Search Results (531)

Background/Objectives: Iatrogenic abductor muscle injury following intramedullary nailing for proximal hip fractures can negatively impact postoperative rehabilitation and clinical outcomes. To quantify iatrogenic abductor muscle injury after intramedullary nailing and detect the degree of degenerative change in muscle around the entry point of trochanteric fractures. Methods: This cross-sectional study used data from a single center database from May to December 2023. This study utilized ultrasound examinations performed by a single expert orthopedic surgeon. This study included 61 patients who underwent intramedullary nailing surgery for adult hip fractures. All surgeries were performed by a single experienced hip surgeon. Patients who declined sonographic evaluation or did not undergo ultrasound during their admission were excluded. For more accurate comparison, sonography was also conducted on the healthy, non-operative limb. Descriptive statistics were used to summarize patient and ultrasound findings. A subgroup analysis using Fisher’s exact test was performed to assess the association between implant type and the incidence of iatrogenic gluteus medius tendon injury. Results: Of the 61 patients, tendon tears were identified in 35 cases (57%) on the affected side, with 20 cases (33%) involving gluteus medius tendon tears without fractures on the ipsilateral facet. Gluteus minimus tendon tears were observed in 13 cases (21%), while gluteus medius tendon tears were noted in 31 cases (51%). In the unaffected limbs, tendon degeneration was detected in the form of tendinosis and calcification. Overall, 39 patients (64%) exhibited abductor tendon tendinosis, and 30 patients (49%) were diagnosed with calcification. Conclusions: Gluteus medius and Gluteus minimus are important abductors for hip disease rehabilitation. Iatrogenic gluteus medius tendon injury during the intramedullary nailing showed 33%. Abductor degeneration also showed 92% of the unaffected limbs. This study suggests that abductor degeneration can be a risk factor of falling among the elderly population and an iatrogenic abductor injury can be an obstacle for the early recovery of ambulation in the hip fracture patients. Prevention of abductor degeneration and iatrogenic abductor injury might be important for the hip fracture prevention and rehabilitation. Full article

Background: This study examines current trends in Canada using data from the Canadian Joint Replacement Registry (CJRR) and includes a national survey to understand the varied uptake of cement for femoral stem fixation. Methods: The survey was available online and the website link was distributed to all orthopaedic surgeons through the Canadian Orthopaedic Association between September and December 2022. The CJRR obtained data from the Canadian Institute for Health Information (CIHI), and information pertaining to patients 55 years of age and older who underwent hemiarthroplasty for hip fracture in Canada between April 2017 and March 2022 was used. Results: Most respondents practiced in an academic community setting (52%). Only 53% of respondents reported using cement, and 71% indicated that cemented fixation was the best practice. The main reasons for using uncemented stems were less operative time (23%), cement disease concerns (11%), and surgeons’ comfort (10%). Similarly, CJRR data showed only 51% cemented fixation among 42,386 hemiarthroplasties performed between 2017 and 2022. The proportion of cemented implants varied by province, but overall, the increase in the use of cement from 2017 to 2022 was from 42.9% to 57.7%. Conclusions: This study demonstrates variability in the use of cement for femoral fixation despite solid evidence showing improved outcomes using cement. Some of the main reasons in favour of uncemented stems include operative time, surgical training, and concerns about cement disease. Establishing clear position statements and guidelines supporting cemented fixation may be prudent to build universal consensus on this practice. Full article

Intertrochanteric fractures in the elderly present complex challenges due to poor bone quality and comorbidities. Cephalomedullary (CM) nails offer biomechanical advantages that support early mobilization, yet complications such as cutout, implant failure, and malalignment persist. This review examines the effectiveness of CM nail fixation in geriatric extracapsular hip fractures and introduces the RESCUE technique—a structured, mnemonic-based approach aimed at improving surgical outcomes and reducing common complications. RESCUE stands for Reduce, Entry point, Screw, Compress, Unleash traction, and Enhance full-weight bearing. This six-step framework addresses the critical elements of fixation, including precise reduction, optimal entry point selection, central screw placement, controlled fracture compression, cautious traction management, and early mobilization. Case illustrations of frequent failure patterns underscore the practical application of the RESCUE technique. By following this systematic approach, surgeons can enhance construct stability, minimize failure risk, and promote functional recovery in elderly patients. Full article

