Explore the vast range of titles available.

Purpose This study aimed to assess the long-term results of THA patients who received a cementless short stem regarding clinical outcomes, bone changes, complications, and incidence of femoral revision. Methods A retrospective evaluation of the first 100 THA employing a type 2B cementless stem (Mini hip stem, Corin, Cirencester, United Kingdom) by the same surgeon at one institution. We only include patients with 18 years or more, and with a minimum follow up of 8 years. Patient’s Harris hip score (HHS), the University of California, Los Angeles activity score (UCLA), and radiographic outcomes were evaluated. Results A total of 100 primary hip arthroplasties with Mini Hip stems were performed on 84 patients, with an average age of 47 years old. The median follow-up was 120 months (IQR 57.5-136.5), with 47 patients having a minimum 10-year follow-up. The patient’s HHS improved significantly ( p  < 0.001) and UCLA’s score was 7 (SD 1.7) at the final follow-up. Only one patient suffered an intraoperative lateral cortical perforation, which was treated on the same day with revision of the short stem to a conventional metaphysodiaphyseal fixation stem. Three incomplete fractures of the calcar occurred intraoperative, of which only one required wire cerclage and unloading partial during the 30 days after surgery. No osteolysis, radiolucency, thigh pain, periprosthetic or ceramic fractures were observed. Only 6% hips experience squeaking without the need for revision. Two acetabular components were revised early, but no stem failures were recorded, yielding an incidence density rate of 0% (95% CI 0-0.05%) over 10 years. Conclusion This study showed that the MiniHip short stem is a reliable option for THA in younger patients, with a high implant survival rate and excellent functional outcomes over the long term.

Purpose Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis secondary to hip dysplasia. However, the reported rate of complications following THA in the settings of neuromuscular diseases is high. This systematic review aimed to analyze the indications, functional outcomes and surgical failures of primary THA in cerebral palsy (CP) patients. Methods MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched, and all clinical studies focusing on THA in patients with CP from inception through March 2020 were included. The methodological quality was assessed with Guo et al.’s quality appraisal checklist for case series and case–control studies, while cohort and prospective studies were evaluated with a modified version of the Downs and Black’s quality assessment checklist. Results The initial search returned 69 studies out of which 15, including 2732 THAs, met the inclusion criteria. The most frequent indication for THA was dislocated painful hip for which previous non-operative treatment had failed. Complications presented in 10 to 45% of cases. The most frequently reported complication was dislocation (1–20%), followed by component loosening (0.74–20%). Aseptic component loosening was the most frequent cause of revision surgery, followed by dislocation and periprosthetic fracture. Mean implant survival at ten years was 84% (range 81–86%). Conclusion The available literature suggests that although THA is a beneficial procedure in CP patients, it has a higher rate of complications and worse implant survival than the general population.

Purpose To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epidemiology. Methods Retrospective case-control study of 160 hip fractures operated upon between December 2019 and May 2020. Based on the date of declaration of national lockdown, the cohort was separated into two groups: ‘pre-COVID time’ (PCT), including 86 patients, and ‘COVID time’ (CT), consisting of 74 patients. All CT patients tested negative for SARS-CoV-2. Patients were stratified based on demographic characteristics. Outcome measures were 30-day complications, readmissions and mortality. A logistic regression model was run to evaluate factors associated with mortality. Results Age, female/male ratio, body mass index and American Society of Anaesthesia score were similar between both groups ( p  > 0.05). CT patients had a higher percentage of Charlson ≥ 5 and Rockwood Frailty Index ≥ 5 scores ( p  < 0.05) as well as lower UCLA and Instrumental Activities of Daily Living scores ( p  < 0.05). This translated into a higher hemiarthroplasty/total hip arthroplasty ratio during CT ( p  = 0.04). Thromboembolic disease was higher during CT ( p  = 0.02). Readmissions (all negative for SARS-CoV-2) were similar between both groups ( p  = 0.34). Eight (10.8%) casualties were detected in the CT group, whereas no deaths were seen in the control group. Logistic regression showed that frailer ( p  = 0.006, OR 10.46, 95%CI 8.95–16.1), less active ( p  = 0.018, OR 2.45, 95%CI 1.45–2.72) and those with a thromboembolic event ( p  = 0.005, OR 30, 95%CI 11–42) had a higher risk of mortality. Conclusion Despite testing negative for SARS-CoV-2, CT patients were less active and frailer than PCT patients, depicting an epidemiological shift that was associated with higher mortality rate.

