Advances in Adult Hip and Knee Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 29961

Special Issue Editor


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Guest Editor
Orthopaedic Department, Medical School of Hannover, Annastift Hospital, Hannover, Germany
Interests: hip surgery; knee surgery, surgical advances, osteotomies, robotics

Special Issue Information

Dear Colleagues,

There is no doubt that much development was seen in the area of musculoskeletal medicine and surgery during recent years.

The demand for motion and physical activity is increasing more than any time before. Physical activity and quality of life are two undividable items which make up the building blocks of humanity.

In the area of hip surgery, tremendous developments in joint preservation surgery and arthroplasty have occurred. Recognition of intra-articular impingement pathology led to the development of open and arthroscopic techniques for the treatment of femoracetabular impingement. The importance and power of surgical techniques for the treatment of dysplasia of the acetabulum were recognised. Arthroplasty became an extremely successful treatment for osteoarthritis. There has been a shift towards proximal fixation in primary arthroplasty. In revision arthroplasty, highly porous biological reconstruction modalities using modular augments are trending.

Knee surgery is also on the rise with developments in tissue engineering approaches in regeneration of cartilage and ligaments. Realignment surgery became extremely safe and low in complications. Arthroplasty showed a revolutionary change in alignment concept, with the help of modern technology and robotics.

There is no doubt that the digital world will heavily impact our field in the coming years. Virtual reality is seeking its place, augmenting surgical capabilities. The impact will be visible in the coming years.

This Issue will present a selected group of articles that reflect on some of the advances in hip and knee surgery. 

Dr. Sufian S. Ahmad
Guest Editor

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Keywords

  • hip surgery
  • knee surgery
  • surgical advances
  • osteotomies
  • robotics

Published Papers (17 papers)

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Editorial

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2 pages, 167 KiB  
Editorial
Back to the Future with Osteotomies around the Hip
by Sufian S. Ahmad, Henning Windhagen and Vikas Khanduja
J. Clin. Med. 2022, 11(15), 4446; https://doi.org/10.3390/jcm11154446 - 30 Jul 2022
Cited by 4 | Viewed by 941
Abstract
If we were to look back at the history of orthopedics only two generations ago, the intertrochanteric osteotomy was a well-established procedure for the treatment of osteoarthritis of the hip [...] Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)