Bioactive glass materials have been used for decades in orthopedic surgery, traumatology, and oral and maxillofacial surgery to repair bone defects. This study aimed to evaluate in vitro the survival and proliferation of MG63 human osteosarcoma-derived cells on S53P4 bioactive glass (BonAlive^® granules). Microscopic visualization was performed to directly observe the interactions between the cells and the material. Osteoblast-like cells were examined on non-adherent test plates, on tissue culture (TC)-treated plates and on the surface of the bioglass to assess the differences. Cell survival and proliferation were monitored using a CCK-8 optical density assay. Comparing the mean OD of MG63 cells in MEM on TC-treated plates with cells on BG, we detected a significant difference (p < 0.05), over each time of observation. The sustained cell proliferation confirmed the non-cytotoxic property of the bioglass, as the cell number increased continuously at 48, 72, 96, and 168 h and even did not plateau after 168 h. Since the properties of bioglasses can vary significantly depending on their composition and environment, a thorough characterization of their biocompatibility is crucial to ensure their effective and appropriate application—for example, during hip and knee prosthesis insertion. Full article

Background: Implantation of modularly built-up stems with a tapered and fluted design is currently state of the art in revision total hip arthroplasty (RTHA). Nevertheless, implant-specific major complications like breakage of taper junctions as well as periprosthetic fractures (PPFs) may lead to failure of reconstruction during follow-up. Methods: A cohort of 117 cases receiving femoral RTHA by a modular stem was investigated retrospectively with a mean follow-up of 5.7 (0.5–13.7) years. Cumulative risk and potential factors affecting the occurrence of PPFs were calculated with the Kaplan–Meier method. In addition, cases were presented to discuss operative treatment options. Results: A cumulative risk of PPF of 12.1% (95% CI: 0–24.6%) was calculated at 13.7 years. Female patients had significantly higher risk compared to male patients (0% after 13.5 years for male patients vs. 20.8% (95% CI: 0.5–41.2%) after 13.7 years for female patients; log-rank p = 0.0438) as all five patients sustaining a PPF during follow-up were women. Four fractures were treated by open reduction and internal fixation. Non-union and collapse of the fracture occurred in one patient after closed reduction and internal fixation. Conclusions: Postoperative PPF after femoral revision with a modular stem has shown to be a frequent complication within this mid-term follow-up. Female patients were at a significantly higher risk in this aged cohort, indicating osteoporosis as a risk factor. The surgical treatment of PPF with an integrated long-stemmed prosthesis is challenging and thorough considerations of adequate operative treatment of PPFs are strongly advised in order to limit complication rates. Full article

Background: Short-stem hip replacements are designed to provide improved load distribution and to mimic natural biomechanics. The interplay between implant design, positioning, and resulting bone biomechanics in individual patients remains underexplored, and the relationship between radiographically assessed bone remodeling around short stems and biomechanical predictions has not been previously reported. Methods: This study evaluated three short-stem hip implant designs: Proxima, Collo-MIS, and Minima. Postoperative bone remodeling patterns were analyzed, categorizing remodeling as bone gain, bone loss, or no observable activity, with changes tracked over time. Patient-specific biomechanical models were generated from 6-week postoperative radiographs. Finite element simulations incorporated body weight and gluteal muscle forces to estimate stress and strain distributions within the proximal femur. Strain energy was then applied to a mechanostat-based remodeling algorithm to predict bone remodeling patterns. These biomechanical predictions were compared to observed radiographic remodeling at 2 years post-surgery. A validated biomechanical model was further used to simulate different postoperative positions of the three types of stems. Results: No differences in bone remodeling patterns were observed among the three short-stem designs. Computational modeling demonstrated a statistically significant correlation between predicted remodeling and radiographic measurements at 2 years (p < 0.001). Proxima stems showed a tendency towards increased cortical bone loading under pronounced varus or valgus position in comparison to other two stems, although this observation requires further validation. Conclusions: This exploratory study demonstrates the feasibility of using biomechanical modeling to estimate bone remodeling around short-stem hip implants based on early postoperative radiographs. While the results are promising, they should be interpreted with caution due to the limited cohort size. The proposed modeling approach may offer clinical value in evaluating implant behavior and informing patient-specific treatment strategies. However, further research with larger populations is necessary to refine and validate these predictive tools. Full article

