BACKGROUND Difficult total hip replacements(THRs)are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue.Difficult THR indications are common in low-income countries,where...BACKGROUND Difficult total hip replacements(THRs)are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue.Difficult THR indications are common in low-income countries,where access to care is often delayed.In these contexts,patients generally consult us with severe impairments that require significant technical adaptations,as well as adaptation to available resources and local conditions.AIM To describe the results and difficulties encountered following difficult THR in the study center.METHODS This bi-centric retrospective study was conducted over a 10-year period(2013-2023)and included 50 patients operated on for difficult THR.The mean age of the patients was 37.8 years.Surgical difficulties were recorded from operative reports,and the strategies employed to overcome these difficulties were analyzed,taking into account the types of implants used.RESULTS At last follow-up,functional results were considered good to excellent according to the Postel-Merle d'Aubignéscore,with significant improvement after surgery(P<0.005).Mean operative time was 177 minutes(range:90-290 minutes),with a mean blood loss of 568 mL(range:200-900 mL).The short-term and medium-term post-operative complication rate was 6%.CONCLUSION Even in difficult conditions,THR can produce favorable results through careful planning,adaptation of techniques and targeted approaches to overcoming challenges.展开更多
In this article,we comment on the article by Oommen et al.Oommen et al provided a comprehensive overview of the management of hip centre restoration in total hip arthroplasty(THA)for childhood hip disorder sequelae.Gi...In this article,we comment on the article by Oommen et al.Oommen et al provided a comprehensive overview of the management of hip centre restoration in total hip arthroplasty(THA)for childhood hip disorder sequelae.Given the developmental disparity in this population,specific preoperative planning is an essential prerequisite for the success of THA procedures.In the review by Oommen et al,assessments of acetabular and femoral anatomic variations were fully described.However,spinal malalignment and stiffness are common in physical and radiological examinations and should be taken into careful consideration when planning surgical procedures.Poor outcomes of THA for patients with comorbid hip and spinopelvic pathologies have been widely reported,especially for hips with childhood disorder sequelae.Therefore,in this editorial,we would like to emphasize the need for a thorough hip-spine evaluation of patients with childhood hip disorder sequelae before THA.展开更多
BACKGROUND Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children.Its prevalence varies across different nations.AIM To evaluate the prevalence of developmental hip dysplasia(DDH...BACKGROUND Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children.Its prevalence varies across different nations.AIM To evaluate the prevalence of developmental hip dysplasia(DDH)within the pediatric population of Al Jouf province.METHODS From January 2018 to December 2023,children with DDH from all cities of Al Jouf were included in this retrospective cross-sectional study.The disease prevalence was calculated for the entire province as well as for individual cities within the territory.RESULTS The study included 427 patients with DDH with an overall prevalence of 0.50%,or 5.0 per 1000 live births.At the city level,Sakaka had the highest prevalence at 14.2 per 1000 Live births followed by Qurayyat at 2.2 per 1000 live births.In contrast,cities like Suwayr,Abu Ajram,and Meegowa did not show any incidence of DDH.Significant differences were observed in the sociodemographic characteristics,such as age,sex,and nationality,across the different cities(P<0.05).CONCLUSION The prevalence of DDH in the Al Jouf province is high.The data delivers invaluable insights into the epidemiology of DDH in the Al Jouf locality.The findings highlight the need for targeted screening of DDH across the province.展开更多
Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for thes...Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for these complex cases.This article explores the integration of finite element analysis(FEA)to enhance surgical precision and outcomes.FEA provides detailed biomechanical insights,aiding in preoperative planning,implant design,and surgical technique optimization.By simulating implant configurations and assessing bone quality,FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy.Advanced imaging techniques,such as 3D printing,virtual reality,and augmented reality,further enhance total hip arthroplasty precision.Future research should focus on validating FEA models,developing patient-specific simulations,and promoting multidisciplinary collaboration.Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes,reduce complications,and enhance quality of life for patients with childhood hip disorder sequelae.展开更多
Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August ...Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August 2021 to August 2024 were selected and randomly divided into two groups using a random number table.The experimental group(16 patients)underwent THA surgery,while the control group(16 patients)underwent proximal femoral nail antirotation(PFNA)surgery.Hip joint function and quality of life indicators were compared between the two groups.Results:Before surgery,there was no significant difference in hip joint function and quality of life scores between the two groups(P>0.05).However,at six months postoperatively,the experimental group had higher hip joint function and quality of life scores compared to the control group(P<0.05).The total effective rate was higher in the experimental group than in the control group(P<0.05).The complication rate in the experimental group was similar to that in the control group(P>0.05).Conclusion:THA can improve the clinical efficacy of elderly patients with IFF,minimize postoperative complications,effectively restore hip joint function,and optimize postoperative quality of life.展开更多
BACKGROUND Although total hip arthroplasty(THA)is an established intervention for advanced hip disorders,not all patients achieve the anticipated functional improvements.AIM To investigate the impact of various preope...BACKGROUND Although total hip arthroplasty(THA)is an established intervention for advanced hip disorders,not all patients achieve the anticipated functional improvements.AIM To investigate the impact of various preoperative factors on clinical outcomes after THA.METHODS Data of 411 patients who underwent unilateral THA were retrospectively analyzed.The associations between preoperative factors,such as age,body mass index,pain severity,functional impairment,psychological status,neuropathic pain,and central sensitization,and clinical outcomes assessed six months postoperatively using the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)and modified Harris Hip Score were evaluated.RESULTS Our results indicated that age and the WOMAC,Center for Epidemiologic Studies Depression Scale,and Central Sensitization Index(CSI)scores significantly predicted the modified Harris Hip Score outcomes,whereas age and preoperative WOMAC,EuroQol 5 dimensions,Center for Epidemiologic Studies Depression Scale,CSI,and Pain Detect Questionnaire scores were significant predictors of WOMAC outcomes.Age,WOMAC,and CSI were consistently significant factors.There were no significant differences in the operative time or blood loss across the outcome categories.CONCLUSION Our findings highlight the importance of preoperative assessment of central sensitization and psychological parameters.Patient-specific preoperative characteristics may play a greater role than intraoperative factors in determining recovery outcomes after THA.展开更多
BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress ...BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.展开更多
BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications o...BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.展开更多
BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outco...BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.展开更多
Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of diffe...Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.展开更多
Background: Hip osteoarthritis (HOA) causes joint destruction, resulting in hip pain, limited range-of-motion, claudication, and joint deformity. In the conservative treatment of HOA, self-management is important to m...Background: Hip osteoarthritis (HOA) causes joint destruction, resulting in hip pain, limited range-of-motion, claudication, and joint deformity. In the conservative treatment of HOA, self-management is important to manage symptoms and control disease progression. In a previous study, the researchers conducted a conceptual analysis of 43 foreign studies on self-management during conservative therapy for patients with HOA. The results revealed a definition of self-management during conservative therapy for patients with HOA. However, because that study analyzed only the foreign literature, it remains unclear whether the findings reflect the characteristics of the Japanese health-care delivery system, health-care insurance system, or the lifestyles and cultural characteristics of Japanese patients with HOA. Objective: We aimed to clarify the self-management behaviors of patients with HOA. Methods: Semi-structured interviews were conducted with five patients diagnosed with HOA, and the results were subjected to inductive qualitative analysis. Results: Six categories of self-management behaviors were extracted for patients with HOA: [active information gathering about HOA], [personalized pain and weight management, and strategies for reducing hip joint load], [reflection on living conditions with individuals and professionals, and determination for future efforts], [continuation of exercise and weight management based on personal strengths and achievements, and mutual support with others], [coexistence with HOA while managing negative feelings], and [choosing treatment methods by trusting doctors while struggling with personal needs]. Conclusion: These findings suggest the need to develop health guidance and educational programs for patients with HOA that focus on how to prevent disease progression and cope with symptoms.展开更多
