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Modern Total Hip Arthroplasty (THA) has evolved allowing orthopaedic surgeons for an exact reconstruction of hip biomechanical parameters thanks to modularity. Modular hip replacement represents, in fact, the best way to reconstruct the joint compared to conventional femoral stems. However, the modular implants are not massively used because of the high risk of breakage. One of the most common causes of their failure is the fretting corrosion at the neck-head interface combined with their relative micro-motion. Thus, the neck component undergoes major wear stresses leading to the implant failure. In order to avoid the risk of failure due to the corrosion fretting, it is necessary to improve the contact surfaces. Furthermore, available actual standards provide long testing procedure for verifying the overall modules fatigue performance thus discouraging researchers to search for possible solutions by changing the manufacturing process of the modules. This work presents a viable manufacturing technique for producing high performance neck components, proposing, at the same time, a faster and reliable testing procedure to predict the wear rate and its driving mechanism affecting the module. Thus, Ti6Al4V neck components have been manufactured by means of burnishing process at varying processing conditions which led to different surface characteristics. Different necks have been tested under real conditions for fretting fatigue simulating a walking loading cycle. Relative micromotions, together with information related to wearing path and operating conditions have been extracted online while testing, using the phase-based motion estimation method (PBME). The overall results demonstrate that burnishing process can tremendously improve the performance under service of the neck component and the proposed testing methodology is able to drastically reduce the testing time improving the reliability of the results. [ABSTRACT FROM AUTHOR]

Introduction: Modular hip implants enables a more precise adaptation of the prosthesis to the patient's anatomy. However, they also carry the risk of increased revision rates due to micromotion at the taper junction. In order to minimize this risk, one potential solution is to establish an adhesive bond between the metal taper junctions. Load-stable bonding techniques, already successfully employed in dentistry for connecting materials such as metals and ceramics or different alloys, offer a promising approach. Nevertheless, the bond strength of tapered adhesive bonds in modular hip implants has not been investigated to date. Materials and methods: Twenty-eight tapered junctions, consisting of a taper (female taper) and a trunnion (male taper) were turned using TiAl6V4 ELI (n = 16) and CoCr28Mo6 (n = 12). The process parameters cutting speed (vc = 50 m/min or 100 m/min) and feed (f = 0.1 mm, 0.05 mm or 0.2 mm) were varied for the trunnions. For each set of process parameters, one trunnion and one taper were additionally subjected to sandblasting. To investigate the effect of geometry, angular mismatch in the samples were measured. The taper pairs were bonded with a biocompatible adhesive, and push-out tests were subsequently performed. Results: The push-out forces generated from the taper connections where both tapers were sandblasted showed a mean push-out force of 5.70 kN. For the samples with only the trunnion sandblasted, the mean force was 0.58 kN, while for the samples with only taper sandblasted the mean push-out force was 1.32 kN. When neither of the tapers was sandblasted the mean push-out force was 0.91 kN. No significant effect of the process parameters on the push-out force was observed. Only the reduced valley depth Svk showed a slight correlation for the CoCr28Mo6 samples (R2 = 0.54). The taper pairs with taper mismatch (between trunnion and taper) greater than |0.1°| did not show lower push-out forces than the specimens with lower taper mismatch. Conclusions: Sandblasted and adhesive-bonded tapered connections represent a viable suitable alternative for modular hip implant connections. Slight differences in taper geometry do not result in reduced push-out forces and are compensated by the adhesive. In mechanically joined tapers these differences can lead to higher wear rates. Further investigation under realistic test conditions is necessary to assess long-term suitability. [ABSTRACT FROM AUTHOR]

Background: Acetabular component anteversion (ACA) markedly impacts the outcome of total hip arthroplasty (THA) and thus is routinely measured on radiographs postoperatively. However, clinical ACA measurement methods are either too complicated or subjective due to three drawbacks: complex calculations, measurement of obscured points, and complex geometric drawings. This study aimed to develop a precise and convenient novel method of measuring ACA on routine radiographs without the three drawbacks and to verify its accuracy and reliability by comparing it against existing methods. Methods: A novel geometric principle to measure ACA was developed. Accordingly, a protractor was designed to measure radiographic anteversion (RA) on anteroposterior (AP) hip radiographs. Three researchers measured RA twice, using the protractor, McLaren's, and Pradhan's method on 26 computer-simulated radiographs with pre-set RAs and 20 actual radiographs. Accuracy was assessed by errors on simulated radiographs, and reliability was assessed by results of measurements on simulated and actual radiographs. Results: The absolute error of the novel method (1.01° ± 1.06°) was lower than McLaren's method (1.34° ± 1.16°) (p < 0.05) and not significantly different from Pradhan's method (1.10° ± 1.02°) (p = 0.392). The protractor's intra-rater and inter-rater reliability were good-to-excellent or excellent and higher or equivalent to the two other methods. Conclusions: The novel method avoids the three major drawbacks of conventional methods. Its accuracy is significantly higher than McLaren's method and comparable to Pradhan's. The novel method has higher or non-inferior accuracy and reliability than McLaren's and Pradhan's methods. [ABSTRACT FROM AUTHOR]

Background: The risk of re-operation, otherwise known as revision, following primary hip replacement depends in part on the prosthesis implant materials used. Current performance evidences are based on a broad categorisation grouping together different materials with potentially varying revision risks. We investigated the revision rate of primary total hip replacement (THR) reported in the National Joint Registry by specific types of bearing surfaces used. Methods and findings: We analysed THR procedures across all orthopaedic units in England and Wales. All patients who received a primary THR between 2003 and 2019 in the public and private sectors were included. We investigated the all-cause and indication-specific risks of revision using flexible parametric survival analyses to estimate adjusted hazard ratios (HRs). We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with head and shell/liner combinations. A total of 1,026,481 primary THRs were analysed (Monobloc: n = 378,979 and Modular: n = 647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n = 7,381 and Modular: n = 13,488). For monobloc implants, compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the all-cause risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome (hazard rate at 10 years after surgery: 1.28 95% confidence intervals [1.10, 1.48]) or stainless steel head (1.18 [1.02, 1.36]) and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any postoperative period (1.18 [1.02, 1.36]). For modular implants, compared to patients with a cobalt chrome head and HCLPE liner primary THR, the all-cause risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic (0.79 [0.73, 0.85]) or oxidised zirconium (0.65 [0.55, 0.77]) head and HCLPE liner had a lower risk of revision throughout the entire postoperative period. Similar results were found when investigating the indication-specific risks of revision for both the monobloc and modular acetabular implants. While this large, nonselective analysis is the first to adjust for numerous characteristics collected in the registry, residual confounding cannot be rule out. Conclusions: Prosthesis revision is influenced by the prosthesis materials used in the primary procedure with the lowest risk for implants with delta ceramic or oxidised zirconium head and an HCLPE liner/cup. Further work is required to determine the association of implant bearing materials with the risk of rehospitalisation, re-operation other than revision, mortality, and the cost-effectiveness of these materials. Erik Lenguerrand and colleagues analyse data from the UK's National Joint Registry to assess the risk of revision (i.e. re-operation following primary procedure) in patients who have under a total hip replacement according to the materials used in the joint. Author summary: Why was this study done?: The classifications used to categorise hip implants in national registries are typically broad and may not allow interested parties to fully understand the risk of postoperative revision (i.e., need for further surgery) associated with different types of implant materials. This research aimed to report the risk of revision by the detailed implant materials used to help the surgical community, and therefore patients, identify those with the lowest risk of further surgery or revision which will improve shared decision-making prior to surgery. What did the researchers do and find?: This research analysed 1,026,481 primary total hip replacements (THRs) performed in England and Wales with information up to 15 years after these initial hip replacement operations. Hip prostheses with a delta ceramic or oxidised zirconium head and highly crosslinked polyethylene liner or cup had the lowest risk of revision throughout the 15 years following surgery. These findings were also found when investigating the specific reasons for revision hip replacements being performed. What do these findings mean?: These results, from one of the largest registries in the world covering all public and private health care structures in England and Wales will help hospitals, surgeons and therefore patients to choose hip implants and combinations of them that can be used with the lowest risk of revision. These results are not from a randomised controlled trial and therefore it is impossible to control for all factors that can influence the risk of revision. [ABSTRACT FROM AUTHOR]

Poor bone quality is a critical factor associated with an increased risk of complications after total hip arthroplasty (THA). However, no consistent recommendations have yet been established for assessing indicators of bone quality preoperatively. Thus, it remains unclear which preoperatively available and readily accessible parameters are most closely associated with femoral bone quality. Here, we obtained femoral neck specimens from 50 patients undergoing THA. Preoperative Dual-energy X-ray absorptiometry (DXA) scans, pelvic radiographs, and laboratory parameters were analyzed. In the obtained specimens, bone microstructure was assessed using micro-CT and histomorphometry. Additionally, matrix mineralization and osteocyte lacunar morphology were evaluated using quantitative backscattered electron imaging. Our analysis revealed that DXA-derived T-scores correlated with trabecular microstructure. Furthermore, radiographic indices and body mass index correlated differentially with aspects of bone quality in women and men. Contrary to previous observations, no correlation was found between serum vitamin D levels and osteoid indices, nor between clinical parameters and matrix mineralization. Age was strongly associated with the number of mineralized osteocyte lacunae, a factor that appeared to be independent of sex. Taken together, our study demonstrates that no single preoperatively available parameter exhibits a strong and consistent association with femoral bone quality. However, DXA remains a reliable preoperative measure for determining the trabecular microstructure of the femoral neck. In clinical practice, surgeons should adopt an individualized approach to preoperative assessments by considering age, sex, BMI, and radiographic indices to enhance their insight into femoral bone quality, particularly when DXA is unavailable. [ABSTRACT FROM AUTHOR]

