Search Results (60)

Background and Objectives: Dual-mobility cups are commonly used to reduce instability after total hip arthroplasty (THA) for femoral neck fracture (FNF), but their advantage over contemporary large-head standard cups remains uncertain. This registry study compared revision-related survival estimates up to 10 years among monoblock dual-mobility cups, modular dual-mobility constructs, and standard cups with femoral heads ≥ 36 mm in cementless THA for FNF. Materials and Methods: We retrospectively analyzed regional residents undergoing cementless, non-metal-on-metal primary THA for FNF. The cohort included 4827 THAs: 1220 monoblock dual-mobility cups, 408 modular dual-mobility constructs, and 3199 standard cups with ≥36 mm heads. Groups differed in age and sex distribution, with modular dual mobility used in older patients and both dual-mobility constructs used more often in women. Kaplan–Meier analysis estimated survival up to 10 years using aseptic failure and revision for dislocation/instability as endpoints. Cox models estimated adjusted hazard ratios, and cumulative incidence of aseptic failure was assessed with death as a competing event. Results: Kaplan–Meier-estimated 10-year aseptic failure-free survival was 94.4% for monoblock dual mobility, 96.8% for modular dual mobility, and 95.4% for standard cups (p = 0.815). Cup construct was not independently associated with aseptic failure: compared with standard cups, the HR was 1.12 for monoblock dual mobility (95% CI, 0.75–1.67) and 1.34 for modular dual mobility (95% CI, 0.71–2.52). Kaplan–Meier-estimated 10-year survival free from revision for dislocation/instability was 99.6%, 99.2%, and 99.3%, respectively (p = 0.620), with no independent effect of cup construct. Male sex increased the risk of both aseptic failure and revision for dislocation/instability. Periprosthetic fracture was the leading cause of aseptic revision in both dual-mobility groups, whereas failures were more evenly distributed in the standard cup group. Death-adjusted cumulative incidence of aseptic failure was similar across constructs (p = 0.919). Conclusions: Neither monoblock nor modular dual mobility improved revision-related outcomes compared with standard cups using femoral heads ≥ 36 mm. Late survival estimates, particularly for modular dual mobility, should be interpreted cautiously because of the limited number of patients remaining at risk. Full article

CaO-based alkali-activated high-strength cementless concrete is considered an environmentally friendly and cost-effective material for sustainable structures; however, to enable its structural application, the bond behavior between steel bars and cementless concrete must be properly assessed. This study experimentally investigates the local bond performance and bond–slip behavior of cementless concrete in comparison with existing design guidelines. For this purpose, steel bars were embedded in cube specimens with dimensions of 150 × 150 × 150 mm³, and direct pull-out tests were conducted. The test variables included embedded length (2d, 4d, and 6d), bar diameter (D10 and D13), and concrete cover thickness (1.5d, 2.5d, and 7d). The results indicate that increasing the bar diameter did not lead to a significant change in bond strength; instead, the bond strength increased by approximately 4.8%, and yielding of the steel bar at the loading end was observed for specimens with an embedded length of 6d. When the cover thickness exceeded 2.5d, its influence on bond strength enhancement became negligible, with similar bond strengths ranging from 23 to 25 MPa. A comparison of the ultimate bond strength revealed that the predicted values based on ACI 318-25 showed the best agreement with the experimental results, with the lowest mean absolute relative deviation (MARD) of 22.14%. Furthermore, in terms of bond–slip behavior, the CMR model demonstrated better agreement with the experimental results than the modified BPE model, exhibiting a coefficient of determination ($R^2$) of 97%. Full article