Developmental dysplasia of the hip(DDH)poses significant challenges in both childhood and adulthood,affecting up to 10 per 1000 live births in the United Kingdom and United States.While newborn screening aims to detec...Developmental dysplasia of the hip(DDH)poses significant challenges in both childhood and adulthood,affecting up to 10 per 1000 live births in the United Kingdom and United States.While newborn screening aims to detect DDH early,missed diagnoses can lead to severe complications such as hip dysplasia and early onset osteoarthritis in adults.Treatment options range from less invasive procedures like hip-preserving surgery to more extensive interventions such as total hip arthroplasty(THA),depending on the severity of the condition.Preoperative planning plays a critical role in optimizing surgical outcomes for DDH patients undergoing THA.This includes accurate imaging modalities,precise measurement of acetabular bone stock,assessment of femoral head subluxation,and predicting prosthesis size and leg length discrepancy.Recent advancements artificial intelligence and machine learning offer promising tools to enhance preoperative planning accuracy.However,challenges remain in validating these technologies and integrating them into clinical practice.This editorial highlights the importance of ongoing research to refine preoperative strategies and improve outcomes in DDH management through evidence-based approaches and technological innovations.展开更多
Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. Thi...Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. This is done by examining the acetabular placement in instances of hip dislocation after total hip arthroplasty (THA). Methodology: The authors searched 2653 patient records from 2015 to 2022 looking for patients who had total hip arthroplasty at our facility. For the analysis, 23 patients were culled from 64 individuals who exhibited post-THA dislocations, employing a stringent exclusion criterion, and the resultant acetabular angulation and anteversion were quantified utilizing PEEKMED software (Peek Health S.A., Portugal) upon radiographic evidence. Results: Within the operational timeframe, from the cohort of 2653 subjects, 64 presented with at least a singular incident of displacement. Post-exclusion criterion enforcement, 23 patients were eligible for inclusion. Of these, 10 patients conformed to the safe zone demarcated by Lewinnek for both inclination and anteversion angles, while 13 exhibited deviations from the prescribed anteversion and/or inclination benchmarks. Conclusion: Analysis of the 23 patients reveals that 13 did not confirm to be in the safe zone parameters for anteversion and/or inclination, whereas 10 were within the safe zone as per Lewinnek’s guidelines. This investigative review, corroborated by extant literature, suggests that the isolated consideration of the Lewinnek safe zone does not suffice as a solitary protective factor. It further posits that additional variables are equally critical as acetabular positioning and mandate individual assessment.展开更多
Hip pain in young patients is a common complaint that can pose diagnostic challenges.Clinical evaluation of hip pain requires strong foundational knowledge of relevant anatomy,careful history-taking,focused physical e...Hip pain in young patients is a common complaint that can pose diagnostic challenges.Clinical evaluation of hip pain requires strong foundational knowledge of relevant anatomy,careful history-taking,focused physical examination,and appropriate imaging techniques.Rapid advancements in hip arthroscopy techniques over the past decade has made it an essential tool in assessing and managing hip pain.This article aims to provide an evidence-based update on ten common causes of non-arthritic hip pain.These causes are categorized into three groups based on predominant symptom location to facilitate the readers’understanding and enhance evaluation of hip pain in the clinical setting.Each condition is discussed with an overview of relevant anatomy,clinical features and evaluation methods,as well as management strategies,emphasizing arthroscopic techniques where applicable.展开更多
BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain d...BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain during IAHIs and the role of preinjection local anesthesia in pain modulation remains unclear.AIM To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia.METHODS This prospective study enrolled 60 patients undergoing IAHI,30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia.Pain levels were assessed using numeric rating scales.RESULTS Patients significantly overestimated anticipated pain compared to experienced pain(6.43±2.48 vs 3.68±2.37,P<0.001).Pre-injection local anesthesia did not significantly reduce experienced pain(3.19±2.38 vs 4.20±2.29,P=0.130).CONCLUSION Patients overestimate anticipated pain during IAHIs.Pre-injection local anesthesia does not reduce experienced pain.展开更多
According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,...According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.展开更多