Objectives: To compare the image quality of 1.5T and 3T prostate MRIs of the same post-hip arthroplasty patients, with a specific focus on the degree of susceptibility artifacts. Methods: This single-center retrospective study included post-hip arthroplasty patients who underwent 1.5T prostate MRIs between 2021 and 2023, as well as comparative 3T prostate MRIs. Three blinded abdominal radiologists retrospectively reviewed their diffusion-weighted imaging (DWI, 50 s/mm2), T2-weighted imaging (T2WI), and dynamic contrast-enhanced imaging (DCE) to evaluate the image quality. The degree of susceptibility artifacts was categorized using a three-point scale, with 3 indicating the least artifact and 1 indicating the most. Image quality was also evaluated using Prostate Imaging Quality (PI-QUAL) version 2. The median of the three raters' scores was compared between 1.5T and 3T prostate MRIs using the Wilcoxon signed-rank test. The inter-rater agreement was evaluated using the multi-rater generalized kappa. Results: Twenty pairs of 1.5T and 3T prostate MRI examinations from 20 unique patients were included. The DWI susceptibility artifact score at 1.5T was significantly higher than at 3T (mean score ± standard deviation, 2.80 ± 0.41 vs. 2.35 ± 0.93, p = 0.014). In contrast, no significant differences were observed in the susceptibility artifact scores in T2WI and DCE, or in the PI-QUAL score. The inter-reader agreement in the susceptibility artifact score was moderate (multi-rater generalized kappa: 0.60) in DWI, perfect in T2WI (not applicable), and substantial (0.65) in DCE. The inter-reader agreement was fair (0.27) in the PI-QUAL score. Conclusion: Using 1.5T scanners may be preferable to reduce susceptibility artifacts from hip prostheses in DWI. [ABSTRACT FROM AUTHOR]

Purpose: The presence of metal implants can produce artifacts and distort Hounsfield units (HU) in patient computed tomography (CT) images. The purpose of this work was to characterize a novel metal artifact reduction (MAR) algorithm for reconstruction of CBCT images obtained by the HyperSight imaging system. Methods: Three tissue‐equivalent phantoms were fitted with materials commonly used in medical applications. The first consisted of a variety of metal samples centered within a solid water block, the second was an Advanced Electron Density phantom with metal rods, and the third consisted of hip prostheses positioned within a water tank. CBCT images of all phantoms were acquired and reconstructed using the MAR and iCBCT Acuros algorithms on the HyperSight system. The signal‐to‐noise ratio (SNR), artifact index (AI), structural similarity index measure (SSIM), peak signal‐to‐noise ratio (PSNR), and mean‐square error (MSE) were computed to assess the image quality in comparison to artifact‐free reference images. The mean HU at various VOI positions around the cavity was calculated to evaluate the artifact dependence on distance and angle from the center of the cavity. The artifact volume of the phantom (excluding the cavity) was estimated by summing the volume of all voxels with HU values outside the 5th and 95th percentiles of the phantom CBCT with no artifact. Results: The SNR, AI, SSIM, PSNR, and MSE metrics demonstrated significantly higher similarity to baseline when using MAR compared to iCBCT Acuros for all high‐density materials, except for aluminum. Mean HU returned to expected solid water background at a shorter distance from metal sample in the MAR images, and the standard deviation remained lower for the MAR images at all distances from the insert. The artifact volume decreased using the novel MAR algorithm for all metal samples excluding aluminum (p < 0.001) and all hip prostheses (p < 0.05). Conclusion: Varian's HyperSight MAR reconstruction algorithm shows a reduction in metal artifact metrics, motivating the use of MAR reconstruction for patients with metal implants. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to analyze the influence of the positioning of the components of total hip arthroplasty (THA) evaluated by the acetabular anteversion (AA) and femoral anteversion (FA) angle on postoperative gait in patients with symptomatic hip osteoarthritis secondary to hip dysplasia undergoing THA. Methods: Between May 2023 and May 2024, patients with symptomatic hip osteoarthritis secondary to hip dysplasia (Crowe Type I and IV) who underwent THA were enrolled in the study. The AA angle and FA angle were measured by computer tomography (CT). Gait data were determined by using the Dynamic Right Gait & Posture analysis system. The relationship between FA, AA and gait data was analyzed by Pearson correlation test, subgroup Pearson correlation test, multiple linear regression. Results: A total of 40 patients (45hips) were included in the study. Compared with preoperative, the patient's postoperative foot progression angle, foot contact angle, plantarflexion velocity, swing foot speed, gait velocity, cadence, stride length were significantly improved. Preoperative FA is significantly different from postoperative FA (P < 0.05), while the difference between preoperative and postoperative AA is not significant. BMI, Crowe Type, AA were related to change of cadence. The less the postoperative AA of patients, and the more the cadence in the postoperative gait of patients. Conclusion: Our study showed that THA could improve the gait function of patients with symptomatic hip osteoarthritis secondary to hip dysplasia. Adjusting AA lower could obtain a much more postoperative cadence. [ABSTRACT FROM AUTHOR]

Purpose: The impact of various hip prosthesis materials on the amount of dose perturbation generated by 9 MeV electron and 18 MV photon beams during pelvic radiation therapy is analyzed in this research. Materials and Methods: The Varian 2100 C/D LINAC head for the electron (9 MeV) and photon (18 MV) modes and a water phantom with a realistic hip prosthesis were modeled using the Monte Carlo (MC) code; MCNPX (Ver. 2.6.0) and were benchmarked for measurement. Four different materials, including Cobalt-Chromium-Molybdenumalloy (CCM), Stainless Steel (SS), Titanium, and Titanium-alloy (Ti-alloy) were evaluated. The changes in electron and photon fluences and dose perturbations due to the presence of the hip prostheses were investigated. Results: An increased dose of 13.29%, 13.77%, 6.16%, and 5.93% for 9 MeV and 30.43%, 33.05%, 10.89%, and 11.27% for 18 MV was calculated for Ti-alloy, Ti, CCM, and SS prosthesis, respectively. At 0.5 mm distance from the prosthesis, the Electron Backscatter Factor (EBF) of 1.31, 1.33, 1.15, and 1.14 for 9 MeV and 1.32, 1.34, 1.11, and 1.12 for 18 MV was calculated for Ti-alloy, Ti, CCM, and SS prosthesis, respectively. Dose perturbation is higher at a near distance from the prosthesis; by reducing the distance from the Ti-alloy prosthesis (1.5 to 0.5 mm), an increased dose of 7.70% and 5.54% resulted in 18 MV and 9 MeV, respectively. The dose decreases of up to 21% behind the hip prosthesis were calculated for 18 MV. Conclusion: It is essential to consider the dose perturbation due to the presence of a hip prosthesis to achieve the optimal treatment planning in radiotherapy. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusion In recent years, the number of hip replacement patients receiving radiation therapy has steadily increased. In parallel, strategies have been developed to reduce metal artifacts in computed tomography (CT) images and improve the accuracy of dose calculation algorithms. However, in certain situations, knowledge of the type of prosthesis material is required to accurately determine the dose distribution.This study aims to identify physical materials in hip prostheses to correctly assign them in the treatment planning system and improve dose calculation accuracy.We first verified the validity of the extended CT mass density calibration curve measured on titanium (Ti) and stainless steel (SS) metal inserts of two different diameters. Then using dedicated reference objects of various circular diameters, we developed a method based on interpolation functions to differentiate between Ti and SS material groups. Forty data sets from 18 patients were used to validate our method on two different reconstruction kernels: a standard Br44f and the electron DirectDensity (Sd40f) kernels from Siemens.Hounsfield units (HU) of Ti and SS inserts were found to vary widely depending on insert diameter, CT spectrum, and reconstruction kernels due to cupping artifacts. The largest HU difference (‐79%) was obtained for SS at 70 kV with Br44f when the diameter increased from 8 to 30 mm. Therefore, under these conditions, the extended CT‐density calibration curve is not recommended for heavy metal density determination. Using our interpolation‐based method, we achieved excellent detection (100%) and material differentiation (100%) results for stems in both reconstruction kernels. At CT energies between 110 and 140 kV, the detection and material differentiation rates were 93.3% and 92.9% for the heads and 93.3% and 92.9% for the acetabular cups, respectively, with the Br44f. Similarly, the use of Sd40f resulted in detection and differentiation rates of 94.7% and 100% for the heads and 100% and 95.0% for the acetabular cups, respectively.This method makes it possible to differentiate between hip prosthesis materials and correctly assign them to the Ti or SS group without prior knowledge of the prosthesis type, regardless of the reconstruction kernels. In combination with the Acuros XB (Varian) or Monte Carlo dose algorithms, excellent dosimetric accuracy can be achieved even in the vicinity of hip prostheses. By performing basic measurements, the method can be adapted to other CT units and reconstruction kernels, replacing the use of an extended CT‐density calibration curve. [ABSTRACT FROM AUTHOR]