Approximately 15% of total knee arthroplasty (TKA) patients remain dissatisfied after surgery, with joint line obliquity (JLO) potentially affecting patient outcomes. This study investigated whether JLO restoration influenced lower extremity frontal plane joint moments during stair negotiation by TKA patients. Thirty unrestored and twenty-two restored JLO patients participated in this study and were asked to perform five trials on each limb for stair negotiation while three-dimensional kinematics and ground reaction forces were recorded. Frontal plane moments at the ankle, knee and hip were calculated using Visual 3D. The restoration of JLO did not alter frontal plane joint moments during stair negotiation. Both groups showed symmetrical moment profiles, indicating no significant biomechanical differences between the restored and unrestored JLO groups. Restoring JLO did not affect frontal plane joint moments during stair negotiation, suggesting it may not contribute to patient satisfaction disparities post-TKA. Further research should explore other factors, such as surgical technique and implant design, that might influence recovery. Full article

Background: Total hip arthroplasty (THA) is a well-established surgical procedure for end-stage hip arthrosis. Innovations such as minimally invasive approaches and new technologies have improved outcomes and reduced invasiveness. The introduction of short-stem prostheses, which offer potential benefits in bone preservation, has been a significant development in recent years. This prospective case series study aims to compare invasiveness of the short-stem (SS) and conventional-stem (CS) prostheses in THA with a posterolateral approach (PLA) by assessing perioperative serum markers. Methods: A prospective case series was conducted involving consecutive patients who underwent primary THA from January 2022 to December 2023. Demographics and preoperative, postoperative day 1 (POD1), and postoperative day 2 (POD2) serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and white blood cells (WBCs) were measured. Results: The study included 21 patients with CS and 19 with SS, with no significant differences between groups in demographic. No statistically significant differences were found in serum markers between SS and CS groups at any time point. Both groups showed significant increases in ESR, CRP, and PCT from preoperative levels to POD2 (p < 0.001), while WBC values increased from preoperative to POD1 but decreased between POD1 and POD2. Conclusion: The short-stem prosthesis does not exhibit significantly different perioperative serum marker profiles compared to the conventional stem, suggesting similar levels of surgical invasiveness between the two implants. Further studies with larger sample sizes are needed to validate these findings and explore other aspects of short-stem THA. Full article

Background: The ROSA Knee System (Zimmer Biomet, Warsaw, IN, USA) is a robotic system aiming to increase bone resections and component alignment accuracy during TKA. While much is known about its performance in the coronal plane, its accuracy in the sagittal plane remains debated. The present investigation evaluated the system’s accuracy in achieving planned mechanical axis alignment and specific knee angles in both planes. Methods: A retrospective analysis was performed on 55 consecutive patients who underwent robotic-assisted TKA using the ROSA Knee System. Data on the medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), hip–knee–ankle angle (HKA), tibial slope (TS), and distal femoral flexion (DFF) were collected pre- and post-operatively using the ROSA software. Planned and achieved angles were compared, with deviations greater than 2° and 3° defined as outliers. Results: The mean differences between planned and achieved angles for LDFA and MPTA were 0.5° ± 1.00° and 0.3° ± 1.3°, respectively, with less than 10% outliers. The hip–knee angle recorded only a minimal deviation from planned values. In contrast, the TS angle showed a statistically significant difference between planned and achieved values, while no significant difference was found for the DFF angle. The surgeon’s experience did not impact alignment accuracy. Conclusions: The ROSA Knee System demonstrates high accuracy in achieving planned alignment in the coronal plane during robotic-assisted TKA, with minimal outliers and reliable predictions for both femoral and tibial angles. However, the ROSA Knee System showed less accuracy in the sagittal plane, particularly for the tibial slope, which did not adversely affect the implant’s stability. Full article