Objective:This study aimed to translate the de Morton Mobility Index(DEMMI)into Thai and assess its measurement properties.Methods:The de Morton Mobility Index(DEMMI)was translated into Thai using a cross-cultural tra...Objective:This study aimed to translate the de Morton Mobility Index(DEMMI)into Thai and assess its measurement properties.Methods:The de Morton Mobility Index(DEMMI)was translated into Thai using a cross-cultural translation method.A cross-sectional study was conducted in four public hospitals in Thailand between January and March 2023.A total of 260 patients were recruited from outpatient clinics.Convergent and known-group validity were evaluated through hypothesis testing.Construct validity was examined using confirmatory factor analysis.Reliability was assessed using Cronbach’s a coefficient.We also employed the Rasch analysis to validate validity and person reliability.Results:Content validity was high(S-CVI=0.96,I-CVI range:0.80e1.00).Strong convergent validity was observed,with a significant correlation(r=0.761,P<0.001)between the Thai DEMMI and the Parker Mobility Scale(PMS).Known-group validity was evident,demonstrating differences in scores across various patient groups.A confirmatory factor analysis supported the hypothesized factor structure of the Thai DEMMI with good fit indices:χ^(2)(df=4)=5.101,P=0.2771;χ^(2)/df=1.275,RMSEA=0.033;CFI=0.998;TLI=0.995;SRMR=0.016.The Thai DEMMI exhibited high internal consistency(Cronbach’s a=0.88).Rasch analysis revealed good person reliability(0.91)and acceptable information-weighted fit means square statistic(0.73-1.06).However,most items showed good fit based on the outlier-sensitive fit means square statistics(Outfit MNSQ),one exhibited a high Outfit MNSQ value of 29.94,suggesting a potential misfit.Conclusion:This study demonstrated the acceptable validity and reliability of the Thai DEMMI.Further evaluation of its responsiveness to change is still recommended.展开更多
BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(TH...BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.展开更多
Background:Developmental dysplasia of the hip(DDH)is a prevalent pediatric condition with a multifactorial etiology.Its incidence varies geographically,with notably higher rates observed on the Xizang plateau.This stu...Background:Developmental dysplasia of the hip(DDH)is a prevalent pediatric condition with a multifactorial etiology.Its incidence varies geographically,with notably higher rates observed on the Xizang plateau.This study was performed to evaluate the lipidomics signatures associated with DDH by analyzing plasma samples.Methods:Fifty infants were recruited,including 25 diagnosed with DDH and 25 age-matched healthy controls.In addition to plasma samples,comprehensive laboratory test results and medical records were collected for each participant.An untargeted lipidomics profiling approach was employed to identify distinguishing metabolic signatures.Results:Lipidomics profiles differed significantly between patients with DDH and healthy controls.Several differential metabolites were identified,including triacylglycerol(TAG)(17:0/18:1/20:1),TAG(17:0/17:0/17:0),phosphatidylethanolamine(PE)(10:0/26:4),TAG(17:0/18:0/18:0),TAG(16:0/17:0/22:1),TAG(16:0/18:0/22:0),TAG(17:0/19:0/19:0),TAG(13:0/20:0/20:0),TAG(18:0/18:0/22:0),and TAG(16:0/20:0/20:0).The primary lipid species showing differences were TAGs and PE.Conclusions:Distinct shifts in lipidomics profiles were observed in infants with DDH.To the best of our knowledge,this study is the first to explore lipidomics signatures in patients with DDH.The combined assessment of TAG(17:0/18:1/20:1)and TAG(17:0/17:0/17:0)may serve as a potential diagnostic tool for DDH.展开更多
Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included pati...Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.展开更多
文摘BACKGROUND Difficult total hip replacements(THRs)are hip arthroplasties performed on patients with compromised or severely altered bone or soft tissue.Difficult THR indications are common in low-income countries,where access to care is often delayed.In these contexts,patients generally consult us with severe impairments that require significant technical adaptations,as well as adaptation to available resources and local conditions.AIM To describe the results and difficulties encountered following difficult THR in the study center.METHODS This bi-centric retrospective study was conducted over a 10-year period(2013-2023)and included 50 patients operated on for difficult THR.The mean age of the patients was 37.8 years.Surgical difficulties were recorded from operative reports,and the strategies employed to overcome these difficulties were analyzed,taking into account the types of implants used.RESULTS At last follow-up,functional results were considered good to excellent according to the Postel-Merle d'Aubignéscore,with significant improvement after surgery(P<0.005).Mean operative time was 177 minutes(range:90-290 minutes),with a mean blood loss of 568 mL(range:200-900 mL).The short-term and medium-term post-operative complication rate was 6%.CONCLUSION Even in difficult conditions,THR can produce favorable results through careful planning,adaptation of techniques and targeted approaches to overcoming challenges.
文摘In this article,we comment on the article by Oommen et al.Oommen et al provided a comprehensive overview of the management of hip centre restoration in total hip arthroplasty(THA)for childhood hip disorder sequelae.Given the developmental disparity in this population,specific preoperative planning is an essential prerequisite for the success of THA procedures.In the review by Oommen et al,assessments of acetabular and femoral anatomic variations were fully described.However,spinal malalignment and stiffness are common in physical and radiological examinations and should be taken into careful consideration when planning surgical procedures.Poor outcomes of THA for patients with comorbid hip and spinopelvic pathologies have been widely reported,especially for hips with childhood disorder sequelae.Therefore,in this editorial,we would like to emphasize the need for a thorough hip-spine evaluation of patients with childhood hip disorder sequelae before THA.