Research

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14 pages, 3572 KiB  
Article
The Validation of Two-Dimensional and Three-Dimensional Radiographic Measurements of Host Bone Coverage in Total Hip Arthroplasty for Hip Dysplasia: A Comparison with Intra-Operative Measurements
by Chang-Jin Yon, Kyung-Jae Lee, Byung-Chan Choi, Ho-Sung Suh and Byung-Woo Min
J. Clin. Med. 2023, 12(19), 6227; https://doi.org/10.3390/jcm12196227 - 27 Sep 2023
Cited by 1 | Viewed by 699
Abstract
Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to [...] Read more.
Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to determine the minimum host bone coverage for achieving stable cup fixation after THA in hip dysplasia. The clinical outcomes of each patient were evaluated during their final follow-up period using the Harris Hip score (HHS). The coverage of the host bone was analyzed by comparing 2D-based, 3D-based, and intraoperative assessments. The mean HHS was increased significantly from 60.84 ± 14.21 pre-operatively to 93.13 ± 4.59 (p < 0.0001). The host bone coverage ratio measured intraoperatively was 83.67 ± 3.40%, while the ratio measured by 3D CT reconstruction was 82.72 ± 3.59%. There was a strong positive correlation between the intra-operative host bone coverage and the 3D-based one (r = 0.826, p < 0.0001). It is recommended that 3D-based measurements are used to evaluate the host bone coverage after THA in patients with hip dysplasia. In addition, achieving a minimum host bone coverage of 75% is recommended for the attainment of stable cup fixation Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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9 pages, 1011 KiB  
Article
Periacetabular Osteotomy with a Modified Fixation Technique Using K-Wires Shows Clinical Results Comparable to Screw Fixation at Mid-Term Follow-Up
by Vincent Justus Leopold, Christian Hipfl, Robert Karl Zahn, Matthias Pumberger, Carsten Perka and Sebastian Hardt
J. Clin. Med. 2023, 12(19), 6204; https://doi.org/10.3390/jcm12196204 - 26 Sep 2023
Viewed by 614
Abstract
Background: The optimal fixation technique in periacetabular osteotomy (PAO) remains controversial. Modified fixation with Kirschner wires (K-wires) was described as a feasible and safe alternative. However, clinical follow-up of patients treated with this technique is lacking. Aims: To assess patient-reported outcomes (PROMs) in [...] Read more.
Background: The optimal fixation technique in periacetabular osteotomy (PAO) remains controversial. Modified fixation with Kirschner wires (K-wires) was described as a feasible and safe alternative. However, clinical follow-up of patients treated with this technique is lacking. Aims: To assess patient-reported outcomes (PROMs) in patients treated with PAO with the K-wire fixation technique and to compare it with the screw fixation technique. Methods: We conducted an analysis of 202 consecutive PAOs at a single university center between January 2015 and June 2017. A total of 120 cases with complete datasets were included in the final analysis. PAOs with K-wire fixation (n = 63) were compared with screw fixation (n = 57). Mean follow-up was 63 ± 10 months. PROMs assessed included the International Hip Outcome Tool (iHOT 12), Subjective Hip Value (SHV), and UCLA activity score (UCLA). Pain and patient satisfaction (NRS) were evaluated. Joint preservation was defined as non-conversion to total hip arthroplasty (THA). Results: Preoperative baseline PROMs in both fixation groups were similar. In both groups, PROMs (p = <0.001) and pain (p = <0.001) improved significantly. Postoperative functional outcome was similar in both groups: iHOT 12 (71.8 ± 25.1 vs. 73 ± 21.1; p = 0.789), SHV (77.9 ± 21.2 vs. 82.4 ± 13.1; p = 0.192), UCLA (6.9 ± 1.6 vs. 6.9 ± 1.9; p = 0.909), and pain (2.4 ± 2.1 vs. 2.0 ± 2.1; p = 0.302). Patient satisfaction did not differ significantly (7.6 ± 2.6 vs. 8.2 ± 2.2; p = 0.170). Conversion to THA was low in both groups (two vs. none; p = 0.497). Conclusion: Periacetabular osteotomy with K-wire fixation provided good clinical results at mid-term follow-up, comparable to those of screw fixation. The technique can therefore be considered a viable option when deciding on the fixation technique in PAO. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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10 pages, 1422 KiB  
Article
Overall Accuracy of Radiological Digital Planning for Total Hip Arthroplasty in a Specialized Orthopaedics Hospital
by Serban Dragosloveanu, Mihnea-Alexandru Petre, Mihai Emanuel Gherghe, Dana-Georgiana Nedelea, Cristian Scheau and Romica Cergan
J. Clin. Med. 2023, 12(13), 4503; https://doi.org/10.3390/jcm12134503 - 5 Jul 2023
Cited by 8 | Viewed by 936
Abstract
Preoperative radiological planning is a key factor in the prediction of implant size and positioning that influences surgical time, the risk of complications, and functional outcomes. We have tested the accuracy of the digital templating performed in our hospital for a sample of [...] Read more.
Preoperative radiological planning is a key factor in the prediction of implant size and positioning that influences surgical time, the risk of complications, and functional outcomes. We have tested the accuracy of the digital templating performed in our hospital for a sample of 215 patients that underwent total hip arthroplasty. We assessed the accuracy of correctly predicting implant size for the femoral and acetabular components, as well as the stem neck length. We found that our method of templating proved accurate (within one size) in 95.8% of cases for the stem and 94.9% for the cup when using the anteroposterior view only, while the lateral view was accurate in 95.8% of cases for the stem and 97.2% for the cup. Exact prediction of the stem size was obtained in 77.7% of cases using the anteroposterior view and 67.0% of cases on the lateral view, and 73.0% and 74.4% of cases for the cup on the AP and LL views, respectively. Stem neck size was predicted exactly in 75.35% of cases and within one size in 93.49% of cases. We concluded that our method of digital templating using dedicated software is highly effective in accurately predicting implant size. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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10 pages, 9348 KiB  
Article
A Monocortical Screw for Preventing Trochanteric Escape in Extended Trochanteric Osteotomy: A Simple Solution to a Complicated Problem?
by Petros Ismailidis, Annegret Mündermann and Karl Stoffel
J. Clin. Med. 2023, 12(8), 2947; https://doi.org/10.3390/jcm12082947 - 18 Apr 2023
Viewed by 1171
Abstract
Extended trochanteric osteotomy (ETO) is an established method in revision total hip arthroplasty. Proximal migration of the greater trochanter fragment and the resulting non-union of the osteotomy remains a major problem, and several techniques have been developed to prevent its occurrence. This paper [...] Read more.
Extended trochanteric osteotomy (ETO) is an established method in revision total hip arthroplasty. Proximal migration of the greater trochanter fragment and the resulting non-union of the osteotomy remains a major problem, and several techniques have been developed to prevent its occurrence. This paper describes a novel modification of the original surgical technique in which a single monocortical screw is placed distally to one of the cerclages used for the fixation of the ETO. The contact between the screw and the cerclage counteracts the forces applied on the greater trochanter fragment and prevents trochanteric escape under the cerclage. The technique is simple and minimally invasive, does not require special skills or additional resources, or add to surgical trauma or operating time, and therefore represents a simple solution to a complicated problem. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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9 pages, 3405 KiB  
Article
The Female Pelvis Is Associated with a Lateralized Ischium and a Reduced Ischiofemoral Space
by Sufian S. Ahmad, Christian Konrads, Marcel Niemann, Ulrich Stöckle, Henning Windhagen and Gregor M. Giebel
J. Clin. Med. 2023, 12(4), 1603; https://doi.org/10.3390/jcm12041603 - 17 Feb 2023
Viewed by 2852
Abstract
Background: Pelvi-femoral conflicts are increasingly recognized for their explanatory role in the pathology of extra-articular hip impingement. Ischiofemoral impingement (IFI) is a type of impingement between the femur and the ischium that causes high femoral antetorsion and valgus femoral neck orientation. It is [...] Read more.
Background: Pelvi-femoral conflicts are increasingly recognized for their explanatory role in the pathology of extra-articular hip impingement. Ischiofemoral impingement (IFI) is a type of impingement between the femur and the ischium that causes high femoral antetorsion and valgus femoral neck orientation. It is unknown whether obstetric adaptation of the female pelvis renders the female hip at a higher risk of sustaining IFI. The aim of this study was to determine the influence of the pelvic morphology on the ischiofemoral space (IFS). Methods: Plain radiographs of healthy individuals with no symptomatic hip disease were obtained in a functional standing position in a standardized manner and utilized for measurement of the interischial and ischiofemoral widths, subpubic angle, and centrum collum diaphyseal (CCD) angle. Linear regression was performed to determine the influence of morphometric measures on the ischiofemoral space. Results: Sixty-five radiographs (34 females and 31 males) were included. The cohort was stratified according to gender. Significant gender-related differences were noted regarding the ischiofemoral distance (31% increase in males, p < 0.001), pubic-arc angle (30% increased in females, p < 0.001), and the interischial space (7% increase in females, p < 0.001). CCD did not significantly differ between genders (p = 0.2). Factors influencing the IFS include the pubic-arc angle (β = −0.01 (CI −0.02–−0.00), p = 0.003), interischial distance (β = −0.11 (CI −0.23–−0.00), p = 0.049) and CCD (β = −0.06 (CI −0.09–−0.04), p < 0.001). Conclusions: Obstetric adaptation is associated with an increased subpubic angle that shifts the ischia laterally and away from the symphysis. The resultant reduction in the ischiofemoral space renders the female pelvis at a higher risk for a pelvi-femoral conflict, or more precisely, an ischiofemoral conflict, due to the reduced ischiofemoral space of the hip. The CCD angle of the femur was shown not to be gender specific. However, the CCD angle demonstrates an influence on the ischiofemoral space, rendering the proximal femur a target for corresponding osteotomies. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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11 pages, 2403 KiB  
Article
Cup Overhanging in Anatomic Socket Position or High Hip Center of Rotation in Total Hip Arthroplasty for Crowe III and IV Dysplasia: A CT-Based Simulation
