Aims. This work aimed at answering the following research questions: 1) What is the rate of mechanical complications, nonunion and infection for head/neck femoral fractures, intertrochanteric fractures, and subtrochanteric fractures in the elderly USA population? and 2) Which factors influence adverse outcomes?. Methods. Proximal femoral fractures occurred between 1 January 2009 and 31 December 2019 were identified from the Medicare Physician Service Records Data Base. The Kaplan-Meier method with Fine and Gray sub-distribution adaptation was used to determine rates for nonunion, infection, and mechanical complications. Semiparametric Cox regression model was applied incorporating 23 measures as covariates to identify risk factors. Results. Union failure occured in 0.89% (95% confidence interval (CI) 0.83 to 0.95) after head/neck fracturs, in 0.92% (95% CI 0.84 to 1.01) after intertrochanteric fracture and in 1.99% (95% CI 1.69 to 2.33) after subtrochanteric fractures within 24 months. A fracture-related infection was more likely to occur after subtrochanteric fractures than after head/neck fractures (1.64% vs 1.59%, hazard ratio (HR) 1.01 (95% CI 0.87 to 1.17); p < 0.001) as well as after intertrochanteric fractures (1.64% vs 1.13%, HR 1.31 (95% CI 1.12 to 1.52); p < 0.001). Anticoagulant use, cerebrovascular disease, a concomitant fracture, diabetes mellitus, hypertension, obesity, open fracture, and rheumatoid disease was identified as risk factors. Mechanical complications after 24 months were most common after head/neck fractures with 3.52% (95% CI 3.41 to 3.64; currently at risk: 48,282). Conclusion. The determination of complication rates for each fracture type can be useful for informed patient-clinician communication. Risk factors for complications could be identified for distinct proximal femur fractures in elderly patients, which are accessible for therapeutical treatment in the management. Cite this article: Bone Jt Open 2023;4(10):801–807

Aims. The aims of this study were to compare clinically relevant measurements of hip dysplasia on radiographs taken in the supine and standing position, and to compare Hip2Norm software and Picture Archiving and Communication System (PACS)-derived digital radiological measurements. Methods. Preoperative supine and standing radiographs of 36 consecutive patients (43 hips) who underwent periacetabular osteotomy surgery were retrospectively analyzed from a single-centre, two-surgeon cohort. Anterior coverage (AC), posterior coverage (PC), lateral centre-edge angle (LCEA), acetabular inclination (AI), sharp angle (SA), pelvic tilt (PT), retroversion index (RI), femoroepiphyseal acetabular roof (FEAR) index, femoroepiphyseal horizontal angle (FEHA), leg length discrepancy (LLD), and pelvic obliquity (PO) were analyzed using both Hip2Norm software and PACS-derived measurements where applicable. Results. Analysis of supine and standing radiographs resulted in significant variation for measurements of PT (p < 0.001) and AC (p = 0.005). The variation in PT correlated with the variation in AC in a limited number of patients (R. 2. = 0.378; p = 0.012). Conclusion. The significant variation in PT and AC between supine and standing radiographs suggests that it may benefit surgeons to have both radiographs when planning surgical correction of hip dysplasia. We also recommend using PACS-derived measurements of AI and SA due to the poor interobserver error on Hip2Norm. Cite this article: Bone Joint J 2021;103-B(11):1662–1668

Ceramic bearing fracture is a rare complication following implantation using modern day ceramic bearing materials. Revision bearing options in such cases is debated, with the choice between ceramic-on-ceramic and ceramic-on-polyethylene bearings. Revision to a hard on soft bearing raises concerns about potential catastrophic wear secondary to a third-body reaction caused by the fractured ceramic particles. Data was collected retrospectively from the NJR, electronic patient records, revision database and picture archiving and communication system. Templating software was used to determine linear wear between first post-operative radiograph and the latest available follow up. Univariate analysis was used to examine patient demographics and the wear rates for revision of ceramic bearing fractures to ceramic on polyethylene components. The intra and inter-rater reliability of wear measurements was calculated. There were twelve patients identified as meeting the inclusion criteria. The average age at revision was 62 years (54–72). There were 6 liner and 6 head fractures revised to delta ceramic heads and cross-linked polyethylene acetabular components. The most frequently used head size was 32mm. At mean follow up of 3.8 years (0.5 6.1 years), median 4.4 years, linear wear rate was calculated at 0.08± 0.06 mm/year. Both intra-rater and inter-rater reliability was excellent with ICC scores of 0.99 at all timepoints. Revision to ceramic on polyethylene (CoP) bearings following ceramic fracture does not cause early catastrophic wear at early follow up. It appears safe to use this hard on soft bearing combination, given that wear rates are comparable to what is expected in a primary hip replacement setting. Longer follow up is required to establish if this trend persists