文摘BACKGROUND Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children.Its prevalence varies across different nations.AIM To evaluate the prevalence of developmental hip dysplasia(DDH)within the pediatric population of Al Jouf province.METHODS From January 2018 to December 2023,children with DDH from all cities of Al Jouf were included in this retrospective cross-sectional study.The disease prevalence was calculated for the entire province as well as for individual cities within the territory.RESULTS The study included 427 patients with DDH with an overall prevalence of 0.50%,or 5.0 per 1000 live births.At the city level,Sakaka had the highest prevalence at 14.2 per 1000 Live births followed by Qurayyat at 2.2 per 1000 live births.In contrast,cities like Suwayr,Abu Ajram,and Meegowa did not show any incidence of DDH.Significant differences were observed in the sociodemographic characteristics,such as age,sex,and nationality,across the different cities(P<0.05).CONCLUSION The prevalence of DDH in the Al Jouf province is high.The data delivers invaluable insights into the epidemiology of DDH in the Al Jouf locality.The findings highlight the need for targeted screening of DDH across the province.
文摘Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for these complex cases.This article explores the integration of finite element analysis(FEA)to enhance surgical precision and outcomes.FEA provides detailed biomechanical insights,aiding in preoperative planning,implant design,and surgical technique optimization.By simulating implant configurations and assessing bone quality,FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy.Advanced imaging techniques,such as 3D printing,virtual reality,and augmented reality,further enhance total hip arthroplasty precision.Future research should focus on validating FEA models,developing patient-specific simulations,and promoting multidisciplinary collaboration.Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes,reduce complications,and enhance quality of life for patients with childhood hip disorder sequelae.
文摘Objective:To evaluate the treatment effect of total hip arthroplasty(THA)for intertrochanteric femur fractures(IFF)in elderly patients.Methods:Thirty-two elderly patients with IFF admitted to the hospital from August 2021 to August 2024 were selected and randomly divided into two groups using a random number table.The experimental group(16 patients)underwent THA surgery,while the control group(16 patients)underwent proximal femoral nail antirotation(PFNA)surgery.Hip joint function and quality of life indicators were compared between the two groups.Results:Before surgery,there was no significant difference in hip joint function and quality of life scores between the two groups(P>0.05).However,at six months postoperatively,the experimental group had higher hip joint function and quality of life scores compared to the control group(P<0.05).The total effective rate was higher in the experimental group than in the control group(P<0.05).The complication rate in the experimental group was similar to that in the control group(P>0.05).Conclusion:THA can improve the clinical efficacy of elderly patients with IFF,minimize postoperative complications,effectively restore hip joint function,and optimize postoperative quality of life.
文摘BACKGROUND Although total hip arthroplasty(THA)is an established intervention for advanced hip disorders,not all patients achieve the anticipated functional improvements.AIM To investigate the impact of various preoperative factors on clinical outcomes after THA.METHODS Data of 411 patients who underwent unilateral THA were retrospectively analyzed.The associations between preoperative factors,such as age,body mass index,pain severity,functional impairment,psychological status,neuropathic pain,and central sensitization,and clinical outcomes assessed six months postoperatively using the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)and modified Harris Hip Score were evaluated.RESULTS Our results indicated that age and the WOMAC,Center for Epidemiologic Studies Depression Scale,and Central Sensitization Index(CSI)scores significantly predicted the modified Harris Hip Score outcomes,whereas age and preoperative WOMAC,EuroQol 5 dimensions,Center for Epidemiologic Studies Depression Scale,CSI,and Pain Detect Questionnaire scores were significant predictors of WOMAC outcomes.Age,WOMAC,and CSI were consistently significant factors.There were no significant differences in the operative time or blood loss across the outcome categories.CONCLUSION Our findings highlight the importance of preoperative assessment of central sensitization and psychological parameters.Patient-specific preoperative characteristics may play a greater role than intraoperative factors in determining recovery outcomes after THA.
文摘BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.
文摘BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.
基金Supported by Wang Zhengguo Foundation for Traumatic Medicine“Sequential Medical Research Special Foundation”,No 2024-XGM05.
