Predicting the necessity of routine postoperative laboratory tests after primary total hip arthroplasty.

Aims: We aimed to develop a predictive model for abnormal postoperative laboratory tests in patients undergoing primary total hip arthroplasty (THA) to aid clinical decision-making.

Methods: We analyzed 4,000 patients undergoing primary THA from 1 January 2016 to 31 December 2020, excluding 1,773 due to incomplete records and 63 for being one-stage bilateral THAs. The final cohort comprised 2,164 patients (60.

Os acetabuli is an indirect radiographic sign of femoral retroversion.

Background: To report the association between os acetabuli and relevant radiologic measurements in a series of surgically treated hip preservation patients.

Methods: We retrospectively reviewed 654 hips who underwent preservation surgery between 2012 and 2019, identifying 50 cases with os acetabuli (7.64%).

Unconventional Therapies in Periprosthetic Joint Infections: Prevention and Treatment: A Narrative Review.

Background: as the demand for total joint arthroplasty continues to grow each year, the healthcare burden is expected to increase due to periprosthetic joint infection (PJI). This review article aims to highlight the significance of biofilms in the pathogenesis of PJI and introduce alternative therapies that prevent bacterial adhesion to implants or enhance their eradication when infection occurs.

Search Strategy: we conducted a bibliographic search in PubMed using the following MeSH terms as follows: "no antibiotic treatment of PJI", "bacterial biofilm eradication agents", and "unconventional prevention of PJI", among others.

Long-term outcomes with a partial neck-preserving cementless short stem in primary total hip arthroplasty for young patients: a single center first one hundred cases.

Purpose: This study aimed to assess the long-term results of THA patients who received a cementless short stem regarding clinical outcomes, bone changes, complications, and incidence of femoral revision.

Methods: A retrospective evaluation of the first 100 THA employing a type 2B cementless stem (Mini hip stem, Corin, Cirencester, United Kingdom) by the same surgeon at one institution. We only include patients with 18 years or more, and with a minimum follow up of 8 years.

How to Best Identify Acetabular Retroversion on Radiographs: Thresholds to Guide Clinical Practice.

Background: Acetabular retroversion is associated with impingement and instability. An adequate interpretation of acetabular version and coverage on radiographs is essential to determine the optimal treatment strategy (periacetabular osteotomy vs hip arthroscopic surgery). The crossover sign (COS) has been associated with the presence of acetabular retroversion, and the anterior wall index (AWI) and posterior wall index (PWI) assess anteroposterior acetabular coverage.

Lower Extremity Arterial Calcification Predicts Referral to a Closed Unit After Primary Total Hip Arthroplasty.

Background: We aimed to determine the association between lower extremity arterial calcification (LEAC) and referral to a closed unit (CU), length of stay, 90-day readmissions, and 1-year mortality in primary total hip arthroplasty (THA) patients.

Methods: We retrospectively analyzed 705 patients who underwent primary THA, identifying 64 patients (9.13%) who had LEAC and 641 who did not have LEAC.

Prediction of 3-Dimensional Coverage Surface Area of the Femoral Head in Hip Dysplasia Through Conventional Computed Tomography.

Background: Assessment of 3-dimensional (3D) femoral head coverage is critical in evaluating, preoperative planning, and treating hip dysplasia.

Purpose: To (1) propose a mathematical model to establish 3D femoral head coverage using conventional computed tomography (CT), (2) determine the correlation of 2D parameters with 3D coverage, and (3) characterize the patterns of dysplasia based on 3D morphology.

Study Design: Cross-sectional study; Level of evidence, 3.

Successful hip revision surgery following refracture of a modern femoral stem using a cortical window osteotomy technique: A case report and review of literature.

Background: The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery. Although there have been few reports of femoral component fracture, removal of a broken femoral stem can be a challenging procedure.

Case Summary: A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem, two years after receiving a revision using a cement-within-cement technique (CWC) through an extended trochanteric osteotomy (ETO).