Background: White blood cell (WBC) scintigraphy plays a major role in the diagnostic approach to periprosthetic infections. Although the procedure has been standardized by the publication of several guidelines, the interpretation of this technique may be susceptible to intra and inter-variability. We aimed to assess the reproducibility of interpretation between nuclear medicine physicians and by the same physician and to demonstrate that Cohen's coefficient is more unstable than Gwet's coefficient, as the latter is influenced by the prevalence rates. Methods: We enrolled 59 patients who performed a Technetium-99m WBC (99mTc-WBC) scintigraphy for suspected hip or knee prosthesis infection. Three physicians, blinded to all patient clinical data, performed two image readings. Each WBC study was assessed both visually and semi-quantitatively according to the guidelines of the European Association of Nuclear Medicine (EANM). For semi-quantitative analysis, readers drew an irregular Region of Interest (ROI) over the suspected infectious lesion and copied it to the normal contralateral bone. The mean counts per ROI were used to calculate lesion-to-reference tissue ( L R ) ratios for both late and delayed images. An increase in L R over time ( L R late > L R delayed ) of more than 20% was considered indicative of infection. Agreement between readers and between readings was assessed by the first-order agreement coefficient (Gwet's AC1). Reading time for each scan was compared between the three readers in both the first and the second reading, using the Generalized Linear Mixed Model. Results: An excellent agreement was found among all three readers: 0.90 for the first reading and 0.94 for the second reading. Both inter- and intra-variability showed values ≥0.86. Gwet's method demonstrated greater robustness than the Cohen coefficient when assessing the intra and inter-rater variability, since it is not influenced by the prevalence rate. Conclusions: These studies can contribute to improving the reliability of nuclear medicine imaging techniques and to evaluating the effectiveness of trainee preparation. [ABSTRACT FROM AUTHOR]

In this study, properties of 316L SS coated with zirconium carbide (ZrC) incorporated Ti-6Al-4 V are discussed. Ti-6Al-4V-2ZrC coating is deposited on 316L SS by magnetron sputtering technique, and also coating morphologies were investigated using SEM, XRD, EDS and AFM. The coatings thickness of 4–5 µm shows dense structure with smooth and crack-free surface and improved surface roughness (Ra) of 0.03 µm. Nanohardness of coated 316L surfaces has been upgraded and showed maximum nanohardness of 14.31 GPa with the highest elastic modulus of 207 GPa. The wear behavior has been analyzed by applying a load of 2–3 N with a contact pressure of 78.56 MPa against E-52100 steel balls which shows improvement in resistance to plastic deformation. The presence of a Ti-6Al-4V-2ZrC layer on the surface of 316L steel has increased the tribocorrosion resistance by 1.2 times higher than the uncoated 316L steel. Scratch test results show the improved adhesion behavior. At an outset, due to its enhanced properties, Ti-6Al-4V-2ZrC-coated SS 316L is an excellent alternative and can replace artificial hip joints. [ABSTRACT FROM AUTHOR]

Introduction: Image quality reduction due to metallic artefacts is a significant challenge during vascular computed tomography (CT) imaging of the lower extremities in patients with hip prostheses. This study aims to analyse various reconstruction algorithms' ability to reduce metal artefacts due to two types of hip prostheses during lower extremity CT angiography examinations. Methods: A pelvis phantom was fabricated with the insertion of a tube filled with contrast media to simulate the femoral artery, and the phantom was then CT scanned with and without hip prostheses. Multimodal images were acquired using different kilovoltage peak (kVp) settings and reconstructed with different algorithms, such as filtered back projection (FBP), iterative reconstruction (iDose4), iterative model‐based reconstruction (IMR) and orthopaedic metal artefact reduction (O‐MAR). Image quality was assessed based on image noise, signal‐to‐noise ratio (SNR) and Hounsfield unit (HU) deviation. Results: The IMR approach significantly improved image quality compared to iDose4 and FBP. For the vascular region, O‐MAR improves SNR by 5 ± 1, 23 ± 5 and 42 ± 9 for FBP, iDose4 and IMR respectively, and improves HU precision towards the baseline values by 49% and 83% for FBP and IMR, respectively. The noise reduction was 71% and 89% for FBP and IMR, and 57% for iDose4. O‐MAR greatly enhances SNR corrections among the most severe artefacts, with 29 ± 1 and 43 ± 4 for FBP and IMR, compared to iDose4 by 37 ± 7. Conclusion: IMR combined with O‐MAR could improve the CT angiography of the lower extremities of patients with a hip prosthesis. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the clinical and radiographic results of total hip arthroplasty (THA) for coxarthrosis secondary to developmental dysplasia of the hip (DDH). Examinations were made of 58 hips in 47 patients with DDH who were operated on between 1990-2000 (patients with anatomic centred hips with or without roof graft and/or femoral shortening). The patients were evaluated using the Modified Harris Hip Score preand postoperatively. The average Harris score increased from 47.7 preoperatively to 89.2 postoperatively. The average age of 43 female and 4 male patients was 48 years (24-65). All the patients presented with a limp, which was resolved after surgery in 34% and partially improved in others. The average medialization was 24 mm, and the average distal placement was 32 mm. A total of 28 (48%) complications were observed in 26 patients. Intraoperatively, fissures were detected in the proximal femur in 5, and were fixed with cerclage wiring. One patient with femoral shortening had hip dislocation one week later, so plate screw fixation was revised with open reduction. One patient had anterior thigh pain, heterotopic ossification was observed in three cases, and polyethylene wear in one case. All 20 patients who had superolateral acetabular grafting showed incorporation but there was observed to be resorption in a 20% section that was non-weight-bearing in 3 cases. THA is an effective treatment option for coxarthrosis in neglected DDH. Patients should be informed about the problems they may encounter after surgery and care should be taken in terms of complications such as dislocation, prosthesis infection, and vascular and nerve damage. [ABSTRACT FROM AUTHOR]

Background: The growth of arthroplasty procedures requires innovative strategies to reduce inpatients' hospital length of stay (LOS). This study aims to develop a machine learning prediction model that may aid in predicting LOS after hip or knee arthroplasties. Methods: A collection of all the clinical notes of patients who underwent elective primary or revision arthroplasty from 1 January 2019 to 31 December 2019 was performed. The hospitalization was classified as "short LOS" if it was less than or equal to 6 days and "long LOS" if it was greater than 7 days. Clinical data from pre-operative laboratory analysis, vital parameters, and demographic characteristics of patients were screened. Final data were used to train a logistic regression model with the aim of predicting short or long LOS. Results: The final dataset was composed of 1517 patients (795 "long LOS", 722 "short LOS", p = 0.3196) with a total of 1541 hospital admissions (729 "long LOS", 812 "short LOS", p < 0.001). The complete model had a prediction efficacy of 78.99% (AUC 0.7899). Conclusions: Machine learning may facilitate day-by-day clinical practice determination of which patients are suitable for a shorter LOS and which for a longer LOS, in which a cautious approach could be recommended. [ABSTRACT FROM AUTHOR]

3D multi-spectral imaging (MSI) of metal implants necessitates relatively long scan times. We implemented a fast isotropic 3D MSI technique at 3 T and compared its image quality and clinical utility to non-isotropic MSI in the evaluation of hip implants. Two musculoskeletal radiologists scored images from coronal proton density-weighted conventional MAVRIC-SL and an isotropic MAVRIC-SL sequence accelerated with robust-component-analysis on a 3-point scale (3: diagnostic, 2: moderately diagnostic, 1: non-diagnostic) for overall image quality, metal artifact, and visualization around femoral and acetabular components. Grades were compared using a signed Wilcoxon test. Images were evaluated for effusion, synovitis, osteolysis, loosening, pseudotumor, fracture, and gluteal tendon abnormalities. Reformatted axial and sagittal images for both sequences were subsequently generated and compared for image quality with the Wilcoxon test. Whether these reformats increased diagnostic confidence or revealed additional pathology, including findings unrelated to arthroplasty that may contribute to hip pain, was also compared using the McNemar test. Inter-rater agreement was measured by Cohen's kappa. 39 symptomatic patients with a total of 59 hip prostheses were imaged (mean age, 70 years ±9, 14 males, 25 females). Comparison scores between coronal images showed no significant difference in image quality, metal artifact, or visualization of the femur and acetabulum. Except for loosening, reviewers identified more positive cases of pathology on the original coronally-acquired isotropic sequence. In comparison of reformatted axial and sagittal images, the isotropic sequence scored significantly (p < 0.01) higher for overall image quality (3.0 vs 2.0) and produced significantly (p < 0.01) more cases of increased diagnostic confidence (42.4% vs 7.6%) or additional diagnoses (50.8% vs 22.9%). Inter-rater agreement was substantial (k = 0.798) for image quality. Mean scan times were 4.2 mins (isotropic) and 7.1 mins (non-isotropic). Compared to the non-isotropic sequence, isotropic 3D MSI was acquired in less time while maintaining diagnostically acceptable image quality. It identified more pathology, including postoperative complications and potential pain-generating pathology unrelated to arthroplasty. This fast isotropic 3D MSI sequence demonstrates promise for improving diagnostic evaluation of symptomatic hip prostheses at 3 T while simultaneously reducing scan time. • Accelerated isotropic 3D MSI at 3 T is clinically feasible in hip implants. • Accelerated isotropic 3D MSI has good visualization of postoperative complications. • This technique can facilitate formation of fast MRI protocol for hip implant patients. [ABSTRACT FROM AUTHOR]

