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Denosumab is a monoclonal antibody used to reduce risk of fractures in osteoporosis. ROSALIA was a multicenter, double-blind, randomized, integrated phase I/phase III study comparing the efficacy, pharmacokinetics (PK), pharmacodynamics (PD), immunogenicity, and safety of proposed biosimilar denosumab GP2411 with reference denosumab (REF-DMAb) (Prolia®; Amgen). Postmenopausal women with osteoporosis were randomized 1:1 to 2 60-mg doses of GP2411 or REF-DMAb, one at study start and one at week 26. At week 52, the REF-DMAb group was re-randomized 1:1 to a third dose of REF-DMAb or switch to GP2411. The primary efficacy endpoint was percentage change from baseline (%CfB) in LS-BMD at week 52. Secondary efficacy endpoints were %CfB in LS-BMD, FN-BMD, and TH-BMD at weeks 26 and 78 (and week 52 for FN-BMD and TH-BMD). Primary PK and PD endpoints were the area under the serum concentration–time curve extrapolated to infinity and maximum drug serum concentration at week 26, and the area under the effect–time curve of the %CfB in serum CTX at week 26. Secondary PK and PD endpoints included drug serum concentrations and %CfB in serum CTX and P1NP during the study period. Similar efficacy was demonstrated at week 52, with 95% CIs of the difference in %CfB in LS-BMD between treatment groups fully contained within prespecified equivalence margins. Similarity in PK and PD was demonstrated at week 26. Immunogenicity was similar between groups and was not impacted by treatment switch. The rate of new vertebral fractures was comparable. Treatment-emergent adverse events were comparable between groups (63.6% [GP2411/GP2411]; 76.0% [REF-DMAb/REF-DMAb]; 76.6% [REF-DMAb/GP2411]). In conclusion, ROSALIA showed similar efficacy, PK and PD, and comparable safety and immunogenicity of GP2411 to REF-DMAb in postmenopausal osteoporosis. [ABSTRACT FROM AUTHOR]

Introduction: Historically, patients with rotator cuff arthropathy had limited reconstructive options. The early generations of reverse total shoulder arthroplasty (rTSA) designs had increased failure rates due to loosening of glenoid baseplates secondary to excessive torques. In 1985, Paul Grammont introduced a prosthetic design changing the center of rotation that addressed this major complication. The Grammont principles remain the foundation of modern reverse total shoulder prostheses, although the original design has undergone several adaptations. We reviewed here the various aspects of prosthetic designs including baseplates, glenospheres, humeral components, and polyethylene bearing interfaces. Areas covered: We discuss the evolution, biomechanics, prosthetic options, and future direction for rTSA. A literature search using the PubMed database including review articles, biomechanical studies, and clinical trials pertaining to rTSA prothesis and outcomes. Expert commentary: Despite an expansion in the understanding of the biomechanics of the rotator cuff deficient shoulder and its effect on the reverse total shoulder prostheses, Grammont principles remain the foundation of contemporary rTSA designs. Further clinical studies are needed to assess how modern prosthetic modifications effect clinical and radiographic outcomes. Additionally, implants are being used in younger individuals with expanded indications, therefore, close clinical monitoring is needed to better evaluate their prosthetic longevity. [ABSTRACT FROM AUTHOR]

Facial make‐up changes the appearance of a person and significantly degrades the performance of automated face verification (FV) systems. Here, the authors propose the design of an end‐to‐end siamese convolutional neural network (SCNN) that simultaneously replicates the facial make‐up of a subject using its target image (under facial make‐up) on a query face image and verifies the identity of the query face sample either with or without make‐up. The SCNN model is designed using loss functions to deal with the variations due to make‐up. The proposed architecture can reciprocate the make‐up at appropriate locations of the face without any human interventions. Rigorous experimentations on four benchmark facial make‐up datasets reveal the efficiency of their proposed model. Ablation studies show improvement of 4% for genuine acceptance rate at 0.1% false acceptance rate and reduction of equal error rate by 42% for FV in case of YouTube Make‐up dataset, and '10%' in case of Virtual Make‐up dataset, when compared to the nearest state‐of‐the‐art method. For the transfer of make‐up, the similarity measures also show the effectiveness of their method, where the peak signal‐to‐noise ratio and structural similarity values show an improvement by ∼20–24 and ∼29–32%, respectively, when compared to a recent state‐of‐the‐art technique. [ABSTRACT FROM AUTHOR]

The article offers information on study related in Garden classification of femora neck fractures. It concludes that Garden classification describes femoral neck fractures as a function of displacement. It mentions that Garden Types I and II nondisplaced fractures be fixed with internal fixation to allow for early weight-bearing and provide stability without increasing the risk for avascular necrosis.

