Higher carboxylated osteocalcin is an independent predictor of improved femoral bone strength: A cross-sectional study.

Carboxylated osteocalcin (cOC), produced during post-translational modification of osteocalcin (OC) in a vitamin K-dependent pathway, has a high affinity for calcium and hydroxyapatite. Despite the observed link between vitamin K deficiency and fracture risk, supplementation studies have not consistently demonstrated improvements in bone mineral density (BMD) or bone microarchitecture, though studies have reported improvement in cOC status. We hypothesise that these inconsistent findings are due to the lack of knowledge on the mechanisms by which cOC affects bone health.

Total hip arthroplasty for acute acetabular fractures through the replace-in-situ philosophy : clinical outcomes.

Aims: This study investigated the outcomes of total hip arthroplasty (THA) performed for acute acetabular fractures through a replace-in-situ technique, where no attempt was made at fracture reduction, fixation, or restoration of columns before acetabular component insertion.

Methods: We report the clinical outcomes at a mean follow-up of five years of 41 acute complex acetabular fractures in 41 patients, with a mean age of 76 years (54 to 97), who underwent THA through a replace-in-situ technique.

Results: Four patients died during the acute episode of care, and one within 12 months.

Relationship between homocysteine levels and bone quality in healthy adults - A systematic review and meta-analysis.

Background And Aims: Patients with elevated homocysteine (Hcy) levels are associated with an increased risk of fracture. B-vitamin supplementation studies have consistently shown an ability to reduce Hcy levels but have had no or marginal effect on bone mineral density (BMD), which led us to hypothesize that hyperhomocysteinemia may increase fracture risk by altering bone quality outcome measures beyond BMD. The aim of our systematic review was to investigate the association between Hcy and bone quality outcome measures, i.

Highly Porous Tantalum Acetabular Components Without Ancillary Screws Are Non-inferior at 7 Years When Compared With Titanium Components With Ancillary Screw Fixation: A Randomized Controlled Trial.

Background: While porous tantalum components have shown to be advantageous in the revision setting, registry studies have identified tantalum components used in primary total hip arthroplasty (THA) to be associated with an increased risk of revision. The only study to examine the migration of tantalum acetabular components with radiostereometric analysis (RSA) beyond 2 years found continued migration. The aim of this 7-year follow-up RSA study was to determine if the mid-term migration of tantalum acetabular components without ancillary screw fixation is no greater than that of fiber metal titanium components with one ancillary screw fixation.

Continued mid-term stability of a novel cementless femoral stem design: A radiostereometric analysis study.

Background: Measuring early micromotion using radiostereometric analysis is the gold standard to evaluate new implant performance. The aim of this study was to assess the continued stability of a new cementless Paragon stem at 5 years. Secondary aims were to assess patient reported outcomes and compare the continued stability between 2 and 5 year to an existing gold standard, the Corail stem.

Automated Acetabular Defect Reconstruction and Analysis for Revision Total Hip Arthroplasty: A Computational Modeling Study.

Revision total hip arthroplasty (rTHA) involving large acetabular defects is associated with high early failure rates, primarily due to cup loosening. Most acetabular defect classification systems used in surgical planning are based on planar radiographs and do not encapsulate three-dimensional geometry and morphology of the acetabular defect. This study aimed to develop an automated computational modeling pipeline for rapid generation of three-dimensional acetabular bone defect geometry.

Automated micro-CT morphometry of femoral biopsies from hip arthroplasties: adaptive local thresholding, volume of interest wrapping and removal of debris.

Bone biopsies are an important biological tool for investigating bone microarchitecture, which can be non-destructively imaged in 3D via micro-computed tomography (micro-CT). Image thresholding and delineation of a region of interest (ROI) are prerequisites for quantifying bone parameters. Validated automatic protocols enable quantification of biopsies that contain trabecular and cortical bone.

Revision Hip Arthroplasty Through a Gluteal-Sparing Extended Posterior Approach May be Able to Achieve Similar Functional Outcomes to Primary Hip Arthroplasty.

Background: Revision total hip arthroplasty (THA) has been reported to have worse outcomes when compared to primary procedures, which may, in part, be due to the increased exposure required for the procedure. We aimed to investigate the postoperative functional outcomes of 2 groups of primary and revision THA, when revision procedures were performed using a gluteal-sparing extended posterior approach.

Methods: Two groups of 51 primary and 21 revision THAs were prospectively recruited from a single center between 2016 and 2019.

The Influence of Cup Orientation on the Primary Fixation of a Hemispherical Cementless Acetabular Cup: A Cohort Based Finite Element Study.