Sound management decisions are critical to outcomes in revision arthroplasty. Aiming to improve outcomes, revision networks facilitate speciality trained, high volume surgeons, share experience and best practice, contributing to decision making within and away from their base hospital. We have reported the early clinical experience of East Midlands Specialist Orthopaedic Network (EMSON). In this paper we report beneficial clinical effects, both demonstrable and unquantifiable supporting the process. Using the UK HES database of revisions, performed before and after EMSON was established, (April 2011 – March 2018), data from EMSON hospitals were compared to all other hospitals in the same time-period. Primary outcome was re-revision surgery within 1 year. Secondary outcomes were re-revision, complications within first two years and median LOS. 57,621 RTHA and 33,828 RTKA procedures were involved with around 1,485 (2.6%) and 1,028 (3.0%) respectively performed within EMSON. Re-revision THA rates, within 1 year, in EMSON were 7.3% and 6.0% with re-revision knee rates 11.6% and 7.4%, pre- and post-intervention. Re-revision rates in the rest England in the same periods were 7.4% to 6.8% for hips and 11.7% to 9.7% for knees. This constituted a significant improvement in 1-year re-revision rates for EMSON knees. (β = −0.072 (−0.133 to −0.01), p = 0.024). The reduction in hip re-revision did not reach statistical significance. Secondary outcomes showed a significant improvement for 1 and 2-year RTHA complication rates. Re-revision rates for RTKA and complication rates for RTHA improved significantly after the introduction of EMSON. Other outcomes studied also improved to a greater extent in the network hospitals. While anecdotal experience with networks is positive, the challenge in collating data to prove clinic benefit should not be underestimated. Beyond the formal process, additional communication, interaction, and support has immeasurable benefit in both elective and emergency scenarios

The purpose of this study is to understand the lived experience of mature patients who undergo a periacetabular osteotomy (PAO), a major surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to better understand how the PAO impacted the lives of the patients and their families, with a long-term goal of improving the experience. We utilized a phenomenological approach with in-depth, semi-structured interviews to investigate the experience of seven women, ages 25–40, who underwent a PAO. A modified intensity sampling method coupled with criterion sampling was used. Inclusion criteria included raising at least one child and being in a committed relationship with a partner. Analysis of interview transcripts revealed eight themes, each of which falls into one of three chronological periods. From the start of dysplasia symptoms until meeting the PAO surgeon: (1) frustration with symptoms disrupting daily activities, (2) discouragement from misdiagnoses and lack of explanation for symptoms, and (3) fear of the PAO operation. During the PAO decision-making process: (1) the importance of education regarding the PAO procedure and full understanding of its purpose, and (2) the utility of social media to learn from past PAO patients in order to feel more confident about the decision to undergo PAO. Post-operation through recovery: (1) feelings of helplessness, isolation and difficulty asking for help, (2) relying heavily on family and/or close friends for assistance, and (3) desire for more support and communication from the healthcare team. Our findings suggest that the psychosocial burden of PAO surgery is great, with major impact on the patient and family. Many important issues lie outside the scope of what healthcare teams currently address