Introduction: Acute traumatic or surgical wounds that cannot be primarily closed often cause substantial morbidity and mortality. This often leads to increased costs from higher material expenses, more involved nursing care, and longer hospital stays. Advancements in soft tissue expansion has made it a popular alternative to facilitate early closure without the need for more complicated plastic surgical procedures. Areas covered: In this review, we briefly elaborate on the history and biomechanics of tissue expansion and provide comprehensive descriptions of traditional internal tissue expanders and a variety of contemporary external tissue expanders. We describe their uses, advantages, disadvantages, and clinical outcomes. The majority of articles reviewed include case series with level IV evidence. Outcome data was collected for studies after 1990 using PubMed database. Expert commentary: An overall reduction in cost, time-to-wound closure, hospital length-of-stay, and infection rate may be expected with most tissue expanders. However, further studies comparing outcomes and cost-effectiveness of various expanders may be beneficial. Surgeons should be aware of the wide array of tissue expanders that are commercially available to individualize treatment based on thorough understanding of their advantages and disadvantages to optimize outcomes. We predict the use of external expanders to increase in the future and the need for more invasive procedures such as flaps to decrease. [ABSTRACT FROM PUBLISHER]

Dislocation of the fourth and fifth tarsometatarsal joints in conjunction with lateral subtalar dislocation is a rare occurrence. Little is known about the mechanism of injury, the appropriate treatment for this condition, and its ultimate prognosis. In this report, we describe this atypical presentation in a middle aged, otherwise healthy male who sustained a trivial twisting injury to the ankle when he slipped and fell on ice. Open reduction and K-wire fixation were necessary to affix the lateral tarsometatarsal and talonavicular joints. At one year postoperatively, he was able to return to his preinjury occupation with mild to moderate pain with prolonged walking. His Foot and Ankle Disability Index and American Orthopaedic Foot and Ankle Society scores were 64 and 65 points, respectively. Surgical intervention resulted in a stable plantigrade foot; however, the patient had early radiographic evidence of posttraumatic arthritis in the midfoot joints at one-year follow-up. [ABSTRACT FROM AUTHOR]

Traumatic rupture of the quadriceps tendon by itself is not an uncommon clinical condition. However, its association with concurrent ipsilateral closed distal tibia oblique fracture is exceedingly rare with only one previously reported case in English literature. The dual diagnosis of this atypical combination of injury may be masked by pain and immobilization of the more obvious fracture and may be missed, unless the treating physician maintains a high index of suspicion. Suprapatellar knee pain with or without a palpable gap in the quadriceps tendon and inability to straight leg raise in the setting of a distal tibia fracture should raise concern, but if initial treatment employs a long-leg splint the knee symptoms may be muted. In this report, we describe this unusual combination of injury in a 67-year-old male patient who sustained a trivial twisting injury to the leg. The aim of this report is to raise awareness and emphasize the importance of thorough and repeated clinical examinations in the presence of distracting injuries. Despite the complexity of the problem, standard techniques for quadriceps tendon repair using transpatellar bone tunnels following locked intramedullary rodding of the tibia fracture may lead to optimal outcomes. [ABSTRACT FROM AUTHOR]

Automatic target localization in satellite images still remains as a challenging problem in the field of computer vision. The issues involved in locating targets in satellite images are viewpoint, spectral (intensity) and scale variations. Diversity in background texture and target clutter also adds up to the complexity of the problem of localizing aircrafts in satellite images. Failure of modern feature extraction and object detection methods highlight the complexity of the problem. In the proposed work, pre-processing techniques, viz. denoising and contrast enhancement, are first used to improve the quality of the images. Then, the concept of unsupervised saliency is used to detect the potential regions of interest, which reduces the search space. Parts from the salient regions are further processed using clustering and morphological processing to get the probable regions of isolated aircraft targets. Finally, a novel conical pyramid based framework for template representation of the target samples is proposed for matching. Experimental results shown on a few satellite images exhibit the superior performance of the proposed methods. [ABSTRACT FROM AUTHOR]

