Search Results (107)

Background/Objectives: Developmental dysplasia of the hip (DDH) affects 1–3% of newborns and requires early detection for optimal outcomes. DDH involves abnormal acetabular–femoral congruence between the acetabulum and femoral head, resulting from either shallow acetabular development or delayed femoral ossification of the femoral head. We evaluated the ossification nucleus of the femoral head (ONFH) to determine prevalence, radiographic timing, and associations with perinatal factors. Methods: We analyzed 100 pelvic radiographs of infants between 90 and 150 days of age. Participants were selected by convenience sampling, based on inclusion criteria. We identified the presence of ONFH and measured biometric parameters, morphology, and anatomical location. Sociodemographic and perinatal data were collected from the participating infants. Results: The prevalence of ONFH was 33%, and the mean age at visualization was 104 days. The presence of ONFH was correlated with birth weight (p = 0.011), discharge weight (p = 0.005), and weight at 1 month (p = 0.034). In our study, female sex (p = 0.004) was associated with a 4.966-fold higher odds of ONFH prevalence compared to males. Conclusions: This study provides relevant evidence regarding the prevalence, morphology, and characteristics of ONFH. Few studies report this information on ONFH in different populations. The optimal timing for radiographic visualization of ONFH in infants remains undefined, but the appearance of the ONFH was concentrated around 104 days of life. The novel association between weight and ONFH provides new insights into DDH. This provides new insights for DDH screening. This association warrants further research for the early detection of DDH. Full article

Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have advanced considerably. Nevertheless, optimal postoperative rehabilitation and particularly weight-bearing (WB) recommendations remain controversial and inconsistent. This review aims to assess rehabilitation protocols, focusing on WB strategies following the surgical treatment of acetabular fractures in older adults. It also examines differences in WB restrictions by surgical technique (ORIF vs. CHP) and their impact on recovery, complications, reoperations, and mortality. Methods: A systematic review of PubMed, Embase, and the Cochrane Library (2006–2024) included studies involving patients aged ≥65 years treated surgically for displaced acetabular fractures. Data included WB protocols (full, partial, toe-touch), length of stay (LOS), healing, functional outcomes (mobility, Harris and Oxford Hip Scores), complications, reoperations, delayed THA, compliance, readmission, and mortality. Due to heterogeneity, findings were narratively synthesized. Risk of bias was assessed using ROBINS-I and RoB2. Results: Twenty studies involving 929 patients (530 isolated ORIF, 399 CHP) were analyzed. The overall mean follow-up was 3.5 years (range: 1–5.25 years). Postoperative WB protocols were reported in 19 studies (95%). Immediate full WB was permitted in 0% of isolated ORIF studies (0/13), with partial WB recommended by 62% (8/13) for durations typically between 6 and 12 weeks. On the other hand, immediate full WB was allowed in 53% (9/17) of CHP studies. Functional outcomes were moderate following isolated ORIF (mean HHS: 63–82 points), with delayed THA conversion rates ranging from 16.5% to 45%. CHP demonstrated superior functional outcomes (mean HHS: 70–92 points), earlier independent ambulation, and higher patient satisfaction (74–90%), yet increased orthopedic complications, including dislocations (8–11%) and implant loosening (up to 18%). LOS varied from 12 to 21 days (mean 16 days) for isolated ORIF and from 8 to 25 days (mean 17 days) for CHP. Readmission within 30 days was not explicitly reported in any study. Mortality at 1 year varied significantly (ORIF: 0–25%; CHP: 0–14%), increasing markedly at long-term follow-up (up to 42% ORIF, up to 70% CHP at five years). Compliance with WB restrictions was monitored in only two studies (11%). Conclusions: Postoperative rehabilitation after acetabular fracture surgery in older adults remains inconsistent and lacks standardization. Combining ORIF with acute THA may enable earlier weight-bearing and improved short-term function but carries risks such as dislocation and implant loosening. In contrast, isolated ORIF avoids these implant-related complications but often requires prolonged weight-bearing restrictions. Robust evidence is still missing. Future trials are essential to establish standardized protocols that balance mechanical protection and functional recovery. Full article

