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Introduction: Degenerative changes in the hip joint as indications for operative treatment are observed in more than a third of the population over the age 50. In most cases, the development of a degenerative process in the hip joint is accompanied by changes in the sacroiliac joint. To improve the quality of life, relieve pain, and improve the clinical outcomes of rehabilitation after total hip arthroplasty (THA), an integrated approach should be chosen.Materials and Methods: Eighty-four patients were enrolled in a prospective randomized study, between 2017 and 2020. The patients were randomly (with the use of computer) divided into two groups (42 to group I, 42 to group II). The first group of patients underwent surgery using a new technique that included intra-operative manual correction of iliosacral dislocation of the sacroiliac joint, whilst the second group of patients underwent THA according to the standard protocol. All groups of patients underwent THA. Clinical treatment outcomes were assessed with the use of the Visual Analogue Scale (VAS) and the Harris Hip Score (HHS). Kaplan-Meier estimator was constructed to determine the differences in the probability of recurrence of pain syndrome depending on the side of the dislocated sacroiliac joint. NCT04673747 (ClinicalTrials.gov identifier).Results: There was a significant pain relief and an improvement in the quality of life of patients who underwent intra-operative manual correction of sacroiliac joint dislocation compared with the group of patients who underwent standard THA.Conclusion: The use of intra-operative manual correction of sacroiliac joint dislocation can lead to a pronounced improvement in the quality of life of patients, pain decrease, and an improvement in rehabilitation of patients after performing THA. According to the analysis of statistical data, a potential risk factor for recurrence of pain, is the presence of dislocation on the contralateral side from the operated joint. [ABSTRACT FROM AUTHOR]

Purpose: Treatment of ONFH at an early stage is a challenging issue. The modified minimally invasive core decompression combined with bone graft implantation remains controversial. This study aimed to compare the early-middle outcomes of four groups with different bone grafts.Methods: A total of 182 patients (192 hips) with ONFH at the ARCO II stage were randomly divided into four groups. The free fibular graft group (FFG), free vascularized fibular graft group (FVFG), autologous iliac bone group (ABG), and β-tricalcium bioceramics phosphate graft (β-TCPG) group. Each group was treated with the modified minimally invasive core decompression and bone graft implantation. The operation time and blood loss were recorded by the same observer. The clinical outcome was evaluated by the Harris Hip Score and VAS score (before, 14 days after surgery, and at the last follow-up). The radiographic progression of ONFH was evaluated at least 36 months of follow-up.Results: All cases were successful without any complications after the operation. The patients were followed up for 42 to 48 (44.62 ± 1.81) months. There were statistically significant differences among the four groups in operation time (F value = 1520.67; P < 0.01) and blood loss (F value = 5366.81; P < 0.01). The Harris Hip Score in each group was improved significantly from pre-operation to last follow-up (all P < 0.01). At the last follow-up, the difference in the Harris Hip Score in each group was not statistically significant (F value = 0.54; P = 0.984). The VAS scores in each group were decreased significantly from the pre-operation to14 days after surgery (all P < 0.01). At 14 days after surgery, the difference in the VAS score in each group was not statistically significant (F value = 0.64; P = 0.59). At the last follow-up, three hips collapsed on the femoral head in the FFG group, two in the FVFG group, two in the ABG group, and three in the β-TCPG group.Conclusion: The four different bone graft implantation showed satisfactory early-middle outcomes. As compared to other bone grafts, the β-TCP bioceramics graft has the advantages of shorter operation time and lesser blood loss. It may be a choice as a bone graft for the treatment of ONFH at an early stage. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this prospective study was to investigate the pre-operative incidence of and risk factors for deep venous thrombosis (DVT) in geriatric intertrochanteric fractures to help facilitate the peri-operative management of them.Materials and Methods: Data of 1515 geriatric intertrochanteric fracture patients were extracted from a prospective intertrochanteric fractures database according to the inclusion criteria and exclusion criteria. The demographics, fracture characteristics, and pre-operative laboratory indicators of patients were evaluated statistically.Results: The incidence of pre-operative DVT was 10.2% (155 in 1360 patients) in the present study. The rates of proximal DVT, distal DVT, and mixed DVT were 18.1% (28 patients), 56.8% (88 patients), and 25.2% (39 patients), respectively. The percentages of DVT developing in the affected limb, uninjured limb, and bilateral limbs were 74.2% (115 in 55 patients), 16.8% (26 in 155 patients), and 9% (14 in 155 patients), respectively. After the multivariable analysis, the time from injury to surgery (TIS) > 4 days [odds ratio (OR) = 1.870, p = 0.001], the number of comorbidities > 2 (OR = 2.124, p = 0.014), and albumin (ALB) < 35 g/L (OR = 1.516, p = 0.043), etc. were significantly associated with the development of preoperative DVT in geriatric intertrochanteric fracture patients.Conclusions: Although routine anticoagulant therapy was used to prevent the formation of DVT, the incidence of which was still high. Therefore, pre-operative ultrasound of both lower extremities was advised for pre-operatively, especially for patients with delayed surgery, hypoproteinemia, three or more comorbidities, and a D-dimer level > 1.59 mg/L. [ABSTRACT FROM AUTHOR]