Although prosthetic hip dislocation is a common reason for revision arthroplasty, few studies have comprehensively evaluated the radiographic factors that may lead to the need for revision. Therefore, the authors radiographically evaluated all prosthetic hip dislocations that were treated at one institution. They then specifically assessed those that required revision surgery. The authors found that the prosthetic center of rotation (pCOR) was located superolateral and inferolateral to the native COR (nCOR) in all patients. Most hips had pCOR distances more than 5 mm from the nCOR. Furthermore, most patients had cup inclination and anteversion angles within Lewinnek's previously defined "safe zone." Determining these similarities and properly planning these procedures may help decrease the instability rate and therefore improve the overall success of this procedure. [Orthopedics.2016; 39(5):e1011-e1018.]. [ABSTRACT FROM AUTHOR]

Prosthetic joint infection is one of the most dreaded complications following elective lower extremity primary total joint arthroplasty, resulting in substantial pain, disability, and health care costs. Both static and articulating antibiotic-impregnated spacers have been used in the management of 2-stage revision for infected total knee arthroplasty, which remains the gold standard for treatment of these infections. Articulating spacers may provide theoretical benefits with regard to improved range of motion after reimplantation secondary to less scar formations and soft tissue contractures. However, static spacers may be necessary to overcome instability associated with substantial bone defects, incompetent extensor mechanisms, and collateral ligament insufficiencies. In these scenarios, static spacers are often reinforced with intramedullary rods or Steinmann pins to provide additional knee stability, improve construct strength, maintain extension, and avoid flexion contractures. This case report describes an extremely rare case of migration of smooth pins through the posterior tibia into the calf following static spacer use in a 48-year-old man. Various mechanical and systemic complications have been reported in up to 50% of patients with the use of polymethyl methacrylate spacer devices, such as acute renal failure, allergic reactions from antibiotic use, stiffness, bone loss, fractures, and dislocations. However, to the best of the authors' knowledge, this complication of hardware migration has not been reported previously in the literature. The authors believe that orthopedic surgeons should consider the use of threaded pin dowels or intramedullary rods to avoid this potential untoward complication. [Orthopedics. 2016; 39(3):e553–e557.] [ABSTRACT FROM AUTHOR]

Rotator cuff injuries in the pediatric and adolescent population are rare. These injuries are normally caused by an acute event or by repeated microtrauma as a result of poor mechanics during overhead sporting activities. Overall, these injuries account for fewer than 1% of all rotator cuff tears. Physeal injuries, tuberosity avulsions ("rotator cuff equivalents"), and proximal humeral fractures commonly occur in the pediatric population. Traumatic full-thickness rotator cuff ruptures that occur in this age group during contact sports are an extremely uncommon cause of shoulder pain. The rarity of this type of injury in the pediatric and adolescent population may be the result of the excellent tensile properties of rotator tendons in childhood that often resist mechanical forces better than the growth plate or the apophyses. This report describes a full-thickness rotator cuff tear and a posterior labral tear in a 12-year-old boy who had a direct injury to the shoulder while playing football. The authors' goal in reporting this case is to increase orthopedic surgeons' awareness of this type of injury. Early use of magnetic resonance imaging for persistent shoulder pain after direct injury during contact sports may avoid undue delay in diagnosis. This report also describes the mini-open transosseous extraphyseal technique of cuff repair and reviews the literature on this infrequent injury. Overall, excellent clinical outcomes and return to sports can be expected after surgical repair of torn and often retracted tendons. [ABSTRACT FROM AUTHOR]

Precise and accurate biomechanical reconstruction during total hip arthroplasty (THA) is essential for durable long-term survivorship. Accurate fit of cementless hip implants is also crucial to reduce micromotion between the bone-implant interfaces to allow for stable osseointegration. Robotic technology aims to minimize potential human errors and improve implant alignment and fit, and address persisting concerns with modern-day cementless THA. Although robotic THA dates back to the early 1990s, concerns with increased operating times, costs, and complications led to its withdrawal. However, semi-active systems have renewed interest in robot-assisted joint arthroplasty. We reviewed the current technology, its potential benefits, and the reported clinical and radiographic outcomes. Early evidence suggests that robotic use may lead to more accurate reconstruction of radiographic parameters, such as implant positioning, fit, center-of-rotation, and leg-length discrepancy. Further research is needed to determine if these will translate into better outcomes and improved implant longevity to justify increased costs. [ABSTRACT FROM PUBLISHER]

