Current treatment options for displaced acetabular fractures in elderly patients include non-surgical management, surgical fixation and surgical fixation with simultaneous hip replacement, the so-called “fix-and-replace”™. There remains a paucity of evidence to guide surgeons in decision making for these difficult injuries. The aim of this study was to assess the feasibility of performing an appropriately powered RCT between treatment options for acetabular fractures in older patients. This was an NIHR funded feasibility triple-arm RCT with participation from 7 NHS MTCs. Patients older than 60 were recruited if they had an acetabular fracture deemed sufficiently displaced for the treating surgeon to consider surgical fixation. Randomisation was performed on a 1:1:1 basis. The three treatment arms were non-surgical management, surgical fixation and fix-and-replace. Feasibility was assessed by willingness of patients to participate and clinicians to recruit, drop out rate, estimates of standard deviation to inform the sample size calculation for the full trial and completion rates to inform design of a future definitive trial. EQ-5D was the primary outcome measure at 6 months, OHS and Disability Rating Index were secondary outcome measures. Of 117 eligible patients, 60 were randomised whilst 50 declined study participation. Nine patients did not receive their allocated intervention. Analysis was performed on an intention to treat basis. During the study period 4 patients withdrew before final review, 4 patients died and 1 was lost to follow-up. The estimated sample size for a full scale study was calculated to be 1474 participants for an EQ-5D MCID of 0.06 with a power of 0.8. This feasibility study suggests a full scale trial would require international collaboration. This study also has provided observed safety data regarding mortality and morbidity for the fix-and-replace procedure to
This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images. The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm3). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis.Aims
Methods
Introduction. Severe osteolysis of the femur secondary to aseptic loosening in hip arthroplasty, remains a difficult revision scenario. Multiple techniques have been developed to
Traditionally, acetabular component insertion during total hip arthroplasty (THA) is visually assisted in the posterior approach and fluoroscopically assisted in the anterior approach. The present study examined the accuracy of a new surgeon during anterior (NSA) and posterior (NSP) THA using robotic arm-assisted technology compared to two experienced surgeons using traditional methods. Prospectively collected data was reviewed for 120 patients at two institutions. Data were collected on the first 30 anterior approach and the first 30 posterior approach surgeries performed by a newly graduated arthroplasty surgeon (all using robotic arm-assisted technology) and was compared to standard THA by an experienced anterior (SSA) and posterior surgeon (SSP). Acetabular component inclination, version, and leg length were calculated postoperatively and differences calculated based on postoperative film measurement.Aims
Methods
Cementless acetabular components rely on press-fit fixation for initial stability. In certain cases, initial stability is more difficult to obtain (such as during revision). No current study evaluates how a surgeon’s impaction technique (mallet mass, mallet velocity, and number of strikes) may affect component fixation. This study seeks to answer the following research questions: 1) how does impaction technique affect a) bone strain generation and deterioration (and hence implant stability) and b) seating in different density bones?; and 2) can an impaction technique be recommended to minimize risk of implant loosening while ensuring seating of the acetabular component? A custom drop tower was used to simulate surgical strikes seating acetabular components into synthetic bone. Strike velocity and drop mass were varied. Synthetic bone strain was measured using strain gauges and stability was assessed via push-out tests. Polar gap was measured using optical trackers.Aims
Methods
The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years.Aims
Patients and Methods
We report patient-reported outcomes and complications
associated with contemporary periacetabular osteotomy (PAO) surgery
in treating symptomatic acetabular dysplasia and compare these outcomes
with total hip arthroplasty (THA) in patients with similar demographic
details. Two consecutive cohorts included patients between aged
18 to 40 years who had undergone either PAO (100 hips; 24 male,
76 female) or THA (55 hips; 18 male, 37 female). At a mean follow-up
of 5.9 years (2 to 13), there was significant improvement in the
modified Harris hip pain (p <
0.001, PAO and p <
0.001, THA),
function (p <
0.001, PAO and p = 0.001, THA), and total scores
(p <
0.001, PAO and p <
0.001, THA) within each cohort. There
were no significant differences in the clinical outcome scores between
the groups. Complication rates were low and similar in each cohort
(p = 0.68). Similar to THA, contemporary PAO surgery is a clinically
effective procedure that improves function and activity levels,
provides pain relief and is associated with an acceptable complication
rate. Cite this article:
Several factors have been implicated in unsatisfactory
results after total hip replacement (THR). We examined whether femoral
offset, as measured on digitised post-operative radiographs, was
associated with pain after THR. The routine post-operative radiographs
of 362 patients (230 women and 132 men, mean age 70.0 years (35.2
to 90.5)) who received primary unilateral THRs of varying designs
were measured after calibration. The femoral offset was calculated
using the known dimensions of the implants to control for femoral
rotation. Femoral offset was categorised into three groups: normal
offset (within 5 mm of the height-adjusted femoral offset), low
offset and high offset. We determined the associations to the absolute
final score and the improvement in the mean Western Ontario and
McMaster Universities osteoarthritis index (WOMAC) pain subscale
scores at three, six, 12 and 24 months, adjusting for confounding
variables. The amount of femoral offset was associated with the mean WOMAC
pain subscale score at all points of follow-up, with the low-offset
group reporting less WOMAC pain than the normal or high-offset groups
(six months: 7.01 ( Cite this article:
