Total Hip Arthroplasty—Current Challenges

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (22 September 2022) | Viewed by 34665

Special Issue Editor


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Guest Editor
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Interests: hip; arthroplasty; fracture (acetabulum; periprosthetic); orthogeriatric
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Special Issue Information

Dear Colleagues,

In 1891, Professor Themistocles Glück in Germany was the first to replace a femoral head in hip joints destroyed by tuberculosis using ivory, followed by Marius Smith-Petersen in 1925 using a mold arthroplasty out of glass. Further attempts in hip joint replacement followed until Sir Jon Charnely significantly advanced total hip arthroplasty in the 1960s. In the following decades, further innovations in materials and design enhanced the outcome. As a result of the enhanced survivorship and low revision rates in 2007, total hip replacement was called the “operation of the century”. However, due to an increasing number of performed total hip arthroplasties in an aging population, hip surgeons have to face various challenges in 2021 and in the near future.

The aim and scope of this Special Issue is to discuss current and future challenges in primary and revision total hip arthroplasty (THA) such as (i) primary complex THA (Perthes diseases, DDH, post-traumatic conditions, acetabular fractures, bone loss/osteolysis, osteoporosis), (ii) complication management (instability, infection, periprosthetic fractures at the femoral and acetabular site), (iii) in specific patients (young, very demanding, older adults, obesity, dissatisfied patients, when to deny a total hip), (iv) modern patient management protocols (prehabilitation, enhanced recovery protocols, fast track surgery, orthogeriatric co-management), (v) outcome analysis (focus on PROMS, predictors and strategies to improve satisfaction), (vi) revision surgery (cement in cement, modularity, dual mobility, trunnionosis, metallosis, pseudotumor), and (vii) new technologies in cutting-edge research topics (robotic surgery, virtual versus augmented reality, 3D printing, learning curves, teaching).

We are soliciting preclinical studies (anatomical, biomechanical, technical reports) and clinical studies (PROM, outcome, registry data, epidemiological), with a focus on original articles. For the submission of reviews, reporting according to the PRISMA guidelines is required.

Prof. Dr. Johannes Dominik Bastian
Guest Editor

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Keywords

  • hip
  • arthroplasty
  • replacement
  • complex
  • Perthes
  • dysplasia
  • complication
  • PROM
  • outcome
  • robotic

Published Papers (12 papers)

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Editorial

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3 pages, 244 KiB  
Editorial
Total Hip Arthroplasty—Current Challenges
by Johannes Dominik Bastian
Medicina 2023, 59(6), 1011; https://doi.org/10.3390/medicina59061011 - 24 May 2023
Viewed by 1246
Abstract
In 1891, Professor Themistocles Glück in Germany was the first to replace a femoral head in hip joints destroyed by tuberculosis using ivory [...] Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)