Robotics in total knee arthroplasty (TKA) has undergone vast improvements. Although some of the systems have fallen out of favor due to safety concerns, there has been recent increased interest for semi-active haptic robotic systems that provide intraoperative tactile feedback to the surgeon. The potential advantages include improvements in radiographic outcomes, reducing the incidence of mechanical axis malalignment of the lower extremity and better tissue balance. Proponents of robotic technology believe that these improvements may lead to superior functional outcomes and implant survivorship. We aim to discuss robotic technology development, outcomes of unicompartmental and total knee arthroplasty and the future outlook. Short-term follow-up studies on robotic-assisted knee arthroplasty suggest that, although some alignment objectives may have been achieved, more studies regarding functional outcomes are needed. Furthermore, studies evaluating the projected cost–benefit analyses of this new technology are needed before widespread adoption. Nevertheless, the short-term results warrant further evaluation. [ABSTRACT FROM PUBLISHER]

Background: Aseptic loosening is the most common cause for revisions after lower-extremity total joint arthroplasties, however studies differ regarding the degree to which host factors influence loosening. Questions/purpose: We performed a systematic review to determine which host factors play a role in the development of clinical and/or radiographic failure from aseptic loosening after (1) THA and (2) TKA. Methods: Two searches on THA and TKA, respectively, using four electronic databases (EMBASE, CINAHL Plus, PubMed, and Scopus) were conducted. We identified a total of 209 reports that encompassed nine potential host factors affecting aseptic loosening. Inclusion criteria for consideration of scientific clinical reports were that 20 or more patients were involved, with more than 1-year followup, with at least three studies pertaining to each factor, and at least six of the Methodological Index for Non-randomized Studies criteria met, and with raw data for odds ratio (OR) calculations. Twenty-one studies (16 THA studies with 45,779 hips and five TKA studies with 288 knees, respectively) were used to calculate weighted OR and CIs (using the random effects theory) and study heterogeneity for four different host factors in THAs (male sex, high activity level, obesity defined as BMI ≥ 30 kg/m, and current or former tobacco use) and one factor in TKA (BMI ≥ 30 kg/m), which were placed in a forest plot. Results: For THA, male sex (OR, 1.39; 95% CI, 1.22-1.58; p = 0.001) and high activity level (University of California Los Angeles [UCLA] activity score ≥ 8 points; OR, 4.24; 95% CI, 2.46-7.31; p = 0.001) were associated with aseptic loosening. However, obesity (OR, 1.01; 95% CI, 0.73-1.40; p = 0.96), and tobacco use (OR, 1.96; 95% CI, 0.43-8.97; p = 0.39) were not associated with an increased risk of aseptic loosening after THA with the numbers available. For TKA, we found no host factors associated with loosening. In particular, obesity (BMI ≥ 30 kg/m) was not associated with aseptic loosening with the numbers available (OR, 2.28; 95% CI, 0.60-8.62; p = 0.22). Conclusions: Patients undergoing a lower-extremity total joint arthroplasty who engage in impact sports should be counseled regarding their potential increased risk of aseptic loosening; however, given the weak evidence available, we believe that higher-level studies are necessary to clearly define the risk factors, particularly with newer-generation constructs. Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Objective: To report a case of a peri-prosthetic hip fracture fixed using a previously unre-ported technique of intramedullary nailing with dual proximal fixation. Case summary: An 81-year-old nursing home resident suffered a multi-fragmentary peri-prosthetic hip fracture around a Birmingham Hip Resurfacing arthroplasty (BHR), which was fixed using a novel technique. Discussion: Such fractures pose a significant surgical dilemma with regards to the optimal method of treatment. The increasing popularity of these implants suggests that these fractures will become increasingly common. Conclusion: We believe that our technique provides a practical and satisfactory solution to these fractures. [ABSTRACT FROM AUTHOR]

