BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to...BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.展开更多
BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the ...BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.展开更多
Total hip arthroplasty(THA)effectively treats advanced hip disorders,yet outcomes vary among patients.Frailty has become a crucial factor influencing these results.Several studies explored multiple preoperative factor...Total hip arthroplasty(THA)effectively treats advanced hip disorders,yet outcomes vary among patients.Frailty has become a crucial factor influencing these results.Several studies explored multiple preoperative factors affecting THA outcomes,highlighting the significance of age,Western Ontario and Mc-Master Universities Osteoarthritis Index,Center for Epidemiologic Studies Depression Scale,and central sensitization index scores in predicting post-operative recovery,emphasizing comprehensive preoperative assessments.Subsequent research has shown that frailty,measured by tools like the hospital frailty risk score and frailty deficit index,is significantly associated with adverse outcomes such as higher 30-day readmission rates,longer hospital stays,increased costs,and elevated mortality and complication risks in both primary and revision THA.Additionally,frailty related to short-term adverse events but stressed the need for standardized frailty measurement.Currently,there is no unified standard for assessing frailty before THA,which hinders cross-study comparison and evidence-based guideline development.Future research should focus on establishing a universal frailty assessment standard considering physical function,comorbidities,cognitive and psychological status.Prospective studies are also needed to clarify the causal relationship between frailty and long-term THA outcomes and identify modifiable factors for preoperative interventions.Overall,understanding the impact of frailty on THA outcomes is essential for improving patient care and resource utilization,especially in an aging population with a rising prevalence of hip disorders.展开更多
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
Objective:To investigate the risk factors for deep vein thrombosis(DVT)following total hip arthroplasty in elderly patients with femoral neck fractures during the winter.Methods:A total of 162 patients who underwent t...Objective:To investigate the risk factors for deep vein thrombosis(DVT)following total hip arthroplasty in elderly patients with femoral neck fractures during the winter.Methods:A total of 162 patients who underwent total hip arthroplasty were categorized based on the development of DVT within 7 days postoperatively:28 patients formed the DVT group and 134 patients the non-DVT group.Collected data included age,gender,history of glucocorticoid use,diabetes,hypertension,body mass index(BMI),triglyceride(TG)levels,cholesterol(CHOL)levels at admission,operative time,and postoperative bed rest duration.D-dimer(D-D)and fibrinogen(Fg)levels,along with the D-D/Fg ratio,were recorded on the first postoperative day.Group comparisons were performed using t-tests.Logistic regression analysis was conducted to identify independent risk factors,and the predictive value of these factors was evaluated using receiver operating characteristic(ROC)curve analysis.Results:In the DVT group,18 patients had diabetes.Levels of TG(1.78±0.44 mmol/L),CHOL(4.70±1.84 mmol/L),D-D(0.40±0.17 mg/L),and the D-D/Fg ratio(0.24±0.07)were significantly higher than in the non-DVT group(P<0.05).Logistic regression identified TG,CHOL,D-D,and the D-D/Fg ratio as independent risk factors for DVT,with odds ratios of 0.987,2.395,0.8,4.992,and 9.004,respectively(P<0.05).ROC curve analysis yielded areas under the curve(AUCs)of 0.715,0.69,0.614,and 0.726 for TG,CHOL,D-D,and the D-D/Fg ratio,respectively.Sensitivities were 0.643,0.500,0.429,and 0.857,and specificities were 0.694,0.978,0.918,and 0.537,respectively.Conclusion:Elevated levels of TG,CHOL,D-D,and the D-D/Fg ratio are independent risk factors for DVT following total hip arthroplasty in elderly patients.Among these,the D-D/Fg ratio demonstrated the highest sensitivity and may serve as an effective marker for early-stage DVT screening.展开更多
BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well...BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.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
BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of an...BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of anxiety and depression among geriatric patients who underwent total hip arthroplasty(THA),explored their association with postoperative pain,and identified contributing risk factors.METHODS A total of 111 geriatric patients who underwent THA between January 2021 and January 2024 were included.Standardized psychological assessment tools-including the Zung Self-Rating Anxiety Scale(SAS)and the Zung Self-Rating Depression Scale(SDS)-and the Numeric Rating Scale(NRS)for pain quantification were systematically administered.Pearson correlation analysis was utilized to explore the relationships among SAS,SDS,and NRS scores.Univariate and multivariate binary logistic regression analyses were conducted to identify risk factors for anxiety and depression in these patients.RESULTS The cohort exhibited moderate anxiety(SAS:44.23±9.03),mild