Aims. Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods. A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results. CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion. This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival. Cite this article: Bone Jt Open 2024;5(4):260–268

Aims. Social media is a popular resource for patients seeking medical information and sharing experiences. periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic acetabular dysplasia with good long-term outcomes. However, little is known regarding the perceived outcomes of PAO on social media. The aims of this study were to describe the perceived outcomes following PAO using three social media platforms: Facebook, Instagram, and X (formerly known as Twitter). Methods. Facebook, Instagram, and X posts were retrospectively collected from 1 February 2023. Facebook posts were collected from the two most populated interest groups: “periacetabular osteotomy” and “PAO Australia.” Instagram and X posts were queried using the most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomyrecovery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data (sex, race, location), perspective (patient, physician, professional organization, industry), timing (preoperative vs postoperative), and perceived outcome (positive, negative, neutral). Results. A total of 1,054 Facebook posts, 1,003 Instagram posts, and 502 X posts were consecutively assessed from 887 unique authors. The majority (63.3%) of these posts were from patients in the postoperative period, with a median of 84 days postoperatively (interquartile range 20 to 275). The longest follow-up timeframe postoperatively was 20 years. Regarding perceived outcomes, 52.8% expressed satisfaction, 39.7% held neutral opinions, and 7.5% were dissatisfied. Most dissatisfied patients (50.9%) reported pain (chronic or uncontrolled acute) as an attributing factor. Conclusion. Most PAO-perceived surgical outcomes on social media had a positive tone. Findings also indicate that a small percentage of patients reported negative perceived outcomes. However, dissatisfaction with PAO primarily stemmed from postoperative pain. Social media posts from other sources (physicians, hospitals, professional organizations, etc.) trend towards neutrality. Healthcare providers must consider the social media narratives of patients following PAO, as they may reveal additional outcome expectations and help improve patient-centred care, create informed decision-making, and optimize treatment outcomes. Cite this article: Bone Jt Open 2024;5(1):53–59

Aims. Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. Methods. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Results. Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. Conclusion. We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity. Cite this article: Bone Joint J 2024;106-B(8):775–782

Aims. Periprosthetic joint infection (PJI) in total hip arthroplasty in the elderly may occur but has been subject to limited investigation. This study analyzed infection characteristics, surgical outcomes, and perioperative complications of octogenarians undergoing treatment for PJI in a single university-based institution. Methods. We identified 33 patients who underwent treatment for PJIs of the hip between January 2010 and December 2019 using our institutional joint registry. Mean age was 82 years (80 to 90), with 19 females (57%) and a mean BMI of 26 kg/m. 2. (17 to 41). Mean American Society of Anesthesiologists (ASA) grade was 3 (1 to 4) and mean Charlson Comorbidity Index was 6 (4 to 10). Leading pathogens included coagulase-negative Staphylococci (45%) and Enterococcus faecalis (9%). Two-stage exchange was performed in 30 joints and permanent resection arthroplasty in three. Kaplan-Meier survivorship analyses were performed. Mean follow-up was five years (3 to 7). Results. The two-year survivorship free of any recurrent PJI was 72% (95% confidence interval (CI) 56 to 89; 18 patients at risk). There were a total of nine recurrent PJIs at a mean of one year (16 days to eight years), one for the same pathogen as at index infection. One additional surgical site infection was noted at two weeks, resulting in a 69% (95% CI 52 to 86; 17 patients at risk) survivorship free of any infection at two years. There were two additional revisions for dislocations at one month each. As such, the two-year survivorship free of any revision was 61% (95% CI 42 to 80; 12 patients at risk). In addition to the aforementioned revisions, there was one additional skin grafting for a decubitus ulcer, resulting in a survivorship free of any reoperation of 54% (95% CI 35 to 73; ten patients at risk) at two years. Mean Clavien-Dindo score of perioperative complications was two out of five, with one case of perioperative death noted at six days. Conclusion. Octogenarians undergoing surgery for PJI of the hip are at low risk of acute mortality, but are at moderate risk of other perioperative complications. One in two patients will undergo a reoperation within two years, with 70% attributable to recurrent infections. Cite this article: Bone Joint J 2023;105-B(2):135–139