Post-traumatic arthritis of the hip can develop in 12-57% of patients after an acetabular fracture. Once it develops, salvage treatment options include arthroplasty or arthrodesis. Delayed total hip arthroplasty (THA) has been shown to be a viable treatment option to decrease pain, improve stability and increase functional outcomes. Using cemented designs, earlier long-term studies reported satisfactory functional outcomes of delayed THA used to treat previously failed acetabular fractures. However, high aseptic loosening rates were also observed. Recent advances in cementless acetabular designs have shown comparable functional outcomes and loosening rates compared to those undergoing THA for non-traumatic arthritis. However, even with improvements in functional and radiographic outcomes, unique complications are commonly encountered in patients with previous acetabular fractures, including heterotopic bone around the hip, increased operative times and blood loss, aseptic loosening, sciatic nerve injury and dislocation. The outcomes and complications of delayed THA in patients with previous acetabular fracture will be reviewed. [ABSTRACT FROM AUTHOR]

ABSTRACT Steep cup abduction angles with adverse joint loading may increase traditional polyethylene bearing wear in total hip arthroplasties. However, there have been few reports evaluating the effect of cup inclination on the wear of dual-mobility devices. In a hip joint simulation, we compared the short-term wear of two-sizes of modular highly cross-linked dual-mobility bearings (28 mm femoral head diameter/42 mm polyethylene insert outer diameter/54 mm acetabular shell diameter; 22.2 mm femoral head diameter/36 mm polyethylene insert outer diameter/48 mm acetabular shell diameter) at 50 and 65° of cup inclination with modular 28 mm femoral head on 54 mm cup diameter metal-on-highly cross-linked polyethylene bearings. Increasing inclination from 50-65° had no changes in volumetric wear of 28/42/54 mm (mean, 1.7 vs. 1.2 mm3/million cycles, respectively; p = 0.50) and 22.2/36/48 mm (mean, 1.7 vs. 1.2 mm3/million cycles, respectively; p = 0.48) dual mobility bearings. At 65°, 22.2/36/48 mm dual-mobility bearings had lower volumetric loss (mean, 2.2 vs. 6.3 mm3; p = 0.03) and wear rates (mean, 1.2 vs. 2.7 mm3/million cycles; p = 0.02) compared to metal-on-highly cross-linked polyethylene bearings. Modern-generation dual-mobility designs with highly cross-linked polyethylenes may potentially withstand edge-loading from steeper cup-inclinations without substantial decreases in wear. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:???-???, 2015. [ABSTRACT FROM AUTHOR]

Variations in the origin of the long head of biceps tendon (LHBT) have been described in literature; however, its clinical significance remains uncertain. We describe in this report, the history, physical examination and the arthroscopic findings in a patient who had an anomalous origin of the LHBT from the rotator cuff, resulting in restriction of range of motion. This anomalous origin of the long head of biceps tendon causing capsular contracture and restriction of movements leading to secondary internal impingement, has not been extensively reported in the literature. Shoulder arthroscopists should be aware that, although, an uncommon clinical condition, the aberrant congenital origin of the LHBT from the rotator cuff can rarely become pathologic in middle age and lead to shoulder dysfunction. In such cases, release of the anomalous band may be required, along with the treatment of other concomitant intraarticular pathologies in the glenohumeral joint. [ABSTRACT FROM AUTHOR]

As the number of primary total hip arthroplasties increase over the next several decades so will the incidence of periprosthetic fractures around the femoral stem. Treatment can reliably be predicted using the Vancouver classification with internal fixation being indicated in fractures involving a stable implant and revision arthroplasty indicated in those with unstable prostheses. Non-displaced fractures involving the greater and lesser trochanter can generally be treated non-operatively. Extensively porous-coated stems and the use of modular uncemented revision stems to treat Vancouver B fractures have shown encouraging results. The treatment of Vancouver C periprosthetic fractures continues to follow basic AO fixation principles with an emphasis on eliminating stress risers with adequate implant overlap and length. This review will focus on the risk factors and classification of these fractures, as well as highlight the treatment options for post-operative periprosthetic femoral fractures around a total hip arthroplasty. [ABSTRACT FROM AUTHOR]

The article presents a study of short bone-conserving stems in cementless hip arthroplasty. It explores the four categories of stems including stems: femoral neck, calcar loading and lateral flare calcar loading, and the clincal outcomes of these stems. It also examines several clinical and nonclinical studies on 25 stems.

An introduction is presented in which the editor discusses various reports within the issue on topics including the method of total hip arthroplasty, use of direct anterior approach in the U.S. and role of surgeon in patient's care.