depression(SDS:46.98±9.15),and moderate postoperative pain(NRS:4.93±2.37).Patients with anxiety or depression reported significantly higher NRS scores than those without these conditions.Significant positive correlations were observed between SAS and SDS scores,as well as between each of these and NRS scores.Univariate analysis revealed that gender,age,disease duration,alcohol use,diabetes history,and NRS scores were significantly associated with anxiety and depression.Multivariate analysis further identified female gender,disease duration≥2 years,alcohol use,and NRS scores≥5 as independent predictors of postoperative psychological distress.CONCLUSION Anxiety and depression are closely linked with postoperative pain in geriatric patients post-THA recovery.Early psychological screening and multimodal pain management strategies are recommended-particularly for individuals with a disease duration of≥2 years,a history of alcohol consumption,or an NRS score of≥5,as well as female patients-to effectively mitigate their negative emotional states and improve postoperative recovery.展开更多
BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following prima...BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.展开更多
This editorial critically evaluated the recent study by Ishikura et al,which examined the impact of anterior minimally invasive total hip arthroplasty(MISTHA)on postoperative quality of life,with a specific focus on t...This editorial critically evaluated the recent study by Ishikura et al,which examined the impact of anterior minimally invasive total hip arthroplasty(MISTHA)on postoperative quality of life,with a specific focus on the timeline and influencing factors for return to work and resumption of driving.Ishikura et al's research demonstrated that anterior MIS-THA could shorten recovery time,reduce postoperative pain,and significantly enhance patients'quality of life and productivity.Their findings identified occupational type and work intensity as key determinants of postoperative recovery.By synthesizing evidence from multiple studies,this analysis systematically evaluated the clinical advantages of anterior MIS-THA—including reduced soft tissue trauma and accelerated functional recovery—while acknowledging its limitations,such as a steep surgical learning curve and early postoperative complication risks.The discussion emphasized the necessity of designing personalized rehabilitation protocols that accounted for patients'occupational demands.Notably,while current findings primarily derived from retrospective analyses,the article highlighted the need for prospective cohort studies to validate these observations.The commentary also addressed ongoing debates in the field,particularly the elevated complication rates associated with the direct anterior approach compared to posterior techniques,thereby underscoring the critical role of surgeon expertise in optimizing procedural safety.Collectively,this evaluation advanced our understanding of postoperative recovery dynamics in anterior MIS-THA and provides evidencebased insights to refine clinical rehabilitation frameworks.展开更多
BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such ...BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such as joint function,quality of life,and postoperative complications remain unclear.AIM To investigate the effects of preoperative psychological stress on selected parameters in older patients who underwent THA.METHODS Ninety older patients who underwent THA between January 2023 and August 2024 were divided into two groups by their preoperative self-rated anxiety scale and self-rated depression scale scores,including high-stress(n=42)and lowstress(n=48).The postoperative joint function,short form-36 health survey(SF36)score,incidence of postoperative complications,and other indicators were compared between the two groups.Pearson’s correlation coefficient analysis of the relationship among preoperative psychological stress,quality of life,and postoperative complications was performed.RESULTS Postoperative joint function and quality of life were lower in the high-stress group than they were in the low-stress group(P<0.05).The incidence of postoperative complications was higher in the high-stress group(29.27%)than it was in the low-stress group(9.30%)(P<0.05).Cor-relation analysis revealed that psychological stress was correlated with the Harris hip and SF-36 scores.Total scores on the scale,including physical function,physical pain,general health,mental health,social function,vitality,and emotional function,were negatively correlated(P<0.05).CONCLUSION Preoperative psychological stress results in adverse effects on quality of life and complications in older patients undergoing THA.Therefore,pre-operative psychological interventions should be strengthened to improve postoperative outcomes.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 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