Different techniques have been described to address massive bone loss of the acetabulum in revision hip surgery. aMace has gained popularity as it provides customization aiming to restore hip centre and provide good initial stability in cases of large non-contained defects. It takes into account quality of host bone. Its porous defect filling scaffold provides an excellent surface for osteointegration. Our aim was to assess the short and mid-term outcomes of patients who underwent revision surgery using aMace system. Ethical approval was obtained. A retrospective study included all patients who had aMace between June 2013 and October 2022 allowing for a minimum of 12-months follow-up. Patients’ demographics, indication, bone-loss severity, reconstruction details, re-operation, complications, mortality, pain and function were assessed. 52 cases were performed by 13 surgeons with median 51 months follow-up. Median age was 72.7 years. 86.5% were female. Average BMI was 25.3. Average ASA grade was 3. 65% were classified as Paprosky IIIB and 32% were IIIA. 73% were found to have poor bone quality on CT. Main indication for aMace was massive bone loss/discontinuity secondary to aseptic loosening in 88.5%. 77% underwent single-stage revision. 53.8% had 2 or more previous revisions. 71% underwent stem revision in the same setting. 77% received a dual mobility bearing. Re-operation rate was 5.7% for instability and femoral PPF. LLD was reported in 9.6%. Permanent Sciatic nerve palsy occurred in 3.8% of the cases. 30-days mortality was 1.9%. Statistically significant post-op improvements in pain and mobility were reported (p<0.001). None of the acetabular components have been revised. Our study shows satisfactory surgical outcomes with a relatively low complication rate and significant pain and mobility improvements in the early to mid-term stages. We recommend these costly cases to be done in highly specialist centres adopting MDT approach

Aims. Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). Methods. A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors. Results. THA was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% CI 84.8 to 100), 86.7% (95% CI 79.8 to 94.3), and 54.8% (95% CI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable PROMs. An advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable OHS, but not with other PROMs. Conclusion. This study demonstrated the durability of TOA for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (OHS), it was not necessarily associated with worse patient satisfaction and joint awareness. Cite this article: Bone Joint J 2022;104-B(7):767–774

Although periacetabular osteotomies are widely used for the treatment of symptomatic acetabular dysplasia, the surgical outcomes after long term follow-up are still limited. Thus, we assessed hip survival and patient-reported outcomes (PROMs) at 20 years after the transposition osteotomy of acetabulum (TOA). Among 260 hips in 238 patients treated with TOA, 172 hips in 160 patients were evaluated at average 20.8 years, excluding patients who died or lost to follow-up. Kaplan-Meier analysis was used to assess survivorship with an end-point of THA. PROMs were evaluated using the VAS satisfaction, VAS pain, Oxford hip score (OHS), and Forgotten joint score (FJS). The thresholds of favorable outcomes of FJS and OHS were obtained using the receiver-operating characteristic curve with VAS satisfaction ≥ 50 and VAS pain < 20 as anchors. Thirty-three hips (19.2%) underwent THA at average 13.3 years after TOA. Kaplan-Meier analysis revealed hip survival rate at 20 years was 79.7%. Multivariate analysis showed the preoperative Tönnis grade significantly influenced hip survival. Survival rates with Tönnis grade 0, grade 1, and grade 2 were 93.3%, 86.7%, and 54.8% at 20 years, respectively. More than 60% of the patients showed favorable PROMs (VAS satisfaction ≥ 50, VAS pain < 20, OHS ≥ 42, FJS ≥ 51). Advanced Tönnis grade at the latest follow-up and higher BMI were significantly associated with unfavorable OHS, but not with other PROMs. This study demonstrated the durability of TOA for hips with Tönnis grade 0–1 and favorable satisfaction in majority of the patients at 20 years after surgery. Current presence of advanced osteoarthritis is associated with the lower hip function (OHS), but not necessarily associated with subjective pain and satisfaction. Higher BMI also showed a negative impact on postoperative function

Aims

Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO.

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In order to release the contracture band completely without damaging normal tissues (such as the sciatic nerve) in the surgical treatment of gluteal muscle contracture (GMC), we tried to display the relationship between normal tissue and contracture bands by magnetic resonance neurography (MRN) images, and to predesign a minimally invasive surgery based on the MRN images in advance.