by Francesco Castagnini, Federico Giardina, Chiara Fustini, Enrico Tassinari, Barbara Bordini, Monica Cosentino and Francesco Traina
J. Clin. Med. 2023, 12(2), 606; https://doi.org/10.3390/jcm12020606 - 12 Jan 2023
Cited by 1 | Viewed by 2186
Abstract
Cup overhanging in total hip arthroplasty is a predisposing factor to iliopsoas impingement. In dysplastic hips, cup implantation was simulated in an anatomic hip center of rotation (AHCR) and in high hip center (HHCR). We sought to assess: (1) the percentage of prominent [...] Read more.
Cup overhanging in total hip arthroplasty is a predisposing factor to iliopsoas impingement. In dysplastic hips, cup implantation was simulated in an anatomic hip center of rotation (AHCR) and in high hip center (HHCR). We sought to assess: (1) the percentage of prominent cups; (2) quantify the cup protrusion at different sites on frontal, axial and sagittal views. In 40 Crowe III-IV hips, using a 3D CT-based planning software, cup planning in AHCR and HHCR (CR height ≥ 20 mm) was performed for every hip. Cup prominence was assessed on every plane. HHCR cups were less anteverted (p < 0.01), less medialized (p < 0.001) and less caudal (p = 0.01) than AHCR sockets. AHCR cups were more frequently prominent on at least one plane (92.5% vs. 77.5%), with minimal agreement between the two configurations (k = 0.31, p = 0.07). AHCR cups protruded more than HHCR sockets in the sagittal (p = 0.02) and axial planes (p < 0.001). Axially, at the center of the cup, prominence 6–11 mm occurred in nine (22.5%) AHCR and one (2.5%) HHCR socket. In conclusion, while a routine high hip center should not be recommended, cup placement at a center of rotation height < 20 mm is associated with higher rates and magnitudes of anterior cup protrusion in severe dysplasia. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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12 pages, 2153 KiB  
Article
Effects of Severe Varus Deformity on Soft Tissue Balancing in Total Knee Arthroplasty
by Il-Hoon Kwak, Sung-Sahn Lee, Jeounghun Lee and Dae-Hee Lee
J. Clin. Med. 2023, 12(1), 263; https://doi.org/10.3390/jcm12010263 - 29 Dec 2022
Cited by 1 | Viewed by 3963
Abstract
This study aimed to establish the effect of severe varus deformity on soft tissue balance in total knee arthroplasty (TKA), which is not yet well established. We retrospectively enrolled 205 patients (270 knees) who underwent primary TKA using the measured resection technique. Four [...] Read more.
This study aimed to establish the effect of severe varus deformity on soft tissue balance in total knee arthroplasty (TKA), which is not yet well established. We retrospectively enrolled 205 patients (270 knees) who underwent primary TKA using the measured resection technique. Four intraoperatively measured TKA gaps and gap differences were compared between the severe varus deformity group (Hip-knee-ankle [HKA] varus angle ≥ 10°) and the mild varus deformity group (HKA varus angle < 10°). Pearson’s correlation analysis and multiple linear regression analysis were used to investigate the factors affecting flexion and extension gap differences (FGD and EGD). A receiver operating characteristic curve was applied to assess the cut-off value of the HKA varus angle to discriminate the rectangular gap. The FGD (1.42 ± 1.35 mm vs. 1.05 ± 1.16 mm, p = 0.019) and the EGD (1.45 ± 1.32 mm vs. 0.97 ± 1.53 mm, p = 0.006) were significantly larger in severe varus deformity group than in mild varus deformity group. The HKA varus angle was positively correlated with both FGD (r = 0.264, p < 0.001) and EGD (r = 0.319, p < 0.001) and was an influencing factor for FGD (β = 0.232, p = 0.040) and EGD (β = 0.229, p = 0.037). A preoperative HKA angle of 12.4° was selected as the cutoff value to discriminate between rectangular and trapezoidal gaps. Thus, the severity of varus deformity (HKA varus angle) was found to be a significant factor affecting the mediolateral gap difference in TKA. When performing TKA in a knee with an HKA varus angle ≥ 12.4°, a trapezoidal gap is more likely to be expected. Level of evidence III, case–control study. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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10 pages, 1146 KiB  
Article
Peripheral Nerve Block for Pain Management after Total Hip Arthroplasty: A Retrospective Study with Propensity Score Matching
by Heon Jung Park, Kwan Kyu Park, Jun Young Park, Bora Lee, Yong Seon Choi and Hyuck Min Kwon
J. Clin. Med. 2022, 11(18), 5456; https://doi.org/10.3390/jcm11185456 - 16 Sep 2022
Cited by 3 | Viewed by 2351
Abstract
This study aimed to evaluate the effect of a peripheral nerve block (PNB) on immediate postoperative analgesia and the early functional outcomes for patients who underwent total hip arthroplasty (THA). From January 2016 to August 2021, 353 patients who underwent THA were divided [...] Read more.