Total hip arthroplasty(THA)has limitations in grinding angles,prosthesis placements,and thickness variations.THA robotics offer promise but encounter challenges like manual control of the robotic arm for precise posit...Total hip arthroplasty(THA)has limitations in grinding angles,prosthesis placements,and thickness variations.THA robotics offer promise but encounter challenges like manual control of the robotic arm for precise positioning and potential over-grinding when controlled manually.This paper presents a THA surgical robot system with automatic positioning and automatic grinding and filing functions.It achieves precise positioning during the surgery by using the singular value decomposition of initial value screening and sliding mode control(SMC),and ensures uniformity,stability and controlled filing thickness through the designed end grinding and filing actuator system.It has been verified experimentally that the average position errors in the x,y,and z directions are 0.692 mm,0.512 mm,and 0.66 mm respectively,and the Euclidean distance error is 1.322 mm.The average angle error is less than 1.136°.The end effector can perform automatic grinding according to the predetermined planning value within the safe force threshold of 30 N.This THA surgical robot system can meet the requirements of the hip replacement surgery for the accuracy,driving ability and robustness of the system.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
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
BACKGROUND With the continuous growth of the modern elderly population,the risk of fracture increases.Hip fracture is a common type of fracture in older people.Total hip arthroplasty(THA)has significant advantages in ...BACKGROUND With the continuous growth of the modern elderly population,the risk of fracture increases.Hip fracture is a common type of fracture in older people.Total hip arthroplasty(THA)has significant advantages in relieving chronic pain and promoting the recovery of hip joint function.AIM To investigate the effect of ulinastatin combined with dexmedetomidine(Dex)on the incidences of postoperative cognitive dysfunction(POCD)and emergence agitation in elderly patients who underwent THA.METHODS A total of 397 patients who underwent THA from February 2019 to August 2022.We conducted a three-year retrospective cohort study in Shaanxi Provincial People’s Hospital.Comprehensive demographic data were obtained from the electronic medical record system.We collected preoperative,intraoperative,and postoperative data.One hundred twenty-nine patients who were administered Dex during the operation were included in the Dex group.One hundred fifty patients who were intravenously injected with ulinastatin 15 min before anesthesia induction were included in the ulinastatin group.One hundred eighteen patients who were administered ulinastatin combined with Dex during the operation were included in the Dex+ulinastatin group.The patients’perioperative conditions,hemodynamic indexes,postoperative Mini-Mental State Examination(MMSE)scores,Ramsay score,incidence of POCD,and serum inflammatory cytokines were evaluated.RESULTS There was a significant difference in the 24 h visual analogue scale score among the three groups,and the score in the Dex+ulinastatin group was the lowest(P<0.05).Compared with the Dex and ulinastatin group,the MMSE scores of the Dex+ulinastatin group were significantly increased at 1 and 7 d after the operation(all P<0.05).Compared with those in the Dex and ulinastatin groups,incidence of POCD,levels of serum inflammatory cytokines in the Dex+ulinastatin group were significantly decreased at 1 and 7 d after the operation(all P<0.05).The observer’s assessment of the alertness/sedation score and Ramsay score of the Dex+ulinastatin group were significantly different from those of the Dex and ulinastatin groups on the first day after the operation(all P<0.05).CONCLUSION Ulinastatin combined with Dex can prevent the occurrence of POCD and emergence agitation in elderly patients undergoing THA.展开更多
Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to...Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.展开更多
Adults requiring total hip arthroplasty(THA)for childhood disorder sequelae present with shortening,limp,pain,and altered gait.THA,which can be particularly challenging due to altered anatomy,requires careful planning...Adults requiring total hip arthroplasty(THA)for childhood disorder sequelae present with shortening,limp,pain,and altered gait.THA,which can be particularly challenging due to altered anatomy,requires careful planning,assessment,and computed tomography evaluation.Preoperative templating is essential to establish the appropriate acetabular and femoral size.Information regarding neck length and offset is needed to ensure the proper options are available at THA.Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure,identification,and stable fixation with optimum-size components.Identifying the actual acetabular floor is essential as changes include altered anatomy,distortion of the margins and version changes.Proximal femur changes include anatomical variation,decreased canal diameter,cortical thickness,changes in anteversion,and metaphyseal and diaphyseal mismatch.Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures.Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy,especially in high-riding hips.The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre.The femoral components may require modularity to enable restoration of anteversion and optimum fixation.展开更多
文摘BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.
基金approved by the Institutional Ethics Committee of Shizuoka Red Cross Hospital(No.2023-36,approval date:January 12,2024).
文摘BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.