Research

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13 pages, 8224 KiB  
Article
Revision of a Failed Primary Total Hip Arthroplasty following Excessive Reaming with a Medial Cup Protrusion
by Silviya Ivanova, Nicolas Vuillemin, Onur Hapa, Klaus A. Siebenrock, Marius J. B. Keel, Theodoros H. Tosounidis and Johannes D. Bastian
Medicina 2022, 58(9), 1254; https://doi.org/10.3390/medicina58091254 - 10 Sep 2022
Cited by 3 | Viewed by 2403
Abstract
Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing [...] Read more.
Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing to this uncommon complication and presents the outcome after the revision surgery using the Ganz reinforcement ring combined with a bone graft and plating of the posterior column and/or screws for the anterior column. Materials and Methods: A retrospective case series study with seven patients (four males, mean age 76 ± 10 years (60–86)) that underwent a revision THA within 24 ± 17 days (5–60) after an atraumatic periprosthetic acetabular fracture with a medial cup protrusion was performed. All fractures were reconstructed with a Ganz reinforcement ring and bone graft with a mean follow-up of 1.7 ± 1.7 years (0.5–5). Radiographs were evaluated for the following: (i) cup positioning immediately after the primary THA and the revision surgery, (ii) cup migration in the follow-up, and (iii) fracture healing. Results: The position of the acetabular component as assessed on the postoperative radiographs after the index surgery and before the complete medial cup protrusion showed a cup placement beyond the ilioischial line indicative of a fracture of the medial wall. The revision surgery with the reconstruction of the medial wall with a Ganz reinforcement ring combined with a bone graft restored in the presented cases the center of rotation in the horizontal direction with a statistical significance (p < 0.05). During the follow-up, there was no aseptic loosening with the relevant cup migration or significant change in the position of the acetabular cup at the final follow-up (p > 0.05) after the revision. All seven fractures and bone grafts realized a bone union until the latest follow-up. Conclusions: Following excessive reaming, the acetabular component was placed too far medially and resulted in an intrapelvic cup protrusion. An unstable cup following a fracture of the medial wall was evident on the immediate postoperative radiographs. In the case of the medial wall perforation with an intrapelvic cup protrusion after the primary THA, the reconstruction with a Ganz reinforcement ring was a successful treatment option resulting in the fracture healing and a stable cup positioning. Surgeons should be aware of that rare and probably underreported complication and restore the anatomic center of rotation by treating the defect intraoperatively. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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12 pages, 2151 KiB  
Article
Image-Less THA Cup Navigation in Clinical Routine Setup: Individual Adjustments, Accuracy, Precision, and Robustness
by Corinne A. Zurmühle, Benjamin Zickmantel, Matthias Christen, Bernhard Christen, Guoyan Zheng, Joseph M. Schwab, Moritz Tannast and Simon D. Steppacher
Medicina 2022, 58(6), 832; https://doi.org/10.3390/medicina58060832 - 20 Jun 2022
Cited by 5 | Viewed by 2591
Abstract
Background and Objectives: Even after the ‘death’ of Lewinnek’s safe zone, the orientation of the prosthetic cup in total hip arthroplasty is crucial for success. Accurate cup placement can be achieved with surgical navigation systems. The literature lacks study cohorts with large [...] Read more.
Background and Objectives: Even after the ‘death’ of Lewinnek’s safe zone, the orientation of the prosthetic cup in total hip arthroplasty is crucial for success. Accurate cup placement can be achieved with surgical navigation systems. The literature lacks study cohorts with large numbers of hips because postoperative computer tomography is required for the reproducible evaluation of the acetabular component position. To overcome this limitation, we used a validated software program, HipMatch, to accurately assess the cup orientation based on an anterior-posterior pelvic X-ray. The aim of this study were to (1) determine the intraoperative ‘individual adjustment’ of the cup positioning compared to the widely suggested target values of 40° of inclination and 15° of anteversion, and evaluate the (2) ‘accuracy’, (3) ‘precision’, and (4) robustness, regarding systematic errors, of an image-free navigation system in routine clinical use. Material and Methods: We performed a retrospective, accuracy study in a single surgeon case series of 367 navigated primary total hip arthroplasties (PiGalileoTM, Smith+Nephew) through an anterolateral approach performed between January 2011 and August 2018. The individual adjustments were defined as the differences between the target cup orientation (40° of inclination, 15° of anteversion) and the intraoperative registration with the navigation software. The accuracy was the difference between the intraoperative captured cup orientation and the actual postoperative cup orientation determined by HipMatch. The precision was analyzed by the standard deviation of the difference between the intraoperative registered and the actual cup orientation. The outliers