Stress shielding (SS) after cementless total hip arthroplasty arises from the stiffness mismatch between conventional Ti-6Al-4V femoral stems (110 GPa) and cortical bone (10–30 GPa). The β-type Ti-33.6Nb-4Sn (TNS) alloy femoral stem addresses this limitation through a continuous Young’s modulus gradient (~70 GPa proximally to ~40 GPa distally) achieved by localized heat treatment of a single homogeneous alloy. This review synthesizes a translational research program encompassing material characterization, finite element modeling (FEM), preclinical animal studies, and prospective clinical follow-up of up to seven years. FEM demonstrated favorable proximal micromotion well below the osseointegration threshold, with physiological proximal stress concentration concordant with clinical outcomes. At seven years, SS grade distribution was significantly lower in the TNS group than in Ti-6Al-4V controls, with SS frequency reduced in Gruen Zones 2, 3, and 6, and no stem-related failures; however, third-degree SS was still observed in 11 of 34 evaluable cases (32%), indicating that modulus-gradient optimization alone is insufficient to fully prevent SS. TNS alloy is currently the only β-type titanium alloy clinically applied in joint prostheses. Remaining challenges include stem geometry optimization, additive manufacturing-based porous structures, and dual-energy X-ray absorptiometry-based bone density quantification. Future directions encompass long-term follow-up, cyclic fatigue FEM simulations, and expansion to fracture fixation devices and dental implants. Full article

Background and Objectives: Cementless total knee arthroplasty (TKA) with two-pegged Trabecular Metal (TM) tibial components composed of porous tantalum was introduced to improve fixation and reduce aseptic implant failure, particularly in younger, more active patients. Despite these theoretical advantages, mid-term outcomes remain uncertain. This retrospective study compares the survival of consecutive cementless TKAs with TM posterior-stabilized (PS) and cruciate-retaining (CR) modular tibial components with cemented PS and CR components from the same implant system, using revision for aseptic causes as the primary endpoint. Materials and Methods: Institutional review board approval was obtained, and a minimum follow-up of two years was required. Between January 2017 and November 2021, a total of 1202 TKAs of a single implant design were performed at a high-volume academic center by five board-certified orthopedic surgeons, predominantly for primary osteoarthritis. Of these, 826 (68.7%) procedures were cemented, and 376 (31.3%) were cementless. Demographic data and revision outcomes were collected for all patients. Results: There was no statistically significant difference between cohorts in the 7-year survival rate for all causes of revision (97.4%, 95% CI 95.6–99.2 for cementless vs. 97.8%, 95% CI 96.6–99.0 for cemented; p = 0.63). However, the 7-year survival rate for aseptic causes was significantly lower (p < 0.05) in the cementless TKA group (97.9%, 95% CI 96.3–99.5) compared with the cemented group (99.4%, 95% CI 98.8–100). Revisions for aseptic causes occurred in 7 cementless (1.86%) and 4 cemented (0.84%) TKAs (p < 0.05), most commonly due to loosening of the tibial TM component (6 [1.59%] vs. 2 [0.24%], respectively; p < 0.05). During follow-up, 94 patients (8.7%) died of causes unrelated to TKA. Conclusions: Cementless TM PS and CR modular TKAs demonstrated inferior mid-term performance compared with their cemented counterparts for aseptic reasons. These findings raise concerns regarding the durability of this cementless design and underscore the need for cautious use and further investigation. Full article

Background and Objectives: Short femoral stems are increasingly used in total hip arthroplasty (THA), yet evidence regarding their performance in elderly femoral neck fracture (FNF) patients is limited. In this study, we compared clinical and radiographic outcomes of the use of a short femoral stem (SFS) versus a conventional standard stem (CSS) in cementless THA. Materials and Methods: This prospective, single-center case–control study (1:2) included patients ≥ 65 years of age with displaced FNF (Garden 3–4) treated with cementless THA. Follow-up lasted a minimum of 2 years. Clinical evaluations included the Harris Hip Score (HHS), Roles and Maudsley satisfaction score, and thigh pain assessment. Radiographic evaluations assessed cup position, osseointegration (Moore signs), radiolucencies (DeLee–Charnley and Gruen zones), subsidence, leg length discrepancy (LLD), and heterotopic ossification. Results: A total of 114 patients were analyzed (38 with SFS versus 76 with CSS). The final follow-up HHS was 87 ± 2.7 (SFS) and 88 ± 2.5 (CSS) (p = 0.231), and satisfaction was excellent in nearly all patients in both groups. Thigh pain was rare and resolved by final follow-up in all SFS patients, and no radiographic loosening was observed. Early subsidence (≤3 mm) occurred in two SFSs and three CSSs without progression, while LLD < 1 cm was present in three SFS and eight CSS cases. No implant-related revisions occurred, and complication rates were low and comparable. Conclusions: Short femoral stems provided clinical and radiographic outcomes equivalent to those of conventional stems in elderly FNF patients treated with cementless THA. Short stems appear to be a safe and effective option in this population, and further studies with longer follow-up are needed to confirm their durability. Full article

