Search Results (179)

Background and Objectives: Spinopelvic alignment may affect the outcomes of total hip arthroplasty (THA), with pelvic version influencing the risk of mechanical complications occurring after surgery. On the other hand, THA surgery itself may contribute to the modification of pelvis version. The sacro-femoro-pubic (SFP) angle is measured on anteroposterior (AP) radiographs of the pelvis in a supine position, and is used to estimate pelvic tilt (PT), representative of pelvic version, which requires lateral views of the sacrum for its calculation; however, these X rays are not routinely performed in the preoperative setting of hip surgery. This study aims to analyze how THA determines changes in the pelvic version of operated patients; the SFP angle will be used to assess pelvic version on standard AP radiographs. Materials and Methods: This retrospective study included 182 consecutive patients undergoing THA for unilateral primary degenerative hip osteoarthritis (HOA-study group, n = 104) or femoral neck fracture (FNF-control group, n = 78) at the author’s institution. The SFP angle was measured on AP pelvic radiographs of the non-replaced hip preoperatively, postoperatively, and at the last follow-up. PT values were derived from SFP angles. Pre- and postoperative PT and its variations ΔPT were assessed. Study groups were compared in terms of native and postoperative variations of pelvic version. Results: The average absolute value of ΔPT was 2.99° ± 3.07° in the HOA group and 3.57° ± 2.92° in FNF group. There was no significant overall difference in preoperative or postoperative PT values between groups. In both groups, THA surgery led to a certain improvement, still not significant, in pelvic orientation, with FNF patients presenting a greater tendency toward retroversion. No significant differences in complication rates were found comparing patients with different pelvic orientations. Conclusions: THA can lead to a “normalization” of pelvic version in a certain number of patients with preoperative anteversion or retroversion. Although statistically non-significant, this observation may have clinical implications for spinopelvic balance and could support prioritizing THA in patients with concurrent spinal disease. Further research is needed to confirm these findings and to evaluate the long-term impact of THA on spinopelvic alignment. Full article

Background: The increasing incidence of revision total hip arthroplasties (rTHAs), particularly due to failure of the acetabular components and severe bone loss, necessitates reliable surgical solutions. Iliac stemmed cups (ISCs) have emerged as effective options for managing complex pelvic defects, including Paprosky type 3A and 3B acetabular defects, severe developmental dysplasia, and selected pelvic discontinuities. This review examines the historical evolution, clinical indications, and outcomes associated with ISCs. Methods: This narrative review analyzed the historical and recent literature concerning various ISC designs. We critically assessed clinical outcomes, complication rates, and implant survival from 13 key studies. Results: ISCs have progressed significantly from initial monobloc designs to contemporary modular configurations, substantially enhancing surgical versatility and biomechanical stability. Clinical outcomes varied with reported complications such as infection, dislocation, mechanical failure, and aseptic loosening ranging from 10% to over 30%. Newer modular implants like the Sansone cup have demonstrated improved outcomes, with complication rates below 10% and five-year survival rates exceeding 95%. Conclusions: ISCs are reliable and versatile implants, particularly suited to address significant pelvic bone deficiencies. Optimal surgical techniques and careful implant selection remain essential to minimize complications and achieve favorable long-term functional outcomes, making these implants valuable tools in complex hip arthroplasty. Full article

Background/Objectives: Additive manufacturing (AM) enables the production of cementless acetabular cups with porous surfaces that facilitate early osseointegration. Directed energy deposition (DED), a form of AM, allows the direct welding of porous structures onto metal substrates without requiring a vacuum environment, offering advantages over conventional powder bed fusion methods. Despite growing interest in DED, no prospective clinical studies evaluating DED-based acetabular components have been published to date. This study assessed short-term outcomes of a DED-based 3D-printed acetabular cup in total hip arthroplasty (THA). Methods: A total of 120 patients who underwent primary cementless THA using the Corentec Mirabo Z^® acetabular cup were prospectively enrolled. Among them, 124 hips from 100 patients who had completed a minimum of 24 months of follow-up were included in the analysis. Clinical outcomes were assessed using the Harris hip score (HHS), WOMAC, EQ-5D-5L, and pain NRS. Radiographic evaluation included measurements of cup position, osseointegration, and detection of interfacial or polar gaps on CT and plain radiographs. Implant-related complications were also recorded. Results: At a mean follow-up of 34.6 months, the implant survival rate was 99.3%, with one revision due to suspected osseointegration failure. The HHS improved from 56.6 to 91.4 at 24 months, and the NRS decreased from 6.2 to 1.1 (both p < 0.001). Interfacial gaps were observed in 58.1% of cases on CT, though most were <1 mm and not clinically significant. Common postoperative issues included greater trochanteric pain syndrome, squeaking, and iliotibial band tightness, all of which were resolved with conservative treatment. Conclusions: DED-based 3D-printed acetabular cups demonstrated favorable short-term clinical and radiographic outcomes, with high survivorship and reliable early osseointegration in cementless THA. Full article

Objective: In recent years, a significant increase in the incidence of both total hip arthroplasty and acetabular revision surgery has been observed. A substantial proportion of patients requiring these revision procedures present with major bone deficits and extensive osteolysis. In light of these challenges, this study aims to provide a comprehensive comparison between two commonly utilized methods: trabecular titanium shell implants and Burch–Schneider acetabular reinforcement cages. Methods: Participants of both sexes were included through a retrospective review of medical records. The sole inclusion criterion was that the patient had undergone revision hip arthroplasty using either Burch–Schneider acetabular reinforcement cages or Regenerex trabecular titanium shell within the past 18 years. No exclusion criteria were applied concerning patient age, laterality, ethnicity, or post-operative status. Each patient was evaluated based on nine predictive factors, including the Paprosky classification, duration of surgery, perioperative blood loss, number of bone grafts and screws used, as well as pre- and post-operative Harris Hip Score (HHS) and Visual Analogue Scale (VAS). Results: A total of 220 patients were included in the analysis, with 75% (n = 165) comprising the group treated with trabecular titanium implants and 25% (n = 55) treated with Burch–Schneider cages. The use of Regenerex trabecular titanium was associated with a 32.40% (n = 23.13 mL) reduction in bone graft tissue required and a 13.7% (n = 0.59) increase in the number of screws needed. Additionally, the trabecular titanium group experienced a 15.93% (n = 179.64 mL) reduction in perioperative blood loss compared to the Burch–Schneider cage group. The other parameters analyzed in the study did not demonstrate statistical significance. Conclusions: The use of a trabecular titanium acetabular shell may be an effective option, particularly in patients with severe acetabular deficits, as it provides favorable clinical and radiological outcomes. Additionally, it reduces the number of bone grafts required and allows for faster and more immediate partial weight-bearing on the operated limb. Full article

Background: Balance and gait are critical for functional recovery and fall prevention following total hip (THA) and knee arthroplasty (TKA). Despite improvements in pain and joint function, residual impairments often persist. The Timed Up and Go (TUG) test and Tinetti Performance-Oriented Mobility Assessment (POMA) objectively measure postoperative mobility and balance, while patient-reported outcome measures (PROMs) assess perceived function and well-being. This study longitudinally evaluates functional measurement and PROMs to explore their interrelationships and compare recovery trajectories in THA and TKA cohorts. Methods: In this prospective study, 22 THA and 21 TKA patients were assessed preoperatively and at 4–6 days, 6 weeks, 3 months, and 12 months postoperatively using TUG, Tinetti, Hip Disability and Osteoarthritis Outcome Score (HOOS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and clinical scores (Harris Hip Score (HHS) for THA, Knee Society Score (KSS) for TKA). Pearson correlation assessed relationships between measures. Results: Both cohorts demonstrated significant immediate postoperative declines in balance and mobility, recovering to baseline by 6 weeks and surpassing it by 3 and 12 months (p < 0.001). PROMs showed earlier and sustained improvements. Objective balance and mobility measures showed minimal correlation with PROMs but were highly interrelated from 6 weeks onward. Conclusions: THA and TKA patients experience early postoperative balance impairments, suggesting heightened fall risk, with functional recovery lagging behind perceived well-being, highlighting the need for cautious rehabilitation strategies. Full article

Effective post-operative pain management following hip arthroplasty is critical to improving recovery, reducing opioid consumption, enhancing mobility, and reducing the risk of complications for patients. Multimodal anesthesia strategies, including the supra inguinal fascia iliac block (SIFIB) and the periarticular nerve group (PENG) block have become the new point of focus as opposed to traditional methods previously used. This narrative review compares the SIFIB and the PENG block in their efficacy to treat post-operative pain management. Mechanism of action, safety, patient outcomes, and clinical applications are compared between the two blocks for evaluation. Clinical studies have indicated that both blocks reduce post-operative pain and reduce opioid use. In contrast, SIFIB has shown to be more preferred in more complex procedures such as total hip arthroplasty, which requires extensive nerve coverage despite its longer onset time. The SIFIB has been shown to carry a higher risk of impairing motor function, making the PENG highly preferred in patients where quick mobility improvement is prioritized. The PENG block also showed slightly higher efficacy in reducing pain associated with post-operative passive limb movements, and a slight decrease in opioid consumption in comparison to SIFIB in the early post-operative time frame. Although the PENG shows more benefits in the early stages of post-operative recovery, the SIFIB shows similar outcomes to PENG over longer durations of recovery. Future studies can aid in establishing a framework for tailoring block selection to individual patient needs to optimize clinical outcomes. Full article