were detected using the Tukey method. Results: Compared to the target value (40° inclination, 15° anteversion), the individual adjustments showed that the cups are impacted in higher inclination (mean 3.2° ± 1.6°, range, (−2)–18°) and higher anteversion (mean 5.0° ± 7.0°, range, (−15)–23°) (p < 0.001). The accuracy of the navigated cup placement was −1.7° ± 3.0°, ((−15)–11°) for inclination, and −4.9° ± 6.2° ((−28)–18°) for anteversion (p < 0.001). Precision of the system was higher for inclination (standard deviation SD 3.0°) compared to anteversion (SD 6.2°) (p < 0.001). We found no difference in the prevalence of outliers for inclination (1.9% (7 out of 367)) compared to anteversion (1.63% (6 out of 367), p = 0.78). The Bland-Altman analysis showed that the differences between the intraoperatively captured final position and the postoperatively determined actual position were spread evenly and randomly for inclination and anteversion. Conclusion: The evaluation of an image-less navigation system in this large study cohort provides accurate and reliable intraoperative feedback. The accuracy and the precision were inferior compared to CT-based navigation systems particularly regarding the anteversion. However the assessed values are certainly within a clinically acceptable range. This use of image-less navigation offers an additional tool to address challenging hip prothesis in the context of the hip–spine relationship to achieve adequate placement of the acetabular components with a minimum of outliers. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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11 pages, 2492 KiB  
Article
Accuracy and Reliability of Software Navigation for Acetabular Component Placement in THA: An In Vitro Validation Study
by Alex W. Brady, Jakub Tatka, Lorenzo Fagotti, Bryson R. Kemler and Bradley W. Fossum
Medicina 2022, 58(5), 663; https://doi.org/10.3390/medicina58050663 - 14 May 2022
Cited by 4 | Viewed by 1936
Abstract
Background and Objectives: Intraoperative fluoroscopy can be used to increase the accuracy of the acetabular component positioning during total hip arthroplasty. However, given the three-dimensional nature of cup positioning, it can be difficult to accurately assess inclination and anteversion angles based on [...] Read more.
Background and Objectives: Intraoperative fluoroscopy can be used to increase the accuracy of the acetabular component positioning during total hip arthroplasty. However, given the three-dimensional nature of cup positioning, it can be difficult to accurately assess inclination and anteversion angles based on two-dimensional imaging. The purpose of this study is to validate a novel method for calculating the 3D orientation of the acetabular cup from 2D fluoroscopic imaging. Materials and Methods: An acetabular cup was implanted into a radio-opaque pelvis model in nine positions sequentially, and the inclination and anteversion angles were collected in each position using two methods: (1) a coordinate measurement machine (CMM) was used to establish a digitalized anatomical coordinate frame based on pelvic landmarks of the cadaveric specimen, and the 3D position of the cup was then expressed with respect to the anatomical planes; (2) AP radiographic images were collected, and a mathematical formula was utilized to calculate the 3D inclination and anteversion based on the 2D images. The results of each method were compared, and interrater and intrarater reliably of the 2D method were calculated. Results: Interrater reliability was excellent, with an interclass correlation coefficient (ICC) of 0.988 (95% CI 0.975–0.994) for anteversion and 0.997 (95% CI 0.991–0.999) for inclination, as was intrarater reliability, with an ICC of 0.995 (95% CI 0.985–0.998) for anteversion and 0.998 (95% CI 0.994–0.999) for inclination. Intermethod accuracy was excellent with an ICC of 0.986 (95% CI: 0.972–0.993) for anteversion and 0.993 (95% CI: 0.989–0.995) for inclination. The Bland–Altman limit of agreement, which represents the error between the 2D and 3D methods, was found to range between 2 to 5 degrees. Conclusions: This data validates the proposed methodology to calculate 3D anteversion and inclination angles based on 2D fluoroscopic images to within five degrees. This method can be utilized to improve acetabular component placing intraoperatively and to check component placement postoperatively. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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11 pages, 2562 KiB  
Article
Indication Criteria for Total Hip Arthroplasty in Patients with Hip Osteoarthritis—Recommendations from a German Consensus Initiative
by Cornelia Lützner, Stefanie Deckert, Klaus-Peter Günther, Anne Elisabeth Postler, Jörg Lützner, Jochen Schmitt, David Limb and Toni Lange
Medicina 2022, 58(5), 574; https://doi.org/10.3390/medicina58050574 - 22 Apr 2022
Cited by 3 | Viewed by 2406
Abstract
Background: Osteoarthritis of the hip (hip OA) is a leading cause of pain and disability in elderly people. If non-surgical therapies become ineffective, patients may consider total hip arthroplasty (THA). The biggest challenge in recommending a THA is identifying patients for whom the [...] Read more.
