Total Hip Arthoplasty

AIMS: Uncemented implants are now commonly used at reimplantation of a two-stage revision total hip arthoplasty (THA) following periprosthetic joint infection (PJI). However, there is a paucity of data on the performance of the most commonly used uncemented femoral implants - modular fluted tapered (MFT) femoral components - in this setting. This study evaluated implant survival, radiological results, and clinical outcomes in a large cohort of reimplantation THAs using MFT components...

Component-on-component impingement in total hip arthroplasty may lead to post-operative complications including dislocation. Despite numerous clinical studies focusing on reducing this risk, assessment methods remain limited to qualitative radiography, finite element analysis, and cadaver studies. There is a need for more precise measurements of impingement in the research setting. We aimed to validate a novel RSA-based impingement metric to measure component-on-component impingement in vivo. A phantom experiment of a standard metal-on-polyethylene total hip system was performed...

BACKGROUND: Enhanced recovery after surgery pathways are essential for ambulatory surgery. They usually recommend lower intraoperative opioid use to avoid opioid-related adverse effects. This has led to opioid-sparing anaesthesia (OSA) techniques, with the extreme approach of opioid-free anaesthesia (OFA) mostly with dexmedetomidine. As evidence is lacking in day-case primary total hip arthroplasty, this study was performed to assess the potential benefits in postoperative analgesia of OFA over OSA...

A portable accelerometer-based navigation system can be useful for achieving the target alignment. Tibial registration is based on the medial and lateral malleoli; however, the identification of landmarks may be difficult in obese (body mass index [BMI] >30 kg/m2 ) patients whose bones are not easily palpable from the body surface. This study compared tibial component alignment achieved using a portable accelerometer-based navigation system (Knee Align 2 [KA2]) in obese and control groups and aimed to validate the accuracy of bone cutting in obese patients...

Background: Total Hip Arthroplasty remains the standard treatment protocol for patients with neglected traumatic dislocations of the hip with arthritis. A total hip arthroplasty needs to be frequently combined with a subtrochanteric shortening femoral osteotomy to aid in the reduction of the hip joint in such cases. Still long-term stable implant fixation, rigid construct, and favorable functional outcome remain a challenge. In respect to subtrochanteric shortening osteotomy, various techniques have been described in the literature, including the step-cut, double chevron, transverse, and oblique osteotomies...

Background: The COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation. Materials and method: All hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents' health-related expenses...

BACKGROUND AND PURPOSE: Intraoperative periprosthetic femoral fractures (IPFFs) can occur during primary total hip arthroplasty (THA). We describe the incidence of IPFFs during THA in Norway and estimate potential risk factors that could be associated with IPFF Patients and methods - Data from the Norwegian Arthoplasty Register (1987-2020) was used: 2,268 IPFFs from 218,423 primary THAs in 172,598 patients. The following factors were analyzed: sex, age, diagnosis, previous operation on the same hip, surgical approach, and stem fixation technique...

INTRODUCTION: Burch-Schneider-like antiprotrusio cages (B-SlAC) still remain helpful implants to bridge severe periacetabular bone losses. The purpose of this study was to evaluate outcomes and estimate both cages' failures and complication risks in a series of B-SlAC implanted in revision of failed total hip arthroplasties (THA) or after resection of periacetabular primary or secondary bone malignancies. Risk factors enhancing the chance of dislocations and infections were checked. MATERIALS AND METHODS: We evaluated 73 patients who received a B-SlAC from January 2008 to January 2018...

BACKGROUND: Fretting and corrosion in metal-on-polyethylene total hip arthoplasty (THA) modular junctions can cause adverse tissue reactions that are responsible for 2% to 5% of revision surgeries. Damage within cobalt-chromium-molybdenum (CoCrMo) alloy femoral heads can progress chemically and mechanically, leading to damage modes such as column damage, imprinting, and uniform fretting damage. At present, it is unclear which of these damage modes are most detrimental and how they may be linked to implant alloy metallurgy...

Arthritis is one of the most important symptoms of late-stage borreliosis, observed in approximately 60% of untreated patients with Lyme disease. In several percent of them, this manifestation is of interest to orthopedic surgeons. The authors present a case of a patient, working as a forester, who underwent left hip replacement arthroplasty having contracted a Borrelia burgdorferi infection in the past, and who was hospitalized 12 years before in the infectious ward due to suspected neuroborreliosis for which he was treated with Ceftriaxone 2 × 2...