Purpose: There is relatively little information on the long-term clinical results of patients aged < 50 years with a contemporary total hip arthroplasty (THA), although a high rate of revision is projected for this group. Therefore, the purpose of this study was to evaluate the long-term results (a minimum of 21 years) of a metaphyseal-engaging anatomic cementless total hip prosthesis in patients aged < 50 years at the time of their THA. Methods: This study included 360 patients (498 hips), specifically 212 men and 148 women. The mean age of the patients at the time of their THA was 45.8 ± 8.1 years. The predominant diagnosis was osteonecrosis (56%). Demographic data, the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the University of California, Los Angeles (UCLA) activity score were recorded. Radiographic evaluation and dual-energy X-ray absorptiometry (DEXA) scanning were used to evaluate implant fixation, bone remodelling, and osteolysis. The mean follow-up was 25.2 year (range 21–28 years). Results: At the latest follow-up, the mean Harris hip, WOMAC, and UCLA activity scores were 93, 10, and 6.7 points, respectively. No patients had thigh pain. All hips had osseous integration of the acetabular and femoral components. No patient had grade 3 stress shielding. The 28-year survival rate was 98.2% (95% confidence interval [CI] 95–100%) for the acetabular components and 98.8% (95% CI 95–100%) for the femoral components. Overall, 90% of the patients were satisfied with the THA results. Conclusion: The results suggest that a metaphyseal-engaging anatomic cementless femoral stem with alumina-on-alumina ceramic articulation provide outstanding long-term fixation and substantial pain relief well into the 3rd decade after surgery. Furthermore, there was no alumina ceramic fracture or osteolysis. Moreover, approximately 90% of the patients were satisfied with the results of their THA. [ABSTRACT FROM AUTHOR]

Ti6Al4V alloy–CoCrMo alloy pair is commonly applied for modular head–neck interfaces for artificial hip joint. Unfortunately, the fretting corrosion damage at this interface seriously restricts its lifespan. This work studied the fretting corrosion of Ti6Al4V–CoCrMo pair in calf serum solution. We established this material pair's running condition fretting map (RCFM) regarding load and displacement, and revealed the damage mechanism of this material pair in various fretting regimes, namely partial slip regime (PSR), mixed fretting regime (MFR), and gross slip regime (GSR). The damage mechanism of Ti6Al4V alloy was mainly abrasive wear induced by CoCrMo alloy and tribocorrosion. Adhesive wear (material transfer) also existed in MFR. The damage mechanism of CoCrMo alloy was mainly abrasive wear induced by metal oxides and tribocorrosion in GSR and MFR, while no apparent damage in PSR. Furthermore, a dense composite material layer with high hardness was formed in the middle contacting area in GSR, which reduced the corrosion and wear of Ti alloys and exacerbated damage to Co alloys. Finally, the ion concentration maps for Ti and Co ions were constructed, which displayed the transition in the amount of released Ti and Co ions under different displacements and loads. [ABSTRACT FROM AUTHOR]

This research aims to identify the prevalence of failure for Birmingham Hip Prosthesis (BHR) in total hip arthroplasty and to analyze its reasons from biomaterials and biofunctional perspectives. We present our current analysis and tests on a series of different BHR-retrieved prostheses after premature failure. Relevant clinical data, such as X-ray investigations and intraoperative images for clinical case studies, were analyzed to better understand all factors involved in BHR prosthesis failure. A detailed analysis of the failures highlighted uneven cement distribution, overloading in certain areas, and void formation in the material. A closer investigation using microscopical techniques revealed the presence of a crack originating from the gap between the cement mantle and human bone. Additionally, scanning electron microscopy analyses were conducted as part of the investigation to examine bone cement morphology in detail and better understand the interactions at the interfaces between implant, cement, and bone. In conclusion, this research emphasizes the importance of surgical technique planning and the cementation procedure in the success rate of BHR prostheses. It also underscores the need to carefully evaluate patient characteristics and bone quality to minimize the risk of BHR prosthesis failure. The cementation procedure seems to be essential for the long-term functionality of the BHR prosthesis. [ABSTRACT FROM AUTHOR]

Introduction: Cementless fixation has become increasingly popular in hip arthroplasty due to its shorter operation time, easier technique, biologic fixation, and avoidance of bone cement implantation syndrome compared to cemented fixation. However, intraoperative periprosthetic femoral fracture (IOPFx) is a disconcerting complication during cementless hip arthroplasty. Our purpose was to identify the features of cementless stem that increase the risk of IOPFx during primary hip arthroplasty. Materials and methods: We retrospectively reviewed all 4806 hip arthroplasties that was performed in a single institution from May 2003 to December 2020. Age at the index arthroplasty, sex, body mass index, physical status, ambulatory function, side of the operation, operational history, cause of the index arthroplasty, type of arthroplasty, surgical approach, surgeon, implant information, and events during the operation were investigated. The shoulder geometry and length of stem were also reviewed. The event of interest was narrowed down to IOPFx among various records of intraoperative events. Results: We found IOPFx of 2.6% among all the hips operated with cementless stem. In the multivariable analysis, female (OR = 1.52), childhood hip disease (OR = 2.30), stove-pipe femur (OR = 2.43), combined approach (OR = 2.60), and standard length of stem (OR = 1.59) were found to be significant risk factors of IOPFx. Conclusions: In conclusion, a stem with a standard length is significantly associated with risk of IOPFx compared to a shortened stem. These findings highlight the importance of careful consideration in terms of the risk of IOPFx when standard length cementless stem is chosen. [ABSTRACT FROM AUTHOR]

Objectives: To compare the image quality and X-ray exposure dose from EOSedge versus standard digital radiography (SDR) focused on the hip for replacement or prosthesis revision surgery. Materials & methods: This prospective single centre study included 97 patients between November 2022 and April 2023. For preoperative assessment, SDR radiographs from frontal pelvic and hip profile were indispensable. Often, surgeon requested spine radiograph from EOSedge, to which we added frontal pelvic and hip profile. A radiologist with 4 years' experience established a score based on European guidelines to evaluate the EOSedge versus SDR image quality. Quality scores (QS) were compared using paired Student's t test. The entrance skin dose (ESD) and dose area product (DAP) of the images were recorded. Results: A total of 97 patients, including 49 women and 48 men (mean 68.10 years ± 13.28) were assessed. The QSEOSedge was significantly higher than the QSSDR, with differences of 1.34 ± 1.90 (p < 0.001) and 1.74 ± 1.90 (p < 0.001), respectively. The difference in total QS was 3.08 ± 3.48 (p < 0.001). The radiation delivered (ESD x DAP) by EOSedge was 29 times lower than that delivered by SDR for frontal pelvic imaging (0.35 ± 0.91 versus 10.20 ± 12.63; p < 0.001) and 17 times lower for hip profile imaging (0.41 ± 0.84 versus 6.91 ± 9.70; p < 0.001). Conclusion: This study highlighted the superior image quality of EOSedge images focused on the pelvis and hip compared to SDR, with significantly less radiation exposure. [ABSTRACT FROM AUTHOR]

Mycosis fungoides (MF) represents the most common type of primary cutaneous T‐cell lymphoma. Recognition of MF variants with divergent immunophenotypes is important for accurate diagnosis and appropriate management, as they can be confused with other lymphoma subtypes. We present a case of a 49‐year‐old male previously diagnosed with a cutaneous lymphoproliferative disorder with an unusual NK/T‐cell phenotype. He presented with a 10‐year history of pelvic girdle rash involving the right hip and upper thigh. The lesions were characterized as atrophic patches concentrated in sun‐protected areas and involving 10% of the body surface area. Shave biopsies revealed an atypical epidermotropic infiltrate composed of hyperchromatic small to medium‐sized lymphocytes with perinuclear halos and "tagging" along the dermal–epidermal junction. The immunophenotype was unusual in that the neoplastic lymphocytes showed complete loss of pan T‐cell antigens along with expression of CD56, cytotoxic markers, and weak CD20. All other B‐cell markers were negative. The combination of clinical findings, in addition to the histopathologic and immunophenotypic profile, were diagnostic of null T‐cell phenotype MF with aberrant expression of CD56 and CD20. Null T‐cell phenotype MF is very uncommon, can be diagnostically challenging, and can mislead the diagnosis of aggressive lymphoma subtypes. [ABSTRACT FROM AUTHOR]

Background: Our study addresses the lack of consensus on measuring leg length discrepancy (LLD) after total hip arthroplasty (THA). We will assess the inter-observer variability and correlation between the five most commonly used LLD methods and investigate the use of trigonometric principles in overcoming the limitations of current techniques. Methods: LLD was measured on postoperative AP pelvic radiographs using five conventional methods. CT images created a 3D computer model of the pelvis and femur. The resulting models were projected onto a 2D, used to measure LLD by the five methods. The measurements were evaluated via Taguchi analysis, a statistical method identifying the process's most influential factors. The approach was used to assess the new trigonometric method. Results: Conventional methods demonstrated poor correlation. Methods referenced to the centers of the femoral heads were insensitive to LLD originating outside the acetabular cup. Methods referencing either the inter-ischial line or the inter-obturator foramina to the lesser trochanter were sensitive to acetabular and femoral components. Trigonometry-based measurements showed a higher correlation. Conclusions: Our results underscore clinicians' need to specify the methods used to assess LLD. Applying trigonometric principles was shown to be accurate and reliable, but it was contingent on proper radiographic alignment. [ABSTRACT FROM AUTHOR]

