Search Results (141)

Sacroiliac joint (SIJ) disruption alters posterior pelvic ring stability and can produce abnormal sacral stress redistribution; the symmetry of sacral load transfer following different fixation strategies remains controversial. This study compared sacral stress patterns under unilateral and bilateral SIJ instability for three fixation constructs using a three-dimensional finite element (FE) model. A lumbosacral–pelvic FE model was reconstructed from computed tomography data of a healthy adult and validated against previously published pelvic biomechanical data. SIJ instability was simulated by reducing the friction coefficient to represent ligamentous failure. Three fixation constructs were analyzed: anterior plate combined with posterior screw fixation (Model 1), spinopelvic fixation (Model 2), and hybrid fixation (Model 3). A 750 N axial compressive load was applied to simulate static standing. Peak sacral von Mises stress, stress amplification factors (SAFs), and left–right asymmetry ratios were computed and compared with the intact reference. Model 1 produced the highest sacral stress amplification (SAF = 3.46 under unilateral instability; peak stress 265.40 MPa). Model 2 reduced peak sacral stress (125.66 MPa under bilateral instability; SAF = 1.64), but values remained above the intact-model baseline. Model 3 yielded sacral stress closest to the intact condition under bilateral instability (81.64 MPa; SAF = 1.06), with near-symmetric load distribution in the bilateral injury configuration. Fixation topology strongly influenced sacral load transfer: hybrid fixation (Model 3) produced sacral stress magnitudes closest to the intact model, particularly under bilateral instability, whereas spinopelvic fixation (Model 2) showed more consistent left–right symmetry under unilateral injury. No single construct was superior across all symmetry-related outcomes. Hybrid stabilization may provide a biomechanically balanced approach to highly unstable posterior pelvic ring injuries under the simulated static axial-loading conditions. Full article

Lateral femoral neck and peritrochanteric fractures are common and clinically challenging injuries, particularly in the elderly population, with significant implications for morbidity, mortality, and functional recovery. Traditional classification systems are widely used to guide treatment, yet their reproducibility and clinical applicability remain debated. Increasing attention has been directed toward trabecular architecture and its role in fracture behavior and reduction strategies. This review aims to summarize current evidence on classification systems, trabecular-based fracture patterns, pre-operative reduction techniques, and fixation strategies. A narrative review was conducted using PubMed/MEDLINE, Embase, and Scopus databases up to May 2026. Original studies, reviews, and biomechanical investigations focusing on proximal femur fracture classification, reliability, trabecular alignment, reduction techniques, and fixation methods were included. Data were qualitatively analyzed, with emphasis on interobserver reliability, biomechanical implications, and clinical outcomes. Conventional classification systems, including anatomical, Evans–Jensen, and AO/OTA frameworks, demonstrated variable and generally moderate reproducibility, with reported interobserver agreement ranging from approximately κ = 0.30 to 0.60. Emerging evidence highlights the importance of trabecular architecture, distinguishing intradigital fractures—confined within trabecular pathways and relatively stable—from extradigital fractures, which disrupt load-bearing structures and are associated with increased mechanical instability and higher failure rates. Biomechanical and clinical studies indicate that inadequate reduction with trabecular misalignment significantly increases the risk of varus collapse and implant cut-out. Reduction strategies tailored to fracture pattern, such as internal rotation for intradigital fractures and external or combined maneuvers for extradigital patterns, improve alignment and load transfer. In terms of fixation, dynamic hip screws remain effective in stable fractures, whereas cephalomedullary nails demonstrate superior performance in unstable patterns, with lower reoperation rates reported (approximately 5–8% vs. 10–15%). Management of lateral femoral neck and peritrochanteric fractures should extend beyond traditional classification systems to incorporate trabecular biomechanics. Restoration of trabecular alignment, alongside established parameters such as neck–shaft angle and tip–apex distance, is critical for optimizing outcomes. Further prospective studies are needed to validate trabecular-based classifications and standardize reduction strategies. Full article