Background/Objectives: Total hip arthroplasty (THA) is a widely performed procedure to alleviate pain and improve function in patients with hip disorders. However, leg length discrepancy (LLD) remains a prevalent complication. LLD can cause gait disturbances, back pain, postural imbalance, and patient dissatisfaction, along with significant medico-legal implications. This review examines the evaluation, management, and medico-legal aspects of LLD. Methods: The review analyzed literature on the prevalence, evaluation methods, and management strategies for LLD in THA. Radiographic and clinical assessment tools were considered, alongside factors such as pelvic obliquity and pre-existing conditions. The importance of preoperative planning, intraoperative techniques (including computer-assisted methods), and comprehensive documentation was evaluated to address both clinical and legal challenges. Results: The review shows that leg length discrepancy (LLD) following total hip arthroplasty (THA) occurs in 3% to 30% of cases, with mean values ranging from 3 to 17 mm. LLD may result from anatomical or procedural factors, and effective evaluation requires both radiographic imaging and clinical assessment. Preoperative planning plays a critical role in accurately assessing anatomical parameters and selecting appropriate prosthetic components to preserve or restore limb length symmetry. Advanced intraoperative techniques, including computer-assisted surgery, help reduce LLD incidence. While some complications may be unavoidable, proper documentation and patient communication, particularly regarding informed consent, are essential to mitigate medico-legal risks Conclusions: LLD after THA requires a multidimensional approach incorporating clinical, radiological, biomechanical, and legal considerations. Effective preoperative and intraoperative strategies, combined with robust communication and documentation, are essential to minimize LLD and its associated risks. A focus on precision and patient-centered care can improve outcomes and reduce litigation. Full article

Hip flexion range of motion (ROM) during gait is an important surgery outcome for patients undergoing total hip arthroplasty (THA) that could help patient monitoring and rehabilitation. To allow systematic measurements during patients’ clinical pathways, hip ROM measurement should be as simple and cheap as possible to ensure patient and clinician acceptance. Single IMU options can match these requirements and offer measurements both during daily living conditions and standardized clinical tests (e.g., 10 m walk, timed up-and-go). However, single-IMU approaches to measure hip ROM have been limited. Thus, the objective of this study was to explore the accuracy of one IMU in measuring hip ROM during gait and to determine whether a single-IMU approach can provide results comparable to those of multi-IMU systems. To assess this, machine learning models were employed, ranging from the simplest (linear regression) to more complex approaches (artificial neural networks). Eighteen patients undergoing THA and seven controls were measured using a 3D opto-electronic motion capture system and one thigh-mounted IMU. Hip ROM was predicted from thigh ROM using regression and classification models and was compared to the reference hip ROM. Multiple regression was the best-performing model, with limits of agreement (LoA) of ±13° and a systematic bias of 0. Random forest, RNN, GRU and LSTM models yielded LoA ranges > 27.8°, exceeding the threshold of acceptable error. These results showed that one IMU can measure hip ROM with errors comparable to those of two-IMU methods, with potential for improvement. Using multiple linear regression was sufficient and more appropriate than employing complex ANN models. This approach offers simplicity and acceptance to users in clinical settings. Full article