A total hip arthroplasty (THA) can improve quality of life, but loosening of the hip prosthesis is a complex problem in which vitamin D may also play a role. The Vitamin D Receptor (VDR) is involved in the response of cells to the action of vitamin D, and its genetic variability raises the question of whether individual differences could influence the risk of prosthesis loosening. The aim of this study was to investigate the relationship between VDR single nucleotide polymorphisms (SNPs) (ApaI, BsmI, FokI and TaqI) and the serum VDR and 25(OH)D levels in three groups of patients: (1) arthroscopy patients after THA without loosening of the prosthesis (CA—Control Arthroplasty), (2) patients after THA with loosened hip prostheses (L—Loosening) and (3) the control group (C—Control). Our results suggest that the genotypes tt of TaqI, BB of BsmI, and FF of FokI may influence the VDR effect in patients with loosened protheses. Our results showed that the ACAC haplotype (AtBF) was over two times more frequent in the L group than in CA + C: OR =2.35 [95% CI 1.44–3.83; p = 0.001]. There was no significant correlation between the VDR and serum 25(OH)D levels, but there were differences between studied groups. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine the lifetime cost of 3 treatments for canine hip osteoarthritis: (1) conservative management, (2) femoral head and neck excision (FHNE), or (3) total hip replacement. We hypothesized that FHNE would be the least expensive treatment at all ages. SAMPLE Cost estimates from 11 private and academic referral centers from 8 randomly chosen cities across the US. METHODS Costs of surgeries were collected from practices in 8 US cities. The literature was used to determine expected postoperative costs. For conservative management, costs of pain medications and diet were obtained by use of online pharmacies. A 4.5% inflation adjustment was used for costs in subsequent years. RESULTS For a dog aged 1 to 7 years, FHNE had the lowest lifetime cost. Total hip replacement had the second lowest cost until age 4, after which conservative management was lower. For dogs > 8 years, conservative management was the most cost-effective. CLINICAL RELEVANCE For dogs presenting with clinical signs at or under 1 year of age, the perceived benefits of total hip replacement may not be financially prohibitive if lifetime cost of care is considered. Femoral head and neck excision was also less expensive than long-term conservative management. This can help veterinarians inform owners on costs of treatments over the lifetime of their pet. This type of analysis is limited to financial costs alone and does not account for differences in outcomes, as these are not well established. It should be expanded in the future as better data on outcomes and impacts of care become available. [ABSTRACT FROM AUTHOR]

Understanding the mechanical and rupture behavior of orthopedic cement fixing the cup of a total hip prosthesis (THP) to cortical bone is crucial for comprehending the conditions governing prosthesis stability and potential loosening. Consequently, this study employs a three-dimensional finite element method to investigate the mechanical behavior of cement with interfacial cracks at the junction between the cement and cup. Through stress distribution analysis, we identify the initiation points of cracks and examine how stress intensity factors (SIFs) vary across three modes of failure (I, II and III) throughout a walking cycle, particularly concerning the femoral head. Our findings reveal that loading stages cause stable variations in SIFs along the crack front, with the highest values consistently at the second end of the crack. Moreover, the propagation mechanism of interfacial cracks is complex, oscillating between modes of opening and plane shear, linked to the SIFs of modes I and II and the material properties of the cement and cup. Furthermore, mode III behavior mirrors that of mode II, with nearly linear increases in SIFs along the crack front, peaking near the crack’s terminus. Overall, mode III (out-of-plane shear) emerges as the primary fracture mode, indicating a risk of damage to the reconstructed acetabulum from fatigue, despite the SIF values being lower than the fracture toughness of both the cup and the cement. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Despite being rare, we have presented a case of osteonecrosis of acetabulum that followed total hip arthroplasty. It's crucial to act appropriately, as it emulates periprosthetic joint infection. The key point is that the osteonecrosis of acetabulum may necessitate revision and can be classified as aseptic loosening. Osteonecrosis of the femoral head is well known and managed with total hip arthroplasty (THA). Acetabulum osteonecrosis can be classified as a cause of painful THA and the cemented acetabular component is a feasible option. However, it seems that the osteonecrosis of acetabulum is sparsely alluded in literature. In this case report sustaining of the right hip pain following THA of 35‐year‐old woman is discussed. [ABSTRACT FROM AUTHOR]

The hip joint plays an important role in providing stability to the human body. Factors such as aging, wear, and tear, make the hip joint degenerate and, in such cases, the same to be replaced through hip arthroplasty surgeries. The background of this study aims to investigate the contact consequence between the artificial femoral head and the acetabular cup for different bearing couples during one-leg stance and standing up from a chair, utilizing the finite element method. The three-dimensional finite dynamic contact model has been developed with different material combinations. The results obtained by the present finite element model align well with the previously available literature. The parameters investigated include maximum von Mises stress, maximum contact pressure and deformation for different material combinations. The results reveal that the pair i.e., Alumina on Ultra-high molecular weight polyethylene (UHMWPE) exhibits lower contact pressure, von Mises Stress and deformation. Therefore, the material pair i.e., Alumina on UHMWPE can be employed in the Total hip replacement (THR) to mitigate contact consequences under both static and dynamic loading conditions, thereby enhancing the durability of the artificial joints. [ABSTRACT FROM AUTHOR]

Hip replacement is a common orthopedic surgery in the aging population. With the rising incidence of prostate cancer, metallic hip prosthetics can cause considerable beam hardening and streak artifacts, leading to difficulty in identifying the target volumes and planning process for radiation treatment. The growing use of Stereotactic Body Radiation Therapy (SBRT) to treat prostate cancer is now well established. However, the use of this treatment modality in the presence of a hip prosthesis is poorly understood. There is enough literature on planning for external beam radiation treatment without any difficulties in the presence of hip prosthesis with conventional or Hypofractionated treatment. However, there is a shortage of literature on the impact of the prosthesis in SBRT planning, and there is a need for further understanding and measures to mitigate the obstacles in planning for SBRT in the presence of hip prosthesis. We present our review of the intricacies that need to be understood while considering SBRT in the presence of hip prostheses in prostate cancer treatment. [ABSTRACT FROM AUTHOR]

Background: During inpatient rehabilitation, physical therapists (PTs) often need to manually advance patients' limbs, adding physical burden to PTs and impacting gait retraining quality. Different electromechanical devices alleviate this burden by assisting a patient's limb advancement and supporting their body weight. However, they are less ideal for neuromuscular engagement when patients no longer need body weight support but continue to require assistance with limb advancement as they recover. The objective of this study was to determine the feasibility of using a hip flexion exosuit to aid paretic limb advancement during inpatient rehabilitation post-stroke. Methods: Fourteen individuals post-stroke received three to seven 1-hour walking sessions with the exosuit over one to two weeks in addition to standard care of inpatient rehabilitation. The exosuit assistance was either triggered by PTs or based on gait events detected by body-worn sensors. We evaluated clinical (distance, speed) and spatiotemporal (cadence, stride length, swing time symmetry) gait measures with and without exosuit assistance during 2-minute and 10-meter walk tests. Sessions were grouped by the assistance required from the PTs (limb advancement and balance support, balance support only, or none) without exosuit assistance. Results: PTs successfully operated the exosuit in 97% of sessions, of which 70% assistance timing was PT-triggered to accommodate atypical gait. Exosuit assistance eliminated the need for manual limb advancement from PTs. In sessions with participants requiring limb advancement and balance support, the average distance and cadence during 2-minute walk test increased with exosuit assistance by 2.2 ± 3.1 m and 3.4 ± 1.9 steps/min, respectively (p < 0.017). In sessions with participants requiring balance support only, the average speed during 10-meter walk test increased with exosuit by 0.07 ± 0.12 m/s (p = 0.042). Clinical and spatiotemporal measures of independent ambulators were similar with and without exosuit (p > 0.339). Conclusions: We incorporated a unilateral hip flexion exosuit into inpatient stroke rehabilitation in individuals with varying levels of impairments. The exosuit assistance removed the burden of manual limb advancement from the PTs and resulted in improved gait measures in some conditions. Future work will understand how to optimize controller and assistance profiles for this population. [ABSTRACT FROM AUTHOR]

In this study, total hip replacement (THR) was performed by using implants from the Innoplant company on 30 dogs and 33 cases. The average weight of the dogs was 33.05 ± 11.15, and their age range was approx. 26.6 months. The breed distribution among the cases was: Golden Retriever (n=5), German Shepherd (n=2), Rottweiler (n=4), Kangal (n=3), Labrador Retriever (n=5), Mixed Breed (n=4), Alabay (n=1), Chow Chow (n=1), Border Collie (n=2), Samoyed (n=1), and Bulgarian Shepherd (n=2). About 57% of the cases had bilateral hip dysplasia, 37% had coxarthrosis, 3% had hip luxation, and 3% had excisional arthroplasty findings. In our study, both porous and non-porous screw cups and stems of the Innoplant brand were used, while complications occurred in 10 cases. Two of these complications happened during the operation, while 8 occurred after the operation. Of these complications, 9 were classified as major, and 1 was classified as minor. The complications observed including femoral fractures (n=2), stem subsidence (n=3), stem loosening (n=1), cup loosening (n=2), cup dislocation (n=1), and loosening in both the stem and the cup (n=1). In 4 of these cases, the prosthesis was completely removed, while revision surgery was performed in 6 dogs. The long-term results of the 6 revised cases were evaluated as very good. The time until the patients could place their foot on the ground after the operation was 24 hours for 11 cases and 36 hours for 20 cases. In conclusion, the cementless Innoplant prosthesis system used for THR, is a viable prosthetic technique with a low complication rate which provides successful clinical and radiographic outcomes over an average period of 31 months. [ABSTRACT FROM AUTHOR]