This study aimed to evaluate the effect of a peripheral nerve block (PNB) on immediate postoperative analgesia and the early functional outcomes for patients who underwent total hip arthroplasty (THA). From January 2016 to August 2021, 353 patients who underwent THA were divided into two groups: the patient-controlled analgesia (PCA) group (n = 217) who received only intravenous (IV) analgesia, and others who received IV PCA and PNB (PCA + PNB group) (n = 136). After propensity score matching for age and sex, 136 patients from each group were included in the study. Primary outcomes were the visual analogue scale (VAS) at rest, activity status at postoperative 6, 24, 48 h. Secondary outcomes were functional scores by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Harris Hip Score (HHS) and rescue medications used. The postoperative VAS at 6, 24, 48 h at rest and 6 h at activity were significantly lower in the PCA + PNB group (p = 0.000, 0.001, 0.000, 0.004 in order). There was no significant difference for postoperative 3-month HHS (p = 0.218), except for 3-month WOMAC index (p = 0.001). There were no significant differences for VAS between the PNB methods except femoral nerve block (FNB) and fascia iliaca compartment block (FICB) at postoperative activity 48 h (p = 0.028). There was no significant difference in the total count and amount of rescue medication (p = 0.091, 0.069) and difference in the quadriceps weakness was not noted. Therefore, PNB is beneficial for patients who undergo THA as it provides sufficient postoperative analgesia, especially during immediate postoperative resting pain without quadriceps weakness. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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10 pages, 2627 KiB  
Article
Lumbosacral Transitional Vertebrae Influence on Acetabular Orientation and Pelvic Tilt
by Luis Becker, Nima Taheri, Henryk Haffer, Maximilian Muellner, Christian Hipfl, Katharina Ziegeler, Torsten Diekhoff and Matthias Pumberger
J. Clin. Med. 2022, 11(17), 5153; https://doi.org/10.3390/jcm11175153 - 31 Aug 2022
Cited by 5 | Viewed by 1281
Abstract
Lumbosacral transitional vertebrae (LSTV) are common congenital variances with a prevalence found in the population up to 35.6%. The literature demonstrates an influence of LSTV on bony pelvic anatomy. The influence on the anatomical acetabular orientation, which is important for cup positioning in [...] Read more.
Lumbosacral transitional vertebrae (LSTV) are common congenital variances with a prevalence found in the population up to 35.6%. The literature demonstrates an influence of LSTV on bony pelvic anatomy. The influence on the anatomical acetabular orientation, which is important for cup positioning in total hip arthroplasty, has not yet been described for patients with LSTV. A total of 53 patients with LSTV were identified from a CT Database including 819 subjects. Fifty patients with LSTV could be included and were matched for age and sex against a control group. We examined the influence of LSTV, classified according to Castellvi, on acetabular orientation and pelvic tilt in the supine position. Functional acetabular anteversion and inclination, assessed against the table plane, were compared against anatomical acetabular anteversion and inclination, assessed against the anterior pelvic plane. The anatomical acetabular inclination correlated with the pelvic tilt (r = 0.363, p < 0.001). The anatomical acetabular inclination was significantly larger than the functional acetabular inclination in the supine position (p < 0.001). Castellvi grading of LSTV correlated negatively with pelvic tilt (ρ = −0.387, p = 0.006). Castellvi grading correlated significantly with functional acetabular anteversion (ρ = 0.324, p = 0.022) and anatomical acetabular anteversion (ρ = 0.306, p = 0.022). A higher Castellvi grading was accompanied by a reduced pelvic tilt in the supine position. The functional acetabular anteversion and anatomical acetabular anteversion increased in parallel to the higher Castellvi grading. Therefore, LSTV and Castellvi grading might be assessed on pre-operative X-rays prior to hip arthroplasty and surgeons might consider adjusting cup positioning accordingly. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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7 pages, 568 KiB  
Article
Transversus Abdominis Plane Block Reduces Intraoperative Opioid Consumption in Patients Undergoing Periacetabular Osteotomy
by Jannis Löchel, Georgi I. Wassilew, Michael Krämer, Christopher Kohler, Robert Karl Zahn and Vincent Justus Leopold
J. Clin. Med. 2022, 11(17), 4961; https://doi.org/10.3390/jcm11174961 - 24 Aug 2022
Cited by 1 | Viewed by 1051
Abstract
Background: Administering intraoperative analgesia in patients undergoing periacetabular osteotomy (PAO) is challenging due to both the relevant surgical approach and osteotomies, which are associated with pain. The aim of this study was to assess the effect of the transversus abdominis plane block (TAPb) [...] Read more.
Background: Administering intraoperative analgesia in patients undergoing periacetabular osteotomy (PAO) is challenging due to both the relevant surgical approach and osteotomies, which are associated with pain. The aim of this study was to assess the effect of the transversus abdominis plane block (TAPb) on intraoperative opioid consumption and circulation parameters in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial involving 42 consecutive patients undergoing PAO for symptomatic developmental dysplasia of the hip (DDH) in our department. Patients assigned to the study group received an ultrasound-guided TAPb with 0.75% ropivacaine before the beginning of the surgery and after general anesthesia induction. Patients assigned to the control group did not receive a TAPb. General anesthesia was conducted according to a defined study protocol. The primary endpoint of the study was the intraoperative opioid consumption, measured in morphine equivalent dose (MED). Secondary endpoints were the assessment of intraoperative heart rate, mean arterial pressure (MAP), need for hypotension treatment, and length of hospital stay (LOHS). A total of 41 patients (n = 21 TAPb group, n = 20 control group) completed the study; of these, 33 were women (88.5%) and 8 were men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All operations were performed by a single high-volume surgeon and all TAPb procedures were performed by a single experienced senior anesthesiologist. Results: We observed a significantly lower intraoperative opioid consumption in the TAPb group compared to the control group (930 vs. 1186 MED per kg bodyweight; p = 0.016). No significant differences were observed in the secondary outcome parameters. We observed no perioperative complications. Conclusion: Ultrasound-guided TAPb significantly reduces intraoperative opioid consumption in patients undergoing PAO. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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9 pages, 1261 KiB  
Article
Periacetabular Osteotomy and Postoperative Pregnancy—Is There an Influence on the Mode of Birth?
by Friederike Schömig, Christian Hipfl, Jannis Löchel, Carsten Perka, Sebastian Hardt and Vincent Justus Leopold
J. Clin. Med. 2022, 11(16), 4836; https://doi.org/10.3390/jcm11164836 - 18 Aug 2022
Cited by 1 | Viewed by 1292
Abstract
As a surgical treatment option in symptomatic developmental dysplasia of the hip, periacetabular osteotomy (PAO) is often performed in female patients of childbearing age. Yet, to date, little is known about the procedure’s influence on postoperative pregnancies and the mode of delivery. Our [...] Read more.
As a surgical treatment option in symptomatic developmental dysplasia of the hip, periacetabular osteotomy (PAO) is often performed in female patients of childbearing age. Yet, to date, little is known about the procedure’s influence on postoperative pregnancies and the mode of delivery. Our study’s aim therefore was to investigate patient and physician decision making in women after PAO. We invited all patients who had undergone PAO in our institution from January 2015 to June 2017 to participate in a paper-based survey. Of these, we included all female patients and performed a retrospective chart review as well as analysis of pre- and postoperative radiological imaging. A total of 87 patients were included, 20 of whom gave birth to 26 children after PAO. The mean overall follow-up was 5.3 ± 0.8 years. Four (20.0%) patients reported that their obstetrician was concerned due to their history of PAO. The mean time before the first child’s birth was 2.9 ± 1.3 years. Eleven (55.0%) patients underwent cesarean section for the first delivery after PAO, three of whom reported their history of PAO as the reason for this type of delivery. Patients with a history of PAO have a higher risk of delivering a child by cesarean section compared with the general population, in which the rate of cesarean section is reported to be 29.7%. As cesarean sections are associated with increased morbidity and mortality compared with vaginal deliveries, evidence-based recommendations for pregnancies after pelvic osteotomy are needed. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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6 pages, 561 KiB  
Article
Intraoperative Fluoroscopy Allows the Reliable Assessment of Deformity Correction during Periacetabular Osteotomy
by Johannes Christian Reichert, André Hofer, Georg Matziolis and Georgi Iwan Wassilew
J. Clin. Med. 2022, 11(16), 4817; https://doi.org/10.3390/jcm11164817 - 17 Aug 2022
Cited by 3 | Viewed by 1253
Abstract
We aimed to determine the accuracy and reliability of measures characterizing anterior, lateral, and posterior acetabular coverage on intraoperative fluoroscopic images compared to postoperative radiographs when performing periacetabular osteotomies (PAOs). A study involving 100 PAOs was initiated applying a standardized intraoperative imaging protocol. [...] Read more.
We aimed to determine the accuracy and reliability of measures characterizing anterior, lateral, and posterior acetabular coverage on intraoperative fluoroscopic images compared to postoperative radiographs when performing periacetabular osteotomies (PAOs). A study involving 100 PAOs was initiated applying a standardized intraoperative imaging protocol. Coverage was determined by the lateral center edge angle (LCEA), the Tönnis angle (TA), and the anterior and posterior wall index (AWI, PWI). An intraclass correlation coefficient (ICC) model was used to assess interrater (ICC (3,2)) and intrarater (ICC (2,1)) reliability. The ICC (2,2) between analyses obtained from intraoperative fluoroscopy and postoperative radiographs and the corresponding 95% confidence interval (CI) were determined and complemented by Bland–Altman analysis, the mean difference, and 95% limits of agreement (LOA). The ICCs were 0.849 for the LCEA (95% CI 0.783–0.896), 0.897 for the TA (95% CI 0.851–0.930), 0.864 for the AWI (95% CI 0.804–0.907), and 0.804 for the PWI (0.722–0.864). The assessed interrater reliability was excellent except for the AWI, which was graded good (ICC = 0.857, 95% CI 0.794–0.902). Interrater agreement was generally good and fair for the AWI (ICC = 0.715, 95% CI 0.603–0.780). For each postoperative radiograph, interrater reliability was good with ICCs ranging from 0.813 (TA) to 0.881 (PWI). Intrarater reliability was good for all measurements and excellent for the preoperative TA (ICC = 0.993, 95% CI 0.984–0.997) and PWI (ICC = 0.954, 95% CI 0.919–0.97). In summary, we confirm the validity and reliability of intraoperative fluoroscopy as an alternative imaging modality to radiography to evaluate acetabular fragment orientation during PAO. We affirm the LCEA and TA as precise measures for lateral head coverage, and show the suitability of the AWI and PWI to steadily assess acetabular version. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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10 pages, 594 KiB  