The increasing number of acetabular revision total hip arthroplasties requires the evaluation of alternative materials in addition to established standards using a defined animal experimental defect that replicates the human acetabular revision situation as closely as possible. Defined bone defects in the load-bearing area of the acetabulum were augmented with various materials in an ovine periacetabular defect model (Group 1: NanoBone^® (artificial hydroxyapatite-silicate composite; Artoss GmbH, Germany); Group 2: autologous sheep cancellous bone; Group 3: Tutoplast^® (processed allogeneic sheep cancellous bone; Tutogen Medical GmbH, Germany)) and bridged with an acetabular reinforcement ring of the Ganz type. Eight months after implantation, a μ-CT examination (n = 8 animals per group) was performed. A μ-CT analysis of the contralateral acetabula (n = 8, randomly selected from all three groups) served as the control group. In a defined volume of interest (VOI), bone volume (BV), mineral volume (MV), and bone substitute volume (BSV), as well as the bone surface (BS) relative to the total volume (TV) and the surface-to-volume ratio (BS/BV), were determined. To assess the bony microarchitecture, trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and trabecular number (Tb.N), as well as connectivity density (Conn.D), the degree of anisotropy (DA), and the structure model index (SMI), were evaluated. The highest BV was observed for NanoBone^® (Group 1), which also showed the highest proportion of residual bone substitute material in the defect. This resulted in a significant increase in BV/TV with a significant decrease in BS/BV. The assessment of the microstructure for Groups 2 and 3 compared to Group 1 showed a clear approximation of Tb.Th, Tb.Sp, Tb.N, and Conn.D to the microstructure of the control group. The SMI showed a significant decrease in Group 1. All materials demonstrated their suitability by supporting biological defect reconstruction. NanoBone^® showed the highest rate of new bone formation; however, the microarchitecture indicated more advanced bone remodeling and an approximate restoration of the trabecular structure for both autologous and allogeneic Tutoplast^® cancellous bone when using the impaction bone grafting technique. Full article

Background: Femoroacetabular impingement (FAI) is a complex hip disorder characterized by abnormal contact between the femoral head and acetabulum, often leading to joint damage, chronic pain, and early-onset osteoarthritis. Despite MRI being the imaging modality of choice, diagnosis remains challenging due to subjective interpretation, lack of standardized imaging criteria, and difficulty differentiating symptomatic from asymptomatic cases. This study aimed to develop and externally validate radiomics-based machine learning (ML) models capable of classifying healthy, asymptomatic, and symptomatic FAI cases with high diagnostic accuracy and generalizability. Methods: A total of 82 hip MRI datasets (31 symptomatic, 31 asymptomatic, 20 healthy) from a single center were used for training and cross-validation. Radiomic features were extracted from four segmented anatomical regions (femur, acetabulum, gluteus medius, gluteus maximus). A four-step feature selection pipeline was implemented, followed by training 16 ML classifiers. External validation was conducted on a separate multi-center cohort of 185 symptomatic FAI cases acquired with heterogeneous MRI protocols. Results: The best-performing models achieved a cross-validation accuracy of up to 90.9% in distinguishing among healthy, asymptomatic, and symptomatic hips. External validation on the independent multi-center cohort demonstrated 100% accuracy in identifying symptomatic FAI cases. Since this metric reflects performance on symptomatic cases only, it should be interpreted as a detection rate (true positive rate) rather than overall multi-class accuracy. Gini index-based feature selection consistently outperformed F-statistic-based methods across all the models. Conclusions: This is the first study to systematically integrate radiomics and multiple ML models for FAI classification for these three phenotypes, trained on a single-center dataset and externally validated on multi-institutional MRI data. The demonstrated robustness and generalizability of radiomic features support their use in clinical workflows and future large-scale studies targeting standardized, data-driven FAI diagnosis. Full article