Bone cements based on polymethyl methacrylate (PMMA) remain the clinical standard for joint replacement and vertebral augmentation but suffer from several major challenges. These include excessive stiffness compared with cancellous bone, lack of resorption and osteoconductivity, and thermal necrosis during curing. Calcium phosphate cements (CPCs) are bioactive and resorbable but tend to exhibit low mechanical strength, poor injectability and brittle fracture. The work reported herein developed an injectable composite bone cement by combining spherical, porous, sintered β-tricalcium phosphate (β-TCP) particles with a cyanoacrylate adhesive. The β-TCP granules provided bioactivity and a favorable microarchitecture while the cyanoacrylate ensured strong adhesion and rapid setting. Ion substitution with Mg, Na and Si was found to modify the surface acidity of the material while also inhibiting cyanoacrylate polymerization, thereby extending the setting time and lowering the exotherm temperature. This composite exhibited high chemical stability, smooth injectability and early surface reactivity indicative of osteoconductivity. The compressive strength of the material stabilized at approximately 40 MPa and so exceeded that of cancellous bone. This new material also showed ductility, energy absorption and superior impact resistance, although its tensile and fatigue resistance remained limited. Importantly, the composite provided strength comparable to that of PMMA in cemented models during fixation tests and significantly outperformed CPCs in cementless tibial tray fixation experiments. These findings demonstrate that the present β-TCP/cyanoacrylate cement bridges the gap between PMMA and CPCs by combining injectability and mechanical reliability with bioactivity. This cement is therefore a promising next-generation option for minimally invasive osteoporotic fracture treatment and revision arthroplasty. Full article

Background and Objectives: The use of cementless total knee arthroplasty (TKA) is increasing, but established methods for assessing bone quality to prevent early failure remain undefined. Current preoperative assessments using central bone mineral density (BMD) do not accurately reflect peripheral bone quality, and intraoperative evaluation is subjective. This study aimed to establish objective assessment methods by analyzing the correlations between a novel visual grading system, CT Hounsfield units (HU), and actual bone strength. Materials and Methods: This prospective study included 131 patients undergoing posterior-stabilized TKA. We developed a novel visual grading system (Excellent, Good, Fair, Poor) based on femoral cutting surface characteristics. CT HUs were measured preoperatively by an assisting surgeon in the box bone area. Femoral box specimens underwent indentation testing to determine their actual bone strength. Minimum Required Strength (MRS) was defined at 2.5-fold the patient’s body weight, and Estimated Withstanding Strength (EWS) was determined by scaling first failure load using area ratios. Patients were classified as “cementless suitable” (EWS > MRS) or “cemented mandatory” (EWS < MRS). Correlations were assessed using Spearman’s rank correlation for visual grade and Pearson correlation for Hounsfield units. ROC curve analysis determined diagnostic accuracy. Results: Visual grade exhibited an exceptionally robust relationship to bone strength (Spearman ρ = 0.903, p < 0.01), whereas HU showed substantial correlation (Pearson r = 0.660, p < 0.01, R² = 0.435). Visual grading achieved excellent diagnostic accuracy (AUC = 0.974, sensitivity 95.1%, specificity 95.9%) using “Good” grade as cutoff. HU demonstrated AUC of 0.938 with 92.7% sensitivity and 81.6% specificity at a cutoff value of 65.2. Conclusions: Our novel visual grading system and CT HU demonstrated excellent correlations with actual distal femoral bone strength and outstanding diagnostic performance for identifying cementless TKA candidates. Unlike traditional subjective intraoperative assessments such as the “thumb test”, this system provides objective visual criteria directly correlated with actual bone strength. Preoperative HU screening with intraoperative visual grading can help prevent early failure. Full article