BACKGROUND: Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization, accuracy and non-invasiveness, but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly. OBJECTIVE: To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS: One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People’s Hospital from January 2019 to December 2022 were selected and randomly divided into a control group (n=65) and an observation group (n=65). Artificial hip hemiarthroplasty was performed in both groups. The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique. Preoperative planning and intraoperative actual application of prosthesis compliance rate, fibrinogen, D-dimer, bilateral femoral eccentric distance difference, bilateral lower limb length difference, Harris hip function score, visual analog scale score, excellent and good rate of hip function, complications, and hospitalization cost were observed in both groups. RESULTS AND CONCLUSION: (1) The proportion of acetabular side and femoral side prosthesis in grade 0 (fully compliant) was higher in the observation group than that in the control group (P < 0.05). (2) Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery (P < 0.05). (3) The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery (P<0.05). The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively, 6 and 12 months postoperatively (P > 0.05). There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively (P>0.05). (4) There was no significant difference in the complication rate between the two groups (P > 0.05). The hospitalization cost of the observation group was higher than that of the control group (P<0.05). (5) It is indicated that digital threedimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery, but also accurately reconstruct the bilateral lower limbs offline, but its hospitalization cost is high. [ABSTRACT FROM AUTHOR]

Objectives: In China, osteoporosis has become a major health concern among elderly population, imposing significant burden on the country’s social and economic systems. The monocyte to high-density lipoprotein ratio (MHR) has been currently recommended as a novel marker of inflammation and oxidative stress associated with osteoporosis in type 2 diabetes mellitus (T2DM). However, its reliability in non-diabetic elderly populations remains unclear. The present study was to evaluate the association between MHR and osteoporosis in a non-diabetic elderly population. Methods: The clinical data of 240 non-diabetic elderly subjects (115 in the osteoporosis group and 125 in the normal bone group) were retrospectively analyzed and all statistical analyses were performed by using SPSS 26.0. Results: Differences in age, neutrophils, lymphocytes, monocytes, MHR, uric acid, creatinine, triglycerides, and high-density lipoprotein cholesterol were found to be statistically significant between the two groups. A binary logistic regression model was conducted by including age, MHR, UA and Cr as variables. The results showed that age was an independent risk factor and MHR was an independent protective factor for bone abnormality in the non-diabetic elderly population. The ROC analysis showed that the area under the curve for the predictive effect of MHR, age and their combined test on osteoporosis in non-diabetic elderly populations was 0.623, 0.728 and 0.761, respectively; the correlation analysis showed that MHR was positively correlated with lumbar and hip BMD, and negatively associated with femoral neck stress ratio, femoral intertrochanteric stress ratio, and femoral stem stress ratio, showing statistically significant differences (P<0.05). Conclusions: For the non-diabetic elderly population: the MHR is a protective factor against bone abnormalities and was significantly higher in the normal bone group than in the abnormal bone group. [ABSTRACT FROM AUTHOR]

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. A total hip replacement (total hip arthroplasty or THA) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedical operations, though patient satisfaction short- and long-term varies widely. In this paper we present the case of a 75-year-old woman, with classic uncemented hip prosthesis intervention, from the preoperative preparation stage to 1 year after the intervention and the recovery phases and their evolution. Due to a quality management of the intervention and good hygiene and nutrition, the lack of osteoporosis and the absence of paleopathology, the patient recovered in a fast and correct manner, returning to a good functionality and state of health. Also, the cooperation between the patient, family, therapist, doctor and psychologist had a decisive role in the success of both the intervention and the postoperative period with optimal results for the age and possibilities of the patient. [ABSTRACT FROM AUTHOR]

We investigated micro-threaded stem taper surface and its impact on premature failures, aseptic loosening, and infection in cementless hip endoprostheses. Our study focused on the fretting, and crevice corrosion of micro-threaded tapers, as well as the characterization of the microstructure and surface properties of two new and three retrieved Zweymüller stem tapers. The retrieved samples were selected and examined based on the head–stem taper interface being the sole source of modularity with a metallic component, specifically between the Ti alloy taper stem and the ceramic head. To determine the surface chemistry and microstructures of both new and retrieved hip endoprostheses stem taper titanium alloy, scanning -electron microscopy (SEM) was employed for morphological and microstructural analyses. Energy dispersive spectroscopy (EDS) was utilized for characterizing chemical element distribution, and electron backscattered diffraction (EBSD) was used for phase analysis. The roughness of the micro-threated stem tapers from different manufacturers was investigated using an optical profilometer, with standard roughness parameters Ra (average surface roughness) and Rz (mean peak to valley height of the roughness profile) being measured. Electrochemical studies revealed no fretting corrosion in retrieved stem tapers with ceramic heads. Consequently, three retrieved tapers and two new ones for comparison underwent potentiodynamic measurements in Hank's solution to determine the corrosion rate of new and retrieved stem taper surfaces. The results showed a low corrosion rate for both new and prematurely failed retrieved samples due to aseptic loosening. However, the corrosion rate was higher in infected and low-grade infected tapers. In conclusion, our study suggests that using ceramic heads reduces taper corrosion and subsequently decreases the incidence of premature failures in total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Prosthetic implants, such as knee or hip prostheses, have significantly improved the wellbeing of citizens with articulation problems. However, there are still significant challenges in these procedures, being recurring infections one of the most challenging. In this context, hyperthermia has been studied as an effective alternative to antibiotics for biofilm eradication. Among the different heating alternatives, induction heating arises as the idoneous for this application due to its contactless nature and the metallic alloys used in prosthesis. This paper details the design of a portable induction heating system for implanted prosthesis disinfection. [ABSTRACT FROM AUTHOR]

Poor implantation positioning of hip prostheses is considered the primary factor affecting postoperative joint wear. Cup anteversion in direct anterior approach (DAA) total hip arthroplasty (THA) is often excessive. Intraoperative fluoroscopy (IF) are effective for improving implant placement accuracy. This study aimed to analyze IF's reliability and accuracy in assessing intraoperative anteversion. Sixty-two consecutive hips underwent primary THA utilizing DAA alongside IF for cup placement. Intraoperative anteversion was measured using IF images, while postoperative CT and standard anteroposterior (AP) radiographs were used to calculate true anteversion component angles. Differences and correlations between intraoperative and true anteversions were analyzed, and intraclass correlation coefficients (ICC) determined the inter- and intra-observer reliabilities. Excellent intra- and inter-observer reliabilities were observed for all radiographic and CT methods (ICC > 0.9). Strong correlations (PCC > 0.6) existed between anteversion measured on IF image and postoperative CT and AP pelvic measurements. Intraoperative anteversion measured on IF images (16.8 ± 3.2°) was smaller than anteversion measured postoperatively on AP X-rays (21.3 ± 4.7°, P < 0.001) and CT (22.0 ± 4.9°, P < 0.001), with average differences of 4.5°and 5.3°, respectively. Under several influencing factors, the accuracy of IF in assessing cup anteversion in DAA-THA may be limited. However, this still requires large-sample experiments for verification. [ABSTRACT FROM AUTHOR]

BACKGROUND: The sclerotic zone in the femoral head is an important imaging feature in the progression of steroid-induced femoral head necrosis, which is associated with disease prognosis. Peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) has been shown to possess biological activities such as osteogenesis, angiogenesis and anti-mitochondrial apoptosis, which may be closely related to bone repair of steroid-induced femoral head necrosis. OBJECTIVE: To screen for the differential proteins in the sclerotic zone of steroid-induced osteonecrosis of the femoral head versus the normal zone, to screen for hub proteins in the sclerotic zone, and to verify the differential expression of hub proteins in the femoral head specimens following steroid-induced femoral head necrosis, and to to explore the repair pattern of the sclerotic zone following steroid-induced femoral head necrosis. METHODS: Femoral head samples were collected from patients with steroid-induced osteonecrosis of the femoral head receiving total hip arthroplasty. The differentially expressed genes in the sclerotic zone and the normal zone were screened by Tandem Mass Tags and analyzed by GO and KEGG signaling pathways to construct a protein-protein interaction network and screen hub genes. In addition, the expression of hub genes in the sclerotic zone was verified by immunohistochemistry and western blot. RESULTS AND CONCLUSION: Quantitative protein profiling by Tandem Mass Tags revealed that 609 proteins were significantly differentially expressed (Log2FC > 1.20, Log2FC < 0.84 and P < 0.05) in the sclerotic zone of the femoral head compared with the normal zone, of which 290 proteins were upregulated and 319 proteins were downregulated. The GO and KEGG pathway enrichment analyses revealed that among the top 10 enriched pathways, Wnt signaling pathway and life-cycle regulatory pathway were closely related to bone repair; in the life-cycle regulatory pathway, PGC-1α was one of the important proteins. In addition, western blot results verified the low expression of PGC-1α and NRF1 in the sclerotic zone and high expression of Cleaved Caspase-3 in the sclerotic zone compared with the normal zone of steroid-induced femoral head necrosis specimens. Light microscopic immunohistochemical results showed the distribution of PGC-1α, NRF1 and Cleaved Caspase-3 positive expression in the sclerotic and normal zones in the femoral head tissue specimens, indicating the presence of their expression in bone trabeculae, osteoblasts and bone marrow. In contrast, the brown area of the sclerotic zone of femoral head necrosis stained darker and showed more obvious expression of Cleaved Caspase-3. To conclude, in the sclerotic zone of steroid-induced femoral head necrosis, biological behaviors including activation of osteogenesis-related pathways such as Wnt and oxidative apoptosis characterized by low expression of PGC-1 are observed. Low expression of PGC-1α in the sclerotic zone of steroid-induced femoral head necrosis may be associated with the activation of oxidative apoptosis. [ABSTRACT FROM AUTHOR]