Background: Osteoarthritis of the hip (hip OA) is a leading cause of pain and disability in elderly people. If non-surgical therapies become ineffective, patients may consider total hip arthroplasty (THA). The biggest challenge in recommending a THA is identifying patients for whom the benefits of this procedure outweigh the potential risks. The aim of this initiative was to develop a clinical practice guideline with accompanying algorithm to guide consultations on THA, supported by a pocket-sized checklist. Methods: The initiative “Evidence- and consensus-based indication criteria for total hip replacement (EKIT-Hip)” used a stepwise approach, starting with an inauguration workshop, where a multidisciplinary German stakeholder panel from various scientific societies agreed on the working process. A Project Coordinating Group (PCG) was formed, and it performed a comprehensive systematic literature search of guidelines and systematic reviews related to the indication criteria for THA, as well as factors influencing outcomes. Based on best-available evidence, preliminary recommendations were formulated by the PCG and discussed with the stakeholder panel during a consensus meeting. In addition, the panel was asked to assess the feasibility of an extracted algorithm and to approve a final checklist. Results: In total, 31 recommendations were approved by 29 representatives of 23 societies. These were used to underpin an algorithm (EKIT-Algorithm), which indicates the minimum requirements for a THA (confirmed diagnosis of hip OA, present and documented individual burden of illness, ineffectiveness of non-surgical therapies, and absence of any contraindications). Once these criteria are fulfilled, further considerations should encompass the medical implications of modifiable risk factors and patients’ individual treatment goals, as discussed during shared decision making. The subsequently developed checklist (EKIT-Checklist) lists relevant criteria for decision making. Conclusions: Adherence to the EKIT-Algorithm, conveniently accessed via the EKIT-Checklist, should improve the standardization of decision making leading to a recommendation for THA. By applying minimum requirements and patient-related risk factors, as well as considering patients’ individual goals, it is possible to identify patients for whom the benefits of THA may exceed the potential risks. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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8 pages, 2301 KiB  
Article
Association between Hip Center Position and Isokinetic Hip Muscle Performance after Anterolateral Muscle-Sparing Total Hip Arthroplasty
by Hidetatsu Tanaka, Norikazu Yamada, Hiroaki Kurishima, Yu Mori and Toshimi Aizawa
Medicina 2022, 58(4), 538; https://doi.org/10.3390/medicina58040538 - 13 Apr 2022
Cited by 6 | Viewed by 1862
Abstract
Background and objectives: The superior placement of the acetabular cup induced the delayed recovery of abductor muscle moment after total hip arthroplasty (THA) with a conventional posterior approach. The anterior-based muscle-sparing (ABMS) THA effectively reduces soft tissue damage, including muscles. The influence of [...] Read more.
Background and objectives: The superior placement of the acetabular cup induced the delayed recovery of abductor muscle moment after total hip arthroplasty (THA) with a conventional posterior approach. The anterior-based muscle-sparing (ABMS) THA effectively reduces soft tissue damage, including muscles. The influence of hip center position on anterior-based muscle-sparing (ABMS) total hip arthroplasty (THA) for post-operative hip muscle strength was unclear. We evaluate whether the hip center position affects the recovery of hip muscle strength after ABMS THA. Materials and Methods: The study was performed as a retrospective cohort study, and included 38 hips in 38 patients that underwent primary ABMS THA. Muscle strength was measured using isokinetic dynamometry before the operation, and at 6 and 12 months after surgery. The horizontal and vertical centers of rotation (H-COR and V-COR), vertical shift (V-shift), leg length, and global femoral offset were determined radiographically in reference to a previous report. Results: A weak negative correlation was observed between abduction muscle strength at 6 months and V-shift; a V-shift more than 15 mm demonstrated significantly decreased abductor muscle strength at 6 months. Conclusions: The superior placement of the hip center caused delayed recovery of abductor muscle strength in hips with anterolateral minimally invasive THA. There seems to exist no biomechanical reason why the same should not also be the case for the muscle-sparing approach. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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9 pages, 1450 KiB  
Article
Dual Mobility Cups as the Routine Choice in Total Hip Arthroplasty
by Ignacio Aguado-Maestro, Inés de Blas-Sanz, Ana Elena Sanz-Peñas, Silvia Virginia Campesino-Nieto, Jesús Diez-Rodríguez, Sergio Valle-López, Alberto Espinel-Riol, Diego Fernández-Díez and Manuel García-Alonso
Medicina 2022, 58(4), 528; https://doi.org/10.3390/medicina58040528 - 9 Apr 2022
Cited by 9 | Viewed by 3230
Abstract
Background and Objectives: Total hip arthroplasty (THA) is considered the most successful surgical procedure in orthopedics. However, dislocation remains the main indication for surgical revision. New designs of dual mobility cups (DMC) have lowered the classical complications and have extended the indications of [...] Read more.
Background and Objectives: Total hip arthroplasty (THA) is considered the most successful surgical procedure in orthopedics. However, dislocation remains the main indication for surgical revision. New designs of dual mobility cups (DMC) have lowered the classical complications and have extended the indications of DMC in elective surgeries. Our aim is to assess the trend of DMC indications in THA as well as the incidence of their dislocation. Materials and Methods: We retrospectively reviewed all patients undergoing THA with DMC during the years 2015 and 2021. The original indication for DMC included patients sustaining neck of femur fractures (NOF#) and associated risk factors for dislocations. Five years later, DMC was considered our standard of care in total hip arthroplasty. The approach (anterolateral or posterolateral) was chosen by the surgeon according to his/her preferences, as was the implant. Data collected included patients’ demographics, diagnosis, admission time, surgical approach, cup models, and inclination and complications. Patients sustaining a hip dislocation were prospectively reviewed and assessed for treatment received, new dislocations, and need for surgical revision. Two groups were created for the analysis according to the presence or absence of dislocation during follow-up. Results: In the analysis, 531 arthroplasties were included (mean age 72.2 years) with a mean follow-up of 2.86 years. The trend of indications for DMC increased from 16% of THA in 2015 to 78% of THA in 2021. We found a total of 8 dislocations (1.5%), none of them associated with elective surgery. Closed reduction was unsatisfactory in four cases (50%). There was one case of intraprosthetic dislocation. Dislocations were associated to smaller heads (22 mm) (1.5% vs. 25%, p = 0.008) and cups (51.2 mm vs. 48.7 mm, p = 0.038) and posterior approach (62.5% vs. 37.5%, p = 0.011). Conclusion: Dual mobility cups are a great option to reduce the risk of dislocation after a THA both in the neck of femur fractures and elective cases. The use of an anterolateral approach in THA after a neck or femur fracture might considerably decrease the risk of dislocation. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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12 pages, 1405 KiB  
Article
Femoral Head and Liner Exchange in Patients with Atraumatic Dislocation. Results of a Retrospective Study with 6 Years Follow-Up
by Maximilian G. Hanslmeier, Michael W. Maier, Manuel Feisst and Nicholas A. Beckmann
Medicina 2021, 57(11), 1188; https://doi.org/10.3390/medicina57111188 - 1 Nov 2021
Cited by 2 | Viewed by 2400
Abstract
Background and Objectives: Femoral head and liner exchange is an established treatment for polyethylene wear but has had a more limited role in the treatment of other conditions including dislocation, because of concerns about an increased postoperative dislocation rate. Some authors have [...] Read more.
Background and Objectives: Femoral head and liner exchange is an established treatment for polyethylene wear but has had a more limited role in the treatment of other conditions including dislocation, because of concerns about an increased postoperative dislocation rate. Some authors have considered dislocation associated with polyethylene wear to be a contraindication for this procedure. Materials and Methods: Our retrospective review evaluated the outcome of head and liner exchange in a small consecutively operated heterogeneous cohort of 20 patients who presented with dislocation unrelated to trauma, component malposition or component loosening. Of this group, 12 had prior primary total hip arthroplasty, and 8 had prior revision total hip arthroplasty, and included 4 patients with prior revision for dislocation. Mean follow-up was 6 ± 3.5 years (range 1–145 months). Results: Kaplan–Meier analysis revealed a revision-free implant survival from any cause of 80% (confidence interval 95%:64.3–99.6%) at 5 years after head and liner exchange (index surgery). At final follow-up, 83.3% of patients (n = 10) with prior primary total hip arthroplasty and 62.5% of patients (n = 5) with prior revision total hip arthroplasty, had not required subsequent revision for any cause. None (0%) of the primary total hip arthroplasty group and 3 (38%) of the revision arthroplasty group had required revision for further dislocation. Of the eight revision arthroplasty patients, four had a prior revision for dislocation and three of these four patients required further revision for dislocation after index surgery. The fourth patient had no dislocation after index surgery. One additional patient who had prior revision surgery for femoral component fracture suffered dislocation after index surgery, but was successfully treated with closed reduction. Conclusions: In our study population, femoral head and liner exchange was an effective treatment option for patients with prior primary total hip arthroplasty and also for a highly select group of revision total arthroplasty patients with no prior history of dislocation. Femoral head and liner exchange does not appear to be a viable treatment option for patients who have had revision total arthroplasty after prior dislocations. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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Review