Background and Objectives: This study aimed to evaluate the factors influencing early postoperative mortality in patients undergoing cementless hemiarthroplasty for proximal femoral fractures. Materials and Methods: The medical records of 227 patients treated between January 2019 and December 2020 were retrospectively reviewed. Patients were divided into two groups: survivors (Group 1, n = 160) and non-survivors (Group 2, n = 67). The variables assessed included demographic data, neutrophil-to-lymphocyte ratio, surgical duration, hospital stay, American Society of Anesthesiologists (ASA) score, cardiac ejection fraction (EF), Charlson Comorbidity Index (CCI), osteoporosis status, and hemoglobin and albumin levels. Clinical evaluation was performed using the Harris Hip Score. Binary logistic regression was used to analyze risk factors; receiver operating characteristic (ROC) analysis was applied to determine cutoff values. Results: The mean follow-up duration was 14.03 ± 10 months. The mean ages were 80 ± 7.68 yr in Group 1 and 83.99 ± 7.42 yr in Group 2. Statistically significant differences were found between groups regarding ASA scores, intensive care unit (ICU) admission rates, and osteoporosis status (p < 0.001). Preoperative and postoperative albumin levels were also significantly different (p < 0.001). The 1-year and 6-month mortality rates were 39.6% and 29.5%, respectively. Univariate analysis identified age, EF, ASA score, preoperative and postoperative albumin levels, CCI, ICU admission, and ICU stay duration as mortality-related factors. Multivariate binary logistic regression analysis revealed that low postoperative albumin levels may have a significant effect on mortality at 1, 3, and 6 months. ROC analysis showed a significant albumin cutoff value of 2.95 g/dL. Conclusions: Higher postoperative albumin levels were inversely associated with early mortality following hemiarthroplasty in elderly patients. Perioperative monitoring of albumin levels may help improve outcomes, particularly in individuals with severe comorbidities. Full article

Background: Two-stage septic hip revision arthroplasty has higher mortality rates than aseptic hip revision arthroplasty, and patients over 75 years have higher fracture rates than younger patients after cementless total hip arthroplasty. Therefore, the aim of this study was to examine whether two-stage septic hip revision arthroplasty in older patients leads to higher complication and mortality rates, as well as whether changing to cementless hip prostheses in older patients could lead to higher fracture and subsidence rates of the stem prosthesis than in younger patients. Material and Methods: In total, 286 two-stage-revision procedures for periprosthetic infections of the hip in 186 patients younger and 118 patients older than 75 years were followed for a minimum of 24 (50.24 ± 20.77) months. A total of 71.3% of procedures were performed via a transfemoral approach using cementless cups and revision stems (93.7%). Complications and mortality were analyzed retrospectively. Results: There was a one-year mortality rate of 1.0% with no difference in the groups, and a general mortality rate of 2.8% with a significantly higher rate in older adults than in the younger group (5.9% vs. 0.6%; p = 0.01). The rate of fractures of the bony flap in transfemoral approaches (9.1%), fissure rate of the isthmus (2.8%), rate of subsidence of cementless stems (1.0%), and rate of reinfections (4.89%) did not differ between the two groups. The general complication rate (not associated with cementless two-stage septic revision) (22.0%) was significantly higher in the older patient group (33.9% vs. 13.7%; p < 0.001). Conclusions: Septic two-stage revision hip arthroplasty, mostly using a transfemoral approach and cementless reimplantation, does not result in a higher one-year mortality rate, reinfection rate, and rate of fissures and fractures of the bony flap, but demonstrates a generally higher mortality and complication rate in older adults. This should be taken into consideration when determining the indication and when offering advice to older adults. Full article

Total knee arthroplasty is an extensive orthopedic surgery for patients with severe cases of osteoarthritis. This surgery restores the range of motion in the knee joint and allows for pain-free movement. Advancements in medical techniques used in the surgical zone and implant technology, as well as the management of operations and administration for around two decades prior, have hugely improved surgical outcomes for patients. In this study, advancements in TKA were examined through exploring aspects such as robotic surgery, new implants and materials, minimally invasive surgery, and post-surgery rehabilitation. This paper entails a review of the peer-reviewed literature published between 2005 and 2025 in the PubMed and Google Scholar databases. For predictors, we incorporated clinical relevance together with methodological soundness and relation to review questions to select relevant research articles. We used the PRISMA flowchart to illustrate the article selection system in its entirety. Since robotic surgical and navigation systems have been implemented, surgical accuracy has improved, there is an increased possibility of ensuring alignment, and the use of cementless and 3D-printed implants has increased, offering durable long-term fixation features. The trend in the current literature is that minimally invasive knee surgery (MIS) techniques reduce permanent pain after surgery and length of hospital stays for patients, though the long-term impact still needs to be established. There is various evidence outlining that the enhanced recovery after surgery (ERAS) protocols show positive results in terms of functional recovery and patient satisfaction. The integration of these new advancements enhances TKA surgeries and translates them into ‘need of patient’ procedures, ensuring improved results and increases in patient satisfaction. The aim of this study was to perform a comprehensive analysis of the existing literature regarding TKA advancement studies to identify current gaps and problems. Full article