Background. Slipped capital femoral epiphysis (SCFE) creates a complex deformity of the hip that can result in cam type of femoroacetabular impingement (FAI), which may in turn lead to the early development of osteoarthritis of the hip. The purpose of this study was to evaluate the existing literature reporting on the efficacy of hip arthroscopic treatment of patients with FAI secondary to SCFE. Methods. A systematic computer search was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed (Medline), and Cochrane Library up to November 2019. Data such as patient demographics, surgical outcomes and complications that described arthroscopic surgery following FAI secondary to SCFE were retrieved from eligible studies. Two authors independently reviewed study inclusion and data extraction with independent verification. Results. Following filtration, seven studies were included in this review comprising 96 patients (100 hips). The mean age was 14.9 years (SD, 2.7), and 54.2% of the cases were male. Eighty seven percent patients had undergone previous procedures at the first diagnosis of SCFE. Slip severity at the time of performing hip arthroscopy was mild for 54%, moderate for 31% and severe deformity for 15%. The mean alpha angle corrections was 32.0° (SD, 6.0°), and the mean improvement of internal rotation angle at 90° flexion was 23.6° (sd, 9.5°). ModifiedHarris Hip Scores (mHHS) was most reported (n = 3 studies; 38 hips) of the clinical outcomes, and the mean improvement of mHHS was 22.0 (sd, 3.6). Complication rates were 10%, and revision rate was 6.0%. Conclusion. Patients with FAI secondary to SCFE undergoing arthroscopic treatment demonstrate improved improvement in clinical outcome, rotation of the hip and correction of the alpha angle. It remains to be seen whether this eventually leads to prevention of OA and avoiding arthroplasty in this group of patients

Aims

The aim of this study was to determine both the incidence of, and the reoperation rate for, postoperative periprosthetic femoral fracture (POPFF) after total hip arthroplasty (THA) with either a collared cementless (CC) femoral component or a cemented polished taper-slip (PTS) femoral component.

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This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices.

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The aims of this study were to validate the Forgotten Joint Score-12 (FJS-12) in the postoperative evaluation of periacetabular osteotomy (PAO), identify factors associated with joint awareness after PAO, and determine the FJS-12 threshold for patient-acceptable symptom state (PASS).

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This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip arthroplasty for aseptic loosening.

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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).

Introduction. Meaningful clinical improvement as demonstrated through patient-reported outcome measures (PROMs) are increasingly used to evaluate success of total hip arthroplasty (THA) procedures. This patient perspective can provide a full picture when used with clinical data to best evaluate surgical outcomes. Methods. All primary THA procedures reported to the American Joint Replacement Registry from 2012–2018 with linked pre-operative and 1-year post-operative functional or anatomical PROMs were included. The achievement of minimal clinically-important difference (MCID) was calculated using the distribution method. Logistic regression models with covariate adjustment for patient demographics, American Society of Anesthesiologists (ASA) score, and body mass index (BMI) were constructed to identify associations with PROMs. Results were analyzed based on hospital size (small, medium and large) and teaching type (non-teaching, minor and major) based on the American Hospital Association Survey (2015). Results. There were 3,952 THA with pre-operative and 1-year post-operative PROMs. The five types of PROMs collected include: HOOS (n=731), HOOS Jr. (n=295), PROMIS-10 (n=1,074), SF-36 (n=976), VR-12 (1,262). The average age was 66.3±10.5 years, and the majority were female (54.7%). 53.1% of THA patients achieved MCID. Age and gender were statistically significant, while ASA score and BMI classification were not. As age increased by 1 year, the odds of achieving MCID increased 0.8% (OR 0.992, 95%CI 0.984, 0.999) and a minor versus major teaching hospital was 20.8% less likely to achieve MCID (p<0.04). While small hospital sizes had significantly fewer linked PROMs (6.5% of all linked PROMs), only 44.5% achieved MCID compared to medium (52.3%) and large (54.5%) hospitals (p<0.02). Conclusion. Older patient age, major teaching hospitals, and large hospitals achieved higher levels of MCID after THA. Identifying patients that are less likely to achieve MCID can aid physicians by determining patients at risk for poor outcomes, then guiding patient expectations and providing patient-centered care. For any tables or figures, please contact the authors directly