Background/Objectives: Total hip joint arthroplasty (THA) is a common procedure aimed at alleviating pain and restoring mobility in patients with severe hip joint conditions, particularly osteoarthritis. While the surgery itself is effective, postoperative rehabilitation is crucial for long-term functional recovery. This study investigates the role of muscle deflection as an indicator of rehabilitation quality, focusing on hip movement improvements (abduction, extension, and flexion) over an 8-week recovery period. The objective is to assess whether muscle deflection measurements can serve as reliable metrics for evaluating recovery progress and functional outcomes. Methods: The study involved post-THA patients from Euroclinic Hospital S.A. and Bucharest Emergency Clinical Hospital, who were divided into an experimental group (undergoing a specialized rehabilitation program) and a control group (receiving standard recovery protocols). Measurements of active range of motion (AROM), passive range of motion (PROM), and muscle deflection were taken using a handheld digital dynamometer (ActivForce 2) at different time points (2, 4, 6, and 8 weeks post-surgery). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was also used to assess pain, physical difficulties, and joint stiffness. Results: The study found progressive improvements in AROM, PROM, and muscle deflection across all movements over the 8-week period. Conclusions: The findings highlight the importance of structured physiotherapy in post-THA rehabilitation. The use of muscle deflection measurements provides an objective and quantifiable method for tracking patient progress. Future rehabilitation protocols could benefit from incorporating muscle deflection monitoring to tailor recovery programs and optimize patient outcomes. Standardizing rehabilitation exercises, including balance training and resistance exercises, may further enhance recovery and reduce long-term functional impairments. Full article

Background: Total hip arthroplasty (THA) remains the standard treatment for advanced osteoarthritis, including for complex deformities. Innovations such as spherical screw-in acetabular components aim to enhance fixation and long-term outcomes. This study evaluated the long-term clinical and radiographic outcomes of cementless THA using such implants. Methods: A retrospective analysis was conducted on 277 patients (293 hips) who underwent THA with a screw-in acetabular cup (Aesculap/BBraun SC, Tuttlingen, Germany) and Antega femoral stem between 2005 and 2024. Patients were evaluated using the modified Merle d’Aubigné and Postel (MAP) score, Visual Analog Scale (VAS), and radiographic classifications, with implant survival assessed via Kaplan–Meier analysis. Results: The mean follow-up was 13.8 years. At the final follow-up, 58.7% of hips achieved excellent MAP scores, and mean VAS pain scores improved from 7.1 to 1.8 (p < 0.05). Implant positioning was within the Lewinnek safe zone in 77.1% of cases. Revision was required in 6.1% of hips, mostly due to aseptic loosening. The five- and ten-year survival rates were 98.3% and 94.0%, respectively. Conclusions: Spherical screw-in acetabular cups provide durable fixation and satisfactory long-term outcomes in THA, particularly for dysplastic hips, supporting their continued use with careful surgical techniques. Full article

Background/Objectives: Total hip arthroplasty (THA) remains a widely utilized and effective intervention for patients with end-stage hip osteoarthritis. Although multiple surgical approaches and fixation techniques are available, their application in non-tertiary clinical settings is less frequently documented. This study primarily aims to provide an educational overview of stepwise THA procedures using intraoperative visual documentation, with a secondary, exploratory assessment of postoperative outcomes related to surgical approach and fixation strategy. Methods: A prospective observational study was conducted at Arad Clinical Emergency County Hospital between March 2023 and March 2024, involving 23 patients undergoing primary THA. Patients received either cemented or uncemented femoral components based on intraoperative bone quality. Procedures were documented using stepwise intraoperative photographs and postoperative radiographs. Recovery was assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at both six weeks and six months postoperatively. Results: Both lateral (Hardinge) and posterolateral approaches provided adequate exposure with reproducible results. Cemented implants allowed for immediate full weight-bearing and were preferred in elderly patients with poor bone quality, while uncemented components were used in younger patients with good bone density, requiring a delayed weight-bearing protocol. Functional scores improved in both groups between six weeks and six months. At six weeks, the mean HHS was 87.6 ± 6.2 and WOMAC 18.3 ± 4.8; by six months, these improved to 91.8 ± 5.1 and 12.7 ± 3.9, respectively. Cemented fixation demonstrated slightly better outcomes at both time points; however, intergroup differences remained below the Minimal Clinically Important Difference (MCID) thresholds. Conclusions: Tailored surgical approaches and fixation strategies, guided by intraoperative assessment, result in favorable short- and mid-term recovery profiles in THA. The integration of intraoperative visual documentation and patient-reported outcome measures (PROMs) enhances procedural transparency while supporting evidence-based decision-making and surgical training. Full article