文摘BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.
文摘Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.
文摘Background: Hip osteoarthritis (HOA) causes joint destruction, resulting in hip pain, limited range-of-motion, claudication, and joint deformity. In the conservative treatment of HOA, self-management is important to manage symptoms and control disease progression. In a previous study, the researchers conducted a conceptual analysis of 43 foreign studies on self-management during conservative therapy for patients with HOA. The results revealed a definition of self-management during conservative therapy for patients with HOA. However, because that study analyzed only the foreign literature, it remains unclear whether the findings reflect the characteristics of the Japanese health-care delivery system, health-care insurance system, or the lifestyles and cultural characteristics of Japanese patients with HOA. Objective: We aimed to clarify the self-management behaviors of patients with HOA. Methods: Semi-structured interviews were conducted with five patients diagnosed with HOA, and the results were subjected to inductive qualitative analysis. Results: Six categories of self-management behaviors were extracted for patients with HOA: [active information gathering about HOA], [personalized pain and weight management, and strategies for reducing hip joint load], [reflection on living conditions with individuals and professionals, and determination for future efforts], [continuation of exercise and weight management based on personal strengths and achievements, and mutual support with others], [coexistence with HOA while managing negative feelings], and [choosing treatment methods by trusting doctors while struggling with personal needs]. Conclusion: These findings suggest the need to develop health guidance and educational programs for patients with HOA that focus on how to prevent disease progression and cope with symptoms.
文摘Developmental dysplasia of the hip(DDH)poses significant challenges in both childhood and adulthood,affecting up to 10 per 1000 live births in the United Kingdom and United States.While newborn screening aims to detect DDH early,missed diagnoses can lead to severe complications such as hip dysplasia and early onset osteoarthritis in adults.Treatment options range from less invasive procedures like hip-preserving surgery to more extensive interventions such as total hip arthroplasty(THA),depending on the severity of the condition.Preoperative planning plays a critical role in optimizing surgical outcomes for DDH patients undergoing THA.This includes accurate imaging modalities,precise measurement of acetabular bone stock,assessment of femoral head subluxation,and predicting prosthesis size and leg length discrepancy.Recent advancements artificial intelligence and machine learning offer promising tools to enhance preoperative planning accuracy.However,challenges remain in validating these technologies and integrating them into clinical practice.This editorial highlights the importance of ongoing research to refine preoperative strategies and improve outcomes in DDH management through evidence-based approaches and technological innovations.
文摘Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. This is done by examining the acetabular placement in instances of hip dislocation after total hip arthroplasty (THA). Methodology: The authors searched 2653 patient records from 2015 to 2022 looking for patients who had total hip arthroplasty at our facility. For the analysis, 23 patients were culled from 64 individuals who exhibited post-THA dislocations, employing a stringent exclusion criterion, and the resultant acetabular angulation and anteversion were quantified utilizing PEEKMED software (Peek Health S.A., Portugal) upon radiographic evidence. Results: Within the operational timeframe, from the cohort of 2653 subjects, 64 presented with at least a singular incident of displacement. Post-exclusion criterion enforcement, 23 patients were eligible for inclusion. Of these, 10 patients conformed to the safe zone demarcated by Lewinnek for both inclination and anteversion angles, while 13 exhibited deviations from the prescribed anteversion and/or inclination benchmarks. Conclusion: Analysis of the 23 patients reveals that 13 did not confirm to be in the safe zone parameters for anteversion and/or inclination, whereas 10 were within the safe zone as per Lewinnek’s guidelines. This investigative review, corroborated by extant literature, suggests that the isolated consideration of the Lewinnek safe zone does not suffice as a solitary protective factor. It further posits that additional variables are equally critical as acetabular positioning and mandate individual assessment.
文摘Hip pain in young patients is a common complaint that can pose diagnostic challenges.Clinical evaluation of hip pain requires strong foundational knowledge of relevant anatomy,careful history-taking,focused physical examination,and appropriate imaging techniques.Rapid advancements in hip arthroscopy techniques over the past decade has made it an essential tool in assessing and managing hip pain.This article aims to provide an evidence-based update on ten common causes of non-arthritic hip pain.These causes are categorized into three groups based on predominant symptom location to facilitate the readers’understanding and enhance evaluation of hip pain in the clinical setting.Each condition is discussed with an overview of relevant anatomy,clinical features and evaluation methods,as well as management strategies,emphasizing arthroscopic techniques where applicable.