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11 pages, 327 KiB  
Review
Sex and Gender-Related Differences in the Outcome of Total Hip Arthroplasty: A Current Concepts Review
by Giuseppe Solarino, Davide Bizzoca, Anna Maria Moretti, Rocco D’Apolito, Biagio Moretti and Luigi Zagra
Medicina 2022, 58(12), 1702; https://doi.org/10.3390/medicina58121702 - 22 Nov 2022
Cited by 18 | Viewed by 2094
Abstract
Background and Objectives: Sex and gender-related differences may influence the outcome of patients undergoing total hip arthroplasty (THA). The present paper aims to depict the importance of sex and gender-related issues in the perioperative management of patients undergoing THA to improve clinical outcomes [...] Read more.
Background and Objectives: Sex and gender-related differences may influence the outcome of patients undergoing total hip arthroplasty (THA). The present paper aims to depict the importance of sex and gender-related issues in the perioperative management of patients undergoing THA to improve clinical outcomes and prevent postoperative complications. Materials and Methods: From January 2002 to August 2022, OVID-MEDLINE, EMBASE, SCOPU S, Web of Science, Google Scholar, and PubMed were searched to identify relevant studies for further analysis. The search strategy included the following terms: ((“gender-related differences” [MeSH Terms] OR “sex-related differences” [All Fields]) OR (“gender indicators” [MeSH Terms] OR “sex” [All Fields])) AND (“total hip arthroplasty” [MeSH Terms] OR (total hip replacement [All Fields])). Results: Twenty-eight papers were included in this current concepts review. Sex and gender-related differences were analyzed with regard to the following points: (1) surgical approach, robotic surgery, scar cosmesis, and implant choice; (2) postoperative clinical outcome and complications; (3) sexual activity after THA; and (4) psychological status and daily functional requirements. The data analysis showed that female patients need more specific attention in the preoperative, intraoperative, and postoperative phases to improve clinical and functional outcomes, reduce complications risk, and manage patient satisfaction. Conclusions: THA outcomes may be influenced by sex and gender-related factors which should be carefully assessed and addressed in patients undergoing surgery to improve the postoperative outcomes of patients’ satisfaction and reduce postoperative complications that can differ between the two sexes. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
18 pages, 5732 KiB  
Review
Robotic-Arm-Assisted Total Hip Arthroplasty: A Review of the Workflow, Outcomes and Its Role in Addressing the Challenge of Spinopelvic Imbalance
by Andrew Ogilvie, Woo Jae Kim, Rhody David Asirvatham, Andreas Fontalis, Pierre Putzeys and Fares S. Haddad
Medicina 2022, 58(11), 1616; https://doi.org/10.3390/medicina58111616 - 9 Nov 2022
Cited by 8 | Viewed by 2607
Abstract
Robotic-arm-assisted total hip arthroplasty (RoTHA) offers the opportunity to improve the implant positioning and restoration of native hip mechanics. The concept of individualised, functional implant positioning and how it relates to spinopelvic imbalance is an important yet rather novel consideration in THA. There [...] Read more.
Robotic-arm-assisted total hip arthroplasty (RoTHA) offers the opportunity to improve the implant positioning and restoration of native hip mechanics. The concept of individualised, functional implant positioning and how it relates to spinopelvic imbalance is an important yet rather novel consideration in THA. There is mounting evidence that a significant percentage of dislocations occur within the perceived “safe zones”; hence, in the challenging subset of patients with a stiff spinopelvic construct, it is imperative to employ individualised component positioning based on the patients’ phenotype. Restoring the native centre of rotation, preserving offset, achieving the desired combined anteversion and avoiding leg length inequality are all very important surgeon-controlled variables that have been shown to be associated with postoperative outcomes. The latest version of the software has a feature of virtual range of motion (VROM), which preoperatively identifies potential dynamic causes of impingement that can cause instability. This review presents the workflow of RoTHA, especially focusing on pragmatic solutions to tackle the challenge of spinopelvic imbalance. Furthermore, it presents an overview of the existing evidence concerning RoTHA and touches upon future direction. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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12 pages, 3835 KiB  
Review
Acetabular Peri-Prosthetic Fractures—A Narrative Review
by Gautier Beckers, Az-Eddine Djebara, Morgan Gauthier, Anne Lubbeke, Axel Gamulin, Matthieu Zingg, Johannes Dominik Bastian and Didier Hannouche
Medicina 2022, 58(5), 630; https://doi.org/10.3390/medicina58050630 - 1 May 2022
Cited by 3 | Viewed by 3091
Abstract
Acetabular peri-prosthetic fractures are rare but their incidence is rising due to the increased prevalence of total hip arthroplasty, the increasing life expectancy and the growing functional demand of an ageing population, the incidence of primary total hip arthroplasty is increasing. They are [...] Read more.
Acetabular peri-prosthetic fractures are rare but their incidence is rising due to the increased prevalence of total hip arthroplasty, the increasing life expectancy and the growing functional demand of an ageing population, the incidence of primary total hip arthroplasty is increasing. They are either intra-operative or post-operative and have various aetiologies. Several factors such as implant stability, bone loss, remaining bone stock, fracture pattern, timing, age and co-morbidities of the patients must be considered for adequate treatment. To date, the literature on this subject has been sparse and no universally recognized treatment algorithm exists. Their rarity makes them a little-known entity and their surgical management represents a challenge for most orthopaedic surgeons. This review aims to present an update on epidemiology, the diagnostic work up, existing classification systems, surgical approaches and therapeutic options for acetabular peri-prosthetic fractures. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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Other

