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Evidence is lacking of an association between anesthetic choice and the risk of psychiatric disorders. Therefore, this study aimed to examine the impact of regional anesthesia (R/A) versus general anesthesia (G/A) on the occurrence of psychiatric disorders in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). Data for this population-based cohort study were sourced from the National Health Insurance Service of South Korea. The study included adult patients who underwent TKA or THA between January 1, 2016, and December 31, 2021. The endpoint was the diagnosis of postoperative psychiatric disorders within 1 year postoperative. This study included 411,967 patients who underwent THA or TKA. Among them, 290,476 (70.5 %) underwent THA or TKA under R/A (R/A group), while 121,491 (29.5 %) underwent THA or TKA under G/A (G/A group). In multivariate logistic regression, the R/A group had an 8 % lower incidence of postoperative psychiatric disorders (odds ratio [OR], 0.92; 95 % confidence interval [CI], 0.90–0.94; P < 0.001) than the G/A group. Specifically, a lower incidence of postoperative psychiatric disorder for depression (OR, 0.89; 95 % CI, 0.86–0.92; P < 0.001), bipolar disorder (OR, 0.88; 95 % CI, 0.83–0.94; P < 0.001), anxiety disorder (OR, 0.95; 95 % CI, 0.92–0.98; P = 0.001), and insomnia disorder (OR, 0.95; 95 % CI, 0.80–1.11; P = 0.496) was observed in the R/A versus G/A group. Among these South Korean patients who underwent TKA or THA, the R/A group had a lower incidence of postoperative psychiatric disorders than the G/A group. • Relationship between anesthesia and psychiatric disorder remain controversial. • General Anesthesia might be risk factor for development of psychiatric disorder. • Opting against General Anesthesia may contribute to preventing psychiatric disorders. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the effectiveness of prehabilitation prior to total knee and hip arthroplasty (TKA/THA) for osteoarthritis on postoperative outcomes assessed by self-report and performance-based measures. Methods: Embase, MEDLINE, CENTRAL, CINAHL and Scopus (inception-August 2022) were searched for randomized controlled trials. Self-report outcomes were function, health-related quality of life (HRQoL), and pain. Performance-based outcomes were strength, range of motion (ROM), balance, and functional mobility. The RoB 2.0 assessed risk of bias. Random-effects meta-analysis was performed up to 52 weeks after TKA/THA. Results: High risk of bias was found in 24 of 28 trials. Prehabilitation improved function (SMD = 0.50 [95%CI: 0.23, 0.77]), pain (SMD = 0.44 [95%CI: 0.17, 0.71]), HRQoL (SMD = 0.28 [95%CI: 0.12, 0.43]), strength (SMD = 0.72 [95%CI: 0.47, 0.98]), ROM (SMD = 0.31 [95%CI: 0.02, 0.59]), and functional mobility (SMD = 0.39 [95%CI: 0.05, 0.73]) post-TKA. No significant effect of prehabilitation on balance (SMD = 0.28 [95%CI: −0.11, 0.66]) post-TKA. All outcomes assessed had significant heterogeneity (p < 0.01). There were limited and contradictory trials (n = 2) for THA. Conclusion: High risk of bias and significant heterogeneity observed in our meta-analysis prevent conclusions regarding prehabilitation effectiveness on outcomes up to one year after TKA/THA. IMPLICATIONS FOR REHABILITATION: Prehabilitation has been promoted to improve postoperative outcomes and shorten recovery periods after total knee/hip arthroplasty (TKA/THA) for osteoarthritis Prehabilitation improved relevant self-report and performance-based outcomes after TKA surgery A high risk of bias and significant heterogeneity across trials prevent drawing any conclusions More high-quality research is required before recommending the implementation of prehabilitation programs in clinical practice for people awaiting TKA/THA [ABSTRACT FROM AUTHOR]

Acute postsurgical pain (APSP) is an important risk factor for pain chronification, with reports of being more intense after total knee arthroplasty (TKA) than after total hip arthroplasty (THA). Psychological variables have been associated with differences in postsurgical pain experience. This study aimed to analyse the longitudinal reciprocal association between pain and anxiety levels in patients undergoing TKA or THA, to investigate the moderator role of the type of surgery and to explore psychological mediators in the anxiety – pain association. Patients undergoing TKA (n = 120) or THA (n = 109) were evaluated before surgery and in the acute postsurgical period (48 h postsurgery). Presurgical assessment comprised sociodemographic, pain-related and psychological variables (anxiety, depression, pain catastrophizing, self-efficacy, optimism and satisfaction with life). Postsurgical assessment focused on pain frequency, pain intensity and anxiety. Longitudinal associations were explored using cross-lagged panel models that included the indirect effect paths through possible mediators (pain catastrophizing and depression). Multigroup analyses compared TKA and THA. In the global sample, higher APSP was predicted by higher presurgical pain and worse presurgical anxiety. Multigroup analyses revealed that worse APSP was predicted by higher presurgical anxiety in patients undergoing TKA and by higher presurgical pain in patients undergoing THA. Furthermore, there was a positive significant indirect effect of pain catastrophizing, but not depressive symptoms, in the relationship between presurgical anxiety and APSP in THA. Anxiety and APSP are differently interrelated in TKA and THA. Psychological characteristics could be managed before surgery to favour better APSP control and potentially prevent pain chronification after total joint arthroplasty. [ABSTRACT FROM AUTHOR]

The article discusses the historical background and resurgence of the direct anterior approach in total hip arthroplasty (THA). It evaluates the outcomes of this approach compared to conventional methods, highlighting conflicting results from various studies. The study conducted a systematic evaluation of meta-analyses of randomized controlled trials (RCTs) to provide an overview of the benefits and limitations of the direct anterior approach. The findings suggest that while the direct anterior approach may offer short-term functional improvements and reduced pain, it also poses risks such as longer operative time and potential complications. The study emphasizes the need for more informed discussions between patients and healthcare professionals regarding the choice of surgical approach in THA. [Extracted from the article]

Purpose: Total hip and knee arthroplasty in patients with previous history of periarticular surgery, such as osteosynthesis, can be surprisingly complex. This type of procedure is known as conversion arthroplasty (cTHA or cTKA) and has a higher risk of complications. The rates of unexpected positive cultures (UPC) and the risk of periprosthetic joint infection (PJI) compared to primary arthroplasty is unclear. The main purpose of this study was to evaluate rates of Unexpected Positive Cultures (UPC) in a series of conversion arthroplasty patients. The main questions to answer are: 1. Are the patients with conversion arthroplasties more susceptible to UPC than other causes of revision arthroplasties? 2. Are the conversion patients with UPC more susceptible to developing PJI? Methods: This was a retrospective review of patients submitted to cTHA and cTKA from January 2012 to September 2018. Patients with history of previous infection or with missing intraoperative cultures were excluded. The UPC was defined as a single positive culture obtained during a procedure previously considered aseptic and PJI was defined according to the 2018 ICM criteria. After excluding 141 cases, 205 patients were analyzed, 160 hips and 45 knees. Results: Nine (4.4%) UPC were identified, five (3.1%) in the hip group and four (8,9%) in the knee group. Staphylococcal species were the most common isolated bacteria (n = 7, 77.7%). During the study period, four (1,9%) patients were diagnosed with PJI. Only one case had an UPC and a different germ was identified during revision arthroplasty workup. Conclusions: While UPC are more prevalent in conversion knee arthroplasties compared to conversion hip arthroplasties, the rates are similar to those observed in revision arthroplasty for other indications. Importantly, the presence of a UPC in conversion arthroplasty does not appear to elevate the risk of subsequent periprosthetic joint infection, provided a thorough PJI workup has been conducted preoperatively. Therefore, in such cases, UPCs may be safely disregarded. [ABSTRACT FROM AUTHOR]

Purpose: Acetabular defect reconstruction can be a complex and challenging surgical procedure, with stable long-term fixation of the implants remaining the ultimate goal. The purpose of this study was (1) to evaluate the radiological and clinical outcome of complex acetabular reconstruction surgery with the use of modular tantalum TM augments in combination with cemented revision cups; (2) to investigate blood tantalum concentrations in these patients; and (3) to report complications and mechanisms of failure related to this procedure at mid-term follow-up (mean 4.5 years). Methods: We retrospectively reviewed 29 patients (29 hips) with severe acetabular bone loss (Paprosky type III A) reconstructed using a modular tantalum TM augment in combination with a cemented cup. We evaluated the implant survival and the radiological and clinical outcomes after a mean follow-up of 4.5 years (SD 2.2; range 8.4 – 2.1 years) using patient reported outcome scores (PROMs). Blood samples were analysed regarding tantalum concentration and compared with a control group. Results: The cumulative survival rate at 4.5 years with the endpoint "revision of the acetabular component for any reason" was 96.2% (95% Confidence Interval 75.7–99.5). The PROMs improved significantly up to the latest follow-up, and radiographic data showed only one patient with signs of initial implant migration with a broken screw and a change of the position of the augment and the cup. Mean blood tantalum concentrations were significantly higher in the study group (0.16 µg/L) compared to the control group (0.002 µg/L) (P < 0.001). Conclusions: This study has demonstrated good mid-term (mean 4.5 years) clinical and radiological outcomes of modular tantalum TM augments in combination with a cemented cup for the reconstruction of major acetabular defects. Mean blood tantalum concentrations were increased in patients with stable tantalum implants compared to healthy controls. [ABSTRACT FROM AUTHOR]