Background and Objective: The use of computed tomography (CT)-based navigation systems has been shown to improve surgical accuracy in total hip arthroplasty. However, there is limited literature available about the application of CT-based navigation systems in severe hip dysplasia. This study aimed to evaluate the accuracy of a CT-based navigation system in patients with severe hip dysplasia using three-dimensional (3D)-printed bone models. Methods: 3D-printed bone models were generated from CT data of patients with severe hip dysplasia (Crowe type II, 10 hips; type III, 10 hips; and type IV, 10 hips). The accuracy of automatic segmentation, success rate, point-matching accuracy across different registration methods, and deviation values at reference points after registration were assessed. Results: For the combined cohort of Crowe II, III, and IV cases (n = 30), the Dice Similarity Coefficient and Jaccard Index were 0.99 ± 0.01 and 0.98 ± 0.02, respectively. These values indicate a high level of segmentation accuracy. The “Matching with true and false acetabulum + iliac crest” method achieved a 100% success rate across all groups, with mean deviations of 0.08 ± 0.28 mm in the Crowe II group, 0.12 ± 0.33 mm in the Crowe III group, and 0.14 ± 0.50 mm in the Crowe IV group (p = 0.572). In the Crowe IV group, the anterior superior iliac spine deviation was significantly lower using the “Matching with true and false acetabulum + iliac crest” method compared to the “Matching with true and false acetabulum” method (0.28 ± 0.49 mm vs. 3.29 ± 2.56 mm, p < 0.05). Conclusions: This study demonstrated the high accuracy of automatic AI-based segmentation, with a Dice Similarity Coefficient of 0.99 ± 0.01 and a Jaccard Index of 0.98 ± 0.02 in the combined cohort of Crowe type II, III, and IV cases (n = 30). The matching success rate was 100%, with additional points on the iliac crest, which improved matching accuracy and reduced deviations, depending on the case. Full article

Canine hip dysplasia (CHD) screening relies on radiographic assessment, but traditional scoring methods often lack consistency due to inter-rater variability. This study presents an AI-driven system for automated measurement of the femoral head center to dorsal acetabular edge (FHC/DAE) distance, a key metric in CHD evaluation. Unlike most AI models that directly classify CHD severity using convolutional neural networks, this system provides an interpretable, measurement-based output to support a more transparent evaluation. The system combines a keypoint regression model for femoral head center localization with a U-Net-based segmentation model for acetabular edge delineation. It was trained on 7967 images for hip joint detection, 571 for keypoints, and 624 for acetabulum segmentation, all from ventrodorsal hip-extended radiographs. On a test set of 70 images, the keypoint model achieved high precision (Euclidean Distance = 0.055 mm; Mean Absolute Error = 0.0034 mm; Mean Squared Error = 2.52 × 10⁻⁵ mm²), while the segmentation model showed strong performance (Dice Score = 0.96; Intersection over Union = 0.92). Comparison with expert annotations demonstrated strong agreement (Intraclass Correlation Coefficients = 0.97 and 0.93; Weighted Kappa = 0.86 and 0.79; Standard Error of Measurement = 0.92 to 1.34 mm). By automating anatomical landmark detection, the system enhances standardization, reproducibility, and interpretability in CHD radiographic assessment. Its strong alignment with expert evaluations supports its integration into CHD screening workflows for more objective and efficient diagnosis and CHD scoring. Full article

Aim: The aim of this study is to assess the prevalence of depressive disorders in patients with pelvic fractures treated surgically at our center in the years 2017–2022. Materials and Methods: The study included 75 patients, 57 men and 18 women, operated on in our center in the years 2017–2022 due to acetabular fracture and pelvic ring injury. Factors such as age, gender, chronic pain measured with the VAS scale, and the incidence of suicidal thoughts were also analyzed. The participants completed the Beck Depression Inventory (BDI). Results: Thirty-five out of the seventy-five patients showed symptoms of depression (BDI score > 11), which is 47%, with an average score of 29 (p < 0.0001). Women obtained an average BDI score of 23, which corresponds to moderate depression on Beck’s scale (p < 0.008). The correlation between BDI score and chronic pain in pelvic trauma patients has been found to be positive (p < 0.0003; r = 0.4094). Furthermore, women in our studied population reported suicidal thoughts more often than men (44% vs. 14%; p < 0.01). No statistically significant correlation was found between the occurrence of depression and the length of hospital stay and the patient’s age (p < 0.5 and p < 0.06, respectively). Conclusions: The prevalence of depression in the pelvic trauma patients of the studied population has been determined to be 47%. Full article