Cup orientation has been investigated in detail with respect to risk of dislocation, however, the impact on the primary fixation of cementless cups is poorly understood. The aim of this study was to assess the influence acetabular component orientation on the primary fixation of cementless acetabular cups using an in silico clinical trial framework. Finite element models of 57 implanted hemi-pelves were generated from CT scans of a cohort of end stage osteoarthritis patients.

Diagnosis and Treatment Influence Hospital Costs of Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Background: This systematic review and meta-analysis aimed to synthesize the hospital costs of revision total hip arthroplasty (rTHA) by periprosthetic joint infection, periprosthetic fracture (PPF), aseptic loosening, and recurrent dislocation diagnoses. In addition, as several surgical options are available within some diagnoses, this study aimed to synthesize the evidence on hospital costs for septic rTHA between debridement, antibiotics, and implant retention and one-stage and two-stage rTHA, and for PPF, the cost between rTHA and open reduction and internal fixation treatment.

Methods: A systematic search of PubMed, Embase, and Scopus identified all studies reporting the hospital costs of rTHA.

Multi-Directional Crosswalk of the Harris Hip Score and the Hip Disability and Osteoarthritis Outcome Score.

Despite the popularity of the modified Harris Hip Score (mHHS) to monitor patient-reported outcome measures (PROMs) following Total Hip Arthroplasty (THA) over the last 5 decades, International Joint Registries have recently favoured the Hip disability and Osteoarthritis Outcome Score (HOOS). The ability to convert mHHS collected in historical and ongoing studies would be beneficial to benchmark more recent HOOS reports. Hence, this study aimed to create multi-directional crosswalks between mHHS and HOOS.

Outcomes of Debridement, Antibiotics, and Implant Retention in the Management of Infected Total Knee Arthroplasty: Analysis of 5,178 Cases From the National Australian Registry.

Background: Periprosthetic joint infection is a devastating and severe complication of total knee arthroplasty (TKA). The Australian Joint Registry reports an increasing number of debridement, antibiotics, and implant retention (DAIR) procedures, underscoring the need to comprehend outcomes for informed treatment decisions. This study aimed to determine the outcome of DAIR procedures, evaluate time since primary TKA, and identify patient-related factors associated with DAIR failure.

The effect of prebiotic fibre on the gut microbiome and surgical outcomes in patients with prosthetic joint infection (PENGUIN) - study protocol for a randomised, double-blind, placebo-controlled trial (ACTRN12623001273673).

Background: Prosthetic Joint Infection (PJI) is the most devastating complication of arthroplasty surgery and affects 1-5% of patients. Despite strict adherence to aseptic protocols and preventive measures, infection is the most common reason for revision arthroplasty, and the incidence is increasing. Treatment of PJI is challenging and often requires repeated major surgeries with sequentially poor results.

Estimation of two-year hospital costs of hip and knee periprosthetic joint infection treatments using activity-based costing.

Aims: Our aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint infection (PJI) by main management strategy within 24 months post-diagnosis using activity-based costing. Additionally, we investigated the influence of individual PJI treatment pathways on hospital costs within the first 24 months.

Methods: Using admission and procedure data from a prospective observational cohort in Australia and New Zealand, Australian Refined Diagnosis Related Groups were assigned to each admitted patient episode of care for activity-based costing estimates of 273 hip PJI patients and 377 knee PJI patients.

Computational modeling of revision total hip arthroplasty involving acetabular defects: A systematic review.

Revision total hip arthroplasty (rTHA) involving acetabular defects is a complex procedure associated with lower rates of success than primary THA. Computational modeling has played a key role in surgical planning and prediction of postoperative outcomes following primary THA, but modeling applications in rTHA for acetabular defects remain poorly understood. This study aimed to systematically review the use of computational modeling in acetabular defect classification, implant selection and placement, implant design, and postoperative joint functional performance evaluation following rTHA involving acetabular defects.

Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations.

Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1].

Virtual biomechanical assessment of porous tantalum and custom triflange components in the treatment of patients with acetabular defects and pelvic discontinuity.

Aims: The aim of this study was to compare the biomechanical models of two frequently used techniques for reconstructing severe acetabular defects with pelvic discontinuity in revision total hip arthroplasty (THA) - the Trabecular Metal Acetabular Revision System (TMARS) and custom triflange acetabular components (CTACs) - using virtual modelling.

Methods: Pre- and postoperative CT scans from ten patients who underwent revision with the TMARS for a Paprosky IIIB acetabular defect with pelvic discontinuity were retrospectively collated. Computer models of a CTAC implant were designed from the preoperative CT scans of these patients.