Introduction. Recent literature has sought to quantify pre-operative work associated with total joint arthroplasty. These studies have utilized surveys or self-reported time logs to estimate the Pre-op Optimization Work (POW) completed by the surgical team. The purpose of this study was to objectively quantify POW associated with total hip arthroplasty (THA) using electronic medical record (EMR) activity audit logs. Methods. Retrospective analysis of EMR activity for 4 arthroplasty surgeons and their clinical staff was collected for 100 consecutive THA cases (25 per surgeon). Clinical informatics data was generated using EMR activity audit logs for pre-THA activity. Every action and mouse-click within a patient's chart was recorded for each team member. The time between mouse-clicks was calculated and summed for each user. Times exceeding five minutes without activity were assumed to reflect inactivity and excluded. Descriptive statistics were used to estimate the POW associated with THA preparation. Results. The mean number of days for pre-THA time period was70.7 (SD43.9; range: 8–175days). During this period, the mean time spent in each patient's chart was 75.5 minutes (SD50.75) minutes. Surgeon's POW in the medical record accounted for 7.3(SD6.7) of these minutes. Much of the work was conducted by nurses (47.0 minutes, SD43.4), physician extenders (10.8 minutes, SD 13.1), and qualified office staff/technicians (10.4 minutes, SD14.9). The majority of work captured in the EMR activity log was associated with medication review, patient optimization, documentation of necessary medical clearances, ordersets, patient communication, and prior authorization requests. Conclusion. A considerable amount of preoperative work is required between the clinic date a patient decides to pursue THA and the day prior to surgery. These retrospective electronic time stamp measurements should represent the absolute minimum time required for surgical preparation

Aims

The aim of this study was to understand the experience of mature patients who undergo a periacetabular osteotomy (PAO), a major hip-preserving surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to improve our understanding of how the operation affected the lives of patients and their families, with a long-term goal of improving their experience.

Aims

The burden of revision total hip arthroplasty (rTHA) continues to grow. The surgery is complex and associated with significant costs. Regional rTHA networks have been proposed to improve outcomes and to reduce re-revisions, and therefore costs. The aim of this study was to accurately quantify the cost and reimbursement for a rTHA service, and to assess the financial impact of case complexity at a tertiary referral centre within the NHS.

We report a case of a male patient presenting with bilateral painful but apparently well-positioned and -fixed large-diameter metal-on-metal hip replacements four years post-operatively. Multiple imaging modes revealed a thick-walled, cystic expansile mass in communication with the hip joint (a pseudotumour). Implant retrieval analysis and tissue culture eliminated high bearing wear or infection as causes for the soft-tissue reaction, but noted marked corrosion of the modular neck taper adaptor and corrosion products in the tissues. Therefore, we believe corrosion products from the taper caused by mismatch of the implant components led to pseudotumour formation requiring revision

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Current diagnostic tools are not always able to effectively identify periprosthetic joint infections (PJIs). Recent studies suggest that circulating microRNAs (miRNAs) undergo changes under pathological conditions such as infection. The aim of this study was to analyze miRNA expression in hip arthroplasty PJI patients.

Aims

Eccentric reductions may become concentric through femoral head ‘docking’ (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI.

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The aims of this study were to evaluate the incidence of reoperation (all cause and specifically for periprosthetic femoral fracture (PFF)) and mortality, and associated risk factors, following a hemiarthroplasty incorporating a cemented collarless polished taper slip stem (PTS) for management of an intracapsular hip fracture.

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This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality.

Aims

Hip dysplasia (HD) leads to premature osteoarthritis. Timely detection and correction of HD has been shown to improve pain, functional status, and hip longevity. Several time-consuming radiological measurements are currently used to confirm HD. An artificial intelligence (AI) software named HIPPO automatically locates anatomical landmarks on anteroposterior pelvis radiographs and performs the needed measurements. The primary aim of this study was to assess the reliability of this tool as compared to multi-reader evaluation in clinically proven cases of adult HD. The secondary aims were to assess the time savings achieved and evaluate inter-reader assessment.

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Delirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total length of hospital stay; 3) need for post-acute inpatient rehabilitation; and 4) hospital readmission within 180 days.

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The aim of this study was to compare open reduction and internal fixation (ORIF) with revision surgery for the surgical management of Unified Classification System (UCS) type B periprosthetic femoral fractures around cemented polished taper-slip femoral components following primary total hip arthroplasty (THA).

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Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA.

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To evaluate how abnormal proximal femoral anatomy affects different femoral version measurements in young patients with hip pain.

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Traditionally, total hip arthroplasty (THA) templating has been performed on anteroposterior (AP) pelvis radiographs. Recently, additional AP hip radiographs have been recommended for accurate measurement of the femoral offset (FO). To verify this claim, this study aimed to establish quantitative data of the measurement error of the FO in relation to leg position and X-ray source position using a newly developed geometric model and clinical data.

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The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique.