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Background: Septic arthritis is a debilitating condition that results in joint destruction and irreversible loss of joint function. Surgical treatment options include arthroscopy, resection arthroplasty, and total hip replacement (THR). Current literature on the treatment of septic arthritis of various joints includes periprosthetic or native joints. However, to our knowledge, a consolidated review that focuses solely on THR outcomes in a previously infected native hip is still lacking. This systematic review, for the first time, examined the clinical outcomes of THR, specifically in adults with septic arthritis of the native hip joint. Methods: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Cochrane Library, grey literature, and bibliographic references were searched from inception to October 2023. Only case series or cohort studies published within the last 20 years assessing the outcomes of THR for native hip septic arthritis were included. Literature retrieval and data extraction were conducted by three independent reviewers. Re-infection rate and various functional outcomes, measured in terms of the Harris Hip Score (HHS), Visual Analogue Scale (VAS), Merle D'Aubigne and Postel (MAP), Western Ontario, McMaster Universities Arthritis Index (WOMAC) Short Form 12-Item (SF-12) scores, were analyzed. Range of motion (ROM) and limb length discrepancy (LLD) were also examined. Results: Against the relevant criteria, seven studies (six case series, one cohort study) involving 1243 patients were included. The patients aged from 18 to 78 years old. The reinfection rate ranged from 0 to 22.8%, with a mean rate of 19.6%. With regards to functional outcomes, the mean increase in HHS was from 39.5 to 48.92 and the increase in MAP ranged from 7.3 to 10.9. Improvement in LLD ranged from 2.28 to 3.52 cm, with all studies reporting < 1 cm of LLD postoperatively. Conclusion: THR, both single and two-staged, is an effective treatment option for septic arthritis of the native hip joint that and yields good functional outcomes and acceptable reinfection rates. However, more prospective and randomized trials are needed to establish clear protocols on antibiotic regimes, clinical criteria clearance, and optimal time from infection to joint replacement. [ABSTRACT FROM AUTHOR]

Background/Objectives: The growing incidence of acetabular revisions has highlighted the importance of achieving reliable fixation to the remaining bone. Proximal transiliac fixation (TIF) of pelvic implants is becoming an increasingly common approach for managing extensive bone defects. This study seeks to provide guidance on TIF implantation by analyzing the optimal screw placement in partial pelvic replacements for acetabular defects. Methods: Between 2014 and 2024, a cohort of 96 consecutive patients (65 females and 31 males) who underwent customized partial pelvic replacement (PPR) with transiliac fixation (TIF) were examined. The angle and entry point of the ideal TIF were determined using preoperative three-dimensional planning and compared with potential influencing factors. Results: All PPRs were successfully implanted, with an average TIF length of 77 mm. The mean anteroposterior angle for TIF was 18° medially and 27° dorsally. Conclusions: Analysis of the entry point showed concentration around the second radius and between the eleven o'clock and one o'clock positions. The AP angle is notably affected by gender and height. Considering the precision of human judgment, a recommendation for TIF placement would be 20° medial and 30° dorsal deviation, with the entry point around the twelve o'clock position and the second ring from the center of the cup. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONPhysical rehabilitation exercises (PRE) are commonly prescribed early after total hip arthroplasty (THA), but the fundamental effectiveness of PRE has been questioned. As little is known about stakeholder perceptions of PRE, the aim was to explore patients’ and physical therapists’ perceptions of using PRE in the early period after THA.A qualitative interview study was conducted. Using a semi-structured interview guide, a focus group interview with six physical therapists and individual phone interviews with 18 patients were completed. Data were transcribed verbatim and analyzed applying a reflexive thematic analysis.Four main themes were identified: “Regaining everyday life,” “Sense of security — trusting the health professionals,” “Seeing the whole person — one size does not fit all,” and “A pathway without PRE is risky.”PRE was perceived to play an essential role in the early postoperative phase and a stratified, individual approach was requested. PRE was considered a means to regain everyday life and improve mental and physical recovery as well as mitigate complications. Guidance from physical therapists providing PRE was highlighted to enhance the patients’ sense of security. Both patients and physical therapists were concerned that a pathway without PRE would lead to poorer patient outcomes.Physical rehabilitation exercise early after total hip arthroplasty is perceived by both patients and physical therapists as essential and a means for patients to achieve their overall goal of regaining everyday life.Individually tailored content and organization of physical rehabilitation exercise is suggested to accommodate each patient’s needs and preferences, and to target their specific activity and rehabilitation goals.Biopsychosocial factors, such as age, physical status and exercise experiences, mental resources, support from relatives, occupational status, and preference of exercising with others or independently, should be considered in the planning and managing of tailored physical rehabilitation exercise.Including guidance from and possibility to contact physical therapists in the physical rehabilitation pathway can enhance patient sense of security.Physical rehabilitation exercise early after total hip arthroplasty is perceived by both patients and physical therapists as essential and a means for patients to achieve their overall goal of regaining everyday life.Individually tailored content and organization of physical rehabilitation exercise is suggested to accommodate each patient’s needs and preferences, and to target their specific activity and rehabilitation goals.Biopsychosocial factors, such as age, physical status and exercise experiences, mental resources, support from relatives, occupational status, and preference of exercising with others or independently, should be considered in the planning and managing of tailored physical rehabilitation exercise.Including guidance from and possibility to contact physical therapists in the physical rehabilitation pathway can enhance patient sense of security. [ABSTRACT FROM AUTHOR]

Background: The ultimate goal of arthroplasty is thought to be the ability to "forget" a joint implant in daily activities. The Forgotten Joint Score (FJS-12), a score system that evaluates how much patients have been able to forget their hip or knee prosthesis, was recently published. It is based on a self-administered questionnaire that consists of 12 items. The major goal of the current study was to validate, adapt, and evaluate a Arabic-language FJS-12 (Ar-FJS-12) version in patients who had undergone total hip replacement (THA). Materials and methods: The study included 107 patients who underwent THA 1–5 years ago and completed the Ar-FJS. The construct validity of the study was evaluated using the reduced Western Ontario and McMaster Universities Osteoarthritis Index (rWOMAC). To assess the test-retest reliability, 72 people took the Ar-FJS test twice. Results: Cronbach's alpha (Internal Consistency) of the Ar-FJS-12 was 0.957 and the intraclass correlation coefficient (ICC) was 0.931 indicating high reliability. For construct validity, there was a moderate significant correlation between the Arabic the rWOMAC with r = 0.595. The ceiling effect was 1.9% (n = 2), whereas the floor effect was 1.9% (n = 2). Conclusion: The Arabic version of the FJS-12 valid, reliable tool and can be recommended for patients in Arabic-speaking communities who have undergone hip arthroplasty. Level of evidence: III, validity and reliability study. [ABSTRACT FROM AUTHOR]

Background: Unrepaired chronic abductor tears may be a cause of residual pain and weakness after hip arthroplasty, but the current incidence is unclear. Methods: From 1994 to 2009, the senior surgeon performed 1628 hip resurfacing and 864 total hip arthroplasties without identifying any gluteal tears. We recognized our first case of concomitant abductor tear during a hip resurfacing procedure in April 2009. After this, we began following a protocol to identify and repair abductor tears in the next 5601 consecutive primary hip arthroplasties (5429 hip resurfacings and 172 total hips). Results: Women over 60 were the highest-risk group for abductor tear, with a 3.6% rate of tears identified. All tears were repaired. We found no differences in mean HHS and VAS pain score in patients with repair gluteal tears versus a control group of cases without a tear. Patients without a tear had higher postoperative UCLA activity scores at 2 years postoperative. The majority (98.1%) of hip arthroplasty patients with a gluteal tear repair at time of surgery presented with 4 or 5 abductor strength at their 2-year postoperative physical exam. Of our abductor tear cohort, 70.3% had no limp and 21.9% had a slight limp at 2 years postoperative. Conclusions: In a large group of hip arthroplasty cases (n = 4507), we identified gluteal tears in 3.6% of women and 1.0% of men. All reported clinical outcomes (excluding mean HHS) in our cohort of hip arthroplasty patients did not differ significantly between cases without abductor tears and those that had gluteal repair at time of surgery. These results suggest abductor tears may be repaired at time of hip arthroplasty surgery without forgoing desirable functional outcomes. Level of evidence: Level 3 Retrospective Cohort Study. [ABSTRACT FROM AUTHOR]

Purpose: The Coronavirus Disease 2019 (COVID-19) pandemic delayed elective procedures such as total joint arthroplasty. As surgical volumes return to prepandemic levels, understanding the implications of COVID-19 becomes imperative. This study explored the effects of COVID-19 on the short-term outcomes of hip arthroplasty. Methods: This multicenter, retrospective, case–control study included patients who had undergone hip arthroplasty between 2020 and 2022. Propensity score matching (PSM) was performed to compare demographic characteristics, primary outcomes, and secondary outcomes between patients with a history of COVID-19 (COVID-19 cohort) and those without it (control cohort). The primary outcomes were surgical site infection, periprosthetic joint infection (PJI), dislocation, prosthesis loosening, deep vein thrombosis, and pulmonary embolism. The secondary outcomes were intraoperative blood loss, nerve injury, renal injury, urinary tract infection (UTI), pneumonia, and acute coronary syndrome. Results: The COVID-19 and control cohorts comprised 153 and 4925 patients, respectively. After PSM, significant between-cohort differences were observed in the incidence of pneumonia (p < 0.001) and UTI (p = 0.0424). The odds ratio for PJI was 1.62, which is not significant (p = 0.3238) but the culture-negativity rate is higher in the COVID-19 cohort (25%). Conclusion: Our findings suggest that COVID-19 only elevated risks of postoperative pneumonia and UTI after hip arthroplasty. This disease significantly increases the risk of postoperative pneumonia but not of 90-day mortality or any major perioperative complication. On the other hand, PJI still remains a concern because its treatment is challenging owing to its culture-negativity, often necessitating the Girdlestone procedure. [ABSTRACT FROM AUTHOR]

The large elderly population has naturally led to an increase in the number of orthopedic surgeries, such as hip replacement, highlighting the need to develop machining manufacturing technologies that meet the quality requirements of the prosthesis. ABNT 316L austenitic stainless steel is used in the manufacture of joint prostheses and, although it is considered a material with low machinability, it is an economical alternative to the application of other biomaterials such as titanium alloys and ceramics. This work presents the optimization of the turning of femoral heads for a total hip prosthesis. To this end, it has used the response surface methodology and the robust parameters design to model and optimize the main process responses: roughness and sphericity. The experiments were carried out based on a combined array considering three control variables: cutting speed, feed rate and depth of cut, and two noise variables: fixed length of the workpiece and cutting fluid flow. As quality characteristics, the surface finish and the sphericity of the femoral heads were analyzed using the mean roughness and total circularity deviation, respectively. Robust optimization was performed by combining mean square error and normal boundary intersection techniques. Therefore, the formulation of the optimization problem was to minimize the roughness in the turning process of ABNT 316L, limiting the sphericity to 10 µm. From the results obtained in this investigation, it was possible to generate components with surface and shape quality simultaneously. The noise variables had significant effects on the evaluated responses leading to their robustness. [ABSTRACT FROM AUTHOR]

Summary Background Methods Results Discussion Demand for total hip and knee arthroplasty procedures continues to rise. Ongoing changes in surgical care and patient populations require continued monitoring of outcome trends. Using nationwide data from the USA, we aimed to describe updated trends in patient and peri‐operative care characteristics as well as complications among total hip and knee arthroplasty recipients.We included patients who underwent elective primary total hip or knee arthroplasty between 2016 and 2021. Trends were reported for a variety of patient and peri‐operative care characteristics as well as complications.We identified significant trends in patient and peri‐operative care characteristics as well as the incidence of complications. While patient median age increased, demographic composition remained consistent over the time period studied. There was a shift towards outpatient total hip and knee arthroplasty procedures, with one in five performed in the outpatient setting in 2021; the median duration of hospital stay decreased by 1 day over the time period for both procedures. Parallel increasing trends of total procedure numbers were found for patients without comorbidities and those with ≥ 3 comorbidities. Postoperative mortality increased significantly over the time period analysed for patients having total hip arthroplasty but not those having total knee arthroplasty (0.08 to 0.15 events per 1000 inpatient days, p = 0.037 and 0.09 to 0.33 events per 1000 inpatient days, p = 0.149, respectively).Compared with previous trend analyses of patients having total hip or knee arthroplasty, the present study shows: an increasing rate of outpatient surgeries; increasing numbers of arthroplasty procedures in high comorbidity burden groups; and an increase incidence of certain serious postoperative complications. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions Many publications on telerehabilitation for hip or knee arthroplasty have been published in recent years. However, no specific studies have attempted to characterize research hotspots, global research collaborations, or trends related to telerehabilitation after hip or knee arthroplasty. Therefore, the aim of this bibliometric analysis was to provide an overview of the current status of research and map the research landscape on telerehabilitation for joint replacement to understand current trends, identify research gaps, and guide future research directions.The Web of Science Core Collection and PubMed were comprehensively searched to identify all relevant English‐language documents published from 2003 to June 7, 2024. Data from these published studies were then cleaned and structured. CiteSpace and VOSviewer were used to conduct the bibliometric visualization and comparative analysis of countries, institutions, journals, authors, references, and keywords. Then, the map illustrating the research hotspots and knowledge structure was plotted based on the analysis results.A total of 229 records were obtained, and the number of articles published has increased steadily over the investigated period. The largest increase was observed in 2022. With the highest number of publications and centrality, the United States was the most influential country. The University of Sherbrooke was the most productive institution. Author Boissy P. ranked first in terms of the number of publications, while Tousignant M. ranked highest in cited authors, with 7 publications and 65 citations. The Journal of Arthroplasty published the greatest number of articles, with 29 publications. The most popular keywords from 2018 to 2023 were “home telerehabilitation,” “older adults,” and “physical therapy”. In terms of the strongest citation burst, the top five keywords were associated with “total knee arthroplasty,” “in home tele rehabilitation,” “physical activity,” “motion,” and “range.” The frontier keywords were “patient satisfaction,” “mobile application,” “self‐efficacy,” “fear avoidance model,” “home assessment tool,” and “cost benefit analysis.”The current status and trends in telerehabilitation for hip or knee arthroplasty are presented. A major concern at present is physical therapy for home telerehabilitation in the elderly. In the future, mobile app–based telerehabilitation programs for arthroplasty will continue to be encouraged, and some outcomes, such as “patient satisfaction,” “self‐efficacy,” and “cost benefit analysis,” are expected to receive more attention. Our work will serve as a valuable resource, providing fundamental references and a directional guide for future research. [ABSTRACT FROM AUTHOR]

Core decompression was developed as a joint-preserving procedure for patients with early-stage osteonecrosis of the femoral head. Previous studies indicated a high success rate that outperforms nonoperative management of pre-collapse hips. The traditional single-tunnel core decompression technique uses a cannulated drill bit inserted into the lateral cortex of the proximal femur. Multiple small drilling was introduced to decrease the risk of fracture through a less invasive technique. Adjunctive therapeutics such as tantalum rods, bone-grafting, orthobiologic (e,g, bone marrow aspirate concentrate, mesenchymal stem cells, platelet-rich plasma, and human umbilical cord mesenchymal stem cell extracts) as well as electric stimulation have all been studied. No consensus regarding the ideal treatment has been reached. This review analyzes the advantages and disadvantages of current core decompression techniques to provide orthopaedic surgeons with direction in managing patients with avascular necrosis of the femoral head. [ABSTRACT FROM AUTHOR]

During maceration, a string of beads was found near the surgically modified right os coxa and femur of the remains of a 55‐year‐old woman donated to the Forensic Investigation Research Station at Colorado Mesa University. The remains were initially used in the study of decomposition of human remains, and then macerated to clean the skeleton. Documentation on this decedent noted three separate "hip replacement" surgeries, but no other details. The surgical modifications include significant alterations to the right os coxa and femur consistent with a Girdlestone procedure, generally used to treat an infected hip replacement unresponsive to other treatment. In this procedure, the surgeon removes the femoral head, and in this case, also the portion of the replacement in the os coxa. In this individual, a portion of the proximal femur was reflected, possibly to reduce contact with the os coxa. The beads are consistent with antibiotic beads, used to treat the infection that likely necessitated the Girdlestone procedure. Both the operation and the inclusion of the antibiotic beads are unusual and are potentially useful in the identification process. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic incidence - lumbar lordosis (PI-LL) mismatch is often considered when assessing spinopelvic alignment in the sagittal plane. The mismatch is conventionally obtained by measuring 2 separate angles on lateral spinopelvic radiographs. This study describes a simplified approach for assessing spinopelvic mobility and measuring the PI-LL mismatch through the evaluation of the L1-spinopelvis angle (L1SP). Methods: 96 standing lateral radiographs were obtained from consecutive patients presenting for total hip arthroplasty between November 2020 and July 2021. 3 operators were recruited to annotate landmarks on digital radiographs. Correlation analysis and error analysis were applied. Measurement reproducibility was assessed using intraclass correlation coefficient (ICC). Results: The correlation coefficients of the 3 variables were respectively 0.87 for PI, 0.94 for LL, and 0.96 for L1SP. The normalised root mean square error between the 2 measurement sets was 9.96% for PI, 5.97% for LL, and 4.41% for L1SP. The absolute error was 3.49° ± 4.63° for PI, 3.23° ± 3.78° for LL, 2.68° ± 3.19° for PI-LL conventional, and 2.35° ± 2.88° for PI-LL via L1SP, respectively. In terms of reproducibility, measurement of L1SP outperformed that of PI and LL (ICC = 0.97 versus 0.83 and 0.93, respectively). Conclusion: The simplified L1SP method, through the measurement of a single angle, produced similar measurements to the conventional PI-LL method. The measurement repeatability between operators was improved using the L1SP method. From a clinical practice perspective, both methods are equivalent. The new method is readily reproducible using commercially available PACS software during preoperative templating. [ABSTRACT FROM AUTHOR]

Background: Patients with total hip arthroplasty (THA) under the age of 35 represent a small and heterogeneous group of 1% of all THA performed. This systematic review aims to analyse the diagnosis, implant type, complications, and long-term results in these patients. Methods: A search was performed on PubMed, Scopus, and Cochrane Library up to 31 July 2023. We included observational prospective and retrospective studies published in the last 20 years, which evaluated diagnosis, implant types, long-term results, and return to sports in patients ⩽35 years who underwent THA. We excluded case reports, case series, and studies with <35 patients. We extracted age, diagnosis, surgical information, follow-up, complications, revision rate, implant survival, and clinical outcomes for each study. The methodology of the included studies was evaluated using the MINORS score. Results: 18 studies with 1955 patients and 2383 THAs were included. Osteonecrosis (40.6%), posterior approach (81%), the uncemented press-fit implants (73.4%), metal-polyethylene bearings (31.3%) were the most frequently found items. All the clinical outcomes reported improvement from the preoperative to postoperative. The most frequent complication was aseptic loosening (4.3%). The survival rate was 92.4% at a mean follow-up of 10 years. Conclusions: THA is a good option for specific hip diseases in the young, but aseptic loosening still is the major point of concern. [ABSTRACT FROM AUTHOR]

Aims/Background Deep venous thrombosis (DVT) represents a significant postoperative complication after artificial femoral head replacement, with the incidence increasing proportionally with patient age. This study aimed to evaluate the effect of early postoperative use of intermittent pneumatic compression devices (IPC), followed by the combined use of low molecular weight heparin (LMWH) after 48 hours, for the prevention of postoperative lower limb DVT in elderly patients undergoing hip arthroplasty. Methods The retrospective study included 100 elderly patients who underwent unilateral femoral head replacement. The control group (n = 55) received combined LMWH initiated 12 hours postoperatively, while the observation group (n = 45) started combined LMWH 48 hours postoperatively. Changes in coagulation parameters, perioperative complications, and the incidence of postoperative lower limb DVT were compared between the two groups. Results Coagulation parameters showed significant changes post-intervention in both groups, with no statistically significant inter-group differences observed post-intervention (p > 0.05). The incidence of postoperative lower limb DVT did not differ significantly between the two groups (p > 0.05). However, the observation group demonstrated significantly lower postoperative blood loss, incidence of periwound hematoma, and transfusion rates compared to the control group (p < 0.05). Conclusion The sequential application of IPC in the early postoperative period, followed by combined LMWH administration after 48 hours, demonstrates comparable efficacy in preventing lower limb DVT formation in elderly patients undergoing hip arthroplasty when compared to the initiation of combined LMWH starting 12 hours postoperatively. In addition, this approach significantly reduces the risk of postoperative bleeding and exhibits a high safety profile. [ABSTRACT FROM AUTHOR]

Background and Objectives: The study aimed to evaluate a newly designed semicircular implant for the fixation of Vancouver Type B1 periprosthetic femoral fractures (PFFs) in total hip arthroplasty (THA) patients. To determine its strength and clinical applicability, the new implant was compared biomechanically with conventional fixation methods, such as lateral locking plate fixation and a plate combined with cerclage wires. Materials and Methods: Fifteen synthetic femur models were used in this biomechanical study. A Vancouver Type B1 periprosthetic fracture was simulated by osteotomy 5 mm distal to the femoral stem. The models were divided into three groups: Group I (lateral locking plate fixation), Group II (lateral locking plate with cerclage wires), and Group III (new semicircular implant system). All fixation methods were subjected to axial loading, lateral bending, and torsional force testing using an MTS biomechanical testing device. Failure load and displacement were measured to assess stability. Results: The semicircular implant (Group III) demonstrated a significantly higher failure load (778.8 ± 74.089 N) compared to the lateral plate (Group I: 467 ± 68.165 N) and plate with cerclage wires (Group II: 652.4 ± 65.474 N; p < 0.001). The new implant also exhibited superior stability under axial, lateral bending, and torsional forces. The failure load for Group III was more robust, with fractures occurring at the screw level rather than plate or screw detachment. Conclusions: Compared to traditional fixation methods, the newly designed semicircular implant demonstrated superior biomechanical performance in stabilizing Vancouver Type B1 periprosthetic femoral fractures. It withstood higher physiological loads, offered better structural stability, and could be an alternative to existing fixation systems in clinical practice. Further studies, including cadaveric and in vivo trials, are recommended to confirm these results and assess the long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) is a common complication after hip arthroplasty. Here, we investigated the clinical efficacy and safety of prophylactic aspirin vs. conventional therapy in hip arthroplasty for femoral neck fracture. Methods: Patients who underwent total hip arthroplasty and hemiarthroplasty for femoral neck fractures between April 2021 and April 2024 were prospectively enrolled. Group A received oral aspirin (100 mg, once daily) as VTE prophylaxis; Group LR received low-molecular-weight heparin (4,250 U, once daily) sequentially followed by rivaroxaban (10 mg, once daily). The patients were followed up for 90 days postoperatively. Safety and efficacy were comprehensively evaluated based on postoperative VTE incidence, laboratory blood tests, bleeding events, and other complications. Results: Group A was noninferior to Group LR in preventing VTE (incidence rates of 11.6% and 10.1%, respectively, with a rate difference of 1.5%, 95% CI: 0.7–2.3%, P for non-inferiority test = 0.017). There was no significant difference between the groups in the incidence of bleeding events (3.3 vs. 8.4%; P = 0.092). Furthermore, the rates of other complications did not differ significantly between groups. Conclusion: In patients undergoing hip arthroplasty for femoral neck fractures, the efficacy and safety of oral aspirin for preventing VTE was similar to that of low-molecular-weight heparin followed by rivaroxaban. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose Methods Results Conclusion Following failed internal fixation of intertrochanteric fractures (FIF‐ITF), the decision to use a long‐stem or standard‐stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF‐ITF failure affects the choice of femoral stem and clinical outcomes.Our retrospective cohort study reviewed 105 cases of patients with FIF‐ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components.The study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402).The selection of femoral prostheses following FIF‐ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long‐stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent. [ABSTRACT FROM AUTHOR]

Background: Predicting the success of a Debridement, Antibiotics, and Implant Retention (DAIR) procedure for periprosthetic joint infection (PJI) for hip and knee joint arthroplasty remains a challenge. A failed DAIR might adversely affect the outcome of any future revision surgery for PJI. Hence, the ability to identify and optimize factors predictive of DAIR success would help target the procedure to the appropriate patient cohort and avoid unnecessary surgery for patients where a DAIR is unlikely to eradicate infection. Methods: A retrospective review of our prospective Bone Infection Group database was performed to identify all patients who underwent a DAIR of their primary or revision hip or knee arthroplasty. All patients had a confirmed PJI as per MSIS 2013 criteria and an outcome according to the MSIS working group outcome-reporting tool. DAIR surgery was then grouped into groups of "successful" or "unsuccessful" outcomes. Results: Sixty-four consecutive patients with an acute PJI underwent a DAIR procedure between 2009 and 2020, with 46 procedures performed for knees and 18 for hips. Treatment was successful in 69% (37 knees and 7 hips). The chance of a successful DAIR was significantly greater if performed at or within one week of symptom onset compared to greater than one-week duration (adjusted odds ratio (OR) 0.11; P = 0.027; 95% CI [0.02–0.78])). For DAIR performed at or within one week of symptom onset, the success rate was 93% for knees and 80% for hips. The chance of a successful DAIR however was not influenced by whether the surgeon was an arthroplasty or non-arthroplasty surgeon (OR 0.28; P = 0.13; 95% CI [0.05–1.48])). Isolated Streptococcus infection had a success rate of 100%. Next came Coagulase-negative Staphylococci (71%) and Methicillin-susceptible Staphylococcus Aureus (65%). Polymicrobial infection had the worst outcome, with a success rate of 40%. Conclusion: In our experience, DAIR surgery performed within one week of symptom onset significantly increased the chance of successful infection eradication. Collaborative work is required to ensure arthroplasty patients can access prompt appropriate surgical decision-making as soon as concerns arise, remove barriers to early assessment and minimise delays to surgery. [ABSTRACT FROM AUTHOR]

Osteoporosis and osteopenia can affect patients undergoing arthroplasty of the hip, which is typically recommended for patients with severe osteoarthritis or elderly patients with a femoral neck fracture. Preoperative screening for this type of bone loss could be helpful to patients and prevent poor outcomes due to the rate of underdiagnosis of osteoporosis, which can reach 73% in patients undergoing hip arthroplasty. Complications associated with low bone mineral density include periprosthetic fractures as well as an increased revision rate. Although the benefit of antiresorptive medications postoperatively has been demonstrated, when administered preoperatively, worse outcomes were reported compared to its non-usage. Surgical management is as important as pre-medication. According to general recommendations, cemented implants provide greater benefit in osteoporotic patients. However, when using cementless implants, ribbed stems, straight tapered stems, stems with medial calcar contact, and titanium-composed stems can be used to prevent periprosthetic loss of bone mineral density; however, they should not be placed in a varus position. These stems can also be coated with zoledronate and other products. [ABSTRACT FROM AUTHOR]

Objective: To construct and internally validate a nomogram that predicts the likelihood of postoperative delirium in a cohort of elderly individuals undergoing hip arthroplasty. Methods: Data for a total of 681 elderly patients underwent hip arthroplasty were retrospectively collected and divided into a model (n = 477) and a validation cohort (n = 204) according to the principle of 7:3 distribution temporally. The assessment of postoperative cognitive function was conducted through the utilization of The Confusion Assessment Method (CAM). The nomogram model for postoperative cognitive impairments was established by a combination of Lasso regression and logistic regression. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. Results: The nomogram utilized various predictors, including age, body mass index (BMI), education, preoperative Barthel Index, preoperative hemoglobin level, history of diabetes, and history of cerebrovascular disease, to forecast the likelihood of postoperative delirium in patients. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.836 (95% CI: 0.797–0.875) for the training set and 0.817 (95% CI: 0.755–0.880) for the validation set. The calibration curves for both sets indicated a good agreement between the nomogram's predictions and the actual probabilities. Conclusion: The use of this novel nomogram can help clinicians predict the likelihood of delirium after hip arthroplasty in elderly patients and help prevent and manage it in advance. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate ground reaction forces (GRFs) in cats after unilateral total hip replacement (THR) and compare them with cats after femoral head and neck ostectomy (FHO). Methods: The databases of the Small Animal Clinic of the Veterinary University in Vienna and three referral clinics were searched for cats that had undergone unilateral THR with the BioMedtrix Micro total hip system or FHO more than 6 months previously. Owners were invited to complete a survey and bring their cats for re-examination, inlcuding clinical and orthopaedic examinations, hip radiography and a gait analysis using a pressure-sensitive plate. Results: Nine cats were included in each group. Cats after THR showed larger GRF values (peak vertical force [PFz] and vertical impulse [IFz] normalised to total force [%TF]) on the operated limb. The resulting symmetry indices (SIs) were lower in terms of vertical force in 7/9 (78%) cats and vertical impulse in 6/9 (67%) cats between the hindlimbs in cats after THR compared with FHO – SI (PFz) = 3.31% ± 2.19% (THR) vs 4.84% ± 2.99% (FHO) and SI (IFz) = 5.17% ± 3.66% (THR) vs 8.27% ± 3.12% (FHO). Cats after FHO showed significantly lower muscle circumference and range of motion (ROM) at the operated hindlimb compared with the contralateral side, whereas cats after THR showed no statistically significant differences between their hindlimbs. Owner surveys revealed significant differences in their subjective assessment of activity and change in gait between the two groups, with better values for cats after THR. Conclusions and relevance: This was the first study that measured GRFs in cats after THR. PFz (%TF) and IFz (%TF) values were higher in the operated limb of the THR group than in those of the FHO group, resulting in lower symmetry indices (indicating better symmetry) and better loading of the corresponding hindlimb. This finding is clinically relevant and can help in making decisions regarding the treatment of hip joint pathologies in cats. [ABSTRACT FROM AUTHOR]

This study reports the minimum 10 years results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head ceramic-on-ceramic bearing. Of the 276 THAs included in this study, there were eleven deaths and 27 patients lost to follow up (11%) during the follow-up, leaving 237 (85%) hips available for review at a mean of 10.5 years (range, 10 to 12) postoperatively. Reoperations, implant revisions, adverse events, clinical outcomes, radiographic evaluation, and whole blood metal ion levels were assessed at the last follow-up. After a minimum of 10 years, implant survivorship was 98.7%. There were 3 revisions (1.3%): one for insufficient acetabular cup primary fixation, one traumatic periprosthetic acetabular fracture, and one probable deep chronic infection. No dislocation or ceramic implant fracture was observed. The mean University of California at Los Angeles activity score, Western Ontario and McMaster Universities Osteoarthritis Index score, and Forgotten Joint Score were 5.6 (2 to 10), 90.1 (9 to 100), and 79.2 (4 to 100), respectively. All patients (100%) were satisfied or very satisfied. Since implantation, 43% of patients reported hearing a squeaking noise from the prosthesis. But all patients who reported squeaking were satisfied with the surgery. The mean titanium level was 2.2 μg/L (1.1 to 5.6). No progressive radiolucent lines, osteolysis, or implant loosening signs were observed at the last radiographic evaluation. A large-diameter head ceramic-on-ceramic THA provides outstanding long-term (minimum 10 years) implant survivorship with unrestricted activity while avoiding implant impingement, liner fracture, and hip instability. Functional outcomes, satisfaction, and joint perception were excellent. Although the incidence of squeaking was high, it did not affect patient satisfaction or function. The systemic titanium levels were low, related to unavoidable passive corrosion of implant surfaces, and did not reveal any indirect signs of trunnionosis. [ABSTRACT FROM AUTHOR]

Using time-driven activity-based costing (TDABC), a novel cost calculation method that more accurately reflects true resource utilization in health care, we sought to compare the total facility costs across different body mass index (BMI) groups following total joint arthroplasty (TJA). The study consisted of 13,806 TJAs (7,340 total knee arthroplasties [TKAs] and 6,466 total hip arthroplasties [THAs]) performed between 2019 and 2023. The TDABC data from an analytics platform was employed to depict total facility costs, comprising personnel and supply costs. For the analysis, patients were stratified into four BMI categories: <30, 30 to <35, 35 to <40, and ≥40. Multivariable regression was used to determine the independent effect of BMI on facility costs. When indexed to patients who had BMI <30, elevated BMI categories (30 to <35, 35 to <40, and ≥40) were associated with higher total personnel costs (TKA 1.03x versus 1.07x versus 1.13x, P <.001; THA 1.00x versus 1.08x versus 1.08x, P <.001), and total supply costs (TKA 1.01x versus 1.04x versus 1.04x, P <.001; THA 1.01x versus 1.02x versus 1.03x, P =.007). Total facility costs in TJAs were significantly greater in higher BMI categories (TKA 1.02x versus 1.05x versus 1.08x, P <.001; THA 1.01x versus 1.05x versus 1.05x, P <.001). Notably, when incorporating adjustments for demographics and comorbidities, BMI values of 35, 40, and 45 relative to BMI of 25, exhibit a significant association with a 2, 3, and 5% increase in total facility cost for TKAs and a 3, 5, and 7% increase for THAs. Using TDABC methodology, this study found that overall facility costs of TJAs increase with BMI. The present study provides patient-level cost insights, indicating the potential need for reassessment of physician compensation models in this population. Further studies may facilitate the development of risk-adjusted procedural codes and compensation models for public and private payors. Level IV, economic and decision analyses. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) has been linked to multiple adverse health outcomes and postoperative complications. Despite the high prevalence of OSA in patients undergoing total joint arthroplasty (TJA), few studies have evaluated the postoperative course of OSA patients after joint arthroplasty surgery. PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, and COMPENDEX) were used to conduct a systematic review of articles from inception to July 2023. Primary studies comparing postoperative outcomes following TJA between patients who had and did not have OSA were included. Postoperative medical complications, utilization of critical care, hospital stay, and mortality data were extracted. Descriptive statistics and random-effects meta-analysis models were used to analyze the available data. Included studies were evaluated for methodological risks of bias using the risk of bias in non-randomized studies of interventions. This review was registered on the International Prospective Register of Systematic Reviews (ID: CRD42023447610). There were 7 studies with a total of 20,977 patients (9,425 hip; 11,137 knee; 415 hip or knee) that were included. Pulmonary complications were most frequently studied, followed by thromboembolic events. Cardiac, gastrointestinal, hematologic, genitourinary, and delirium events were also reported across studies. Meta-analysis revealed that OSA patients had 4-fold increased odds of overall medical complications (OR [odds ratio], 4.23; 95% confidence interval (CI), 2.97 to 6.04; P <.001; I2 = 0%), 4-fold increased odds of pulmonary complications (OR, 4.31; 95% CI, 2.82 to 6.60; P <.001; I2 = 0%), 2-fold increased odds of thromboembolic complications (OR, 1.92; 95% CI, 1.22 to 3.03; P =.005; I2 = 9%), and 4-fold increased odds of delirium (OR, 3.94; 95% CI, 1.72 to 9.04; P =.001; I2 = 0%). A significant association was found between OSA and overall medical, pulmonary, and thromboembolic complications. These patients also had a higher incidence of postoperative delirium. The present findings underscore the need for comprehensive perioperative strategies to mitigate these risks in OSA patients who elect to undergo TJA. [ABSTRACT FROM AUTHOR]