Acetabular Sector Angles in Asymptomatic and Dysplastic Hips: Defining Dysplasia and Thresholds to Guide Management.

Background: Radiographic evaluation plays an important role in detecting and grading hip dysplasia. Acetabular sector angles (ASAs) measure the degree of femoral head coverage provided by the acetabulum on computed tomographic (CT) scans. In this study, we aimed to determine ASA values at different axial levels in a control cohort with asymptomatic, high-functioning hips without underlying hip pathology and a study group with symptomatic, dysplastic hips that underwent periacetabular osteotomy (PAO), thereby defining the ASA thresholds for hip dysplasia.

Late Periprosthetic Femoral Stress Fracture Associated with Extra-articular Deformity in a Patient with Fibrous Dysplasia: A Case Report.

Case: In the setting of a total hip arthroplasty performed in a patient with a proximal femoral deformity, atraumatic periprosthetic femoral stress fracture may arise as a complication. We report a rare case of a late periprosthetic femoral stress fracture around a cemented stem in a patient with a history of fibrous dysplasia of the proximal femur. After a 10-year uneventful period, the patient complained about a subtle, subacute pain in his left thigh induced by exercise but not with daily axial load.

What is the Fate of Undisplaced Femoral Neck Fractures Treated With Cannulated Screws?

Background: We aimed to report implant survival in Garden type I and II femoral neck fractures treated with cannulated screws in elderly patients.

Methods: We retrospectively studied 232 consecutive unilateral Garden I and II patients (232 fractures) treated with cannulated screws. Mean age was 81 years (range, 65 to 100), and a body mass index of 25 (range, 15.

Medium-term outcomes of conventional versus short uncemented femoral stems for primary total hip arthroplasty in patients younger than 55 years.

Background: Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up.

Methods: We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B).

Anterior Center-Edge Angle Is Less Reliable Than Anterior Wall Index to Predict Anterior Coverage of the Femoral Head.

Background: No consensus is available regarding which radiographic measurement most accurately correlates with anterior coverage of the femoral head.

Purpose: (1) To determine the correlation between 2 measurements of anterior wall coverage: total anterior coverage (TAC) calculated from radiographs and equatorial anterior acetabular sector angle (eAASA) calculated from computed tomography (CT) scans; (2) to define the correlation between anterior center-edge angle (ACEA) and anterior wall index (AWI) with TAC and eAASA; and (3) to investigate what other radiographic metrics may help predict anterior coverage.

Study Design: Cohort study (Diagnosis); Level of evidence, 3.

Do nonagenarians have more complications and unplanned readmissions than octogenarians following primary THA? A retrospective cohort study.

Introduction: The performance of total hip arthroplasty in elderly patients, especially nonagenarians, is challenging due to higher patient frailty and medical comorbidities. We compared 90-day postoperative complications and unplanned readmissions between nonagenarians and octogenarians undergoing elective THA.

Methods: One hundred and eleven patients undergoing elective, unilateral THA were retrospectively analyzed.

Intraoperative unfractionated heparin before femoral component cementation should be avoided in femoral neck fracture treated with hybrid total hip arthroplasty.

Purpose: To compare the incidence of perioperative thromboembolic events in femoral neck fracture (FNF) patients treated with hybrid total hip arthroplasty (THA) with intraoperative unfractionated heparin (UFH) versus a control group without intraoperative UFH before femoral component cementation.

Methods: We compared 139 cases without UFH (group A) versus 134 who received 10 UI/kg UFH (group B). Indication of UFH before cementation depended on the preferences of the anaesthesiologists in each case.

Cerclage wire or positional cortical screw for the treatment of intraoperative calcar fractures during primary total hip arthroplasty? A biomechanical study.