Background: Forearm fractures involving both bones are common orthopedic injuries. Children have a higher tolerance for greater displacement and angulation owing to the remodeling potential. The optimal fixation method for managing pediatric forearm fractures has not been definitively established. This study evaluated the safety and efficacy of a stepwise surgical algorithm, wherein single-bone plating was attempted first, and both-bone fixation was strictly reserved for cases demonstrating persistent intraoperative instability. Methods: In this retrospective analysis, we evaluated 48 skeletally immature children with both-bone forearm fractures managed via our stepwise protocol. Initially, single-bone plating was performed. Dynamic manual stress testing was then applied under fluoroscopy. If the unplated bone exhibited rotational instability, residual angulation >15°, or translation >50%, the procedure was converted to both-bone plating (Group B, n = 16). Patients who achieved stable alignment without requiring a second plate formed Group A (n = 32). Results: Both groups achieved 100% union. Postoperative angulations of the radius on the anteroposterior view were 1.91 ± 2.73° in Group A and 0.88 ± 1.96° in Group B; meanwhile, the lateral angulation of the radius in Groups A and B was 1.88 ± 3.56° and 0.00 ± 0.00°, respectively. The anteroposterior angulation of the ulna was 2.31 ± 3.60° in Group A and 2.19 ± 4.00° in Group B, whereas the lateral angulation of the ulna was 2.81 ± 3.74° in Group A and 1.75 ± 3.47° in Group B. Only the lateral angulation of the radius showed a significant difference (p = 0.0418). In the subgroup analysis, minor differences in ulna angulation on the anteroposterior view reached statistical significance in the older cohort (p = 0.027) and in the distal-third fracture group (p = 0.001). No differences in bone healing or functional outcomes were observed, and complication rates were similar. Conclusion: Our stepwise surgical algorithm appears to be a safe and effective approach. By adhering to this protocol, 66.7% of patients were successfully spared the morbidity of a second incision, while all patients achieved solid union and excellent functional outcomes. However, further high-quality studies are essential to establish comprehensive protocols for intraoperative stability assessment and postoperative care. Full article

Patient-specific implants (PSIs) in orthognathic surgery offer optimal intraoperative accuracy. However, evidence regarding their postoperative skeletal stability, specifically comparing distinct fixation designs and segmentation patterns, remains limited. We present a retrospective cohort study that evaluated 64 adult patients undergoing customized maxillary orthognathic surgery between January 2020 and June 2025. The primary predictor variables were fixation design (conventional customized plates vs. minimally invasive plates) and maxillary segmentation (monoblock vs. multisegmental). The outcome variable was 3D skeletal stability, measured as linear displacement between preoperative planning and 6-month postoperative imaging. Non-parametric tests compared displacements and clinical instability rates (defined as ≥2.0 mm). Mann–Whitney tests compared landmark displacements, Fisher’s exact tests compared proportions with ≥2.0 mm displacement, and ORs with 95% CIs were computed (α = 0.05). Analysis of 64 patients revealed that median displacement across landmarks ranged from 0.7 to 4.28 mm and 28.1% exhibited displacement ≥ 2.0 mm, primarily in molar and canine regions. While overall instability rates did not differ significantly between single-segment and multisegmental osteotomies (p = 0.28), multisegmental cases showed significantly higher displacement at the left canine (p = 0.027). Plate design was not associated with skeletal instability (p = 0.88), suggesting that minimally invasive plates provide comparable stability to conventional designs. Customized maxillary plates provide reliable postoperative stability with median displacements within clinically acceptable limits (<2 mm). Minimally invasive PSI designs offer stability comparable to conventional extended designs. However, localized instability in multisegmental cases suggests a need for careful biomechanical management regardless of the fixation method used. Full article