Background: Acetabular morphology in hip dysplasia is typically assessed using computed tomography (CT) for bone coverage and magnetic resonance imaging (MRI) for soft tissues. However, agreement between CT and 3.0-T fast field echo (FFE) MRI for anterior and posterior acetabular sector angles (AASA, PASA) remains insufficiently defined. Hypothesis: FFE T1-weighted MRI measurements would strongly correlate with CT-based acetabular sector angles (ASAs). Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 65 symptomatic dysplastic hips were evaluated. Two independent observers measured on CT and 3.0-T MRI scans the lateral center-edge angle (LCEA), anterior and posterior acetabular wall indices (AWI, PWI), Tönnis angle, and pelvic signs. Equatorial, intermediate, and proximal AASA and PASA were obtained on each modality. CT-MRI agreement was assessed using Spearman rho (ρ). Results: Intermediate AASA demonstrated strong CT-MRI correlation (ρ = 0.807), whereas equatorial and proximal AASA correlations were moderate (ρ = 0.408 and 0.398, respectively). All PASA measurements showed good MRI-CT agreement (equatorial ρ = 0.766; intermediate ρ = 0.747; proximal ρ = 0.739). AWI correlated well with CT-AASAs but weakly with MRI-derived AASAs (equatorial ρ = 0.345; intermediate ρ = 0.325; proximal ρ = 0.255). Conclusion: T1-weighted FFE MRI cannot currently replace CT for measuring acetabular coverage of the femoral head. Although MRI and CT seemed to correlate better at the posterior level, they did not correlate accurately anteriorly; thus, the estimation of AWI by MRI with the current echo sequence alone may lead to misinterpretation. Given that the most common type of dysplasia in the setting of normal LCEA is that with an anterior wall defect only, the authors strongly recommend using CT (or other MRI sequences) to assess patients who are potential candidates for hip joint preservation surgery.

IntroductionThe performance of total hip arthroplasty in elderly patients, especially nonagenarians, is challenging due to higher patient frailty and medical comorbidities. We compared 90-day postoperative complications and unplanned readmissions between nonagenarians and octogenarians undergoing elective THA.MethodsOne hundred and eleven patients undergoing elective, unilateral THA were retrospectively analyzed. Forty-four patients were nonagenarians (Group A), and 67 patients were octogenarians (Group B). Demographic data included age, gender, body mass index (BMI), ASA score and Charlson Comorbidity Index (CCI). Frailty was defined according to the Rockwood Frailty Index. All patients underwent a thorough preoperative assessment through a specific institutional clinical pathway created for this matter. Postoperative adverse events were grouped into major or minor. A regression model was used to evaluate independent risk factors for the development of complications.ResultsThere were no differences in the ASA score (65.9% vs. 53.7% ASA III-IV), prevalence of frailty (1% vs. 9%) and comorbidities between both groups (p > .05). The CCI was higher in nonagenarians (p = 0.007). Nonagenarians had more in-hospital complications, although most were minor (p = 0.002), none of which resulted in mortality. Ninety-day unplanned readmissions were similar between groups, with 4 (9.1%) and 6 (9%) in groups A and B, respectively (p = 1). Although age was a factor associated with the development of postoperative complications in the univariate regression model (OR 3.81, 95% CI 1.31 to 11.11, p = 0.014), it lost significance after performing the multivariate analysis (OR 2.48, 95% CI 0.78 to 7.90, p = 0.125).ConclusionThe age of 90 years old was not a barrier to perform elective THA safely. Nonagenarians had higher in-hospital minor complications when compared to the younger cohort. However, age over 90 years was not an independent risk factor for unplanned readmissions or mortality. Multimodal protocols of perioperative care are paramount for improving outcomes after THA in very old patients.