Background: During primary total hip arthroplasty, intra-operative calcar fractures have been historically treated with cerclage wires. However, interfragmentary screw fixation technique can possibly achieve the same results with technical advantages. The aim of this biomechanical study was to assess stability of calcar fractures fixed using interfragmentary screw technique compared to a traditional cerclage system specifically in context of total hip arthroplasty.

Acetabular coverage analysis of the proximal femoral head accurately characterizes dysplastic acetabular morphology.

This study aimed to (1) measure acetabular sector angle (ASA) from proximal to distal positions along the axial femoral head axis, (2) identify acetabular deficiency patterns, and (3) correlate ASA at different axial positions with other radiological measurements in acetabular dysplasia. We identified 30 hips with dysplasia (lateral center edge angle [LCEA] <20°) and 30 hips without dysplasia (LCEA >25°) from a retrospective cohort. Anterior and posterior ASA (AASA, PASA) were measured in the axial computed tomography plane through the femoral head center (equatorial) and two axial positions above the equatorial line (intermediate and proximal).

Feasibility of total hip arthroplasty in cerebral palsy patients: a systematic review on clinical outcomes and complications.

Purpose: Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis secondary to hip dysplasia. However, the reported rate of complications following THA in the settings of neuromuscular diseases is high. This systematic review aimed to analyze the indications, functional outcomes and surgical failures of primary THA in cerebral palsy (CP) patients.

Impaction Bone Grafting for Severe Femoral Bone Loss: Surgical Technique in Revision Total Hip Arthroplasty.

Unlabelled: Revision total hip arthroplasty in the setting of extensive femoral bone loss poses a considerable challenge to the adult reconstructive surgeon. When the proximal femoral bone stock is deficient or absent, there are few options for reconstruction. In such cases, treatment options include distal cementless fixation (either modular or nonmodular), impaction bone grafting (IBG), a megaprosthesis, or even an allograft-prosthesis composite.

Prevention of early complications following total hip replacement.

Total hip arthroplasty (THA) has been quoted as "the operation of the century", owing to its efficacy and the substantial improvements evidenced with respect to functional patient outcomes and quality of life. However, early postoperative complications are often inevitable, hence it is imperative to take every step to prevent them and minimise morbidity and mortality. This manuscript focuses on the most common early complications following THA, namely venous thromboembolism (VTE), prosthetic joint infection, periprosthetic fracture, instability, and leg length inequality.

A Repeat Dose of Perioperative Dexamethasone Can Effectively Reduce Pain, Opioid Requirement, Time to Ambulation, and In-Hospital Stay After Total Hip Arthroplasty: A Prospective Randomized Controlled Trial.

Background: The ideal dose of intravenous glucocorticoids to control pain in total hip arthroplasty (THA) remains unclear. This randomized controlled trial compared postoperative pain and tramadol requirement in patients undergoing unilateral primary THA who received one versus two perioperative doses of dexamethasone.

Methods: Patients consented to undergo blinded, simple randomization to either one (at anesthetic induction [1D-group]: 54 patients) or two (with an additional dose 8 hours after surgery [2D-group]: 61 patients) perioperative doses of 8-mg intravenous dexamethasone.

One-stage exchange should be avoided in periprosthetic joint infection cases with massive femoral bone loss or with history of any failed revision to treat periprosthetic joint infection.

Aims: There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA.

Methods: We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI.

Selected Vancouver B2 periprosthetic femoral fractures around cemented polished femoral components can be safely treated with osteosynthesis.

Aims: We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty.

Methods: We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient).

Preliminary outcomes of the cementless UNITED hip system for primary total hip arthroplasty at a minimum 2-year follow-up.

Introduction: This study aimed to report the initial results of the cementless UNITED hip system in primary total hip arthroplasty (THA) with a minimum follow-up of 2 years.

Methods: We retrospectively studied a consecutive series of 203 cementless THAs in 180 patients operated between 2015-2017. We included 89 female and 91 male patients with a mean age of 67 (28 to 89) years.