Purpose: Hip and knee arthroplasties are daily procedures in orthopaedic departments. Recently, same-day discharge (SDD) became increasingly popular, but doubts remain about its safety and generalization. Our hypothesis is that outpatient arthroplasty, in a high volume centre and with an institutional protocol, is an effective and reliable practice. Methods: We realized a monocentric retrospective study of patients undergoing outpatient partial (UKA) or total (TKA) knee or hip arthroplasty (THA) in a high volume academic centre using a well-defined institutional pathway. Epidemiological data and complications occurring in the month following surgery were studied. Results: 498 patients undergoing 501 arthroplasties (219 hips and 282 knees) were examined. The percentage of men and women was 60.28% and 39.72% respectively, mean age was 64.56 ± 9.59 years, mean BMI was 26.87 ± 4.2 and the most represented ASA score was 2. The success rate for same-day discharge was 97.21%. The most frequent causes of failure were urinary retention (28.6%), orthostatic hypotension (28.6%) and insufficiently controlled pain (14.3%). The readmission rate in the month following the operation was 0.8% and the rate of emergency department visits was 1.6%. Finally, the rate of early consultation visits was 7.98%. The comparison between success and failure subgroups in the outpatient setting of our cohort did not highlight statistically significant differences for studied parameters. Conclusion: Outpatient arthroplasty, performed in a center used to managing such operations and with a well-established institutional pre- and post-operative protocol, is a safe practice. [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]

Purpose: To report the prevalence of articular noise following total hip arthroplasty (THA) with custom stems and ceramic-on-ceramic (CoC) bearings, to determine the risk factors for articular noise, and the effect of articular noise on quality of life (QoL). Methods: A consecutive series of uncemented primary THAs using custom stems implanted between 01/02/ 2014–01/04/2017 were evaluated. The cohort comprised 479 patients (529 hips, 301 males and 228 females), aged 55.9 ± 11.6 with a BMI of 25.8 ± 4.3 kg/m2. Postoperative assessment included Oxford hip score (OHS), forgotten joint score (FJS), and a dedicated questionnaire on articular noise. Descriptive statistics were used to summarise the data. Regression analyses were performed to study factors associated with presence of noise. Results: At a minimum follow-up of five years, 431 patients (476 hips) were available for postoperative assessment. OHS was 45.3 ± 6.1, FJS was 83.6 ± 24.7, and 69 patients (71 hips, 15%) reported articular noise. The impact of noise on QoL was 1.4 ± 2.1. Multivariable analyses confirmed that the presence of articular noise was associated with younger age (OR,0.95; 95%CI,0.93–0.97; p < 0.001), smaller native femoral offset (OR, 0.95; 95%CI,0.90–1.00;p = 0.034), as well as intense (OR, 3.15; 95%CI, 1.15–9.79; p = 0.033) and very intense physical activity (OR, 4.71; 95%CI, 1.52–16.15; p = 0.009). Conclusion: The prevalence of articular noise following primary THA with custom stems and CoC bearings was 15%, but the impact of noise on QoL was minimal for most patients. Younger, highly active patients should be advised of an increased likelihood of noise from CoC THA, particularly if they have low native femoral offset on preoperative imaging. [ABSTRACT FROM AUTHOR]

To clarify the relevance of physical activity (PA) with respect to a decrease in minimal joint space (MJS) of the nonoperative hip in female patients at 24 months post‐contralateral total hip arthroplasty (THA). This prospective cohort study was conducted from six to 24 months post‐THA. The subjects were 85 female patients with hip osteoarthritis (OA) who had undergone unilateral THA. The primary outcome was a change in MJS (ΔMJS). Daily step counts and moderate to vigorous physical activity were measured. To identify factors related to ΔMJS, a generalized linear model approach was used, with adjustment factors, Kellgren–Lawrence (KL) grade, PA, and interaction terms between PA and KL grade as explanatory variables. The interaction term between daily step count and KL grade was significant. The regression coefficient of the daily step count for ΔMJS was significant in the KL ≥ 1 group, but not in the KL = 0 group. A model with adjustment factors, an interaction term, and PA showed that the daily step count increased ΔMJS. PA was related to ΔMJS of the nonoperative hip in female patients with KL grade ≥1, but was not related to ΔMJS in patients without OA post‐THA. Excessive daily step count may be a risk factor for a decrease in MJS of the nonoperative hip. [ABSTRACT FROM AUTHOR]

Large acetabular bone defects are challenging in hip revision surgery. Clinical assessment is crucial to evaluate modern technologies in surgical reconstruction. We aimed to better understand the bone remodeling that occurs following acetabular reconstruction. Our objectives were: (1) To characterize changes in the shape of the pelvis by studying sequential computed tomography (CT) scans collected immediately and 1‐year postoperatively and (2) to identify which part of the pelvis is most susceptible to remodeling. We used the CT scans taken at two timepoints, of 24 patients with acetabular bone defects classified as Paprosky IIIB, treated with three‐dimensional (3D)‐printed custom‐made acetabular implants. Segmented 3D models of the bony pelvis were co‐registered using three different techniques. A global co‐registration of the full pelvis was conducted, followed by the co‐registration of the innominate bone and then ilium only, on the ipsilateral reconstructed side. The relative movements of the ilium, ischium, and pubis were analyzed from visual inspection and using co‐registration metrics (root mean square error and intersection over union). No bone remodeling was found in 14/24 patients (58%). The co‐registration of the innominate bone indicated bone remodeling in five cases (21%), while the remaining five cases (21%) presented remodeling in the global co‐registration but not the innominate bone co‐registration, suggestive of changes occurring at the sacroiliac joint. Changes in the pelvic shape were greatest at the pubis and ischium. Bone remodeling may occur in complex cases of Paprosky type IIIB defects, after acetabular reconstruction (occurrence of 21%, 5/24 cases). Surgeons and engineers should consider this when monitoring implant migration. [ABSTRACT FROM AUTHOR]

Periacetabular osteotomy (PAO) is a common treatment for prearthritic hip dysplasia. The goal of this investigation was to determine if computationally assessed hip contact mechanics are associated with joint failure at minimum 10‐year follow‐up. One hundred patients with hip dysplasia (125 hips) completed patient‐reported outcomes an average of 13.8 years (range 10.0–18.0 years) after PAO. 63/125 hips were classified as having failed: 26 converted to total hip arthroplasty (THA) and 37 with significant disability indicated by modified Harris Hip Score (mHHS) ≤ 70. Differences in discrete element analysis‐computed contact mechanics were compared between (1) preserved and failed hips, (2) preserved hips and hips that failed by THA, and (3) preserved hips and hips that failed by mHHS ≤ 70. Failed hips had significantly higher preoperative contact stress and exposure metrics (p < 0.001–0.009) than preserved hips. Failed hips also had significantly higher postoperative peak contact stress (p = 0.018), higher mean contact stress (p < 0.001), and smaller contact area (p = 0.044). When assessed based on type of failure, hips that failed by THA had significantly higher postoperative contact stress and exposure metrics than preserved hips (p < 0.001–0.020). In hips that failed by mHHS ≤ 70, mean postoperative contact stress exposure was significantly higher compared to preserved hips (p = 0.043). Despite improved radiographic measures of dysplasia after PAO, pathologic joint contact mechanics can persist and predict treatment failure at minimum 10 years after surgery. Operative and nonoperative techniques specifically intended to reduce harmful contact mechanics in dysplastic hips may have the potential to further improve clinical outcomes after PAO. [ABSTRACT FROM AUTHOR]