Background and Objectives: Adequate bone quality is essential for promoting initial bone ingrowth and preventing early migration during cementless total knee arthroplasty (TKA). However, gold-standard criteria for identifying suitable bone strength have yet to be established. Dual-energy computed tomography (DECT)-based volumetric bone mineral density (vBMD) is an emerging tool for assessing bone quality. This study aimed to determine whether DECT-derived vBMD can accurately predict suitable bone strength for cementless TKA. Materials and Methods: A total of 190 patients undergoing primary TKA with a standardized posterior-stabilized implant were prospectively enrolled. Prior to TKA, DECT-derived vBMD was measured in the femoral box region. Actual bone strength was evaluated using an indentation test on resected femoral box specimens. Correlation and linear regression analyses were performed to assess the relationship between DECT vBMD and actual bone strength. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) calculations were used to determine the optimal cut-off value and diagnostic accuracy of DECT vBMD in identifying candidates suitable for cementless TKA. Results: DECT-derived vBMD exhibited a strong correlation with actual bone strength (correlation coefficient = 0.719, p < 0.01), while linear regression analysis revealed a moderate association (R² = 0.51, p < 0.01). In addition, it demonstrated excellent diagnostic performance in predicting adequate bone quality for cementless TKA, yielding an AUC of 0.984, with a sensitivity of 91.9% and a specificity of 92.0%. Conclusions: DECT-derived vBMD is a reliable and accurate tool for assessing bone strength around the knee and predicting the suitable bone quality for cementless TKA. Full article

Background and objectives: The objective was to validate the Beyond the Vancouver classification. Based on this algorithm, it was hypothesized that cemented polished tapered stems with an intact cement mantle and cementless stable stems with defined criteria could be classified as stable and therefore treated with open reduction and internal fixation (ORIF). Materials and Methods: This retrospective, single-center cohort study re-analyzed patients initially diagnosed with Vancouver type B2 fractures treated with ORIF between 2007 and 2020. Clinical and radiological outcomes were extracted from medical reports. A combined radiological and clinical score was used as the main outcome measure. Patients categorized according to the Beyond the Vancouver classification were compared for functional outcome. Results: 42 patients (25 male, 17 female) with a median (range) age of 83 years (75–88 years) and follow-up time of 25 weeks (12–35 weeks) were reviewed. It was found that ORIF achieved excellent or good results in 81% of cases for stems classified as stable (n = 16) and in 30% of cases for stems classified as loose (n = 23). Successful cases (30%), although classified as loose, all had the same fracture pattern: an intact greater trochanter and a fracture fragment attached laterally to the stem with distal fixation of the stem. Conclusions: This case series suggests that certain Vancouver B2 fractures can be treated with ORIF. The Beyond the Vancouver classification may support the categorization of ‘stable’ and ‘loose’ stems. The validity of the algorithm was supported by the observation that ORIF provided excellent and good results for the majority of stems classified as ‘stable’, but poor results for stems classified as ‘loose’. Furthermore, the fracture pattern has been shown to be a crucial factor that should be considered when treating distally fixed cementless stems. The classification was therefore expanded to include the specific fracture patterns in cementless distally fixed stems that can be successfully treated with ORIF. The Beyond the Vancouver classification can provide further guidance in the identification of ‘loose’ or ‘stable’ stems. Full article