13 pages, 628 KiB  
Systematic Review
Effect of Prehabilitation in Form of Exercise and/or Education in Patients Undergoing Total Hip Arthroplasty on Postoperative Outcomes—A Systematic Review
by Patrick Widmer, Peter Oesch and Stefan Bachmann
Medicina 2022, 58(6), 742; https://doi.org/10.3390/medicina58060742 - 30 May 2022
Cited by 17 | Viewed by 6972
Abstract
Background and Objectives: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both together, improves postoperative outcomes, such as physical functioning, compared with no intervention. Materials and [...] Read more.
Background and Objectives: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both together, improves postoperative outcomes, such as physical functioning, compared with no intervention. Materials and Methods: A systematic literature search was performed in the online databases PubMed, PEDro and Cochrane Library using the following search keywords: “prehabilitation”, “preoperative care”, and “total hip replacement”. Results: A total of 400 potentially relevant studies were identified. After title, abstract and full-text screening, 14 studies fulfilled all inclusion criteria and were included in this systematic review. Patients who completed exercise-based prehabilitation before their operation showed significant postoperative improvements compared with no intervention in the following tests: six-minute walk test, Timed Up and Go test, chair-rise test, and stair climbing. For various other assessments, such as the widely used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip disability and Osteoarthritis Outcome Score (HOOS), 36-item Short Form Survey (SF-36) and Barthel Index, no significant differences in outcomes regarding exercise therapy were reported in the included studies. Education alone had no effect on postoperative outcomes. Conclusions: Prehabilitation in the form of a prehabilitation exercise therapy is an effective prehabilitation measure with regard to postoperative physical functioning, while prehabilitation in the form of education has no significant effects. No negative effects of prehabilitation on the outcomes examined were reported. Full article
(This article belongs to the Special Issue Total Hip Arthroplasty—Current Challenges)
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