoral head and the acetabular cup (pre- and post-vector, Figure 1) allow for calculation of linear wear and wear rate. The angle (β) between the linear wear vector and the cup inclination line was quantified (Figure 1). Patients with negative β were excluded from volumetric analyses (n0mm=11, n4mm=7). Volumetric wear was accordingly calculated accounting for wear vector direction. The results from three randomly selected patients were compared to results achieved using the “Hip Analysis Suite” software package (UChicagoTech).Introduction
Methods
Radiological Inclination (RI) is defined as the angle formed between the acetabular axis and the longitudinal axis when projected onto the coronal plane. Higher RI angles are associated with adverse outcomes. Primary aim: to investigate the effect of adjusting patient pelvic position in the transverse plane by using a ‘head-down’ (HD) operating table position. This was to determine, when aiming for 35° Apparent Operative Inclination (AOI), which operating table position most accurately achieved a target post-operative RI of 42°. N=270. Patients were randomised to one of three possible operating table positions: 0°HD (Horizontal), 7°HD, or Y°HD (Patient Specific Table Position) Operating table position was controlled using a digital inclinometer. RI was measured using EBRA software.Introduction
Methods
From 18 to 60 months of follow up we observed a significant rise in BMD in all Gruen zones but zone 4 and 7. Despite this the total periprostetic BMD decreased during the study periode. There was no significant decrease in BMD in the contra lateral hip. In the spine, we observed a significant rise in BMD.
Metal on metal articulations produce chromium (Cr) and cobalt (Co) debris, particularly when the articulations are worn in. High levels in the peripheral blood are indicative of excess wear and may cause adverse effects. The present RCT investigates metal ion levels and the relationship of Co, Cr ions and lymphocyte counts during the running-in period. Following randomization to RHA (ASRTM, DePuy) or THA we obtained whole blood (wb), and serum (s) samples at baseline, 8 w, 6 m and 1 y. We measured the Co and Cr concentrations, the total lymphocyte count as well as the CD3+, CD4+, CD8+, CD19+ and CD16+/CD56+ sub populations. Cup inclination and anteversion angles came from conventional radiographs. Activity was measured as steps by pedometer and UCLA activity. Data are presented as median (range).Introduction
Materials and Methods
Aims. Osteoporosis is common in
Aims. Conventional patient-reported surveys, used for patients undergoing
Aims. Young adults undergoing
Aims. Oxidized zirconium (OxZi) and highly cross-linked polyethylene (HXLPE) were developed to minimize wear and risk of osteolysis in
Aims. Patients with femoral neck fractures (FNFs) treated with
Aims. Adult patients with history of childhood infection pose a surgical challenge for
Aims. Professional dancers represent a unique patient population in the setting of hip arthroplasty, given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to professional dance after
Aims.
Aims. Surgery is often delayed in patients who sustain a hip fracture and are treated with a
Aims. The primary aim of our study was to assess the influence of age on hip-specific outcome following
Aims. The aim of this study was to assess medium-term improvements following
Aims. Navigation devices are designed to improve a surgeon’s accuracy in positioning the acetabular and femoral components in
Aims. Golf is a popular pursuit among those requiring
Aims. Septic arthritis of the hip often leads to irreversible osteoarthritis (OA) and the requirement for
Aims. This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent
Aims.
Aims.
Aims. After failed acetabular fractures,
Aims. This study aimed to use intraoperative free electromyography to examine how the placement of a retractor at different positions along the anterior acetabular wall may affect the femoral nerve during
Aims. The aim of this study was to examine whether socioeconomic status (SES) is associated with a higher risk of infections following
Aims. Vitamin E-infused highly crosslinked polyethylene (VEPE) has been introduced into
The October 2023 Hip & Pelvis Roundup360 looks at: Femoroacetabular impingement syndrome at ten years – how do athletes do?; Venous thromboembolism in patients following total joint replacement: are transfusions to blame?; What changes in pelvic sagittal tilt occur 20 years after total hip arthroplasty?; Can stratified care in hip arthroscopy predict successful and unsuccessful outcomes?; Hip replacement into your nineties; Can large language models help with follow-up?; The most taxing of revisions – proximal femoral replacement for periprosthetic joint infection – what’s the benefit of dual mobility?