Article
Diagnostic Accuracy for Periprosthetic Joint Infection Does Not Improve by a Combined Use of Glucose and Leukocyte Esterase Strip Reading as Diagnostic Parameters
by Marco Haertlé, Louisa Kolbeck, Christian Macke, Tilman Graulich, Ricarda Stauß and Mohamed Omar
J. Clin. Med. 2022, 11(11), 2979; https://doi.org/10.3390/jcm11112979 - 25 May 2022
Cited by 1 | Viewed by 1415
Abstract
The diagnosis of periprosthetic infections (PJI) can be challenging in clinical practice because the clinical presentations of aseptic loosening and low-grade infections are similar. Semiquantitative evaluation of leukocyte esterase (LE) in synovial fluid using a urine strip test has already established itself as [...] Read more.
The diagnosis of periprosthetic infections (PJI) can be challenging in clinical practice because the clinical presentations of aseptic loosening and low-grade infections are similar. Semiquantitative evaluation of leukocyte esterase (LE) in synovial fluid using a urine strip test has already established itself as a diagnostic method over the past decade. The analysis of LE in synovial fluid leads to a high number of false-positive test results. In the present study, the value of a combined semiquantitative determination of glucose and LE in synovial fluid to improve the diagnosis of PJI was investigated. Over a 4-year period, 145 synovial samples were collected from patients who developed joint effusion after arthroplasty. LE and glucose test strips were considered as an index test for the diagnosis of PJI. A ++ or +++ LE and a negative glucose test strip reading were considered as positive test results. Modified diagnostic criteria for PJI as recommended by the Musculoskeletal Infection Society (MSIS) served as the reference test, except that intraoperative findings were excluded. Forty-six out of 145 samples were classified as septic complication according to the reference test. In regard to PJI, our data showed that combined use of LE and glucose strip test reading displayed a 98.0% specificity (95% confidence interval (CI): 95.2% to 100%), a 50% sensitivity (95% CI: 35.6% to 64.4%), a 92% positive predictive value (95% CI: 81.4% to 100.0%), and an 80.3% negative predictive value (95% CI: 73.2% to 87.4%). In contrast, the exclusive analysis of LE on the urine strip to diagnose PJI demonstrated a 90.9% specificity (95% CI: 85.2% to 96.6%), a 67.4% sensitivity (95% CI: 53.8% to 80.9%), a 77.5% positive predictive value (95% CI: 64.6% to 90.4%), and an 85.7% negative predictive value (5% CI: 79.0% to 92.4%). A combination of LE and glucose test pad reading is considered superior as a potential “rule-in” method for the diagnosis of PJI compared with LE test pad analysis alone. However, combined LE and glucose synovial fluid testing also demonstrated lower test sensitivity and thus diagnostic accuracy compared with LE analysis alone. Therefore, combined glucose and LE test pad analysis does not represent a sufficient diagnostic standard to exclude PJI with certainty. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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8 pages, 386 KiB  
Article
Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections
by Marcel Niemann, Ellen Otto, Karl F. Braun, Frank Graef, Sufian S. Ahmad, Sebastian Hardt, Ulrich Stöckle, Andrej Trampuz and Sebastian Meller
J. Clin. Med. 2022, 11(10), 2730; https://doi.org/10.3390/jcm11102730 - 12 May 2022
Cited by 1 | Viewed by 1287
Abstract
Background: Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification. Objective: This study investigates the potential benefit of OIB [...] Read more.
Background: Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification. Objective: This study investigates the potential benefit of OIB in THA and TKA patients with suspected PJI and ambigious diagnostic results following synovial fluid aspiration. Methods: We retrospectively assessed all patients treated from 2016 to 2020 with suspected PJI. Comparing the microbiology of OIB and the following revision surgery, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the number needed to treat (NNT). Results: We examined the diagnostic validity of OIB in 38 patients (20 female) with a median age of 66.5 years. In THA patients (n = 10), sensitivity was 75%, specificity was 66.67%, PPV was 60%, NPV was 80%, and NNT was 2.5. In TKA patients (n = 28), sensitivity was 62.5%, specificity was 95.24%, PPV was 83.33%, NPV was 86.96%, and NNT was 1.42. Conclusions: Our results indicate that OIB represents an adequate diagnostic tool when previously assessed microbiological results remain inconclusive. Particularly in TKA patients, OIB showed an exceptionally high specificity, PPV, and NPV, whereas the predictive validity of the diagnosis of PJI in THA patients remained low. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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Review