A low-energy hit, such as a slight fall from a bed, results in a bone fracture, especially in the hip, which is a life-threatening risk for the older adult and a heavy burden for the social economy. Patients with low-energy traumatic bone fractures usually suffer a higher level of bony catabolism accompanied by osteoporosis. Bone marrow-derived stem cells (BMSCs) are critical in osteogenesis, leading to metabolic homeostasis in the healthy bony microenvironment. However, whether the BMSCs derived from the patients who suffered osteoporosis and low-energy traumatic hip fractures preserve a sustained mesodermal differentiation capability, especially in osteogenesis, is yet to be explored in a clinical setting. Therefore, we aimed to collect BMSCs from clinical hip fracture patients with osteoporosis, followed by osteogenic differentiation comparison with BMSCs from healthy young donors. The CD markers identification, cytokines examination, and adipogenic differentiation were also evaluated. The data reveal that BMSCs collected from elderly osteoporotic patients secreted approximately 122.8 pg/mL interleukin 6 (IL-6) and 180.6 pg/mL vascular endothelial growth factor (VEGF), but no PDGF-BB, IL-1b, TGF-b1, IGF-1, or TNF-α secretion. The CD markers and osteogenic and adipogenic differentiation capability in BMSCs from these elderly osteoporotic patients and healthy young donors are equivalent and compliant with the standards defined by the International Society of Cell Therapy (ISCT). Collectively, our data suggest that the elderly osteoporotic patients-derived BMSCs hold equivalent differentiation and proliferation capability and intact surface markers identical to BMSCs collected from healthy youth and are available for clinical cell therapy. [ABSTRACT FROM AUTHOR]

The increase of revision surgeries in hip replacement procedure in Colombian young adult population can be addressed by a new design of femoral stem that reduces stress shielding. A new femoral stem was designed using topology optimization as a design aid to reduce the mass in the femoral stem and its overall stiffness, combined with the theoretical, computational, and experimental assessment of the new design that complies with a static and fatigue safety factor greater than one. The new femoral stem design can be used as a design tool to reduce the number of revision surgeries caused by stress shielding. [ABSTRACT FROM AUTHOR]

Introduction: The optimal positioning of the hip prosthesis components is influenced by the mobility and balance of the spine. The present study classifies patients with pathology of the spino-pelvic-hip complex, showing possible methods of preventing hip dislocations after arthroplasty. Hypothesis: Hip-Spine Classification helps arthroplasty surgeons to implant components in more patient-specific position. Materials and methods: The group of 100 patients treated with total hip arthroplasty. Antero-posterior (AP) X-rays of the pelvis in a standing position, lateral spine (standing and sitting) and AP of the pelvis (supine after the procedure) were analyzed. We analyzed a change in sacral tilt value when changing from standing to sitting (∆SS), Pelvic Incidence (PI), Lumbar Lordosis (LL) Mismatch, sagittal lumbar pelvic balance (standing position). Patients were classified according to the Hip-Spine Classification. Postoperatively, the inclination and anteversion of the implanted acetabular component were measured. Results: In our study 1 A was diagnosed in 61% of all cases, 1B in 18%, 2 A in 16%, 2B in 5%. 50 out of 61 (82%) in group 1 A were placed within the Levinnek "safe zone". In 1B, 2 A, 2B, the position of the acetabular component was influenced by both the spinopelvic mobility and sagittal spinal balance. The mean inclination was 43.35° and the anteversion was 17.4°. Conclusions: Categorizing patients according to Hip-Spine Classification one can identify possible consequences the patients at risk. Pathology of the spino-pelvic-hipcomplex can lead to destabilization or dislocation of hip after surgery even though implanted according to Lewinnek's indications. Our findings suggest that Lewinnek safe zone should be abandoned in favor of the concept of functional safe zones. [ABSTRACT FROM AUTHOR]

Background: Erectile dysfunction (ED) stands out as one of the most prevalent sexual disorders in men, with its incidence progressively escalating with age. As delineated by the International Consultation Committee for Sexual Medicine on Definitions/Epidemiology/Risk Factors for Sexual Dysfunction, the prevalence of ED among men under 40 years is estimated to be within the range of 1–10%. The aim of this study was to determine the relationship between the concentration of bioelements (Zn, Cu, Fe, Cr, Mg, and Mn) in the serum and bone tissue and the concentration of selected hormones in men with and without erectile dysfunction. Materials and methods: The retrospective cohort study included 152 men who underwent total hip arthroplasty for hip osteoarthritis at the Department of Orthopaedic Traumatology and Musculoskeletal Oncology at the Pomeranian Medical University in Szczecin. Certain exclusion criteria were applied to ensure the integrity of the study. These included individuals with diabetes, a history of cancer, alcohol abuse, liver or kidney failure, New York Heart Association (NYHA) class III or IV heart failure, and those taking medications that affect bone metabolism, such as mineral supplements, neuroleptics, chemotherapeutic agents, immunosuppressants, corticosteroids, or antidepressants. Patients with hypogonadism or infertility were excluded from the study. Results: The study showed an association between bioT concentrations and Cu concentrations in both patients with and without erectile dysfunction. A correlation between bioactive testosterone and Cr concentrations was also observed in both groups. Patients with erectile dysfunction showed a relationship between bioT concentration and Zn concentration, TT concentration and Mn concentration, FT concentration and Zn concentration, and E2 concentration and Cr concentration. An analysis of elemental concentrations in bone tissue showed an association between FT and Mg and Mn concentrations, but only in patients with erectile dysfunction. In patients without erectile dysfunction, a correlation was observed between FT and Cu concentrations. A correlation was also observed between bioT concentrations and Mg, Mn, and Zn concentrations, but only in patients with erectile dysfunction. In patients without erectile dysfunction, a correlation was observed between bioT and Cu concentrations. Conclusions: Studying the relationship between the concentration of bioelements (Zn, Cu, Fe, Cr, Mg, and Mn) in the serum and bone tissue and the concentration of selected hormones in men may be important in explaining the etiology of the problem. The study of the concentration of Zn and Cu in bone tissue and serum showed that these two elements, regardless of the place of accumulation, may be related to the concentration of androgens in men. [ABSTRACT FROM AUTHOR]

Over the past five decades, artificial hip joint materials, such as ceramic, titanium, and cobalt-chromium molybdenum alloy, with significantly improved wear resistance or biocompatibility have been developed and used in medical procedures. The application of AISI 316L, a first-generation artificial joint model, is limited due to its low wear resistance and corrosion resistance. However, AISI 316L is still used in medical procedures. Therefore, improving the wear resistance and corrosion resistance of AISI 316L has attracted research attention. This study aims to improve the wear resistance of AISI 316L for metal on metal (MoM) combination by applying surface texturing technology. Herein, surface work hardening and the generation of the prow of the AISI 316L material were controlled by the dimple effect, the width of the deep groove shown in the profile of the wear surface was reduced by 2 times compared to the surface without dimples. [ABSTRACT FROM AUTHOR]

This document is a special issue of the journal Biomimetics, focusing on advances in biomimetic scaffolds for hard tissue surgery. The special issue includes contributions on topics such as biomimetic design strategies, techniques for fabricating scaffolds, novel biomaterials, biodegradability design, surface functionalization, and clinical applications. The published papers cover a range of areas, including bone and joint surgery, maxillofacial surgery, and general surgery. The articles discuss various contributions to the field of biomimetic scaffolds for hard tissue surgery, including the use of spider silk, biomimetic fixation for arthroplasty endoprostheses, and bioactive 3D implants for long bone defects. The document demonstrates advancements in the field and the potential for biomimetic scaffolds to assist in tissue regeneration. [Extracted from the article]