基金approved by the Medical Ethics Committee of the Tel Aviv Sourasky Medical Center Institutional Review Board,approval No.TLV-0674-21.
文摘BACKGROUND Intra-articular hip injections(IAHIs)are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear.The disparity between anticipated and experienced pain during IAHIs and the role of preinjection local anesthesia in pain modulation remains unclear.AIM To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia.METHODS This prospective study enrolled 60 patients undergoing IAHI,30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia.Pain levels were assessed using numeric rating scales.RESULTS Patients significantly overestimated anticipated pain compared to experienced pain(6.43±2.48 vs 3.68±2.37,P<0.001).Pre-injection local anesthesia did not significantly reduce experienced pain(3.19±2.38 vs 4.20±2.29,P=0.130).CONCLUSION Patients overestimate anticipated pain during IAHIs.Pre-injection local anesthesia does not reduce experienced pain.
文摘According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.
文摘Objective:This study aimed to translate the de Morton Mobility Index(DEMMI)into Thai and assess its measurement properties.Methods:The de Morton Mobility Index(DEMMI)was translated into Thai using a cross-cultural translation method.A cross-sectional study was conducted in four public hospitals in Thailand between January and March 2023.A total of 260 patients were recruited from outpatient clinics.Convergent and known-group validity were evaluated through hypothesis testing.Construct validity was examined using confirmatory factor analysis.Reliability was assessed using Cronbach’s a coefficient.We also employed the Rasch analysis to validate validity and person reliability.Results:Content validity was high(S-CVI=0.96,I-CVI range:0.80e1.00).Strong convergent validity was observed,with a significant correlation(r=0.761,P<0.001)between the Thai DEMMI and the Parker Mobility Scale(PMS).Known-group validity was evident,demonstrating differences in scores across various patient groups.A confirmatory factor analysis supported the hypothesized factor structure of the Thai DEMMI with good fit indices:χ^(2)(df=4)=5.101,P=0.2771;χ^(2)/df=1.275,RMSEA=0.033;CFI=0.998;TLI=0.995;SRMR=0.016.The Thai DEMMI exhibited high internal consistency(Cronbach’s a=0.88).Rasch analysis revealed good person reliability(0.91)and acceptable information-weighted fit means square statistic(0.73-1.06).However,most items showed good fit based on the outlier-sensitive fit means square statistics(Outfit MNSQ),one exhibited a high Outfit MNSQ value of 29.94,suggesting a potential misfit.Conclusion:This study demonstrated the acceptable validity and reliability of the Thai DEMMI.Further evaluation of its responsiveness to change is still recommended.
文摘BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.
基金graciously funded by the Central Government Guidance Fund for Supporting the Local Science and Technology Development(No.XZ202101YD0002C).
文摘Background:Developmental dysplasia of the hip(DDH)is a prevalent pediatric condition with a multifactorial etiology.Its incidence varies geographically,with notably higher rates observed on the Xizang plateau.This study was performed to evaluate the lipidomics signatures associated with DDH by analyzing plasma samples.Methods:Fifty infants were recruited,including 25 diagnosed with DDH and 25 age-matched healthy controls.In addition to plasma samples,comprehensive laboratory test results and medical records were collected for each participant.An untargeted lipidomics profiling approach was employed to identify distinguishing metabolic signatures.Results:Lipidomics profiles differed significantly between patients with DDH and healthy controls.Several differential metabolites were identified,including triacylglycerol(TAG)(17:0/18:1/20:1),TAG(17:0/17:0/17:0),phosphatidylethanolamine(PE)(10:0/26:4),TAG(17:0/18:0/18:0),TAG(16:0/17:0/22:1),TAG(16:0/18:0/22:0),TAG(17:0/19:0/19:0),TAG(13:0/20:0/20:0),TAG(18:0/18:0/22:0),and TAG(16:0/20:0/20:0).The primary lipid species showing differences were TAGs and PE.Conclusions:Distinct shifts in lipidomics profiles were observed in infants with DDH.To the best of our knowledge,this study is the first to explore lipidomics signatures in patients with DDH.The combined assessment of TAG(17:0/18:1/20:1)and TAG(17:0/17:0/17:0)may serve as a potential diagnostic tool for DDH.
文摘Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.