Patient-Related Predictors of Treatment Failure After Two-Stage Total Hip Arthroplasty Revision for Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis.

Background: Periprosthetic joint infection (PJI) treatment has high failure rates even after 2-stage revision. Risk factors for treatment failure (TF) after staged revision for PJI are not well defined, nor is it well established how they correlate with the risks of developing an index PJI. Identifying modifiable risk factors may allow preoperative optimization, while identifying nonmodifiable risk factors can influence surgical options or advise against further surgery.

What is the Long-term Wear of a 5-Mrad Highly Crosslinked Polyethylene Liner? A 14-year RSA Study.

Background: Lower doses of irradiation (≤ 5 Mrad) during the manufacture of highly crosslinked polyethylene acetabular liners may result in less crosslinking and an increased wear rate. Radiostereometric analysis (RSA) studies have found that wear of more highly irradiated highly crosslinked polyethylene liners (7 to 10 Mrad) decreases at longer-term follow-up compared with earlier reports of the same cohorts. Although wear of 5-Mrad irradiated liners appears to increase at midterm follow-up, it is unclear whether that remains true at longer follow-up.

Migration patterns of acetabular cups: a systematic review and meta-analysis of RSA studies.

Background And Purpose: We conducted a systematic review and meta-analysis of RSA studies to investigate the early and long-term migration patterns of acetabular cups and the influence of implant factors on cup migration over time.

Methods: We performed a systematic search of PubMed, Embase, and Scopus databases to identify all RSA studies of cup migration following primary total hip replacement (THR). Proximal migration at 3 and 6 months, 1, 2, 5, and 10 years were considered for analysis.

Large articulations do not increase wear rates of thin second-generation highly cross-linked polyethylene liners at ten years.

Aims: Radiostereometric analysis (RSA) is the most accurate radiological method to measure in vivo wear of highly cross-linked polyethylene (XLPE) acetabular components. We have previously reported very low wear rates for a sequentially irradiated and annealed X3 XLPE liner (Stryker Orthopaedics, USA) when used in conjunction with a 32 mm femoral heads at ten-year follow-up. Only two studies have reported the long-term wear rate of X3 liners used in conjunction with larger heads using plain radiographs which have poor sensitivity.

Long Cephalomedullary Nails Can Be a Cheap and Effective Interval Revision Prosthesis in Infected Hip Replacements That Require Proximal Femoral Replacement: A Small Case Series.

Hip prosthetic joint infection management is complex and expensive, especially in severe bone loss. Reducing the price of interval prosthesis when performing staged revision could minimize costs without compromising outcomes. We present 2 similar techniques developed independently that use an antibiotic-coated cephalomedullary nail with a total hip arthroplasty bearing (head and cemented acetabular component) attached to it as an interval proximal femoral replacement prosthesis.

Corroboration of coupled musculoskeletal model and finite element predictions with in vivo RSA migration of an uncemented acetabular component.

While finite element (FE) models have been used extensively in orthopedic studies, validation of their outcome metrics has been limited to comparison against ex vivo testing. The aim of this study was to validate FE model predictions of the initial cup mechanical environment against patient-matched in vivo measurements of acetabular cup migration using radiostereometric analysis (RSA). Tailored musculoskeletal and FE models were developed using a combination of three-dimensional (3D) motion capture data and clinical computerized tomography (CT) scans for a cohort of eight individuals who underwent primary total hip replacement and were prospectively enrolled in an RSA study.

Staged Revision Hip Arthroplasty With Femoral Impaction Bone Grafting for Prosthetic Joint Infections: Radiostereometric Analyses and Clinical Outcomes at Minimum 5-Year Follow-Up.

Background: There are ongoing concerns regarding the use of bone graft following prosthetic joint infection and subsequent implant subsidence. The aim of this study was to determine whether the use of a cemented stem combined with femoral impaction bone grafting (FIBG) at second stage revision for infection results in stable femoral stem fixation, determined by accurate methods, and good clinical results.

Methods: A prospective cohort of 29 patients underwent staged revision total hip arthroplasty for infection using an interval prosthesis followed by FIBG at the final reconstruction.

The effect of weight compared to BMI on patient reported outcomes at long term follow up of primary total hip arthroplasty.

Introduction: Obesity has been linked to the development of osteoarthritis meaning that a large portion of arthroplasty patients are overweight or obese. Whilst the short-term complications associated with obesity are well described there is a paucity of evidence on the effect of weight compared to BMI for long term functional outcomes of total hip replacements (THR). The aim of this study was to investigate the influence of BMI and weight on long-term patient reported outcome measures following primary THR.