Background Following a total hip arthroplasty (THA), early hospital re-admission rates of 3–11% are considered as ‘acceptable’ in terms of medical care cost policies. Surprisingly, the impact of re-admissions on mortality has not been priorly portrayed. Therefore, we sought to determine the mortality rate after 90-day re-admissions following a THA in a series of patients from a captive medical care program. Patients and methods We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated upon between 2010 and 2014 whose medical care was the one offered by our institution. We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazards model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with early and late mortality. Results We found 37 (4.53%) re-admissions at a median time of 40.44 days (IQR 17.46–60.69). Factors associated with re-admission were hospital stay ( p  = 0.00); surgical time ( p  = 0.01); chronic renal insufficiency ( p  = 0.03); ASA class 4 ( p  = 0.00); morbid obesity ( p  = 0.006); diabetes ( p  = 0.04) and a high Charlson index ( p  = 0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR 297.58–1170.65). One-third (11/37) of the re-admitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day re-admissions remained associated with mortality with an adjusted HR of 3.14 (CI95% 1.05–9.36, p  = 0.04). Conclusions Unplanned re-admissions were an independent risk factor for future mortality, increasing three times the risk of mortality.

Complex regional pain syndrome (CRPS) constitutes an atypical cause of pain after orthopaedic procedures. To our knowledge, there is a paucity of literature reporting this syndrome after total hip arthroplasty (THR), since only two case reports have been published. We thenceforth describe the clinical outcome of three cases of type-1 CRPS developed after elective THR, two of them initially diagnosed with secondary osteoarthritis whereas the remaining one presented a sequel of a failed osteosynthesis that required conversion to THR. Remission of disease was found at an average seven months (range: 4-9). Medical treatment involved a combined therapy of pain management, bisphosphonates and intense physical therapy. One patient was additionally treated with a corticosteroid blockade of his right sympathetic lumbar ganglia. None of the patients required surgical treatment. At final follow-up, physical examinations and imaging were negative for disease.

Incapacitating articular sequelae in the hip joint have been described for patients with late effects of poliomyelitis. In these patients, total hip arthroplasty (THA) has been associated with a substantial rate of dislocation. This study was conducted to evaluate the long-term clinical and radiologic outcomes of unconstrained THA in this specific group of patients. The study included 6 patients with ipsilateral polio who underwent primary THA between 1985 and 2006. Patients with polio who underwent THA on the nonparalytic limb were excluded. Mean follow-up was 119.5 months (minimum, 84 months). Clinical outcomes were evaluated with the modified Harris Hip Score (mHHS) and the visual analog scale (VAS) pain score. Radiographs were examined to identify the cause of complications and determine the need for revision surgery. All patients showed significantly better functional results when preoperative and postoperative mHHS (67.58 vs 87.33, respectively; P =.002) and VAS pain score (7.66 vs 2, respectively; P =.0003) were compared. Although 2 cases of instability were diagnosed, only 1 patient needed acetabular revision as a result of component malpositioning. None of the patients had component loosening, osteolysis, or infection. Unconstrained THA in the affected limb of patients with poliomyelitis showed favorable long-term clinical results, with improved function and pain relief. Nevertheless, instability may be a more frequent complication in this group of patients compared with the general population. [ Orthopedics. 2017; 40(2):e255–e261.]