Cite this article:
Lateral femoral cutaneous nerve (LFCN) injury is a potential complication after the direct anterior approach for total hip arthroplasty (DAA-THA). The aim of this study was to determine how the location of the fasciotomy in DAA-THA affects LFCN injury. In this trial, 134 patients were randomized into a lateral fasciotomy (n = 67) or a conventional fasciotomy (n = 67) group. This study was a dual-centre, double-blind, prospective randomized controlled two-arm trial with parallel group design and a 1:1 allocation ratio. The primary endpoint was the presence of LFCN injury, which was determined by the presence of numbness, decreased sensation, tingling, jolt-like sensation, or pain over the lateral aspect of the thigh, excluding the surgical scar, using a patient-based questionnaire. The secondary endpoints were patient-reported outcome measures (PROMs) using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), and the Forgotten Joint Score-12 (FJS-12). Assessments were obtained three months after surgery.Aims
Methods
The risk factors for abnormal spinopelvic mobility (SPM), defined as an anterior rotation of the spinopelvic tilt (∆SPT) ≥ 20° in a flexed-seated position, have been described. The implication of pelvic incidence (PI) is unclear, and the concept of lumbar lordosis (LL) based on anatomical limits may be erroneous. The distribution of LL, including a unusual shape in patients with a high lordosis, a low pelvic incidence, and an anteverted pelvis seems more relevant. The clinical data of 311 consecutive patients who underwent total hip arthroplasty was retrospectively analyzed. We analyzed the different types of lumbar shapes that can present in patients to identify their potential associations with abnormal pelvic mobility, and we analyzed the potential risk factors associated with a ∆SPT ≥ 20° in the overall population.Aims
Methods
The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). We undertook a registry study combining the National Joint Registry dataset with polyethylene manufacturing characteristics as supplied by the manufacturers. The primary endpoint was revision for any reason. We performed further analyses on other reasons including instability, aseptic loosening, wear, and liner dissociation. The primary analytic approach was Cox proportional hazard regression.Aims
Methods
The current study aimed to compare robotic arm-assisted (RA-THA), computer-assisted (CA-THA), and manual (M-THA) total hip arthroplasty regarding in-hospital metrics including length of stay (LOS), discharge disposition, in-hospital complications, and cost of RA-THA versus M-THA and CA-THA versus M-THA, as well as trends in use and uptake over a ten-year period, and future projections of uptake and use of RA-THA and CA-THA. The National Inpatient Sample was queried for primary THAs (2008 to 2017) which were categorized into RA-THA, CA-THA, and M-THA. Past and projected use, demographic characteristics distribution, income, type of insurance, location, and healthcare setting were compared among the three cohorts. In-hospital complications, LOS, discharge disposition, and in-hospital costs were compared between propensity score-matched cohorts of M-THA versus RA-THA and M-THA versus CA-THA to adjust for baseline characteristics and comorbidities.Aims
Methods
Aims. Day-case arthroplasty is gaining popularity in Europe. We report outcomes from the first 12 months following implementation of a day-case pathway for unicompartmental knee arthroplasty (UKA) and
Aims. This study aimed to describe practice variation in the use of
Aims. Dual-mobility (DM) components are increasingly used to prevent and treat dislocation after
Aims. Pelvic discontinuity is a rare but increasingly common complication of
Aims. This study was designed to develop a model for predicting bone mineral density (BMD) loss of the femur after
Aims. The aim of this investigation was to compare risk of infection in both cemented and uncemented hemiarthroplasty (HA) as well as in
Aims. The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of
Aims. Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in
Aims. We aimed to assess the cumulative risk of
Aims. Successful cell therapy in hip osteonecrosis (ON) may help to avoid ON progression or
Aims. The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a
Aims. The aim of this study was to evaluate the reliability and validity of a patient-specific algorithm which we developed for predicting changes in sagittal pelvic tilt after
Aims. In metal-on-polyethylene (MoP)
Aims. A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in
Aims.
Aims. Modular dual-mobility (DM) articulations are increasingly used during
Aims. Manual impaction, with a mallet and introducer, remains the standard method of installing cementless acetabular cups during
Aims.