Background: Accurate partial weight-bearing (PWB) is essential for postoperative recovery after lower limb surgery, yet patients often fail to maintain load within clinically meaningful thresholds. Methods: In this pilot randomised controlled trial with 1:1 concealed allocation, 34 inpatients aged 18–85 who underwent femoral fracture fixation, hip arthroplasty, or knee arthroplasty were enrolled and followed for 14 days. Participants were randomly assigned to either standard physiotherapy or the same protocol with a low-cost tactile insole (“incentiviser”) that provides mechanical feedback when the prescribed 20% body weight (BW) load is exceeded. The primary outcome was absolute deviation from target load, with a minimal clinically important difference (MCID) of ±2 kg. Results: In total, 88% of the intervention group achieved the MCID at discharge versus 24% of controls. The between-group difference in final load error was 10.8 kg (95% CI: −15.2 to −6.4), with a large effect size (Cohen’s d = 1.71). No significant differences were found in pain (NRS) or walking distance (6MWT) between groups. Conclusions: The tactile incentiviser significantly improved PWB accuracy within 14 days, meeting MCID thresholds in most cases. Its low cost and simplicity make it promising for routine or home-based use. Limitations include the small sample, diagnosis heterogeneity, and absence of a sham control. Larger multicentre trials are needed to confirm generalisability and long-term clinical impact. Full article

Total hip arthroplasty (THA) is the definitive treatment for end-stage hip osteoarthritis, reliably relieving pain and restoring joint function. However, patient-reported quality of life (QoL) after THA remains heterogeneous, with recovery trajectories influenced by a range of biological, psychological, and social factors. A comprehensive synthesis of these determinants is lacking, limiting our ability to optimize individualized perioperative care and long-term outcomes. This review examines the various factors impacting quality of life (QoL) before and after hip arthroplasty. An analysis of 67 studies reveals significant postoperative enhancements in physical function, pain alleviation, and overall patient satisfaction. Identified key factors encompass physical activity, mental health status (anxiety and depression), lifestyle choices (diet and weight management), and social support systems, particularly from spouses and family members. The review indicates that, although these elements positively influence recovery, it also recognizes limitations including dependence on subjective, self-reported QoL measures, possible selection biases, and inconsistencies in study design. The results indicate that a com-prehensive, patient-focused strategy—integrating organized rehabilitation, psychological assistance, and family engagement—can markedly improve recovery and long-term QoL for arthroplasty patients. Nonetheless, additional research employing standardized protocols and extended follow-up durations is essential to corroborate these findings and guide clinical practice. The early implementation of tailored, multidisciplinary perioperative pathways—including structured rehabilitation programs, routine psychological screening and intervention, nutritional counseling for weight management, and active family involvement—may optimize functional recovery, reduce complications, and maximize long-term QoL in patients undergoing THA. This review highlights the importance of a multidisciplinary approach to enhance post-surgical quality of life, thereby advancing the understanding of patient-centered recovery strategies in orthopedic care. Full article

Total Hip Arthroplasty (THA) is a widely used surgical procedure to restore mobility and reduce pain in patients with hip joint disorders. Implant success and longevity are influenced by the selection of appropriate materials. This study presents a comprehensive literature review based on structured searches in Scopus and Web of Science, focusing on material selection criteria and methods in THA. The inclusion criteria targeted original studies and reviews addressing material properties, selection techniques, and clinical performance. A bibliometric analysis and keyword co-occurrence network were used to highlight major research themes. The review examines traditional materials such as Metal-on-Polyethylene (MoP), as well as advanced options like ceramics, composites, and Functionally Graded Materials (FGMs). Key challenges discussed include aseptic loosening, wear resistance, and stress shielding. Selection methodologies such as Multi-Criteria Decision-Making (MCDM), Weighted Properties Methods (WPM), and computational tools like Ashby charts and CES Selector are analyzed. The findings from international arthroplasty registries show that more than half of implant failures are linked to material-related factors. This study therefore aims to guide material selection processes in THA by aligning clinical performance with biomechanical and biological requirements, supporting improved implant outcomes and long-term surgical success. Future developments should focus on patient-specific solutions and continuous innovation. Full article

The rapid advancement of materials science has revolutionized total hip arthroplasty (THA), a critical orthopedic procedure aimed at restoring mobility and improving patient quality of life. This review investigates the evolution of biomaterials used in THA, analyzing their mechanical, biological, and chemical properties. The study outlines the transition from early natural materials to modern metals, polymers, and ceramics, highlighting their benefits and limitations in clinical applications. Particular emphasis is placed on the development of advanced materials such as highly cross-linked polyethylene (HXLPE), zirconia-toughened alumina (ZTA), and tantalum alloys (Ta), which demonstrate enhanced biocompatibility, wear resistance, and longevity. By examining emerging trends, including bioactive coatings and nanotechnology, this paper aims to provide a comprehensive understanding of current challenges and future directions in material selection for hip prostheses, ultimately aiming to minimize annual revision rates and improve long-term outcomes. Full article