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8 pages, 246 KiB  
Review
Graft Intra-Articular Remodeling and Bone Incorporation in ACL Reconstruction: The State of the Art and Clinical Implications
by Lorenzo Moretti, Davide Bizzoca, Giuseppe Danilo Cassano, Nuccio Caringella, Michelangelo Delmedico and Biagio Moretti
J. Clin. Med. 2022, 11(22), 6704; https://doi.org/10.3390/jcm11226704 - 12 Nov 2022
Cited by 8 | Viewed by 2206
Abstract
The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous [...] Read more.
The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous activity. There are different surgical techniques and different possible usable grafts. The graft used for ACLR surgery undergoes a bone incorporation process and an intra-articular remodelling named ligamentization until it reaches characteristics similar to the native ligament. After the first incorporation stage, the remodelling process is divided into an early stage that could last 4 weeks, a proliferative stage that lasts 4 to 12 weeks, and a final stage of ligamentization that could last over 1 year. The period of return to sport (RTS) after ACLR, which is becoming shorter and shorter, can be a high-risk period for athletes due to the risk of graft failure. This systematic review aims to define the phases of the ligamentization process considering graft type and fixation techniques, as well as the graft’s anatomopathological and biomechanical characteristics, to evaluate a criterion-based rehab progression and maximize patient outcomes for an RTS respecting graft biology. The rehabilitative program has to promote and optimize the graft remodelling and incorporation processes; moreover, it has to accommodate physiological graft healing and avoid overloading. An early RTS and noncompliance with the biological characteristics of the graft in the various phases are associated with a high incidence of re-injury. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
14 pages, 3524 KiB  
Review
The Scientific Evolution of Periacetabular Osteotomy: A Global Review
by Sufian S. Ahmad, Marco Haertlé, Christian Konrads, Alexander Derksen, Henning Windhagen and Nils Wirries
J. Clin. Med. 2022, 11(20), 6099; https://doi.org/10.3390/jcm11206099 - 17 Oct 2022
Cited by 6 | Viewed by 2323
Abstract
It is well-known that hip disorders are frequently of bony origin related to an underlying pathomorphology. A fundamental understanding of morphology and biomechanics is therefore of essential importance for a targeted approach in defining treatment plans. Treatment is frequently based on altering bony [...] Read more.
It is well-known that hip disorders are frequently of bony origin related to an underlying pathomorphology. A fundamental understanding of morphology and biomechanics is therefore of essential importance for a targeted approach in defining treatment plans. Treatment is frequently based on altering bony morphology, for which a set of effective techniques have been proposed. Periacetabular osteotomy (PAO) allows for reorientation of the acetabulum and powerful correction of acetabular coverage. The revolutionary aspect of PAO compared to prior osteotomies lies in maintenance of the integrity of the posterior column. This allows for a substantial increase in primary stability, a larger bony surface for healing, and simple reorientation of the acetabular fragment that is free of posterior ligamentous restraints. The results for dysplasia are very promising. Indications have been refined by studies revealing that the presence of degenerative changes and age > 40 years at the time of surgery represent prognostic factors of poorer outcome. Indications have also been broadened to include acetabular retroversion (with posterolateral dysplasia) and borderline hip dysplasia. A glimpse at the future would reflect major advances related to individual planning, surgical training, and precise surgical conduction. In the era of digitalization, augmented reality may assist in performing bony cuts and act as an aid for some of the blind ischial and retro-acetabular cuts. Innovations in perioperative management will enhance recovery after the procedure and allow for early recovery programs with optimized protocols of pain management. Considering that the success of PAO in the young is comparable to the success of hip arthroplasty in the old, PAO should be considered one of the pillars of modern orthopedic surgery. Full article
(This article belongs to the Special Issue Advances in Adult Hip and Knee Surgery)
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