Introduction Implant sonication is useful for recovery of periprosthetic joint infection (PJI) pathogens in culture, but exact cutoff points for definition of clinically significant sonicate fluid culture results vary from study to study. The aim of this study was to define ideal sonicate fluid culture cutoff points for PJI diagnosis. Methods Sonicate fluid cultures from hip and knee prosthesis components removed between February 2007 and December 2020 were studied. Prosthesis components were placed in solid containers in the operating room; in the clinical microbiology laboratory, 400 mL Ringer's solution was added, and containers subjected to vortexing, sonication and then vortexing, followed by centrifugation. Concentrated sonicate fluid was plated on aerobic and anaerobic solid media, and culture results reported semiquantitatively, as no growth, <20, 20–50, 51–100, or >100 CFU/10 mL sonicate fluid. Sonicate cultures from cement spacers and cultures yielding more than 1 microorganism were excluded. Sensitivity and specificity of each cutoff point was evaluated. Results A total of 1448 sonicate fluid cultures were evaluated, 68% from knees and 32% from hips. PJI was present in 644 (44%) cases. Sensitivity of sonicate culture was 75.0% at <20 CFU/10 mL, 55.3% at ≥20 CFU/10 mL, 46.9% at >51 CFU/10 mL, and 39.8% at >100 CFU/10 mL. Specificity was 78.2%, 99.8%, 100%, and 100%, at the 4 cutoff points, respectively. Conclusions A cutoff point for sonicate fluid culture positivity of ≥20 CFU/10 mL is suitable for PJI diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Automated methods for prostate segmentation on MRI are typically developed under ideal scanning and anatomical conditions. This study evaluates three different prostate segmentation AI algorithms in a challenging population of patients with prior treatments, variable anatomic characteristics, complex clinical history, or atypical MRI acquisition parameters. Materials and methods: A single institution retrospective database was queried for the following conditions at prostate MRI: prior prostate-specific oncologic treatment, transurethral resection of the prostate (TURP), abdominal perineal resection (APR), hip prosthesis (HP), diversity of prostate volumes (large ≥ 150 cc, small ≤ 25 cc), whole gland tumor burden, magnet strength, noted poor quality, and various scanners (outside/vendors). Final inclusion criteria required availability of axial T2-weighted (T2W) sequence and corresponding prostate organ segmentation from an expert radiologist. Three previously developed algorithms were evaluated: (1) deep learning (DL)-based model, (2) commercially available shape-based model, and (3) federated DL-based model. Dice Similarity Coefficient (DSC) was calculated compared to expert. DSC by model and scan factors were evaluated with Wilcox signed-rank test and linear mixed effects (LMER) model. Results: 683 scans (651 patients) met inclusion criteria (mean prostate volume 60.1 cc [9.05–329 cc]). Overall DSC scores for models 1, 2, and 3 were 0.916 (0.707–0.971), 0.873 (0–0.997), and 0.894 (0.025–0.961), respectively, with DL-based models demonstrating significantly higher performance (p < 0.01). In sub-group analysis by factors, Model 1 outperformed Model 2 (all p < 0.05) and Model 3 (all p < 0.001). Performance of all models was negatively impacted by prostate volume and poor signal quality (p < 0.01). Shape-based factors influenced DL models (p < 0.001) while signal factors influenced all (p < 0.001). Conclusion: Factors affecting anatomical and signal conditions of the prostate gland can adversely impact both DL and non-deep learning-based segmentation models. [ABSTRACT FROM AUTHOR]

We investigated the impact of mesenchymal stem cell (MSC) therapy on treating bilateral human hip osteonecrosis, analyzing 908 cases. This study assesses factors such as tissue source and cell count, comparing core decompression with various cell therapies. This research emphasizes bone repair according to pre-treatment conditions and the specificities of cell therapy in osteonecrosis repair, indicating a potential for improved bone repair strategies in hips without femoral head collapse. This study utilized a single-center retrospective analysis to investigate the efficacy of cellular approaches in the bone repair of osteonecrosis. It examined the impact on bone repair of tissue source (autologous bone marrow concentrate, allogeneic expanded, autologous expanded), cell quantity (from none in core decompression alone to millions in cell therapy), and osteonecrosis stage and volume. Excluding hips with femoral head collapse, it focused on patients who had bilateral hip osteonecrosis, both pre-operative and post-operative MRIs, and a follow-up of over five years. The analysis divided these patients into seven groups based on match control treatment variations in bilateral hip osteonecrosis, primarily investigating the outcomes between core decompression, washing effect, and different tissue sources of MSCs. Younger patients (<30 years) demonstrated significantly better repair volumes, particularly in stage II lesions, than older counterparts. Additionally, bone repair volume increased with the number of implanted MSCs up to 1,000,000, beyond which no additional benefits were observed. No significant difference was observed in repair outcomes between different sources of MSCs (BMAC, allogenic, or expanded cells). The study also highlighted that a 'washing effect' was beneficial, particularly for larger-volume osteonecrosis when combined with core decompression. Partial bone repair was the more frequent event observed, while total bone repair of osteonecrosis was rare. The volume and stage of osteonecrosis, alongside the number of injected cells, significantly affected treatment outcomes. In summary, this study provides comprehensive insights into the effectiveness and variables influencing the use of mesenchymal stem cells in treating human hip osteonecrosis. It emphasizes the potential of cell therapy while acknowledging the complexity and variability of results based on factors such as age, cell count, and disease stage. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the impact of susceptibility artifacts from hip prosthesis on cancer detection rate (CDR) in prostate MRI. Materials and methods: This three-center retrospective study included prostate MRI studies for patients without known prostate cancer between 2017 and 2021. Exams with hip prosthesis were searched on MRI reports. The degree of susceptibility artifact on diffusion-weighted images was retrospectively categorized into mild, moderate, and severe (> 66%, 33–66%, and < 33% of the prostate volume are evaluable) by blind reviewers. CDR was defined as the number of exams with Gleason score ≥7 detected by MRI (PI-RADS ≥3) divided by the total number of exams. For each artifact grade, control exams without hip prosthesis were matched (1:6 match), and CDR was compared. The degree of CDR reduction was evaluated with ratio, and influential factors were evaluated by expanding the equation. Results: Hip arthroplasty was present in 548 (4.8%) of the 11,319 MRI exams. CDR of the cases and matched control exams for each artifact grade were as follows: mild (n = 238), 0.27 vs 0.25, CDR ratio = 1.09 [95% CI: 0.87–1.37]; moderate (n = 143), 0.18 vs 0.27, CDR ratio = 0.67 [95% CI: 0.46–0.96]; severe (n = 167), 0.22 vs 0.28, CDR ratio = 0.80 [95% CI: 0.59–1.08]. When moderate and severe artifact grades were combined, CDR ratio was 0.74 [95% CI: 0.58–0.93]. CDR reduction was mostly attributed to the increased frequency of PI-RADS 1-2. Conclusion: With moderate to severe susceptibility artifacts from hip prosthesis, CDR was decreased to 74% compared to the matched control. Clinical relevance statement: Moderate to severe susceptibility artifacts from hip prosthesis may cause a non-negligible CDR reduction in prostate MRI. Expanding indications for systematic prostate biopsy may be considered when PI-RADS 1-2 was assigned. Key Points: • We proposed cancer detection rate as a diagnostic performance metric in prostate MRI. • With moderate to severe susceptibility artifacts secondary to hip arthroplasty, cancer detection rate decreased to 74% compared to the matched control. • Expanding indications for systematic prostate biopsy may be considered when PI-RADS 1–2 is assigned. [ABSTRACT FROM AUTHOR]

BACKGROUND: Artificial femoral head replacement is an effective method for the treatment of elderly unstable intertrochanteric fractures. However, the effect of lesser trochanter reconstruction in femoral head replacement for Evans-III femoral intertrochanteric fractures has not been reported. OBJECTIVE: To analyze the effect of lesser trochanter reconstruction on the outcome of artificial femoral head replacement with long stem in elderly patients with Evans-III femoral intertrochanteric fracture. METHODS: A retrospective analysis was performed on medical records of 45 elderly patients who underwent bipolar long-stem artificial femoral head replacement due to Evans-III femoral intertrochanteric fractures in the Department of Bone and Joint Surgery, Second Affiliated Hospital of Xi’an Jiaotong University from June 2017 to May 2021. According to whether the small trochanter was reconstructed during surgery (reduction and fixation), they were divided into the reconstruction group (n=25) and the non-reconstruction group (n=20). The operation time, bleeding volume, time of getting out of bed, hospital stay time, Harris scores at 3 and 6 months postoperatively, and the incidence of complications during follow-up were compared between the two groups. RESULTS AND CONCLUSION: (1) The operation time of the reconstruction group was longer (99.72±13.41 minutes) than that of the non-reconstruction group (88.90±16.53 minutes) (t=2.369, P=0.023), and there were no significant differences in bleeding volume, time of getting out of bed or hospital stay time between the two groups (P > 0.05). (2) The Harris score of the reconstruction group (69.06±5.64 points) was higher than that of the non-reconstruction group (63.35±5.93 points) at 3 months postoperatively (t=2.982, P=0.005). At 6 months postoperatively, the Harris score of the reconstruction group (86.67±4.49 points) was higher than that of the non-reconstruction group (82.34±5.68 points) (t=2.782, P=0.009). (3) In addition, no significant difference existed in the incidence of complications between the reconstruction and non-reconstruction groups (χ²=0.008, P=0.927). (4) It is concluded that in elderly patients with Evans-III femoral intertrochanteric fractures, lesser trochanter reconstruction in the artificial femoral head replacement significantly improved postoperative hip function despite increased operative time, demonstrating the importance of the lesser trochanter reconstruction in the artificial femoral head replacement for Evans-III intertrochanteric fractures in the elderly people. [ABSTRACT FROM AUTHOR]