Introduction. There is a paucity of research investigating the effect of the experience of the operating surgeon on the long term function and survivorship of total hip replacements (THR). With the advent of individualised surgeon data being available to patients via the National Joint Registry, the desire to avoid complications and poor performance grows. This potentially reduces the availability of operative opportunities for trainees as consultants seek to ensure good results. Method & Results. A multicentre retrospective study of 879 THR was undertaken to investigate any differences in outcome between trainee surgeons and consultants. The effect of trainee supervision on the surgical outcome was also assessed. The primary outcome measures were survivorship and the Harris Hip Score (HHS). Rates of deep infection and dislocation were also recorded. Patients were evaluated pre-operatively and at 1, 3, 5, 7 and 10 years post-operatively. Surgical outcome was compared between junior trainees, senior trainees and consultants. The effect of supervision on final outcome was determined by comparing supervised and unsupervised trainees. 66.4% of patients were operated by consultants, 15.7% by junior trainees (ST3–5 equivalent) and 16.8% by senior trainees (ST6–8 equivalent). 10 year implant survival rates were; consultants 96.4 %, senior trainees 98.0 % and junior trainees 97.1%. There was no significant difference in post-operative HHS among consultants, senior and junior trainees at 1 year (p=0.122), 3 year (p=0.282), 5 year (p=0.063), 7 year (p=0.875), or at 10 years (p=0.924). There was no significant difference in HHS between supervised and unsupervised trainees at 1 year (p=0.220), 3 year (p=0.0.542), 5 year (p=0.880), 7 year (p=0.953) and 10-years (p=0.787). Comparison of surgical outcome between the supervised and unsupervised trainees also shows no significant difference in implant survival years (p=0.257). Conclusion. This study provides evidence that when trainees are appropriately supervised there is no negative effect on patient outcomes

Background. Total hip arthroplasty (THA) in patients with congenital dysplasia of the hip (CDH) is complex and challenging. The Crowe and Hartofilakidis classification systems are the most commonly used. However, neither encompasses the whole spectrum of disease and deformity and therefore does not guide modern surgical options. We present a new classification system which aims to guide surgical strategy by focusing on the three main areas of disease and deformity: Cup defect; De-rotation of femoral neck ante-version; Height of femoral subluxation. Each component is graded from 1–3 based on the severity of deformity and the potential surgical strategy required (with 3 being the most severe). A total numerical score will reflect the overall degree of difficulty which may be used when assessing surgical outcomes. The aim of this study is to assess the reliability of this new adult CDH classification system in the setting of THA. Study design and Methods. A sample size calculation showed 28 evaluations were required to reach a power of 85% (based on a kappa value of 0.4). The anterior-posterior pelvis and lateral hip radiographs of 30 hips, in 26 patients were evaluated by three Consultant Orthopaedic Surgeons using the classification detailed in table 1. A second evaluation, with the case order randomised, was performed after a minimum period of 1month. Randolph's free multi-rater Kappa co-efficient was used to assess for inter and intra- observer reliability and 95% confidence intervals were calculated. Results. The results of the Inter and intra–observer reliability for each classification component and for each rater respectively are shown in table 2 and 3. Conclusions. In comparison with other studies our reliability results were poorer when compared to the Hartofilakidis and Crowe classification systems. It was reported by the participants that our system enabled a more logical breakdown of the component deformities to address when performing THA in these hips. As with the Paprosky system for revision hip arthroplasty, this X-ray classification is intended as a practical pre-op guide to planning for all eventualities. Limitations due to level of observer experience and finer intra-operative judgements may alter the final result, but the essence is to understand the anatomical pitfalls enabling appropriate surgical planning and a total score against which to judge outcomes. For any figures or tables, please contact the authors directly

Aims

Total hip arthroplasties (THAs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is safe practice with comparable outcomes to consultant-performed THA. Our aim was to examine the association between surgeon grade, the senior supervision of trainees, and the risk of revision following THA.

Since the introduction of national guidelines in 2009 encouraging the use of total hip arthroplasty (THA) to treat intracapsular neck of femur fractures there has been no population-based studies into the surgical outcomes for this indication. This study aims to calculate the complication rates for THA when performed for a fractured neck of femur and compare them to THA performed for primary osteoarthritis in the same population. The Scottish Arthroplasty Project was used to identify all THAs performed in Scotland for neck of femur fracture and osteoarthritis between 1st of January 2009 and 31st December 2014. Dislocation, infection and revision rates at 1 year were calculated. The rate of dislocation, infection and revision at 1 year were all significantly increased among the fracture neck of femur cohort. In total 44046 THAs were performed, 38316 for OA and 2715 for a neck of femur fracture. 2.1% of patients (n=57) who underwent a THA for a neck of femur fracture suffered a dislocation in the 1st year postoperatively, compared to 0.9% (n=337) when the THA was performed for osteoarthritis. Relative Risk of dislocation: 2.3870 (95% C.I. 1.8077–3.1252, p value <0.0001). Relative Risk of infection: 1.4561 (95% C.I. 1.0496–2.0200, p value 0.0245) Relative Risk of revision: 1.4807 (95% C.I. 1.0308–2.1268, p value 0.0336). This is the first time a dislocation rate for THA performed for a neck of femur fracture has been calculated for an entire population. As the number of THAs for neck of femur fracture increases this dislocation rate will have clinical implications