This review aims to summarize the evolution of surgical techniques for periacetabular metastatic cancer, assess their strengths and limitations, and clarify the corresponding indications. We conducted a comprehensive literature review on periacetabular metastatic cancer, summarizing surgical techniques involving both open and minimally invasive approaches. Additionally, we evaluated the indications for different minimally invasive techniques and proposed potential combinations of these techniques. Our review underscores the benefits of minimally invasive surgery, including reduced surgical trauma, improved patient mobility, lower complication rates, and expedited recovery times, facilitating earlier initiation of systemic cancer therapies. These techniques show substantial potential for broader application in the future. Despite the historical reliance on open surgery as the standard treatment, minimally invasive approaches are emerging as a promising alternative, particularly for managing osteolytic metastases around the acetabulum. This review provides insights into the optimal integration of these techniques, aiming to support evidence-based clinical decision-making and improve patient outcomes. Full article

Background: Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability and decrease dysplasia in children with neurological disability. Some children with cerebral palsy (CP) are treated with bisphosphonates for bone insufficiency, which leaves a dense growth arrest band in the bone at the time of treatment. The aim of this study was to develop a novel approach to understand the growth and maturation impact on hip development in children with CP using this growth arrest band. Methods: Pelvic radiographs of children with CP Gross Motor Function Classification System (GMFCS) level IV/V treated with bisphosphonate were analyzed. We measured neck–shaft angle (NSA), head–shaft angle (HSA), and migration percentage (MP) based on pamidronate bands (PamMP), NSA based on pamidronate bands (PamNSA), and HSA based on pamidronate bands (PamHSA). These measurements were compared using t-test. Results: Seven children (two GMFCS IV and five GMFCS V) were included. The mean age of the radiographic assessment was 11.4 ± 1.3 (range, 8.6–12.5) years, mean MP 22 ± 7% (range, 13–39%), PamMP 33 ± 7% (range, 18–46%), NSA 151 ± 7° (range, 140–161°), PamNSA 153 ± 4° (range, 142–163°), HSA 164 ± 12° (range, 142–175°), and PamHSA 169 ± 8° (range, 154–175°). MP decreased by 10.5% compared with PamMP (p < 0.001). NSA compared with PamNSA (p = 0.117) and HSA compared with PamHSA (p = 0.325) were not statistically different. Conclusions: This novel assessment method demonstrates that ossification of the lateral acetabulum and femoral head in children with CP GMFCS IV/V from age 8 to 12 years undergoes a mean decrease of 10% MP. A decrease of 10% MP after proximal femoral-guided growth has been reported as a positive outcome. However, based on the current measurements, this may be due to normal development. HSA and NSA remained unchanged. Full article

Femoroacetabular impingement syndrome (FAIS) is characterized by hip pain and restricted range of motion (ROM), typically due to structural conflict between the femoral neck and the acetabulum. This study aimed to quantify active ROM limitations in FAIS patients, comparing them with healthy controls to establish normative values, particularly in non-conflicting directions. Methods: A total of 53 FAIS patients scheduled for hip arthroscopy were compared to 49 healthy matched controls. Active ROM was assessed using inertial measurement unit (IMU) sensors, with measurements taken in standing and prone positions. Outcomes included flexion, external rotation, internal rotation, and total rotation ROM, alongside demographic and radiographic data. Gender-based ROM differences were also analyzed. Results: FAIS patients demonstrated significant reductions in flexion, internal rotation, and total rotation ROM in the involved hip, with large effect sizes, while external rotation remained unaffected. ROM in the uninvolved hip was also lower than in controls but showed increased external rotation. Gender differences were observed, with females exhibiting significantly higher internal rotation and, in healthy controls, greater total rotation than males. Conclusions: FAIS patients have significant active ROM restrictions in non-conflicting directions, suggesting broader joint limitations potentially tied to early hip osteoarthritis or capsular and musculoskeletal adaptations. Gender differences highlight the importance of individualized ROM assessment. This study introduces IMU-based ROM evaluation as a promising tool for diagnosing and monitoring FAIS, providing insights into functional impairments that can be used to guide targeted interventions. Full article