Purpose: Total knee arthroplasty (TKA) has consistently demonstrated lower patient satisfaction compared to total hip arthroplasty (THA). However, prior investigations failed to account for the patients' demographic characteristics. This study aimed to conduct a comparative analysis of patient-reported outcomes between TKA and THA while adjusting for patient background. Methods: A total of 326 primary TKAs and 259 THAs conducted at a single center were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores preoperatively and at 3 months, 1 year, and 2 years postoperatively. Notably, TKA patients exhibited advanced age and higher body mass index (BMI) than their THA counterparts. To mitigate the impact of these differences, we employed propensity score-matched data, adjusting for background characteristics such as age, gender, BMI, and diagnosis. Results: THA consistently demonstrated significantly superior WOMAC total, pain, and stiffness scores compared to TKA at 3 months, 1 year, and 2 years postoperatively. Nevertheless, no statistically significant disparity in WOMAC physical function scores was observed between the two groups at 3 months and 1 year postoperatively in the matched data (3 months, p = 0.131; 1 year, p = 0.269). Conclusion: In contrast to earlier findings, our analysis of propensity score-matched data revealed no significant differences in WOMAC physical function scores between the TKA and THA groups at 3 months and 1 year postoperatively. The distinctive background factors observed in patients undergoing TKA and THA, notably advanced age and higher BMI, coupled with the delayed improvement timeline in TKA's WOMAC scores compared to that of THA, have the potential to impact patient-reported outcomes. Consequently, clinicians should be mindful of the potential impact of patient background on variations in patient-reported outcome measures following total joint arthroplasty. [ABSTRACT FROM AUTHOR]

Purpose: Modular dual-mobility cups (MDMCs) have a lower risk for dislocation after total hip arthroplasty (THA). The primary aims of our study were to analyze implant survivorship and to determine complications, especially dislocation, and revision rates of primary THAs used for hip fracture patients and for revision THAs. Secondary aims were to evaluate mortality after MDMC surgery and to find out if introduction of MDMC at our institution (Kuopio University Hospital, Finland) have decreased dislocation rate. Methods: This retrospective cohort study consisted of 101 MDMC patients who were consecutively operated at our institution between April 1, 2018 and June 30, 2020. The implant survival rate, complications and mortality were evaluated with minimum of 2-year follow-up. Finnish Hospital Discharge Register was used to find out yearly dislocation rates following THA at our institution. Results: The cumulative estimate implant survival after MDMC in the primary THA group was 97% at 2 years, and in the revision THA group, it was 90% at 2 years. Dislocation was a rare complication in the primary THA group (1.4%), while it was common in revision THA group (12.9%). The cumulative estimate for mortality after MDMC in the primary THA group was 13% at 2 years, and in the revision group, it was also 13% at 2 years. The yearly number of patients who had re-hospitalization period due to THA dislocation decreased 46% after implementation of MDMC. Conclusion: Short-term survival and complication rates after MDMC were excellent after primary THA and moderate after revision THA. Implementation of MDMC THA for hip fracture patients seems to have effectively decrease dislocation rate during a short follow-up. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aimed to compare outcomes between multiple and single debridement, antibiotics, and implant retention (DAIR) procedures for early periprosthetic joint infection (PJI) in hip and knee arthroplasty. Methods: Four databases were searched from inception till January 2024 for original studies investigating the outcomes of multiple DAIR in hip and knee PJI. The primary outcome was the success rate in eradicating joint infection. This review was conducted per PRISMA guidelines. Results: A total of 9 observational studies with 1104 participants were included, with a mean age and BMI of 58.37 years (95%CI: 25.77–90.98) and 31.43 kg/m2 (95%CI: 28.89–34.98), respectively. The mean follow-up period was 58.37 months (95%CI: 25.77–90.98), and the average MINORS score assigned to the review was 17.6 ± 3.46, indicating a low overall risk of bias. An equivalent success rate between single and double DAIR was observed, at 67% (95%CI: 64–71%) and 70% (95%CI: 48–86%), respectively, with no statistically significant difference between the two treatment modalities (p = 0.740). Additionally, the success rate for triple DAIR ranged from 50 to 60%. Conclusion: This study suggests that double DAIR is a valid treatment option for acute PJI after TKA and THA, with a success rate comparable to single DAIR (70% vs. 67%, p = 0.740). Triple DAIR achieved success rates ranging from 50 to 60%. However, caution is warranted when interpreting these results due to heterogeneity in host comorbidity factors, DAIR protocols, and antibiotic regimens. Level of Evidence: Therapeutic, Level III. [ABSTRACT FROM AUTHOR]

Purpose: The effect of cancellation and postponement of primary total hip arthroplasty (THA) or knee arthroplasty (TKA) on patient outcomes is unclear. The aim was to assess whether cancellation and delay to arthroplasty was associated with worse joint specific function and quality of life (QoL) 1-year postoperatively. Methods: A single centre retrospective case–control study was performed for all patients planned to undergo THA or TKA in 2019. A total of 3133 arthroplasties were scheduled for 2019 (1484 THA, 1649 TKA), of which 344 (11.0%) were cancelled (136 THA [9.2%], 208 TKA [12.6%]). Pre-operative and one-year post-operative EuroQol (EQ-5D) and Oxford hip (OHS) or knee (OKS) scores were collected. Results: The median time between the date of cancellation and the subsequent operation was 46.0 days for TKA and 45.5 days for THA. The cancelled group were more likely to be male (odds ratio [OR] 1.23, p = 0.03), older (mean difference [MD] 1.19, p = 0.03), with a higher ASA grade (OR 1.88 [ASA 3], OR 5.3 [ASA 4], p = 0.001) or planned for a TKA (OR 1.41, p = 0.003). There were no differences in pre-operative OKS (mean difference [MD] 0.19, p = 0.828) or EQ-5D (MD 0.028, p = 0.394) or in the one-year postoperative OKS (MD 1.51, p = 0.064) or EQ-5D (MD 0.041, p = 0.067) between groups undergoing TKA. However, cancelled THA patients had lower pre-operative OHS (MD 2.73, p = 0.018) and EQ-5D (MD 0.134, p = 0.0017) but at one-year postoperatively there was no difference in the absolute OHS (MD 2.07, p = 0.052) or EQ5D (MD 0.04, p = 0.142). The improvement in hip EQ-5D was greater (MD 0.096, p = 0.016) in the cancelled group. Conclusion: Cancellation and short delay did not influence joint specific outcome or QoL following THA or TKA at one-year. Preoperative hip specific pain, function and QoL were worse in cancelled THA patients, suggesting deterioration while waiting for their surgery, but this did not affect their postoperative outcome. [ABSTRACT FROM AUTHOR]

Purpose: Recent studies have proposed optimizing the position of the acetabular component based on spinal deformity and stiffness classification to avoid mechanical complication after total hip arthroplasty (THA). The aim of this study was to characterize the dynamic changes in cup alignment post-THA based on the spinopelvic classification and to evaluate the efficacy of cup placement of preventing dislocation. Methods: This prospective study included a total of 169 consecutive patients awaiting THA who were classified into four groups based on spinal deformity (pelvic incidence minus lumbar lordosis) and spinal stiffness (change in sacral slope from the standing to seated positions). The cups were aligned based on the group with fluoroscopy. Additionally, postoperative radiographic inclination (RI), radiographic anteversion (RA) in standard anteroposterior radiograph, and lateral anteinclination (AI) in sitting and standing positions were measured. The cumulative incidence of dislocation was evaluated at a follow-up two years post-THA. Result: RA was significantly greater in the group with normal spine alignment and stiff spine than in other groups (P = 0.0006), and AI in the sitting position was lower than in other groups (P = 0.012). Standing AI did not significantly differ between the groups. One posterior dislocation occurred during the study period (0.6%). Conclusion: AI in the sitting position was lower in patients with normal spinal alignment and stiff spine despite larger RA in the standard anteroposterior radiographs. Consequently, with more anteversion in the normal spinal alignment and stiff spine group, spinopelvic parameters can help guide cup placement to prevent short-term dislocation post-THA. [ABSTRACT FROM AUTHOR]

Purpose: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for psychiatric conditions. Previous studies have shown that SSRIs can increase bleeding risk by affecting platelet aggregation. However, their impact on perioperative outcomes in hip surgery remains uncertain. This case-control study examines the link between preoperative SSRI use and perioperative transfusion requirements in hip surgery patients. Methods: Data from the M161Ortho dataset of Pearl Diver patient records database were utilized. Patients who underwent hip joint surgery between 2010 and 2022 and had documented preoperative SSRI use within one month prior to surgery were included. Patients with coagulopathy disorders or coagulopathy medication use were excluded. Perioperative transfusion need was defined as receiving red blood cell or whole blood transfusions on the same date or within 10 days following the surgery. Results: A total of 75,374 patients with preoperative SSRI use were matched with an equal number of non-SSRI users. Preoperative SSRI use was associated with an increased risk of requiring perioperative transfusion (5.7% vs. 5.1%, P < 0.001). Subgroup analysis demonstrated increased transfusion risk in patients undergoing pinning (2.6% vs. 1.8%, P = 0.02), open reduction with internal fixation (ORIF) (8.9% vs. 8.2%, P = 0.007), and total hip arthroplasty (THA) (3.8% vs. 3.4%, P < 0.001), but no significant difference was observed in patients undergoing hemiarthroplasty. Conclusion: Clinicians should be aware of the potential risk of increased perioperative transfusion requirements in hip surgery patients using SSRIs, especially during pinning, ORIF, and THA procedures. It is essential to consider this when managing patients on SSRIs before hip surgery. [ABSTRACT FROM AUTHOR]