Osteonecrosis (ON) is a devastating illness that can lead to severe joint disease in young patients. The pathogenesis of ON is largely unknown; however, there have been numerous reports associating risk factors including systemic lupus erythematosus (SLE) with the disease. The risk of ON for SLE patients is believed to be a result of both the SLE disease state itself and the concomitant use of corticosteroids. The objective of osteonecrosis treatment is typically to halt progression or delay the onset of end-stage arthritis that may require a total joint arthroplasty (TJA). Joint-preserving procedures are attempted for pre-collapse and some post-collapse lesions. After severe subchondral collapse has occurred, TJA is often necessary to relieve pain. The purpose of this article is to draw attention to recent evidence regarding several treatment options for the management of SLE-associated ON, including lesion observation, medication, joint-preserving techniques, and TJA. [ABSTRACT FROM AUTHOR]

Background: Manipulation under anesthesia has been reported to improve range of motion when other rehabilitative efforts fail to obtain adequate motion after total knee arthroplasty. The purpose of this study was to evaluate the effects of the timing of the manipulation on knee range of motion and clinical outcomes. Methods: All 2128 total knee arthroplasties performed at our institution from 2005 to 2011 were reviewed to determine the number of patients who had undergone manipulation under anesthesia. A total of 144 manipulations in eighty-eight women and forty-five men were reviewed. Manipulations under anesthesia that were performed within the first twelve weeks after total knee arthroplasty were considered early and those after that period were considered late. Patients were further substratified according to the timing of the manipulation: Group I included those who had the manipulation within six weeks; Group II, at seven to twelve weeks; Group III, at thirteen to twenty-six weeks; and Group IV, after twenty-six weeks. Outcomes evaluated included gains in flexion and final range of motion, and Knee Society objective and function scores between early and late manipulation, using various adjusted multivariable regression models and at a mean followup of fifty-one months (range, twelve to eighty-one months). Mediation analysis was used to investigate whether gains in range of motion from the manipulations under anesthesia alone had mediated the effect between the timing of the manipulation and the clinical outcomes. Results: Patients who underwent early manipulation had a significantly higher mean gain in flexion (36.5° versus 17°), higher final range of motion (119° versus 95°), and higher Knee Society objective (89 versus 84 points) and function scores (88 versus 83 points) than those who had late manipulation under anesthesia. There were no significant differences in the outcomes of Groups I and II. Manipulations after twenty-six weeks resulted in unsatisfactory clinical outcomes. Multivariable regression analyses confirmed significantly better clinical outcomes with early manipulation. Mediation analysis showed that the timing of manipulation independently had significantly contributed to the outcomes. Conclusions: Orthopaedic surgeons should have a low threshold for performing early manipulations with the patient under anesthesia within twelve weeks after an arthroplasty, to achieve higher knee range of motion and improved clinical outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Successful total knee arthroplasty (TKA) has often been based on the restoration of the knee to neutral alignment postoperatively. Numerous reports have linked malaligned TKA components to increased wear, poor functional outcomes, and failure. There have been many different alignment philosophies and surgical techniques that have been established to attain the goal of proper alignment, which includes such techniques as computerized navigation, and custom cutting guides. In addition, these methods could potentially have the added benefit of leading to improved functional outcomes following total knee arthroplasty. In this report, we have reviewed and analyzed recent reports concerning mechanical, anatomic, and kinematic axis/alignment schemes used in total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Dual-mobility acetabular cups have been marketed with the purported advantages of reduced dislocation rates and improvements in ROM; however, the relative efficacies of these designs in terms of changing joint stability via ROM and dislocation distance have not been thoroughly evaluated. Questions/purposes: In custom computer simulation studies, we addressed the following questions: (1) Do variations in component geometry across dual-mobility designs (anatomic, modular, and subhemispheric) affect the posterior horizontal dislocation distances? (2) How do these compare with the measurements obtained with standard hemispheric fixed bearings? (3) What is the effect of head size on posterior horizontal dislocation distances for dual-mobility and standard hemispheric fixed bearings? (4) What are the comparative differences in prosthetic impingement-free ROM between three modern dual-mobility components (anatomic, modular, and subhemispheric), and standard hemispheric fixed bearings? Methods: CT scans of an adult pelvis were imported into computer-aided design software to generate a dynamic three-dimensional model of the pelvis. Using this software, computer-aided design models of three dual-mobility designs (anatomic, modular, and subhemispheric) and standard hemispheric fixed bearings were implanted in the pelvic model and the posterior horizontal dislocation distances measured. Hip ROM simulator software was used to compare the prosthetic impingement-free ROMs of dual-mobility bearings with standard hemispheric fixed-bearing designs. Results: Variations in component design had greater effect on posterior horizontal dislocation distance values than increases in head size in a specific design (p < 0.001). Anatomic and modular dual-mobility designs were found to have greater posterior horizontal dislocation distances than the subhemispheric dual-mobility and standard hemispheric fixed-bearing designs (p < 0.001). Increasing head sizes increased posterior horizontal dislocation distances across all designs (p < 0.001). The subhemispheric dual-mobility implant was found to have the greatest prosthetic impingement-free ROM among all prosthetic designs (p < 0.001; R = 0.86). Conclusions: The posterior horizontal dislocation distances differ with the individual component geometries of dual-mobility designs, with the anatomic and modular designs showing higher posterior horizontal dislocation distances compared with subhemispheric dual-mobility and standard hemispheric fixed-bearing designs. Clinical Relevance: Static, three-dimensional computerized simulation studies suggest differences that may influence the risk of dislocation among components with varying geometries, favoring anatomic and modular dual-mobility designs. Clinical studies are needed to confirm these observations. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. Method: A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. Results: The mean aseptic survivorship was 97.2 % (range, 80-100 %). The Harris hip scores improved from a mean pre-operative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of peri-acetabular radiolucencies was 2.4 % (range, 0-8.8 %) and 4.6 % (range, 0-19 %), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. Conclusion: The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss. [ABSTRACT FROM AUTHOR]