Background/Objectives: The Chiari pelvic osteotomy (CPO) creates a bony roof by medialization of the acetabulum, thus improving the biomechanics of dysplastic hip joints. Long-term results have already been examined in various studies. However, the impact on the axis of the lower limb has not been investigated yet. The aim of this study was the analysis of changes in the alignment of the lower limb and leg length caused by a CPO and, consecutively, the impact on conversion total hip arthroplasty and primary knee arthroplasty. Methods: A total of 85 patients with 111 CPOs were clinically examined, patient reported outcome measures collected, and long leg standing radiographs analysed according to Paley. Results: The patients were examined an average of 34 years (±7.8; 23–53) after CPO. Unilaterally operated patients (N = 59 hips) showed a pathological MAD in 71% (N = 42) on the operated side (90% valgus, 10% varus). On the unaffected side, we could identify 56% (N = 33 hips) pathological cases (70% valgus, 30% varus). When patients underwent CPO bilaterally (N = 52 hips), the MAD was abnormal in 34 operated hips (65%; 97% valgus, 3% varus). If a leg length discrepancy occurred after the operation, the pelvis and the femur contributed the most to the total leg length discrepancy. Conclusions: Shifts in the mechanical axis following a CPO must be considered in order to inform patients appropriately preoperatively and quantified postoperatively by performing long leg standing radiographs in order to plan following joint replacement therapy adequately and maximize the chance of a successful long-term outcome on a functional level as well as for the patient’s satisfaction. Full article

Background/Objectives: As the rate of revision total hip arthroplasty (THA) has risen, there has been a drive to improve the technology in the manufacturing of the implants used. One recent advance has been 3-D printing of trabecular titanium implants to improve implant stability and osteointegration. The aim of this study was to review the clinical and radiological outcomes of these acetabular implants in revision THA. Methods: A manual search of the databases of the US National Library of medicine (PubMed/MEDLINE), Embase, and the Cochrane library was performed. The following keywords of “revision total hip arthroplasty” AND “acetabulum” AND “titanium” AND “porous” were utilised. Results: In total, 106 abstracts were identified during manual search of databases. In total, 11 studies reporting 4 different implants, with a total of 597 operated joints in 585 patients were included in this review. There were 349 (59.7%) female patients, and the mean age per study ranged from 56.0 to 78.4 years. The all-cause survival rate was 95.52% (95% CI: 92.37–97.96) at a mean follow up of 3.8 years (95% CI: 2.6–5.1). The 40 cases that required re-operation included 17 (2.8%) for infection, 14 (2.3%) instability, 2 (0.3%) for shell migration and 5 (0.8%) for aseptic loosening. The most commonly used patient reported outcome measure was the Harris Hip Score with the mean post-operative score of 86.7 (95% CI: 84.3–89.1). Conclusions: Trabecular titanium acetabular implants, when used in revision THA, resulted in excellent short- to mid-term outcomes with improved hip specific outcomes and a survivorship of 95.52% over the reported follow-up period. Future prospective studies evaluating long term outcomes are needed to make comparisons between more established solutions used in revision THA. Full article

Background/Objectives: The aim of the study is to present middle-term results of tailored bone and soft-tissue surgeries in subluxated and dislocated hips in children affected by cerebral palsy. Methods: A total of 87 medical records belonging to 73 children affected by CP, treated with combined soft-tissue releases, VDO, and pelvic osteotomy, were reviewed retrospectively. Radiological measurements of AI, RI, and NSA were obtained before surgery, postoperatively, at 12 and 24 months after surgery. Results were assessed globally and by GMFCS, age, and Robin score. Results: Postoperative results are not statistically influenced by age and GMFCS levels at surgery. All three radiographic parameters showed persistent statistically significant improvement after surgery and at follow-up, respectively. Conclusions: Obtaining the best possible concentric reduction of the femoral head in the acetabulum, with simultaneous multilevel soft-tissue rebalancing, creates the best mechanical and biological environment to allow the reshaping of both articular surfaces, obtaining physiological internal joint pressure. The anatomical best congruency is protective from recurrence. Full article