Purpose: Achieving the initial stability of implants is necessary for hip hemiarthroplasty (HHA), especially in elderly patients, and this can be achieved with a cement mantle of quality. The direct anterior approach (DAA) for HHA lately has shown positive results. However, evidence is lacking of HHA in elderly patients with osteoporosis after femoral neck fracture (FNF). This study compares differences in cement mantle quality after HHA, its complications, radiological outcomes and functional status in elderly patients with FNF intervened through different approaches. Methods: A non-interventional, retrospective case–control study was conducted. 150 cases were selected based on the surgical approach (DAA, DLA and PLA) in a 1:1:1 proportion between 2018 and 2019. Under 75 years old suspicion or confirmation of a pathological fracture were excluded. Antibiotic-loaded cement was utilized. Cement preparation involved vacuum centrifugation and standard instructions for preparation canal and filling, and prosthesis placement were followed. Results: No statistically significant differences in cement mantle quality, radiological outcomes, and the majority of the postoperative complications and functional status considering the surgical approach (p > 0.05). However, the DAA was associated significantly with shorter hospital stays (8.3 days vs 11.3 and 13 days for DLA and PLA) a decrease in postoperative blood transfusion (22% vs 34% and 53%), and lower rate of loss of walking (8% vs 20% and 28.6%). Conclusion: The DAA for HHA in patients with FNF provides a high-quality cement mantle, similar to other approaches. Also, the DAA shows advantages like shorter hospital stays and lower transfusion rates in elderly patients. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 is known to cause severe acute respiratory syndrome, and serious cases need to be treated with corticosteroids. Herein, we report an 87-year-old woman who developed bilateral osteonecrosis of the femoral head after corticosteroid treatment for coronavirus disease 2019-related pneumonia. Sixteen months after treatment, she developed right hip pain without any evidence of trauma. A diagnosis of bilateral osteonecrosis of the femoral head was made based on sclerotic bands on plain radiographs and low-signal bands on T1-weighted magnetic resonance images. The patient underwent right total hip arthroplasty 4 months after symptom onset. Histological examination of the resected femoral head revealed pathological evidence of osteonecrosis. The postoperative course was good, and the patient can now walk unassisted. To the best of our knowledge, this is the first report of histologically proven osteonecrosis after corticosteroid therapy for coronavirus disease 2019-related disease. [ABSTRACT FROM AUTHOR]

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]

Objective: This study aims to investigate the feasibility and effectiveness of enhanced recovery after surgery (ERAS) in HIV-positive patients diagnosed with osteonecrosis of the femoral head (ONFH) undergoing total hip replacement (THR). Methods: We retrospectively included 80 HIV-positive patients diagnosed with ONFH who underwent THR between 2011 and 2022. Forty patients treated before August 2019 constituted the control group, receiving standard antiviral regimens and traditional perioperative management pathways. The remaining 40 patients, treated after August 2019, formed the study group, which followed the ERAS protocol. This protocol emphasized the use of more effective antiviral medications, rapid viral load reduction, immune enhancement, improved nutritional status, control of co-infections, prophylactic antibiotics, and anti-osteoporosis measures. We recorded patients' general status and imaging examinations before surgery, as well as detailed perioperative management strategies, antiviral regimens, durations, and immunological indicators for both groups. Targeted and standardized treatment measures were applied to the ERAS group, allowing for a comparison of the efficacy of perioperative management between the two patient groups. Results: Preoperative nutritional and immune indicators were lower in the control group than in the study group, while inflammatory markers were higher. Postoperatively, immune, nutritional, and inflammatory indicators were significantly better in the ERAS group compared to the control group. Following antiviral treatment, the viral load was predominantly undetectable in the ERAS group (target not detected, TND). Comprehensive measures minimized complications in the ERAS group (P = 0.028, P < 0.05). The hospitalization duration for the ERAS group was significantly shorter than that of the control group, with both groups showing marked improvement compared to preoperative conditions and no incidents of loosening or dislocation. Conclusion: Strengthening antiviral treatment, anti-infective strategies, incision care, and nutritional support effectively prevents and reduces complications such as delayed wound healing in HIV-positive patients. The implementation of ERAS measures requires careful attention to the patient's immune status, close monitoring of clinical changes, and timely adjustments to treatment and care plans. Level of evidence: Treatment studies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion According to Association Research Circulation Osseous (ARCO) staging, patients with ARCO III osteonecrosis of femoral head (ONFH) have joint pain and dysfunction due to the collapse of femoral head. Current hip preservation surgeries are not satisfying in the treatment of ARCO III ONFH according to the long‐term follow‐up. In our practice, we focused on reconstructing femoral head by restoring the round shape of femoral head and subsequently preventing the development of hip arthritis. To lift the collapsed femoral head and postpone the potential total hip arthroplasty, we practiced Jack surgery, combining surgical hip dislocation, removal of necrotic bone, impaction bone grafting, and lifting the cartilage of femoral head.From February 2019 to July 2022, 13 patients (15 hips) who received Jack surgery in the research center were included in this retrospective study. Follow‐up was conducted every 3 months after surgery for imaging and clinical evaluation. The differences between visual analogue scale (VAS) and Harris hip score (HSS) before and after surgery were compared to observe whether the femoral head collapsed and whether osteotomy healed after surgery. Severe collapse of the femoral head ( > 2 mm) or receiving total hip arthroplasty (THA) was defined as failure of hip preservation therapy. An Independent sample t‐test was used to compare the data, and the chi‐square test was used for categorical data.All the 13 patients successfully completed the surgery and were followed up. The average time of follow‐up was 36.46 ± 16.87 months (ranging from 14 to 66 months). HSS was assessed 12 months after surgery: excellent in 1 patient with 1 hip; good in 9 patients with 11 hips; modest in 3 patients with 3 hips. To the last follow‐up, the VAS scores decreased from 6.17 ± 1.02 to 2.08 ± 0.90 (p < 0.001), HSS increased from 46.69 ± 4.15 to 89.77 ± 2.86 (p < 0.001). No deep infection, fracture, osteotomy nonunion, nerve injury, deep vein thrombosis, pulmonary embolism, or other complications occurred.For young patients with ONFH of ACRO III, this surgical technique can effectively restore the original shape of the femoral head and achieve satisfactory hip function in the short term. The mechanism is similar to jacking the roof of a house; thus, we named it “Jack surgery”. [ABSTRACT FROM AUTHOR]