Background: Giant retroperitoneal schwannomas with vertebral body erosion are exceedingly rare, and the decision regarding spinal instrumentation following tumor resection remains controversial in the absence of established guidelines. A 25% vertebral body involvement threshold has been proposed as an indication for fixation, yet this criterion does not account for bone quality or the potential biological adaptation of bone to chronic mechanical loading. Case Presentation: A 56-year-old man presented with bilateral gluteal pain and urinary urgency secondary to a giant retroperitoneal lumbar schwannoma (97 × 67 mm) with 36.6% erosion of the L5 vertebral body, confirmed by CT-guided biopsy (S100+, SOX10+, Ki-67 < 5%). Despite erosion exceeding the proposed instrumentation threshold, complete tumor resection was performed via an anterior laparotomic approach without spinal fixation, based on the absence of clinical or radiological signs of instability and the integrity of the intervertebral disc and posterior ligamentous complex. Intraoperative neurophysiological monitoring guided sacrifice of the tumor-origin root. The postoperative course was uneventful, with complete resolution of symptoms and no new complaints or neurological deficits at one-year follow-up. Conclusions: Post-hoc Hounsfield Unit measurements on pre-operative CT demonstrated markedly elevated bone density at the eroded L5 vertebral body (480 HU) compared with the adjacent L4 vertebra (317 HU), consistent with compensatory sclerosis induced by chronic mechanical compression. Pre-operative HU assessment may represent a valuable, readily available adjunct to anatomical erosion criteria in the surgical decision-making process for giant schwannomas with vertebral body involvement. Full article

Background and Objectives: Percutaneous iliosacral screw fixation is a standard treatment for posterior pelvic ring instability and sacral insufficiency fractures. However, conventional transsacral S1 screw fixation is associated with notable complication rates, most commonly implant loosening; dysmorphic sacral anatomy increases the risk of iatrogenic L5 or S1 nerve root injury. This study presents a modified S1 trajectory to engage the high-density bone of the anterior and cranial S1 vertebral body (promontory) by transferring preoperative 3D planning to intraoperative 2D fluoroscopy. Materials and Methods: This retrospective study analyzed implant placements for posterior pelvic ring instability, including high-velocity trauma and fragility fractures of the pelvis (FFPs). Preoperative computed tomography (CT) multiplanar reconstruction defined a modified corridor from a posterior-caudal iliac entry point directed cranially and ventrally into the S1 promontory. The 3D trajectory was transferred intraoperatively using standard 2D fluoroscopy (lateral, anteroposterior, inlet, and outlet views) with the patient prone. In cases of reduced bone quality or intended sacroiliac fusion, 3D-printed titanium implants (triangular or cylindrical threaded, 10.0–13.5 mm outer diameter) were selected over 7.5 mm cannulated screws. Results: Overall, 137 implants were placed in 71 patients: 13 cannulated screws in high-velocity pelvic ring trauma, 72 triangular titanium sacroiliac fusion implants (iFuse Implant System^®, SI-Bone), and 52 threaded titanium fusion implants (iFuse TORQ^®, SI-Bone) in patients with FFP. The modified trajectory consistently engaged the anterior and cranial S1 vertebral body. Postoperative 3D CT confirmed accurate placement of all implants. No iatrogenic nerve injuries or revisions for implant malposition occurred. Mean follow-up was 12 ± 9 months. Conclusions: Preoperative 3D CT planning combined with standard 2D fluoroscopy guided a modified S1 trajectory toward the cranial S1 vertebral body. Accurate and safe implant placement was achieved in the prone position without navigation systems, providing a practical alternative when standard transverse trajectories are limited by narrow bony corridors or sacral or pelvic dysmorphy. Full article