Background/Objectives: Developmental dysplasia of the hip (DDH), defined by the malalignment of the femoral head and acetabulum, is a major precursor to coxarthrosis, posing substantial challenges during total hip arthroplasty (THA). Patients with coxarthrosis secondary to DDH often exhibit acetabular bone insufficiency, which makes challenging surgical reconstruction difficult. This study aimed to compare the radiologic and functional outcomes of robotically assisted and conventional manual THA techniques in patients with coxarthrosis secondary to Crowe type III–IV DDH. Methods: This prospective study included 40 patients divided into robotically assisted (n = 20) and conventional manual (n = 20) THA groups. Evaluations encompassed hip pain (Visual Analogue Scale, VAS), function (Harris hip score and University of California, Los Angeles, activity scale), quality of life (Short Form-12), and prosthesis sensation (Forgotten Joint Score-12). Radiologic outcomes included acetabular inclination and anteversion angles. Femoral shortening, operative duration, and follow-up times were also analyzed. Results: Demographic characteristics did not differ between groups (p > 0.05). Robotically assisted THA exhibited a significantly longer operative time (171.40 ± 11.96 vs. 150.30 ± 14.67 min; p = 0.001) but a shorter follow-up (29.3 ± 8.51 vs. 52.95 ± 18.96 months; p = 0.001), without a difference in the amount of femoral shortening (p = 0.947). Despite the extended surgical duration, the two techniques achieved comparable radiologic outcomes, with no significant differences in acetabular inclination or anteversion angles (p > 0.05). Functional assessments, including Harris hip scores (73.85 vs. 73.95; p = 0.978), UCLA activity scores, and VAS, indicated similar efficacy between groups. SF-12 physical and mental quality of life and Forgotten Joint Score-12 prosthesis sensation did not differ between groups (p > 0.05). Conclusions: This study concludes that robotically assisted and conventional manual THA present similar radiologic and functional outcomes in patients with coxarthrosis secondary to Crowe type III–IV DDH, as displayed by comparable acetabular anteversion and inclination alignment, femoral shortening, hip function, pain, quality of life, and prosthesis sensation scores. While robotically assisted THA requires a longer operative time, its precision in implant placement may hold potential advantages for long-term outcomes, demanding further investigation in extended follow-up studies. Full article

Background/Objectives: Acetabular fractures are rare fractures of the pelvis which usually result from trauma. Whilst data are reported on sexual and genitourinary function in those with pelvic fractures, less is known about those with isolated acetabulum fractures. This systematic review aimed to determine, first, the frequency of sexual and genitourinary dysfunction following isolated acetabulum fractures and, second, the nature of these complications. Methods: A PRISMA strategy was used. Medline, Cochrane Central Register of Controlled Trials, Scopus, and EMBASE library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. Results: Seven studies based on 648 individuals were identified with a mean follow-up time of 33.6 ± 22.4 months. Five papers described sexual functional outcomes, and two reported genitourinary function. Acetabulum fractures were noted to have an impact on sexual function ranging from 20.0% to 39.8% within the groups analysed. With respect to genitourinary outcomes, incidence of lower urinary tract injury and spontaneous voiding failure was quite low, but due to the existence of little data, firm conclusions cannot be made. Conclusions: This review has highlighted a paucity of data related to outcomes of sexual and genitourinary function in patients who are post-acetabulum fracture. The limited available data suggests that acetabular fractures have an impact on sexual function, but the impact on genitourinary function is less clear. Further prospective work is required to better understand the relationship between baseline demographics, injury characteristics, injury mechanism and concurrent injuries, and surgical fixation and acetabular-fracture outcomes. Full article