基金Supported by the Natural Science Foundation Project of the Science and Technology Bureau of Yuzhong District,Chongqing,No.20240129.
文摘Total hip arthroplasty(THA)effectively treats advanced hip disorders,yet outcomes vary among patients.Frailty has become a crucial factor influencing these results.Several studies explored multiple preoperative factors affecting THA outcomes,highlighting the significance of age,Western Ontario and Mc-Master Universities Osteoarthritis Index,Center for Epidemiologic Studies Depression Scale,and central sensitization index scores in predicting post-operative recovery,emphasizing comprehensive preoperative assessments.Subsequent research has shown that frailty,measured by tools like the hospital frailty risk score and frailty deficit index,is significantly associated with adverse outcomes such as higher 30-day readmission rates,longer hospital stays,increased costs,and elevated mortality and complication risks in both primary and revision THA.Additionally,frailty related to short-term adverse events but stressed the need for standardized frailty measurement.Currently,there is no unified standard for assessing frailty before THA,which hinders cross-study comparison and evidence-based guideline development.Future research should focus on establishing a universal frailty assessment standard considering physical function,comorbidities,cognitive and psychological status.Prospective studies are also needed to clarify the causal relationship between frailty and long-term THA outcomes and identify modifiable factors for preoperative interventions.Overall,understanding the impact of frailty on THA outcomes is essential for improving patient care and resource utilization,especially in an aging population with a rising prevalence of hip disorders.
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.
基金supported by grants from the Youth TCM scientific research Project of Heilongjiang Province TCM Administration(ZHY2024-283)the Health and Family Planning Commission of Heilongjiang Province(20240404070039)+1 种基金Heilongjiang Postdoctoral Fund(NO.LBH-Z23257)the Innovative Science Research Fund of Harbin Medical University(also known as Heilongjiang Provincial University's Project of Graduate Scientific Research Business Fees)(2024,Xin Zhang)and the Postdoctoral Program of Heilongjiang Province(NO.LBH-Z23234).
文摘Objective:To investigate the risk factors for deep vein thrombosis(DVT)following total hip arthroplasty in elderly patients with femoral neck fractures during the winter.Methods:A total of 162 patients who underwent total hip arthroplasty were categorized based on the development of DVT within 7 days postoperatively:28 patients formed the DVT group and 134 patients the non-DVT group.Collected data included age,gender,history of glucocorticoid use,diabetes,hypertension,body mass index(BMI),triglyceride(TG)levels,cholesterol(CHOL)levels at admission,operative time,and postoperative bed rest duration.D-dimer(D-D)and fibrinogen(Fg)levels,along with the D-D/Fg ratio,were recorded on the first postoperative day.Group comparisons were performed using t-tests.Logistic regression analysis was conducted to identify independent risk factors,and the predictive value of these factors was evaluated using receiver operating characteristic(ROC)curve analysis.Results:In the DVT group,18 patients had diabetes.Levels of TG(1.78±0.44 mmol/L),CHOL(4.70±1.84 mmol/L),D-D(0.40±0.17 mg/L),and the D-D/Fg ratio(0.24±0.07)were significantly higher than in the non-DVT group(P<0.05).Logistic regression identified TG,CHOL,D-D,and the D-D/Fg ratio as independent risk factors for DVT,with odds ratios of 0.987,2.395,0.8,4.992,and 9.004,respectively(P<0.05).ROC curve analysis yielded areas under the curve(AUCs)of 0.715,0.69,0.614,and 0.726 for TG,CHOL,D-D,and the D-D/Fg ratio,respectively.Sensitivities were 0.643,0.500,0.429,and 0.857,and specificities were 0.694,0.978,0.918,and 0.537,respectively.Conclusion:Elevated levels of TG,CHOL,D-D,and the D-D/Fg ratio are independent risk factors for DVT following total hip arthroplasty in elderly patients.Among these,the D-D/Fg ratio demonstrated the highest sensitivity and may serve as an effective marker for early-stage DVT screening.
文摘BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.