(1) Background: The reconstruction of periacetabular defects after tumor resection remains one of the most challenging procedures in orthopaedic oncology. The modular LUMiC^® system was designed to improve fixation stability and reduce implant-related complications compared with earlier hemipelvic prostheses. We investigated patient and implant survival after LUMiC^® reconstruction, complication types and functional outcomes. (2) Methods: Eighteen patients (8 men, 10 women; mean age 58.9 years) underwent LUMiC^® endoprosthetic reconstruction between 2011 and 2025. Kaplan–Meier analysis was used to estimate patient and implant survival. Complications were categorized according to Henderson. Functional results were evaluated at follow-up using MSTS and TESS. (3) Results: Mean follow-up was 35.52 months (SD 36.89). Overall implant survival was 72.2%. Instability (27.8%) and infection (16.7%) were the leading complications. Two-thirds of patients required at least one revision (mean 3.1 revisions per case). Metastatic disease reduced patient survival (p = 0.012) but did not affect implant longevity (p = 0.31). Functional outcomes were available for only 3 of 18 patients and should therefore be regarded as exploratory. Mean MSTS was 58.9% (SD 21.43) and mean TESS was 73.4% (SD 6.836). (4) Conclusions: Despite high revision rates, the LUMiC^® prosthesis provides durable fixation. Early revision does not appear to compromise implant survival. However, the small and heterogeneous cohort represents a limiting factor of this study. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Intrabody cage augmentation has emerged as a minimally invasive technique for anterior column reconstruction in Kümmell disease and osteoporotic burst fractures. These osteoporotic conditions lead to progressive vertebral collapse, kyphosis, and instability. While cement augmentation provides rapid pain relief, it often fails to reliably restore sagittal balance or ensure biological integration in advanced stages of collapse. Although conventional anterior corpectomy with long-segment posterior fusion can achieve satisfactory deformity correction, these procedures are associated with substantial surgical morbidity. In contrast, screw fixation alone often fails to withstand anterior loading, resulting in loss of correction or hardware failure. By adapting standard interbody devices for off-label intravertebral use, this technique utilizes the intravertebral cleft as a natural cavity to restore vertebral height and sagittal alignment while preserving adjacent intervertebral discs and reducing stress on posterior instrumentation. The surgical technique involves transpedicular access, meticulous curettage of necrotic tissue, and insertion of a cage packed with osteoinductive material. This approach minimizes surgical trauma and operative time compared with conventional corpectomy procedures. Reported outcomes from retrospective series suggest promising pain relief, maintenance of correction, and low complication rates. Collectively, current evidence suggests that intrabody cage augmentation may serve as a potential, less invasive surgical option, acting as an intermediate approach between cement augmentation and corpectomy. However, as the existing evidence remains preliminary, high-quality prospective comparative studies are required to establish definitive indications and long-term efficacy. Full article

Background/Objectives: Rami fractures in anteroposterior compression (APC)-type pelvic ring injuries show favorable outcomes with conservative management in isolated settings; however, the necessity of direct rami fixation when posterior instability is present remains unclear. This study aimed to determine whether adding direct rami fixation to symphyseal plating improves clinical and radiologic outcomes in APC-type pelvic ring injuries. Methods: This retrospective cohort study included a final cohort of 98 patients with APC type II or III pelvic ring injuries and concomitant pubic rami fractures treated at a Level 1 trauma center (2014–2022). All patients underwent plate-based symphyseal fixation, classified into four groups by fixation strategy. Primary outcomes were rami nonunion and implant-related complications, analyzed with parsimonious multivariate logistic regression (events-per-variable ratio ≥ 10). Results: Among 98 patients (mean age 45.4 ± 16.2 years; 76.5% male), complete posterior ring injury was independently associated with rami nonunion (aOR 8.176; 95% CI 2.448–27.309; p = 0.001), implant-related complications (aOR 3.364; 95% CI 1.250–9.049; p = 0.016), and overall complications (aOR 4.292; 95% CI 1.640–11.233; p = 0.003). Female sex was an additional independent predictor of overall complications (aOR 4.226; 95% CI 1.443–12.378; p = 0.009). Direct rami fixation was not a significant predictor of any outcome but consistently increased operative time in pairwise subgroup comparisons (Group 1 vs. 2: 64.9 vs. 106.9 min, p < 0.001; Group 3 vs. 4: 95.1 vs. 153.5 min, p < 0.001). Pairwise subgroup comparisons were severely underpowered (power range 5–16%); therefore, the absence of statistically significant differences between fixation strategies should not be interpreted as evidence of equivalence. Because more complex fractures were more likely to receive additional fixation, confounding by indication further limits these comparisons. Conclusions: Complete posterior ring injury was the dominant predictor of adverse outcomes in APC-type pelvic ring injuries. In this underpowered exploratory analysis, adding direct rami fixation to symphyseal plating did not demonstrate a statistically significant reduction in complications but was associated with longer operative time. Direct rami fixation may be reserved for selected cases with marked displacement, poor indirect reduction, or compromised bone quality; larger prospective studies are needed before firm recommendations can be made. Full article