Background: Local infiltration analgesia (LIA) is a crucial component of multimodal analgesia that enhances recovery after total hip arthroplasty (THA) and knee arthroplasty (TKA). However, LIA can cause fatal local anesthetic systemic toxicity (LAST). The incidences of LIA-induced LAST in different surgeries and anesthetic agents have not been well investigated. Methods: This observational study enrolled 1,267 adult patients who received LIA with bupivacaine for primary THA or TKA under general anesthesia at a single medical center between January 2020 and October 2021. LAST incidence was graded by severity: severe (refractory seizure or arrhythmia requiring lipid rescue), major (seizure or arrhythmia requiring prompt medication), and minor (all other) events. Patient demographics, surgical and anesthesia details, recovery profiles, and LAST incidences were recorded and analyzed. Results: The incidence of severe LAST events was 2.41 per 1000 in unilateral THA, 0 in TKA, and 3.16 per 1000 in the entire cohort. The odds ratio of developing major LAST events was 4.35 in patients undergoing unilateral THA compared with those undergoing unilateral TKA in a matched comparison. Patients who underwent bilateral THA had the highest risk of developing LIA-induced LAST. Additionally, patients using propofol infusion for anesthesia maintenance had a lower risk of seizures and tremors than those using sevoflurane inhalation. The odds ratio of major LAST events was 0.47 in matched comparisons. Conclusions: LIA was associated with a significantly higher risk of LAST in the THA group than in the TKA group. Propofol maintenance reduces the likelihood of seizures and tremors compared with sevoflurane inhalation. Exploring strategies to reduce the incidence of LIA-induced LAST is essential to improve perioperative patient safety. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe long-term (10-year) patient survival after arthroplasty for hip fracture and to determine what patient factors are associated with that outcome. Methods: We performed a retrospective cohort analysis of patients ≥60 years old who underwent either hemiarthroplasty or total hip arthroplasty for femoral neck fracture between 2002 and 2009. We used routinely collected, validated health-care databases linked through ICES (formerly known as the Institute for Clinical Evaluative Sciences). We estimated the association between baseline variables and survival 10 years post-fracture using Poisson regression. Restricted cubic spline functions modeled the probability of 10-year survival by age and tested whether there was an inflection point after which the probability of 10-year survival decreased more rapidly. We estimated 10-year survival probabilities for different patient groups. Results: There were 19,659 patients in the final cohort. Eighteen percent (3,564) of the patients were alive at 10 years postoperatively. Factors associated with a higher likelihood of 10-year survival included younger age, female sex (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.46 to 1.68), lower American Society of Anesthesiologists (ASA) class (ASA I or II versus IV or V: RR = 1.96, 95% CI = 1.76 to 2.19), independent living status (RR = 2.68, 95% CI = 2.23 to 3.22), and fewer specific comorbidities. A threshold age of 73 years was the inflection point after which the probability of 10-year survival decreased more rapidly in females. Estimated 10-year survival probabilities ranged from 79.0% (95% CI = 75.5% to 82.5%) to 0.8% (95% CI = 0.6% to 1.0%). Conclusions: Approximately 1 in 6 patients live at least 10 years following a hip fracture. This study identifies baseline characteristics that predict survival greater than 10 years, including an age of <75 years, an ASA class of I or II, and independent living status prior to the hip fracture. Results can inform discussions around treatment choices, anticipated outcomes, and the natural history of hip fractures. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Purpose: The dual mobility cup (DMC) reduces the dislocation rates in total hip arthroplasty (THA). DMC systems include anatomical (non-modular or monoblock) (ADM) and modular dual mobility (MDM) components (Stryker Orthopaedics, Mahwah, NJ, USA). This review aims to assess differences between these two types of DMC implants concerning dislocation and revision rates, as well as patient-reported outcomes. Methods: This systematic review and meta-analysis of studies reports data from patients undergoing primary THA using MDM and/or ADM implants. Following the PRISMA guidelines, we analyzed articles from Science Direct/Scopus, PubMed, and the Cochrane Database of Systematic Reviews. We compared dislocation rates, revisions for any reason, aseptic loosening, infections, fractures, and functional outcomes between ADM and MDM components. Results: Eleven studies were considered eligible for further analysis. A total of 3369 patients (mean age = 65.4 years) underwent primary THA, including 3386 DMC implants. The mean follow-up for the MDM and ADM groups was 2.9 years and 3.9 years, respectively. The study revealed one dislocation in the MDM and none in the ADM. By proportion metanalysis, the review did not show statistical differences in all-cause revisions (p = 0.93, [CI [0.01;0.02]) or periprosthetic fractures (p = 0.18, CI [0.01;0.02]). Conclusions: MDM and ADM systems, both, represent safe DM options regarding dislocation, all-causes revisions and functional outcomes. [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: Post-operative delirium (PD) is a common post-operative complication with significant clinical and financial impacts on patients. Erythropoietin (EPO), a multi-functional glycoprotein hormone, exhibits erythropoietic and non-erythropoietic anti-inflammatory properties. This study aimed to determine the role of perioperative EPO administration in the development of postoperative delirium in older adult patients undergoing total joint arthroplasty. Methods: Seventy-one patients (> 65 years old) scheduled for total joint arthroplasty were randomly assigned to two groups: EPO-treated (EPO, n = 35) and placebo (control, n = 36). All patients completed the Mini Mental State Examination (MMSE) pre-operatively and on post-operative day (POD) 2. The confusion assessment method (CAM) was used to assess the patients until discharge (POD 5). Serum C-reactive protein (CRP) and inflammatory cytokine levels were measured and compared pre- and post-operatively. The development of delirium and cognitive dysfunction was evaluated post-operatively. Results: One patient in the control group developed delirium on POD 2 (3.2%), whereas no patient in the EPO group developed PD (0% vs. 3.2%, p = 0.500). Post-operatively there was no significant difference in MMSE scores between groups. Both groups showed increases in pro- and anti-inflammatory cytokine levels, with no significant differences. Similarly, CRP levels, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) showed no intergroup differences in post-operative inflammatory responses. Conclusions: Perioperative EPO reduced the incidence of post-operative delirium, although not statistically significant, with no differences in post-operative cognitive function and inflammatory responses. Trial registration: The trial was registered on December 12, 2023 at http//clinicaltrials.gov, registration number NCT06178835. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose Methods Results Conclusion Level of Evidence The aim of this systematic review and survival analysis was to quantify the benefits of orthobiologic augmentation therapies for the treatment of avascular necrosis (AVN) of the femoral head and identify the most effective approach to delay the need for total hip arthroplasty (THA).A systematic review of the literature was performed on PubMed, Scopus, and Cochrane on clinical studies on orthobiologic therapies used alone or as an augmentation to core decompression or other procedures to address hip AVN. A qualitative analysis of the different biological therapies applied was performed. Afterward, the results of these procedures were quantitatively analysed to document their survivorship from THA compared to treatment groups without orthobiologics. Kaplan–Meier analysis was performed for all studies and then by categorising orthobiologics into treatment subgroups.A total of 106 studies were included (4505 patients). Different orthobiologic approaches have been evaluated: cell‐based therapies including bone marrow aspirate concentrate (BMAC) and bone marrow mesenchymal stromal cells (BM‐MSCs), platelet‐rich plasma (PRP), or other bioactive molecules applied in the osteonecrotic area or as intra‐arterial injections. The survival analysis at 120 months documented a higher (p < 0.0005) cumulative survivorship with orthobiologics (69.4%) compared to controls (48.5%). The superiority was shown specifically for BMAC (p < 0.0005), BM‐MSCs (p < 0.0005), intra‐arterial (p < 0.0005) and PRP (p = 0.011) approaches, but the direct comparison of these approaches with their controls confirmed benefits only for BMAC (p < 0.0005).This systematic review and survival analysis demonstrated that orthobiologics have the potential to improve survivorship in patients affected by hip AVN. In particular, the specific analysis of different orthobiologic products supported relevant benefits for BMAC augmentation in terms of survival from the need for THA, while no clear benefits were confirmed for other orthobiologics.Level III. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose Methods Results Conclusions Level of Evidence Hip fractures in the elderly, especially those discharged to a rehab facility, have historically been associated with poor outcomes. There has yet to be identified which patients have a higher likelihood of a rehab discharge after isolated hip fracture fixation. The purpose of this study was to identify factors that predispose patients to require short or long‐term rehab after surgical intervention of traumatic, isolated hip fractures.Patients undergoing operative management of hip fractures (n = 71,849) from 2017 to 2019 at institutions that submitted data to a nationwide database were analyzed retrospectively. Various factors were compared between patients discharged to inpatient rehab (n = 56,178) versus home (n = 15,671).The rehab discharge group was significantly older and predominantly female. This cohort had a longer average hospital stay, higher incidence of diabetes, congestive heart failure, chronic renal failure, history of cerebrovascular accident, functionally dependent health status, hypertension, chronic obstructive pulmonary disease, dementia, baseline anticoagulation therapy, and history of myocardial infarction. DVT during hospitalization was encountered more often in patients discharged to rehab. Patients with femoral neck fractures and those undergoing total hip arthroplasty were more often discharged home. Patients with intertrochanteric hip fractures and those undergoing fracture fixation were more often discharged to rehab.Multiple risk factors associated with a significantly higher likelihood of a rehab discharge after isolated hip fracture surgery were identified. Early identification of these patients may provide an opportunity to optimize patients for home discharge and better outcomes.Level III, Case‐Control Study. [ABSTRACT FROM AUTHOR]

Introduction: Femoral neck fractures (FNF) represent a significant challenge in orthopedic practice, demanding prompt intervention to restore function and mobility in affected individuals. Numerous surgical interventions have been developed to address these fractures, including internal fixation with devices such as the Femoral Neck System (FNS, DePuy Synthes, Inc., West Chester, PA, USA). However, the optimal fixation system remains unclear. Understanding the postoperative outcomes associated with these interventions is crucial for optimizing patient care and informing treatment decisions. Significance: This PRISMA-compliant systematic literature review evaluates the efficacy and safety of the Femoral Neck System relative to other operative treatment options. Clinical and safety outcomes included mortality, perioperative complications, postoperative complications at 1 year, and reoperation. Results: A total of 117 studies with 68,567 patients with FNF treated with internal fixation were identified. Of these, thirteen included FNS as a treatment arm (1078 patients). Due to heterogeneity in study designs and populations, only the eleven studies that directly compared FNS to other operative treatments, and 2 non-comparative studies that treated with FNS were included in the systematic review. Seven of the eleven included studies had high risk of bias, 2 had moderate risk of bias, and 2 had low risk of bias. FNS groups had similar or significantly lower incidences of postoperative complications, reoperations, and mortality compared to cannulated screw, cancellous screw, or dynamic or sliding hip screw groups in all studies. Conclusion: FNS can be a safe and effective operative treatment option for FNF. Safety outcomes and reoperation rates are comparable between patients treated with FNS and patients treated with cannulated screws, cancellous screws, and dynamic or sliding hips screws. Future prospective, controlled studies are needed to confirm the safety and efficacy of FNS relative to other operative treatment options. [ABSTRACT FROM AUTHOR]