This study explores the potential of using sustainable materials in brick manufacturing by designing a novel brick mix in the laboratory, incorporating sand, lime kiln dust (LKD) waste, tyre rubber, and ground granulated blast furnace slag (GGBFS) waste. These cementless bricks blended LKD–GGBFS wastes as the binder agent and fine crumb rubber from waste tyres as a partial replacement for sand in measured increments of 0%, 5%, and 10% by volume of sand. Ordinary Portland cement (OPC) and fired clay bricks were sourced from the industry, and their properties were compared to those of the laboratory bricks. Tests performed on the industry and laboratory bricks included compressive strength (CS), freeze-thaw (F-T), and water absorption (WA) tests for comparison purposes. Additionally, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) analyses were performed on the bricks to assess the morphological and mineralogical changes responsible for the observed strengths and durability. The CS and WA values of the engineered bricks were 12, 6, and 4 MPa, and 7, 12, and 15%, respectively, for 0, 5, and 10% crumb rubber replacements. The industry bricks’ average CS and WA values were 13 MPa and 8%, respectively. From the results obtained, the green laboratory bricks passed the minimum strength requirements for load-bearing and non-load-bearing bricks, which can be used to construct small houses. Lastly, the engineered bricks demonstrated strength and durability properties comparable to those of the industry-standard bricks, indicating their potential as a sustainable alternative to help divert waste from landfills, reduce the pressure on natural fine sand extraction, and support eco-conscious brick production for a sustainable environment. Full article

The increasing demand for sustainable construction materials has driven the exploration of alternatives to traditional cement-based concrete. In this context, this study investigates a cement-less material, specifically an alkali-activated or geopolymer concrete (GPC), which presents potential environmental benefits. The material has been characterized with respect to both its fresh and hardened properties, providing groundwork for future structural applications. A key focus of the research is the bond behavior between GPC and reinforcing bars, including both steel and non-metallic fiber-reinforced polymer (FRP) bars. The use of non-metallic bars is particularly relevant as they offer the potential to enhance the durability of structures by mitigating issues such as corrosion. Current research lacks comprehensive studies on factors affecting stress transfer at the GPC-reinforcing bar interface, such as bar diameter, bond length, and surface finish. This study aims to expand knowledge on the bond between GPC and steel/FRP rebars through experimental and analytical approaches. The tests, which included different bar types and bond lengths, showed that GPC exhibited similar bond behavior with steel and ribbed glass FRP bars in terms of bond strength and stress-slip curves. The results indicate that GPC exhibits comparable bond strength and stress-slip behavior when reinforced with either steel or ribbed glass FRP bars. Full article

This study demonstrates the conversion of agricultural and industrial waste into construction materials by developing ultra-high-performance concrete using cold-bonded sesame ash and waste glass aggregates. The primary focus of this study was sustainability and waste valorization in self-curing concrete systems. This study focuses on many aspects of producing cementless concrete with superior short- and long-term properties, incorporating an innovative artificial aggregate premanufactured using sesame ash and waste glass. Prepacking technology of casting was used. A self-curing additive is used to reduce the energy required for curing. In cold-bonded aggregates (CBAs), the aggregate content ranged from 10 to 50% of the total sand volume. Polyethylene glycol was used as an internal curing agent to evaluate the mechanical properties of the concrete, including the compressive strength and tensile strength at different ages. The durability characteristics of the concrete were also analyzed in terms of its resistance to sulfates, chloride ion penetration, and performance at elevated temperatures of 300 and 600 °C. Microscopic analyses were conducted by scanning electron microscopy (SEM), thermogravimetric analysis (TGA), Fourier transform infrared spectroscopy (FTIR), and Differential Scanning Calorimetry (DSC). The results showed a significant improvement in the mechanical and durability performance, especially at 30%, which resulted in the highest compressive strength of 147.2 MPa at 90 days. This is an 11.93% increase compared with that of the reference mix. The tensile strength was also improved by 14.5% at the same replacement ratio. The mix containing 30% manufactured aggregate demonstrated the best thermal resistance, retaining the highest percentage of residual strength at both 300 °C and 600 °C, as well as superior sulfate impact resistance, with a strength reduction factor of 39.5%. When the replacement ratio was increased to 50%, the chloride penetration resistance improved significantly by 41% compared with that of the reference mix. FTIR, TGA, and DSC analyses also demonstrated enhanced silicate polymerization and increased carbonate formation, contributing to the improved chemical stability and density of the concrete matrix. Full article