The purported improvement in the initial stability and enhanced osseointegration has stimulated a recent increase in the use of highly-porous interfaces for acetabular fixation in cementless hip arthroplasty. The aim of this study was to comprehensively review the literature and report the clinical outcomes of highly-porous metals in primary cementless acetabular fixation. Aseptic survivorship, osteolysis, Harris hip scores, cup migration and the incidence of peri-acetabular gaps, and periprosthetic fractures were assessed. A search of four electronic databases yielded 16 level IV studies that reported on the use of these newer highly-porous metals in primary cementless acetabular fixation. The mean cup-survivorship for aseptic loosening with the use of these modern interfaces was 100% and the mean acetabular component revision rate for any reason at 100-component years was 0.14 (range 0 to 0.55) at a mean follow-up of five years. The functional outcomes were also noted to be excellent with significant improvement in Harris Hip scores from a mean of 46 points pre-operatively (15 to 85 points) to 91 points (range, 80 to 97 points) post-operatively. Cup-stability was found to be excellent with a mean incidence of migration of less than 2% at mean follow-up of five years (range, 0.6 to 12 years). None of the studies on primary arthroplasty had any evidence of progressive periacetabular osteolysis in their study population at final follow-up. In summary, randomised controlled trials and long-term evaluation of these highly-porous implants will be needed in future to determine their potential superiority and to justify the increased cost. [ABSTRACT FROM AUTHOR]

The purported improvement in the initial stability and enhanced osseointegration has stimulated a recent increase in the use of highly-porous interfaces for acetabular fixation in cementless hip arthroplasty. The aim of this study was to comprehensively review the literature and report the clinical outcomes of highly-porous metals in primary cementless acetabular fixation. Aseptic survivorship, osteolysis, Harris hip scores, cup migration and the incidence of peri-acetabular gaps, and periprosthetic fractures were assessed. A search of four electronic databases yielded 16 level IV studies that reported on the use of these newer highly-porous metals in primary cementless acetabular fixation. The mean cup-survivorship for aseptic loosening with the use of these modern interfaces was 100% and the mean acetabular component revision rate for any reason at 100-component years was 0.14 (range 0 to 0.55) at a mean follow-up of five years. The functional outcomes were also noted to be excellent with significant improvement in Harris Hip scores from a mean of 46 points pre-operatively (15 to 85 points) to 91 points (range, 80 to 97 points) post-operatively. Cup-stability was found to be excellent with a mean incidence of migration of less than 2% at mean follow-up of five years (range, 0.6 to 12 years). None of the studies on primary arthroplasty had any evidence of progressive periacetabular osteolysis in their study population at final follow-up. In summary, randomised controlled trials and long-term evaluation of these highly-porous implants will be needed in future to determine their potential superiority and to justify the increased cost. [ABSTRACT FROM AUTHOR]