Introduction: The periacetabular bone defects caused by metastatic disease often necessitate acetabular reconstruction and various techniques have been employed with varying degrees of success. The purpose of this study was to evaluate the efficacy and safety of acetabular reconstruction in conjunction with adjuvant microwave ablation as a surgical intervention for patients with periacetabular metastases. Methods: Between January 2019 and September 2023, 17 consecutive patients with different tumor subtypes required surgical intervention for periacetabular metastases. The acetabular reconstruction was performed by utilizing an acetabular reconstructive cage and cement total hip arthroplasty with microwave ablation. A retrospective review was performed to assess pain relief, intraoperative details and postoperative complications. Functional status following procedures was determined by the 1993 Musculoskeletal Tumor Society (MSTS) score and the overall survival of patients was estimated by Kaplan-Meier analysis Results: In total, 8 males and 9 females were included with an average age of 48.6 years (range 34-66). Patients reported a significant improvement in the level of pain and the mean VAS score declined from 7.7 preoperatively to 2.2 postoperatively. Of the 17 patients, 16 could ambulate either independently (6 patients) or using a walking aid (10 patients) with a mean MSTS score of 18.9. The median follow‐up was 9.0 months. Nine patients were alive at the most recent follow-up with overall survival of 40.9% at 12 months and 30.7% at 36 months, respectively. Conclusion: In selected patients with periacetabular metastasis, the utilization of an acetabular cage and cement total hip arthroplasty presents a less invasive reconstruction technique. The incorporation of adjuvant microwave ablation has shown promise in providing long-lasting pain relief, reducing intraoperative bleeding, and improving local tumor control. However, further research and extended follow-up are necessary to establish the effectiveness of this procedure. [ABSTRACT FROM AUTHOR]

Introduction: For advanced osteoarthritis of the knee and hip, the most clinically effective treatment remains total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Success of these surgeries have traditionally been appraised by economic and volume-based measures. There has been a shift towards the use of patient reported outcome measures (PROMs) to quantify success and guide treatment. The present study provides analysis of three PROMS which have been validated for use in orthopaedic settings; the Oxford Knee Score (OKS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and the EuroQol-Visual Analogue Scale (EQ-VAS) - a non-disease specific measure of health. PROMs were completed pre-operatively, 6-weeks, and 1-year after elective TKA and THA undertaken in 2018 in a public teaching hospital in South Australia. Post-operative satisfaction/dissatisfaction was measured using a 5-point Likert scale and was collected at the same 6-week and 1-year points. Results: PROMs were collected from 285 eligible elective knee-arthroplasty, and 205 elective hip-arthroplasty patients. There was significant average improvement, greater than minimal clinical important differences between pre-operative and 1-year post-operative scores for all three PROMs tools. Inter-PROM correlation was strongest between FJS and OKS at 1-year post TKA (rs = 0.722), and between FJS and OHS in post-THA at the same interval (rs = 0.609). TKA patients with higher pre-surgical 10-year mortality were weakly associated with lower pre-operative OKS score (rs = 0.169). BMI was weakly negatively associated with pre-operative and 6-week post-operative EQ-VAS scores (rs = -0.291 and rs = -0.149 respectively). Post-TKA satisfaction was 77.2% at 1-year, and THA 88.5% at the same interval. Conclusion: This study provides an early insight from the use of the OKS, OHS, the EQ-VAS and the FJS as PROMs in primary TKA and THA at our centre. All PROMs demonstrate significant increase (improvement) at both 6-week and 1-year post-operative intervals, relative to pre-operative scores. The FJS demonstrated good sensitivity. Pre-existing co-morbidities do not appear to have any significant relation with post-operative PROMs collected in this study. [ABSTRACT FROM AUTHOR]

Background: Pericapsular nerve group (PENG) block has emerged as a reliable analgesia technique for hip arthroplasty (HA). However, the effects of PENG block on perioperative neurocognitive disorder (PND) after HA has not yet been assessed. The present study aimed to investigate the effects of PENG block on early postoperative cognitive function in older people undergoing hip arthroplasty. Methods: Sixty older patients undergoing HA under spinal anesthesia were randomly assigned to group P (n = 30) receiving PENG block with ropivacaine and patient-controlled intravenous analgesia (PCIA) pump with sufentanil after surgery or group C (n = 30) only receiving PCIA pump with sufentanil after surgery. The primary outcome was the Mini-Mental State Examination (MMSE) score at 7 days postoperatively. Secondary outcomes consisted of the incidence of PND 7 days postoperatively, the static VAS pain scores at 6, 12, 24, and 48 h postoperatively; cumulative sufentanil consumption and the requirement of rescue analgesia during the 0–24 h period after surgery; quality of recovery-15 (QoR-15) scale scores at 24 h postoperatively; and the plasma levels of high mobility group box protein 1 (HMGB1) preoperatively and 1 day after surgery, and adverse events. Results: After surgery, the PENG block group had higher MMSE score than the control group at 7 days postoperatively (27.0 ± 1.8 vs. 26.1 ± 1.7, P = 0.048), with a mean difference of 0.9 (95%CI, 0.1–0.9). The incidence of PND at 7 days postoperatively was 6.7% in group P, lower than that of 30% in group C (P = 0.044). In group P, the static VAS scores at 6, 12, and 24 h postoperatively were significantly lower than those in group C (all P < 0.05). Compared with group C, the cumulative sufentanil consumption and the number of patients required rescue analgesia during the 0–24 h period after surgery were significantly lower in group P (all P < 0.05). The scores of QoR-15 scale were higher in group P at 24 h postoperatively than those in group C (P < 0.05). Patients in group P showed lower plasma levels of HMGB1 than group C at 1 day after surgery (P < 0.05), and the rate of complications didn't differ between both groups. Conclusions: Older people undergoing HA receiving a PENG block for perioperative analgesia experience improved early postoperative cognitive function, reduced postoperative pain, higher quality of recovery, and less postoperative inflammatory response. Trial registration: Chictr.org.cn identifier ChiCTR2200061055 (Date of registry: 15/06/2022, prospectively registered). [ABSTRACT FROM AUTHOR]

Introduction: This study investigated stem subsidence following primary total hip arthroplasty (THA) with a Corail stem in patients who underwent two-staged bilateral THA. The second outcome of interest was to investigate whether a specific single cortical bone contact point might reduce postoperative stem subsidence. Methods: The present study was conducted following the STROBE guidelines. The records of patients who underwent THA between 2016 and 2023 were accessed. All patients who underwent two-staged bilateral THA were retrieved. The direct contact between the stem and the cortical bone was assessed at various points in the metaphysis and the distal portion of the stem (diaphysis) in both anteroposterior radiographs of the pelvis (medial and lateral bone contact) and a Lauenstein view of the hip (anterior and posterior bone contact). The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the tip of the lesser trochanter (distance A); distance from the tip of the lesser trochanter and the tip of the femoral stem (distance B). Results: In total, 250 patients were included, 45% (149 of 250 patients) were women and 61% (153 of 250 THAs) were implanted primarily on the right side. The mean age of patients at the time of the first THA was 64.3 ± 10.0 years and the mean body mass index (BMI) was 28.0 ± 4.9 kg/m2. The mean length of the follow-up was 14.1 ± 10.8 months. The overall stem subsidence following THA was 2.8 ± 0.7 mm (P < 0.006). A direct cortical bone-implant contact did not exert a statistically significant difference in subsidence of the THA stem at the metaphysis and diaphysis (P > 0.5). Stem subsidence following THA with a collarless cementless Corail stem was approximately 2.8 mm at 14 months. Conclusions: Direct cortical bone contact of the stem at diaphysis and metaphysis seems not to influence stem subsidence following THA using the Corail stem. [ABSTRACT FROM AUTHOR]

Background: Predicting the progression of hip osteoarthritis (OA) remains challenging, and no reliable predictive method has been established. This study aimed to develop an artificial intelligence (AI) model to predict hip OA progression via plain radiographs and patient data and to determine its accuracy. Methods: This retrospective study utilized anteroposterior pelvic radiographs of consecutive patients with hip OA who underwent primary unilateral total hip arthroplasty. Radiographs diagnosed with Kellgren–Lawrence (KL) grade 0–2 were extracted from 361 patients and 1697 images. This AI model was developed to predict whether OA would progress from KL grade 0–2 to KL grade ≥ 3 within n years (n = 3, 4, 5). A gradient-boosting decision tree approach was utilized according to feature extractions obtained by a convolutional neural network from radiographs and patient data (height, body weight, sex, age, and KL grade given by an orthopedic surgeon) with five-fold cross-validation. The model performance was assessed using accuracy, specificity, sensitivity, and the area under the receiver operating characteristic curve (AUC). Results: The mean accuracy, specificity, sensitivity, and AUC of our prediction model were, respectively, 81.8%, 88.0%, 66.7%, and 0.836 for 3 years; 79.8%, 85.0%, 71.6%, and 0.836 for 4 years; and 78.5%, 80.4%, 76.9%, and 0.846 for 5 years. Conclusions: The proposed AI model performed adequately in predicting hip OA progression and may be clinically applicable with additional datasets and validation. [ABSTRACT FROM AUTHOR]