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BACKGROUND Anxiety,depression,and postoperative pain are common in patients with hip joint disorders and are associated with compromised functional outcomes and delayed recovery.AIM To investigate the prevalence of anxiety and depression among geriatric patients who underwent total hip arthroplasty(THA),explored their association with postoperative pain,and identified contributing risk factors.METHODS A total of 111 geriatric patients who underwent THA between January 2021 and January 2024 were included.Standardized psychological assessment tools-including the Zung Self-Rating Anxiety Scale(SAS)and the Zung Self-Rating Depression Scale(SDS)-and the Numeric Rating Scale(NRS)for pain quantification were systematically administered.Pearson correlation analysis was utilized to explore the relationships among SAS,SDS,and NRS scores.Univariate and multivariate binary logistic regression analyses were conducted to identify risk factors for anxiety and depression in these patients.RESULTS The cohort exhibited moderate anxiety(SAS:44.23±9.03),mild depression(SDS:46.98±9.15),and moderate postoperative pain(NRS:4.93±2.37).Patients with anxiety or depression reported significantly higher NRS scores than those without these conditions.Significant positive correlations were observed between SAS and SDS scores,as well as between each of these and NRS scores.Univariate analysis revealed that gender,age,disease duration,alcohol use,diabetes history,and NRS scores were significantly associated with anxiety and depression.Multivariate analysis further identified female gender,disease duration≥2 years,alcohol use,and NRS scores≥5 as independent predictors of postoperative psychological distress.CONCLUSION Anxiety and depression are closely linked with postoperative pain in geriatric patients post-THA recovery.Early psychological screening and multimodal pain management strategies are recommended-particularly for individuals with a disease duration of≥2 years,a history of alcohol consumption,or an NRS score of≥5,as well as female patients-to effectively mitigate their negative emotional states and improve postoperative recovery.
文摘BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.
文摘This editorial critically evaluated the recent study by Ishikura et al,which examined the impact of anterior minimally invasive total hip arthroplasty(MISTHA)on postoperative quality of life,with a specific focus on the timeline and influencing factors for return to work and resumption of driving.Ishikura et al's research demonstrated that anterior MIS-THA could shorten recovery time,reduce postoperative pain,and significantly enhance patients'quality of life and productivity.Their findings identified occupational type and work intensity as key determinants of postoperative recovery.By synthesizing evidence from multiple studies,this analysis systematically evaluated the clinical advantages of anterior MIS-THA—including reduced soft tissue trauma and accelerated functional recovery—while acknowledging its limitations,such as a steep surgical learning curve and early postoperative complication risks.The discussion emphasized the necessity of designing personalized rehabilitation protocols that accounted for patients'occupational demands.Notably,while current findings primarily derived from retrospective analyses,the article highlighted the need for prospective cohort studies to validate these observations.The commentary also addressed ongoing debates in the field,particularly the elevated complication rates associated with the direct anterior approach compared to posterior techniques,thereby underscoring the critical role of surgeon expertise in optimizing procedural safety.Collectively,this evaluation advanced our understanding of postoperative recovery dynamics in anterior MIS-THA and provides evidencebased insights to refine clinical rehabilitation frameworks.
文摘BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such as joint function,quality of life,and postoperative complications remain unclear.AIM To investigate the effects of preoperative psychological stress on selected parameters in older patients who underwent THA.METHODS Ninety older patients who underwent THA between January 2023 and August 2024 were divided into two groups by their preoperative self-rated anxiety scale and self-rated depression scale scores,including high-stress(n=42)and lowstress(n=48).The postoperative joint function,short form-36 health survey(SF36)score,incidence of postoperative complications,and other indicators were compared between the two groups.Pearson’s correlation coefficient analysis of the relationship among preoperative psychological stress,quality of life,and postoperative complications was performed.RESULTS Postoperative joint function and quality of life were lower in the high-stress group than they were in the low-stress group(P<0.05).The incidence of postoperative complications was higher in the high-stress group(29.27%)than it was in the low-stress group(9.30%)(P<0.05).Cor-relation analysis revealed that psychological stress was correlated with the Harris hip and SF-36 scores.Total scores on the scale,including physical function,physical pain,general health,mental health,social function,vitality,and emotional function,were negatively correlated(P<0.05).CONCLUSION Preoperative psychological stress results in adverse effects on quality of life and complications in older patients undergoing THA.Therefore,pre-operative psychological interventions should be strengthened to improve postoperative outcomes.
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 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.