Introduction: The idyllic treatment of hip dysplasia is periacetabular osteotomy (PAO). Since the indication of arthroscopy as a unique action is controversial in the treatment of dysplasia, our objective was to analyze its clinical and radiological results in a cohort of patients with borderline dysplasia and compare them with controls with femoroacetabular impingement (FAI). Material and methods: We retrospectively analyzed a group of 29 patients with a labral lesion secondary to borderline hip dysplasia (group 1) and another group of 197 patients with FAI (group 2) treated with hip arthroscopy, evaluating reoperations and joint survival as the main outcomes. Only patients with both diagnoses treated with hip arthroscopy and with a minimum follow-up of 2 years were included. We excluded patients with coxa profunda, patients who only underwent labral debridement, revisions, cases with dysplasia initially treated with PAO and those with previous ipsilateral hip pathology such as local neoplasia, avascular necrosis, Perthes disease or epiphysiolysis. The diagnosis of borderline dysplasia was made radiologically, with a lateral center-edge angle greater than 18° but less than 25°. Among patients of group 1, the arthroscopic capsulotomy was minimal (punctate) and the iliofemoral ligament was always respected; thus, capsular plicature was not performed in any case. The average follow-up was 43 months, being 41 months for group 1 and 43 months for group 2 (p=0.33). Although there was a greater proportion Tönnis 2 of degenerative changes among patients with FAI (10%) than in the group with borderline dysplasia (0.5%), this difference was not significant (p=0.14). Both groups presented with a high prevalence of CAM type lesion (88% of the series). However, the mean radiological alpha angle value was higher in group 1 (61°) than in group 2 (57°) (p=0.002). The Tönnis angle was categorized as normal (0-10°) in all patients with borderline dysplasia and in 71% of the FAI group, but in the rest of the latter group it was less than 0° (p<0.001). The average Wiberg angle was 22° in group 1 and 34° in those with FAI (p<0.001); while the average anterior center-edge angle was 23° in the first group and 30° in the second (p <0.001). We performed a multivariate regression analysis to associate the need of reoperation with different demographic, radiological and intraoperative variables. Results: There were 7 complications among patients of group 2: a superficial wound infection medically treated; 3 cases of paresthesias in pudendal territory that resolved spontaneously in all cases at 3 months postoperatively; 1 deep vein thrombosis and 2 cases of heterotopic calcifications in patients who remained asymptomatic. No complications were recorded in the borderline dysplasia group. Thirty-eight percent of the series presented with osteochondral lesions detected during the arthroscopy (p=0.69). Of these, 42% were treated with microfractures (p=0.21) because they were classified as Outerbridge grade 4. Five patients in group 2 required a new surgical procedure. In 2 of them, the reoperation consisted of a controlled dislocation due to the progression of the size of their osteochondral lesions at 21 and 48 months of the initial procedure. Both cases presented an Outerbridge 4 osteochondral lesion greater than 0.5 cm2 in the initial arthroscopy. The remaining 3 cases were treated with a revision arthroscopy due to the persistence of their symptoms at a mean of 22 months postoperatively, due to an insufficient osteochondroplasty done at the first procedure. However, the rate of joint preservation was 100% since at the end of follow-up none of the patients had to be converted to total hip replacement. Although there were no reoperations in the borderline dysplasia group, this difference with group 1 was not statistically significant (p=0.38). The multivariate regression model adjusted for reoperation showed a very strong statistical association between the finding of osteochondral lesions and therapeutic failure, with a coefficient of 0.12 (p<0.001, CI95% = 0.06 - 0.17). In the same way, although the association was weak (p=0.04, CI95% = -0.4 - -0.01), the fact of resecting the CAM lesion behaved as protector for the model with a coefficient of -0.2. Conclusion: Hip arthroscopy was useful in the treatment of borderline dysplasia, without showing survival differences with the FAI group. We suggest indicating it carefully in the dysplasia, whenever the symptoms of FAI prevail over those of instability.

Despite the theoretical advantages of uncemented short stems, postoperative thigh pain is still matter of concern and can be attributed to different causes. We report a peculiar case of a stress fracture around a short cementless stem with cervico-metaphyseal fixation in an otherwise healthy patient. We implanted a MiniHip TM stem in a 43 year-old male professional golf player for the treatment of primary osteoarthritis using a ceramic on ceramic bearing. Against medical advice, the patient started to play soccer at the 4th postoperative month and was completely asymptomatic to that extent; but at 8 months follow-up and without a history of trauma he started complaining about progressive hip pain. After ruling out infection and loosening, histological analysis from a bone biopsy confirmed the diagnosis of stress fracture. Although revision surgery was initially scheduled, pain started to decrease gradually with protected weight-bearing (crutches) and disappeared around the first postoperative year, remaining the patient asymptomatic at 2 and half years of follow-up, with radiographs depicting a healed fracture with a hypertrophic callus. We encourage surgeons to be aware of the existence of periprosthetic stress fractures as a source of thigh pain (sometimes intractable), and despite being infrequent, they should always be contemplated, providing that these cases can be managed conservatively with rest and limited weight-bearing. After this uncommon case, we suggest to align the stem in order to equally distribute loads onto the medial calcar and the lateral femoral cortical.