When a severe medial wall defect is present in revision total hip arthroplasty (THA), simple bone grafting (BG) may not be sufficient, and trabecular metal (TM) augmentation is often necessary. We aimed to evaluate whether there were differences in outcomes of revision THA with medial wall defects depending on the use of TM augmentation. Between 2009–2021, 130 patients were classified into two groups: 80 patients undergoing bone grafting (BG group) and 50 patients undergoing both bone grafting and TM augmentation (BG/TM group). We evaluated the postoperative center of rotation (COR) position and changes in vertical and horizontal COR at last follow-up. Additionally, we categorized the fate of the transplanted bone graft into four groups: unchanged, initially changed, resorption-no further intervention, and resorption-revision. The mean horizontal COR changes were −3.50 mm in the BG group and −1.07 mm in the BG/TM group (p = 0.005). In the BG/TM group, a higher proportion of the patients showed unchanged or only initial changes when compared to the BG group (88.0% and 65.0%, respectively). The BG/TM group showed more favorable results regarding horizontal changes in the COR and fate of the bone graft. Therefore, for revision THA in patients with severe medial wall defects, the combined use of bone graft and TM augmentation can be a suitable option. [ABSTRACT FROM AUTHOR]

Background: While the pericapsular nerve group (PENG) block has become increasingly popular for managing pain after hip surgery, its efficacy remains controversial. Methods: We systematically searched Pubmed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials to assess current evidence about the efficacy of the PENG block. Patients who received PENG block were compared to those who received sham/no block in terms of opioid consumption and pain within 24h after surgery, time to first opioid requirement, functional recovery, risk of nausea and vomiting, and patient dissatisfaction. The quality of evidence was assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system. Results: We meta-analyzed six trials involving 416 patients who received preoperative PENG block and 415 who received sham/no block. Patients did not receive any other type of multimodal analgesia. Within 24 h after hip surgery, PENG block significantly reduced postoperative opioid consumption (MD = -12.03, 95% CI: -21.47 to -2.59, P < 0.01, I2 = 97%), particularly in subpopulations undergoing hip replacement, hip fracture, or who had spinal anesthesia, and it significantly decreased dynamic pain scores, but not static scores, without increasing risk of nausea or vomiting or patient dissatisfaction. Individual studies suggested that the PENG block can prolong the time to the first opioid requirement and can improve functional recovery. Most meta-analyses provided evidence of moderate quality according to the GRADE system. Conclusions: The available evidence indicates that preoperative PENG block can significantly decrease opioid consumption and pain early after hip surgery, and it may also promote early functional rehabilitation. However, the limited number of included studies and sample size make it difficult to draw firm conclusions. The decision on whether to apply the PENG block should take into account the patient's age and the type of surgery and anesthesia. [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]

ABSTRACT Objective Methods Results Conclusion The impact of preoperative consultations on mortality and morbidity rates, and their association with delays and hospital stays for surgery, remains a topic of discussion. This study aims to elucidate the necessity of consultations for those undergoing femoral neck fracture surgery, examining their influence on delays, hospital durations, and their correlation with mortality rates.The study examined data from 320 emergency department patients with femoral neck fractures undergoing hip arthroplasty surgery at our hospital between 2011 and 2021, using digital medical records. Patients were consulted in relevant departments for risk optimization. They were categorized into two groups based on the time of surgery: Group 1 (operated within 48 h) and Group 2 (delayed surgery). The analysis included days from admission to surgery, total hospital stay, and time from surgery to discharge. Mortality rates, with a minimum 2‐year follow‐up, were assessed using digital records, patient contact, or a death notification system. Statistical analyses involved Mann–Whitney U, Kruskal–Wallis, post hoc analysis, Pearson's chi‐squared, and Fisher–Freeman–Halton tests (α = 0.05). SPSS v25.0 software was used.Patients with consultation requests experience significantly delayed surgery compared to those without (p < 0.001). Statistically significant differences were observed between consulted and nonconsulted groups in time until surgery (p < 0.001), time from surgery to discharge (p < 0.001), and overall length of hospital stay (p < 0.001). However, there is no statistically significant difference in 30‐day and 1‐year mortality between consulted and nonconsulted patients, both departmentally and overall.This study found that advanced age and high ASA scores were the main factors causing surgical delays in hip fracture patients. While modifiable comorbidities could reduce hospital stays, they did not significantly affect postoperative mortality. Streamlining elective consultations and reducing organizational delays could help prevent delayed surgeries and improve outcomes. [ABSTRACT FROM AUTHOR]

The inferior vena cava collapsibility index (IVCCI) has been used to predict fluid responsiveness. This study aimed to evaluate the accuracy of the perioperative IVCCI to predict postinduction hypotension (PIH) under general anaesthesia (GA) combined with lumbar plexus sacral plexus block (LSPB) in elderly patients undergoing hip arthroplasty. A total of forty patients aged over 65 years were recruited for this prospective observational study. The diameters of the inferior vena cava (IVC), common iliac vein (CIV) and IVCCI were measured at baseline and 15 min post-LSPB. PIH was defined as a systolic blood pressure less than 90 mmHg or a ≥ 30% drop from baseline; patients were divided into hypotensive and nonhypotensive groups. The primary objective of this study was to evaluate the ability of the IVCCI to predict PIH via receiver operating characteristic (ROC) analysis. The secondary objective was to observe the change in CIV diameter. Eighteen patients (45%) developed PIH during GA. No statistically significant differences in baseline or post-LSPB IVCCI were detected between hypotensive and nonhypotensive patients (p > 0.05), whereas a significant expansion of the CIV (0.83 cm to 1.10 cm) was observed 15 min post-LSPB in all patients (p < 0.0001). According to the ROC curve analysis, the IVCCI cannot accurately predict severe PIH: the area under the ROC curve for the IVCCI was 0.54 (95% confidence interval: 0.35–0.72, P = 0.69). Thus, the IVCCI is not an effective predictor of PIH during GA combined with LSPB in elderly patients undergoing hip arthroplasty. Additionally, significant expansion of the CIV was observed 15 min after LSPB, indicating sympathetic blockade of the unilateral lower extremity. [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]

Background: The health-care sector and particularly the surgical sector are major contributors to the exacerbation of the global climate crisis. Little is known about the carbon emissions caused by surgical procedures. Therefore, the aim of this study was to estimate the carbon footprint associated with common orthopaedic surgical procedures. Methods: Eight surgical procedures (total hip arthroplasty, total knee arthroplasty, knee arthroscopy, anterior cruciate ligament reconstruction, shoulder arthroscopy, elective foot surgery, revision hip arthroplasty, and revision knee arthroplasty) were selected for analysis. The inventory process was performed according to the Greenhouse Gas Protocol for all activity occurring in the operating room. Results: The carbon footprint (in CO2 equivalents, CO2e) ranged between 53.5 kg for knee arthroscopy and 125.9 kg for revision knee arthroplasty. Energy consumption accounted for 57.5% of all emissions, followed by other indirect emissions (38.8%) and direct emissions (3.7%). The largest single contributors were the supply chain (34.6%) and energy consumption for ventilation, heating, and air conditioning (32.7%). Conclusions: Orthopaedic surgical procedures produce considerable amounts of CO2. Reduction in and greening of energy consumption, as well as the decarbonization of the supply chain, would have the greatest impact in reducing the carbon footprint of orthopaedic surgical procedures. Clinical Relevance: Orthopaedic surgical procedures contribute to the climate crisis by emitting relevant amounts of CO2. It should therefore be imperative for all orthopaedic surgeons to endeavor to find solutions to mitigate the environmental impact of their practice. [ABSTRACT FROM AUTHOR]

Despite progress with the development of joint replacement registries in the United States, surgeons may have limited opportunities to determine the cumulative outcome of their own patients or understand how those outcomes compare with their peers; this information is important for quality improvement. In order to provide surgeons with accurate data, it is first necessary to have a registry with complete coverage and patient matching. Some international registries have accomplished this. Building on a comprehensive statewide registry in the United States, a surgeon-specific report has been developed to provide surgeons with survivorship and complication data, which allows comparisons with other surgeons in the state. This article describes funnel plots, cumulative sum reports, complication-specific data, and patient-reported outcome measure data, which are provided to hip and knee arthroplasty surgeons with the goal of improving quality, decreasing variability in the delivery of care, and leading to improved value and outcomes for hip and knee arthroplasty in the state of Michigan. [ABSTRACT FROM AUTHOR]