Fixation instability (FI) and vergence instability (VI) in amblyopia and strabismus are associated with disrupted physiologic fixation eye movements (FEMs). This study examined how viewing conditions affect FEM patterns in strabismic subjects with and without amblyopia. FEMs of the non-dominant/amblyopic and dominant/fellow eyes were recorded using video-oculography during both-eye viewing (BEV), fellow/dominant-eye viewing (FEV/DEV), and amblyopic/non-dominant-eye viewing (AEV/NDEV) in strabismic subjects with amblyopia (SA, n = 56), without amblyopia (S, n = 19), and controls (C, n = 25). FI, VI, fast FEM amplitudes, slow FEM velocities, and time-based control of eye deviation were analyzed. The SA group showed the greatest FI in the amblyopic eye during AEV compared with the fellow eye during FEV, whereas minimal inter-ocular FI differences were observed in the S group and controls. Under monocular viewing, both SA and S groups exhibited increased FI in the non-viewing eye and higher VI than controls. Regression analyses indicated that visual acuity deficits primarily influenced viewing-eye FI and FEM dynamics, while strabismus mainly affected non-viewing-eye FI and slow FEMs. C and S groups showed the least eye deviation during BEV, whereas the SA group showed the least eye deviation—but the highest VI—during AEV, indicating a distinct pattern of incomitance. Distinct FEM patterns shaped by viewing conditions may reflect underlying visuomotor control mechanisms and serve as biomarkers for AI (artificial intelligence)-based classification. Full article

Background: Pubic symphysis plating is a common method for stabilizing traumatic pubic symphysis disruptions, yet reported rates of implant failure vary widely in the literature. This variability may reflect inconsistent definitions and failure to distinguish clinically significant early construct failure from later asymptomatic postoperative radiographic changes. Methods: We performed a retrospective observational study of 30 patients with traumatic pubic symphysis disruption without associated fractures of the pubic body or pubic rami treated with open reduction and plate fixation. Pubic symphysis distance (PSD) was measured on admission CT, immediate postoperative anteroposterior pelvic radiographs, and follow-up CT scans obtained at 3, 6, and ≥12 months. Early mechanical failure, qualitative radiographic signs of implant loosening, and radiographic loss of reduction were predefined. Non-parametric tests were used to compare patients with and without early mechanical failure and to evaluate longitudinal PSD changes; analyses of potential associated factors were exploratory. Results: Early mechanical failure occurred in 4 patients (13.3%) within 30 days and presented as an acute symptomatic event with imaging-confirmed construct compromise requiring revision. In exploratory univariable analysis, early failure was more frequent in female patients and in those with obesity or osteoporosis, although these findings should be interpreted cautiously given the very small number of events. PSD changed significantly over time (p < 0.001), with minimal increase during the first 3 months, greater widening between 3 and 6 months, and little additional change thereafter. Qualitative radiographic signs of implant loosening and widening were observed in 8 patients (26.7%) during follow-up without clinically documented pain, instability, or need for revision. No clear association was demonstrated between PSD widening and final functional outcome measured by the Majeed score, although these analyses were limited by sample size and wide confidence intervals. Conclusions: In this retrospective cohort, postoperative radiographic widening and qualitative signs of implant loosening were not by themselves associated with clinically evident failure requiring revision during the available follow-up. Early failure was identified by acute clinical symptoms with imaging-confirmed construct compromise, whereas delayed widening was often observed without clinically documented pain, instability, or reoperation. These findings suggest that postoperative imaging should be interpreted together with symptoms and overall pelvic stability, while recognizing the methodological limitations of the study. Full article

Objectives: Management of unstable pelvic fractures during pregnancy presents a major therapeutic challenge, requiring careful multidisciplinary evaluation to balance maternal benefits and fetal radiation risks. Methods: We report the case of a 32-year-old patient who presented with a pelvic fracture due to a road traffic accident at three months of pregnancy. A left sacroiliac osteosynthesis was performed to treat a left sacroiliac diastasis with pelvic osteosynthesis using a trans-iliosacral approach under cone-beam CT (CBCT) guidance using a very-low-dose protocol. Radiation parameters and fetal dose estimates were calculated in advance in collaboration with a medical physicist. Tight beam collimation, a reduced field of view, and minimization of fluoroscopic checks were applied to keep fetal exposure as low as reasonably achievable. This article aims to demonstrate the feasibility of managing a complex pelvic fracture using interventional radiology and to review the literature on management options and gestational age-dependent fetal risks. Results: The estimated cumulative fetal dose from initial imaging, open surgery, and CBCT-guided osteosynthesis remained below 70 mGy using a pregnant phantom (Duke Organ Dose–Dosewatch–General Electric system), which is below thresholds associated with deterministic effects. The procedure achieved optimal screw positioning with less than 40 s of fluoroscopy. Maternal postoperative recovery was favorable, and follow-up revealed normal fetal development. Conclusions: This case demonstrates that CBCT-guided percutaneous iliosacral screw fixation can be safely performed during pregnancy with meticulous planning, dose-reduction strategies, and multidisciplinary collaboration, maintaining fetal radiation exposure below accepted safety thresholds. Full article