基金supported by the Li Ka Shing Foundation Cross Research Project(No.2020LKSFG02D)the Guangdong Basic and Applied Basic Research Foundation(Nos.2021A1515011285,2022A1515110566,2023A151501221574 and 2019A1515010800)+2 种基金Major Project under the Science and Technology Development Scheme of Guangdong Province(Nos.210715106900918 and[2020]53-129)the Shantou Science and Technology Plan Medical and Health Category Project(No.211114216492935)the 2022 Guangdong Science and Technology Innovation Strategy Special Fund for University Students(Science and Technology Innovation Cultivation)Project(No.pdjh2022a0186).
文摘Total hip arthroplasty(THA)has limitations in grinding angles,prosthesis placements,and thickness variations.THA robotics offer promise but encounter challenges like manual control of the robotic arm for precise positioning and potential over-grinding when controlled manually.This paper presents a THA surgical robot system with automatic positioning and automatic grinding and filing functions.It achieves precise positioning during the surgery by using the singular value decomposition of initial value screening and sliding mode control(SMC),and ensures uniformity,stability and controlled filing thickness through the designed end grinding and filing actuator system.It has been verified experimentally that the average position errors in the x,y,and z directions are 0.692 mm,0.512 mm,and 0.66 mm respectively,and the Euclidean distance error is 1.322 mm.The average angle error is less than 1.136°.The end effector can perform automatic grinding according to the predetermined planning value within the safe force threshold of 30 N.This THA surgical robot system can meet the requirements of the hip replacement surgery for the accuracy,driving ability and robustness of the system.
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.
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BACKGROUND With the continuous growth of the modern elderly population,the risk of fracture increases.Hip fracture is a common type of fracture in older people.Total hip arthroplasty(THA)has significant advantages in relieving chronic pain and promoting the recovery of hip joint function.AIM To investigate the effect of ulinastatin combined with dexmedetomidine(Dex)on the incidences of postoperative cognitive dysfunction(POCD)and emergence agitation in elderly patients who underwent THA.METHODS A total of 397 patients who underwent THA from February 2019 to August 2022.We conducted a three-year retrospective cohort study in Shaanxi Provincial People’s Hospital.Comprehensive demographic data were obtained from the electronic medical record system.We collected preoperative,intraoperative,and postoperative data.One hundred twenty-nine patients who were administered Dex during the operation were included in the Dex group.One hundred fifty patients who were intravenously injected with ulinastatin 15 min before anesthesia induction were included in the ulinastatin group.One hundred eighteen patients who were administered ulinastatin combined with Dex during the operation were included in the Dex+ulinastatin group.The patients’perioperative conditions,hemodynamic indexes,postoperative Mini-Mental State Examination(MMSE)scores,Ramsay score,incidence of POCD,and serum inflammatory cytokines were evaluated.RESULTS There was a significant difference in the 24 h visual analogue scale score among the three groups,and the score in the Dex+ulinastatin group was the lowest(P<0.05).Compared with the Dex and ulinastatin group,the MMSE scores of the Dex+ulinastatin group were significantly increased at 1 and 7 d after the operation(all P<0.05).Compared with those in the Dex and ulinastatin groups,incidence of POCD,levels of serum inflammatory cytokines in the Dex+ulinastatin group were significantly decreased at 1 and 7 d after the operation(all P<0.05).The observer’s assessment of the alertness/sedation score and Ramsay score of the Dex+ulinastatin group were significantly different from those of the Dex and ulinastatin groups on the first day after the operation(all P<0.05).CONCLUSION Ulinastatin combined with Dex can prevent the occurrence of POCD and emergence agitation in elderly patients undergoing THA.
文摘Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.
文摘Adults requiring total hip arthroplasty(THA)for childhood disorder sequelae present with shortening,limp,pain,and altered gait.THA,which can be particularly challenging due to altered anatomy,requires careful planning,assessment,and computed tomography evaluation.Preoperative templating is essential to establish the appropriate acetabular and femoral size.Information regarding neck length and offset is needed to ensure the proper options are available at THA.Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure,identification,and stable fixation with optimum-size components.Identifying the actual acetabular floor is essential as changes include altered anatomy,distortion of the margins and version changes.Proximal femur changes include anatomical variation,decreased canal diameter,cortical thickness,changes in anteversion,and metaphyseal and diaphyseal mismatch.Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures.Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy,especially in high-riding hips.The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre.The femoral components may require modularity to enable restoration of anteversion and optimum fixation.