Background: The risk of falls causing periprosthetic fracture has become an issue with the increase in the number of patients undergoing long-term follow-up after total hip arthroplasty (THA) and the aging of patients. The Timed Up and Go test (TUG) is utilized to evaluate fall risk. This study investigated muscle volume around the hip joint based on computed tomography (CT), CT value, and muscle strength to investigate contributing factors to poor TUG 1 year post-THA. Methods: This study retrospectively investigated 124 patients with unilateral hip osteoarthritis who underwent THA and classified them based on TUG results at 1 year postoperatively into TUG of < 10 s (fast group [103 patients]) and ≥ 10 s (slow group [21 patients]). Body mass index, the volume and CT density of the psoas major and gluteus medius muscles on CT images, pre- and postoperative hip flexion muscle strength, and hip abductor muscle strength were compared in each group. Results: Age was significantly older and preoperative abductor (fast Group: 1.0 ± 0.3 and slow Group: 0.7 ± 0.3, P = 0.003) and flexion muscle strengths (0.9 ± 0.3 and 0.7 ± 0.3, respectively, P = 0.02) on the healthy side were significantly lower in the slow group. The gluteus medius muscle demonstrated significantly lower CT density in the slow group on both sides. Nominal logistic regression analysis revealed that age and preoperative healthy abductor muscle strength, which are poor factors for TUG 1 year post-THA, were significantly associated with TUG of ≥ 10 s at 1 year post-THA. Conclusions: The poor factors for TUG 1 year after THA were age and preoperative abductor muscle strength on the healthy side. [ABSTRACT FROM AUTHOR]

Background: The pelvic and femoral morphology are associated with the occurrence of early periprosthetic femoral fractures (PFFs) in cementless total hip arthroplasty (THA). Differences exist depending on the performed approach and implanted stem design. Therefore, this study was conducted to analyze the pelvic and femoral morphology in cementless short stem THA via a minimally-invasive (MIS) anterolateral approach. Methods: A retrospective, single-center, multi-surgeon, comparative propensity-score matched study of a cohort of 1826 short stem THAs was conducted. A total of 39 PFFs within the first 90 days after surgery was matched on a 2:1 ratio to non-fracture patients. The morphology of the proximal femur was analyzed with canal flare index (CFI), canal-calcar ratio (CCR), canal-bone ratio (CBR), morphological cortical index (MCI), and femoral cortical index (CI). The pelvic morphology was analyzed with ilium–ischial ratio (IR), distance anterior superior iliac spine to the tip of the greater trochanter (AGT). Both groups were analyzed regarding several parameters for femoral and pelvic morphology in non-parametric testing and univariate regression analysis. Results: A significantly higher AGT was detected in the fracture group (104.5 mm ± 18 versus 97.4 mm ± 9.8; p = 0.016). All other femoral and pelvic parameters did not differ between both groups, also when compared depending on the Vancouver type of the PFF. Conclusions: The morphology of the proximal femur and the pelvis do not differ in several radiological parameters in patients sustaining a PFF in cementless short stem THA via an anterolateral approach compared with matched non-fracture group. The findings are controversial to other studies with different stem types and approaches. Future studies should focus on analyzing the influence of the pelvic geometry and the shape of the proximal femur in the occurrence of PFFs in different approaches with the same stem type and vice versa. Level of Evidence Level III case-controlled study [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Older adults often require surgical care and are at elevated risk of delirium. We explored delirium risk profiles across the population of U.S. older adults who underwent one of 10 common noncardiac surgeries.We analyzed Health and Retirement Study (HRS) participants linked with Medicare billing data who underwent the following 10 noncardiac surgeries from 2000 to 2018 at age 65 or more: total knee arthroplasty (TKA), total hip arthroplasty (THA), spine surgery, cholecystectomy, colorectal surgery, hernia repair (ventral, umbilical, or incisional), endarterectomy, prostatectomy, transurethral resection of the prostate (TURP), and hysterectomy. Demographic and health covariates were obtained from the HRS dataset. Latent cognitive ability was calculated from cognitive testing, proxy reports, and demographics at the preoperative HRS interview. We compared standardized differences for delirium risk factors across the 10 surgeries and qualitatively clustered them into phenotypical subgroups.We analyzed 7424 older adults (mean age 76 ± 6 years, 45% male). Endarterectomy patients presented with the highest burden of nearly all health and cognitive factors, implying higher delirium risk (e.g., stroke, 22%; depressive symptoms, 30%; high school or less education, 73%; frailty, 42%; lowest latent cognitive ability). A second “general surgery” phenotype, including cholecystectomy, colorectal, and hernia surgery patients, experienced more frailty (29%–32%) and depressive symptoms (24%–26%), with moderate comorbidity burden. A third “pain” phenotype, which included TKA, THA, and spine surgery patients, commonly reported moderate or severe pain (47%–53%) and impairment in activities of daily living (ADL, 23%–30%), but fewer comorbid medical conditions. The remaining surgery types (hysterectomy, prostatectomy, TURP) were not phenotypically grouped and generally had lower risk features for delirium.In an epidemiological cohort of US older adults, we identified clinically meaningful heterogeneity in delirium risk profiles across different surgical types, which may have implications for delirium risk stratification and delirium prevention or treatment. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty or total knee arthroplasty (THA/TKA) is often associated with varying degrees of pain. In recent years, transdermal buprenorphine (TDB) patch has shown encouraging results for acute postoperative pain control in orthopedic surgery. The aim of our study was to investigate the efficacy and safety of the combination of TDB patch and nonsteroidal anti-inflammatory drugs (NSAIDs) as a multimodal analgesic regimen after THA/TKA. Methods: Patients who underwent THA and TKA between January 2022 and January 2023 were reviewed. Three postoperative analgesic regimens were selected: Group A (flurbiprofen 50 mg and tramadol 37.5 mg/acetaminophen 325 mg), Group B (flurbiprofen 50 mg and TDB 5 mg), and Group C (Parecoxib 40 mg and TDB 5 mg). The primary outcomes were the Wong-Baker face pain scale revision (FPS-R) scores and the rate of sleep disturbances. Secondary outcomes of the study included the proportion of patients with postoperative pain relief rates categorized as 0%, <50%, ≥50%, and 100%. Results: The dynamic FPS-R pain scores on day 3 after surgery in Group B were significantly lower than those in Group A for THA (P < 0.017). The dynamic FPS-R pain scores were lowest in Group C on day 2 and 3 after THA and TKA (P < 0.017). Rate of sleep disturbances was significantly lower in Group B for THA and in Group C for TKA, respectively, compared with that in Group A (P < 0.017). The proportion of dynamic pain relief rate ≥50% in Group C was statistically higher than that in Group A for THA (P < 0.017). Rate of adverse reactions among three groups for THA and TKA was not statistically different (P > 0.05). Conclusion: This study suggests that the combination of TDB patch and NSAIDs is safe and effective for postoperative analgesia after THA/TKA. [ABSTRACT FROM AUTHOR]

Purpose: Although many factors were suggested to affect acetabular cup positioning during primary total hip arthroplasty, the effect of surgeon handedness was rarely evaluated. We aimed primarily to assess the difference in cup positioning (inclination and anteversion) between the right and left sides during primary THA. Secondly, to check the difference in the percentages of cups positioned in the safe zone for inclination and anteversion and if there will be a difference in cup positioning according to the type of cup fixation (cemented vs. cementless). Methods: Cup inclination and anteversion of 420 THAs were radiographically evaluated retrospectively. THAs were performed by a senior right-handed surgeon, who operated through a direct lateral approach in a lateral decubitus position using manual instruments and freehand technique for cup placement. Patients were assigned to two groups: Group A (right, or dominant side), and Group B (left, or non-dominant side), with equal cases of THAs (n = 210) in each group. Results: No difference was found in patients' basic characteristics, preoperative diagnosis, and cup fixation (54.3% cemented and 45.7% cementless) between the two groups. There was a significant difference in cup inclination between Groups A and Group B (40.1° ± 6.3° vs. 38.2° ± 6.1°) (P = 0.002). No significant difference was revealed in anteversion between the two groups (11.7° ± 4.4° vs. 11.8° ± 4.7°) (P = 0.95). The percentage of cups located within the safe zone in terms of both inclination and anteversion was 85.2% vs. 83.8% and 69% vs. 73.3% for Group A and Group B, according to Lewinnek and Callahan's safe zones, respectively. There existed a significant difference in the cemented cup inclination between Group A and Group B (40.8° ± 6.4° vs. 38.3° ± 6.3°) (P = 0.004). Conclusion: Cup inclination is affected by the surgeon's handedness when operating through a direct lateral approach and using a freehand technique, while anteversion is less affected. Furthermore, the difference is greater with cemented cups. [ABSTRACT FROM AUTHOR]