Background: Tile C1.2 pelvic ring injuries are characterized by combined rotational and vertical instability and require reliable posterior stabilization. The aim of this exploratory biomechanical study was to compare the construct-level mechanical behavior of three posterior pelvic ring fixation strategies in a standardized Tile C1.2 injury model while maintaining identical anterior symphyseal fixation in all specimens. Methods: Nine fourth-generation composite pelvic specimens with a simulated Tile C1.2 injury pattern were allocated to three groups (n = 3 per group) according to posterior fixation method: anterior sacroiliac plating, sacroiliac screw fixation, and ilioiliac plate fixation. All specimens received the same anterior symphyseal plate. Mechanical testing was performed under monotonic axial compression using a universal testing machine and a custom acetabular support designed to ensure reproducible load transmission. A preload of 50 N was applied before data acquisition, after which displacement was zeroed. Loading was then continued up to a predefined maximum load of 1.9 kN. Axial displacement was obtained from actuator travel, and apparent axial secant stiffness was evaluated at predefined load levels. Results: Across the tested loading range, sacroiliac screw fixation demonstrated the lowest axial displacement and the highest apparent axial secant stiffness, whereas ilioiliac plate fixation showed the greatest displacement and the lowest stiffness values. Anterior sacroiliac plate fixation showed intermediate mechanical behavior. No structural failure occurred within the tested load range. Conclusions: Within the limits of this small synthetic biomechanical study, the investigated posterior fixation strategies showed different construct-level displacement and stiffness profiles under monotonic axial compression when anterior fixation was kept constant. Among the tested posterior constructs, sacroiliac screw fixation was associated with lower displacement and higher apparent stiffness within this experimental model. Full article

Background: Dual mobility (DM) total hip arthroplasty (THA) was introduced to reduce postoperative instability, one of the most frequent causes of revision after hip replacement. Its use has progressively expanded beyond revision surgery to selected high-risk primary cases; however, comparative data integrating both clinical and radiographic outcomes from real-world tertiary centers remain limited. Methods: A retrospective comparative study was conducted including 78 patients who underwent THA with a DM acetabular component between January 2019 and December 2024, and 78 matched controls who received conventional fixed-bearing THA during the same period. Matching criteria were age, sex, and procedure type (primary versus revision). Clinical outcomes were assessed using the Harris Hip Score (HHS) and visual analogue scale (VAS) for pain. Radiographic evaluation focused on component positioning, radiolucent lines, and signs of loosening. Complications and revision rates were compared between groups. Results: The mean age was 71 ± 9 years, and 62% of patients were female. Mean follow-up was 38 months. HHS improved from 54 ± 10 preoperatively to 89 ± 8 postoperatively in the DM group (p < 0.001), with similar final functional outcomes in the conventional THA group (90 ± 9, p = 0.48), and comparable improvement between groups (p = 0.62). Radiographic parameters demonstrated stable fixation and appropriate component positioning in both groups, with no significant intergroup differences. The dislocation rate was numerically lower in the DM group (1.3% vs. 5.1%), although this difference did not reach statistical significance (p = 0.37). No cases of intraprosthetic dislocation occurred. Overall implant survival free from revision at five years was 96.5% for DM and 94.7% for conventional THA (p = 0.47). Conclusions: DM THA achieved excellent clinical and radiographic outcomes, with a numerically lower dislocation rate than conventional THA. Mid-term implant survivorship was comparable between groups, supporting DM as a reliable option for improving stability in appropriately selected patients. Full article