Aims. The aim of this study was to compare the pattern of initial fixation and changes in periprosthetic bone mineral density (BMD) between patients who underwent
Aims. The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in
Aims. A revision for periprosthetic joint infection (PJI) in
Aims. Head-taper corrosion is a cause of failure in
Aims. The aim of this study was to estimate the 90-day periprosthetic joint infection (PJI) rates following total knee arthroplasty (TKA) and
Aims. Iliopsoas impingement occurs in 4% to 30% of patients after undergoing
Aims. Dual-mobility acetabular components (DMCs) have improved
Aims. Leg length discrepancy (LLD) is a common pre- and postoperative issue in
Aims. The primary aim of this study is to assess the survival of the uncemented hydroxyapatite (HA) coated Trident II acetabular component as part of a hybrid
Aims. Spinopelvic pathology increases the risk for instability following
Aims. Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate femoral stem version in postoperative
Aims. Hyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and symptomatic osteoarthritis of the hip. The purpose of this study is to analyze the clinical and radiological long-term outcome of patients treated with osteochondral autograft transfer. To our knowledge, this study represents a series of osteochondral autograft transfer of the hip with the longest follow-up. Methods. We retrospectively evaluated 11 hips in 11 patients who underwent osteochondral autograft transfer in our institution between 1996 and 2012. The mean age at the time of surgery was 28.6 years (8 to 45). Outcome measurement included standardized scores and conventional radiographs. Kaplan-Meier survival curve was used to determine the failure of the procedures, with conversion to
Aims. Waiting times for arthroplasty surgery in Northern Ireland are among the longest in the NHS, which have been further lengthened by the onset of the COVID-19 global pandemic in March 2020. The Department of Health in Northern Ireland has announced a new Elective Care Framework (ECF), with the framework proposing that by March 2026 no patient will wait more than 52 weeks for inpatient/day case treatment. We aimed to assess the feasibility of achieving this with reference to
Aims. Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in
Aims. Femoral component anteversion is an important factor in the success of
Aims. Osteoporosis can determine surgical strategy for
Aims. Mechanical impingement of the iliopsoas (IP) tendon accounts for 2% to 6% of persistent postoperative pain after
Aims. Several short- and mid-term studies have shown minimal liner wear of highly cross-linked polyethylene (HXLPE) in
Aims. The duration of systemic antibiotic treatment following first-stage revision surgery for periprosthetic joint infection (PJI) after
Aims. The objective of this study was to compare the two-year migration and clinical outcomes of a new cementless hydroxyapatite (HA)-coated titanium acetabular shell with its previous version, which shared the same geometrical design but a different manufacturing process for applying the titanium surface. Methods. Overall, 87 patients undergoing
Aims. Patients with a high comorbidity burden (HCB) can achieve similar improvements in quality of life compared with low-risk patients, but greater morbidity may deter surgeons from operating on these patients. Whether surgeon volume influences
Aims. The COVID-19 pandemic has caused unprecedented disruption to elective orthopaedic services. The primary objective of this study was to examine changes in functional scores in patients awaiting
Aims. The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous
Aims. Traditionally,
Aims. Periprosthetic proximal femoral fractures (PFFs) are a major complication after
Aims. It is unclear whether mortality outcomes differ for patients undergoing
Aims. To investigate the optimal thresholds and diagnostic efficacy of commonly used serological and synovial fluid detection indexes for diagnosing periprosthetic joint infection (PJI) in patients who have rheumatoid arthritis (RA). Methods. The data from 348 patients who had RA or osteoarthritis (OA) and had previously undergone a total knee (TKA) and/or a
Aims.
Aims. Breast cancer survivors have known risk factors that might influence the results of
Aims. The Birmingham Hip Resurfacing (BHR) was introduced in 1997 to address the needs of young active patients using a historically proven large-diameter metal-on-metal (MoM) bearing. A single designer surgeon’s consecutive series of 130 patients (144 hips) was previously reported at five and ten years, reporting three and ten failures, respectively. The aim of this study was to extend the follow-up of this original cohort at 25 years. Methods. The study extends the reporting on the first consecutive 144 resurfacing procedures in 130 patients for all indications. All operations were undertaken between August 1997 and May 1998. The mean age at operation was 52.1 years (SD 9.93; 17 to 76), and included 37 female patients (28.5%). Failure was defined as revision of either component for any reason. Kaplan-Meier survival analysis was performed. Routine follow-up with serum metal ion levels, radiographs, and Oxford Hip Scores (OHSs) was undertaken. Results. Overall implant survival was 83.50% (95% confidence interval (CI) 0.79 to 0.90) at 25 years, and the number at risk was 79. Survival in male patients at 25 years was 89.5% (95% CI 0.83 to 0.96) compared to 66.9% for female patients (95% CI 0.51 to 0.83). Ten additional failures occurred in the period of ten to 25 years. These involved an adverse reaction to metal debris in four patients, a periprosthetic femoral neck fracture affecting five patients, and aseptic loosening in one patient. The median chromium levels were 49.50 nmol/l (interquartile range (IQR) 34 to 70), and the median cobalt serum levels were 42 nmol/l (IQR 24.50 to 71.25). The median OHS at last follow-up was 35 (IQR 10 to 48). During the 25-year study period, 29 patients died. Patient survival at 25 years was 75.10% (95% CI 0.67 to 0.83). Conclusion. This study demonstrates that MoM hip resurfacing using the BHR provides a durable alternative to
Aims. The volume of ambulatory
Aims. The primary aim was to assess whether preoperative health-related quality of life (HRQoL) was associated with postoperative mortality following
Aims. The overall aim of this study was to determine the impact of deprivation with regard to quality of life, demographics, joint-specific function, attendances for unscheduled care, opioid and antidepressant use, having surgery elsewhere, and waiting times for surgery on patients awaiting
Aims. Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods. Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to
Aims. Despite higher rates of revision after