BACKGROUND: Two-stage revision remains the standard of care for prosthetic joint infection after total hip arthroplasty. However, there are substantial complications associated with articulating antibiotic hip spacers. Handmade and molded spacers have been shown to have higher rates of spacer fracture than antibiotic-coated prostheses (ACPs). The aim of this study is to review outcomes with an implant that is often categorized as an ACP spacer, the Zimmer-Biomet StageOne Select Femoral Spacer (ZBSO)...

AIMS: Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. METHODS: A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology...

PURPOSE: We present a randomised clinical trial using F-PET/CT to analyse new bone metabolic mineralisation adjacent to acetabular cups following total hip arthoplasty (THA). PATIENTS AND METHODS: THA was performed on 26 patients (26 cases) with hip OA. Patients with hip osteoarthritis (OA) were randomly assigned to operations with cemented or uncemented acetabular components. The contralateral, healthy acetabulum was used as referent for normal bone metabolism...

INTRODUCTION: Revision rates of total hip arthoplasty have decreased after introducing total hip arthroplasty using ceramic component due to reduce wear and osteolysis. CASE REPORT: 29 year old male case of bilateral hip avascular necrosis operated for bilateral hip THA presented 30 months after with complaint of squeaking, x-ray showing left ceramic liner fracture without any history of trauma. Revision of ceramic liner and head with ceramic on polyethylene was done...

RATIONALE: Cases of pseudotumor complicated after THA with metal-on-metal articulation as a bearing surface have been reported. Most of the pseudotumors occurred near or inside the hip joint, and usually have similar features with the infectious condition. We herein report a case of pseudotumor with huge size in the pelvic cavity mimicking features of iliacus muscle abscess. PATIENTS CONCERNS: A 70-year-old female was referred to our emergency department due to huge mass in her right pelvic area on abdominal CT...

OBJECTIVE: Highly porous titanium cups have been recently introduced, with contradictive outcomes. A retrospective consecutive case series involving bilateral metachronous total hip arthoplasties (THAs) performed with two different cups, Fixa (F) and Fixa Tipor (T) (Adler Ortho, Milan), and the same stem, was evaluated. T sockets, manufactured using electron beam melting, were supposed to prove superior in terms of clinical results, survival rates and radiographic parameters in comparison to hydroxyapatite coated F cups with conventional porosity...

Osteoarthritis, a degenerative disease of the joints, is the most common form of arthritis in the knee. Total joint arthoplasty is a commonly used treatment for joint degeneration and osteoarthritis, and due to these factors, TJA for hip and knee joints is projected to grow by 137% and 601% between 2005 and 2030. Matrix metalloproteases are enzymes found in the extracellular matrix that cleave matrix components. Normally MMPs are downregulated in tissues by Tissue Inhibitors of Metalloproteases, or TIMPs. The relative concentration of TIMPs also may denote some of the activity of the MMPs found in serum...

Purpose: A relevant proportion of patients undergoing joint replacement surgery for the treatment of osteoarthritis exhibit COPD. This coincidence may result from an increased prevalence of both the diseases in elderly patients. In this study, COPD, which is known to be associated with a variety of comorbidities, and its potential interactions, eg, mediated via systemic inflammation, are discussed. The purpose of the present study was to identify the role of COPD as an independent risk factor for complications after total knee and hip arthroplasty...

BACKGROUND: There is currently a lack of consensus regarding the most effective diagnostic algorithm for cases of supposed low-grade infection after total hip arthoplasty (THA). OBJECTIVE: The aim of this study was to assess reliability in the use of biopsies, obtained by hip arthroscopy, to detect a periprosthetic hip joint infection (PJI). METHODS: From 2012 to 2016, diagnostic arthroscopy of the hip joint was performed in 20 patients with a supposed PJI following THA...

BACKGROUND: Little is known about the causes and mechanisms underlying periprosthetic fractures around femoral components particularly in relation to the stem design. In an in vitro study 20 pairs of fresh cadaveric femora were loaded to fracture axially and transversally. FINDINGS: When proximal femoral strain was measured at the time of impaction of cementless stems the load transfer was determined by the underlying anatomy rather than by the shape of the stem, so that the so-called "load transfer" properties - proximal or distal - ascribed to stem designs are a myth...