Background/Objectives: The optimal treatment for femoral neck fractures (FNFs) in the elderly remains unclear. Internal fixation, bipolar hip hemiarthroplasty (BH), standard total hip arthroplasty (THA), or dual mobility (DM-THA) cups have been employed, each presenting various advantages and disadvantages. This systematic review and meta-analysis evaluated comparative studies of BH and DM-THA in FNFs among the elderly, aiming to ascertain differences in outcomes, including functional recovery, patient-reported outcome measures, implant survival, complications, and mortality rates. Methods: This meta-analysis followed PRISMA 2020 guidelines with a pre-registered PROSPERO protocol (CRD420251065762). A comprehensive search of electronic databases and grey literature included only comparative studies of BH and DM-THA in patients over 65 years with FNFs. Results: Sixteen studies were eligible, comprising four randomised controlled trials and twelve retrospective comparative studies involving 11,460 patients (10,036 BH; 1424 DM-THA). Patients with DM-THA exhibited a higher postoperative Harris Hip Score (4.55, p < 0.0001), alongside a lower dislocation risk ([OR] 2.77, p < 0.0001), a reduced revision rate ([OR] 2.36, p < 0.0001), and decreased mortality ([OR] 1.94, p < 0.0001). The operative time was somewhat longer in the DM-THA group, by 12.71 min, and blood loss was greater by 121 mL, indicating significant heterogeneity across the studies. Conclusions: DM-THA for FNFs in elderly patients results in improved functional recovery and lower dislocation, reoperation, and mortality risk. However, longer operative times and increased blood loss remain significant considerations. Further, well-designed comparative studies are required to evaluate overall cost-effectiveness and define the optimal age threshold, beyond which the limitations of DM-THA may outweigh its benefits. Full article

Hip implant optimization is increasingly receiving attention due to the development of manufacturing technology and artificial intelligence interaction in the current research. This study investigates the development of hip implant stem design with the application of lattice structures, and the utilization of the MATLAB regression learner app in finding the best predictive regression model to calculate the mechanical behavior of the implant’s stem based on some of the design parameters. Many cases of latticed hip implants (using 3D lattice infill type) were designed in the ANSYS software, and then 3D printed to undergo simulations and lab experiments. A surrogate model of the implant was used in the finite element analysis (FEA) instead of the geometrically latticed model to save computation time. The model was then generalized and used to calculate the mechanical behavior of new variables of hip implant stem and a database was generated for surgeon so they can choose the lattice parameters for desirable mechanical behavior. This study shows that neural networks algorithms showed the highest accuracy with predicting the mechanical behavior reaching a percentage above 90%. Patients’ weight and shell thickness were proven to be the most affecting factors on the implant’s mechanical behavior. Full article

Background/Objectives: Ketorolac is commonly used for pain management after orthopedic surgery, but concerns regarding its effects on postoperative complications remain. This study evaluates the impact of ketorolac use on short- and long-term outcomes in adult patients undergoing uncemented primary total hip arthroplasty (THA), where implant stability relies on biological fixation through bone ingrowth into a porous-coated prosthesis rather than bone cement. Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Patients aged 18 years or older who underwent uncemented primary THA between 1 January 2004 and 1 January 2024 were included. Two cohorts were compared: those who received ketorolac on the day of or within one week of surgery and those who did not. Cohorts were propensity score-matched. Outcomes were assessed at 30 days, 1 year, and 5 years postoperatively. Results: At 30 days, ketorolac use was associated with significantly lower risks of transfusion (RR: 0.6, p < 0.01). However, it was linked to higher rates of acute posthemorrhagic anemia (RR: 1.2, p < 0.01) and periprosthetic fracture (RR: 1.4, p < 0.01). At 1 year, ketorolac use was associated with reduced risks of death (RR: 0.8, p < 0.01) and transfusion (RR: 0.7, p < 0.01), but increased risks of acute posthemorrhagic anemia (RR: 1.2, p < 0.01), deep surgical site infection (SSI) (RR: 1.8, p = 0.01), superficial SSI (RR: 1.9, p < 0.01), periprosthetic joint infection (RR: 1.1, p < 0.01), wound dehiscence (RR: 1.2, p < 0.01), periprosthetic mechanical complication (RR: 1.2, p < 0.01), and periprosthetic fracture (RR: 1.5, p < 0.01). Conclusions: Our findings highlight the complex risk profile of ketorolac in uncemented THA patients and suggest that clinicians should carefully consider individual patient factors and engage in shared decision-making when counseling patients on the use of ketorolac in the perioperative setting. 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: 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

Background/Objectives: Aseptic loosening is a major challenge in hip and knee arthroplasty. While radiostereometric analysis (RSA) is the gold standard for detecting early migration, it is static, costly, and requires metal beads. Provocation CT-based analysis studies implants under physiological stresses and offers a marker-free alternative with comparable accuracy. This systematic review evaluates its effectiveness, cost, and role in orthopedic imaging. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were searched, with no date restrictions, using keywords related to the research area. The risk of bias was assessed using the RoB-1 tool. Results: The initial search identified 42 studies, with 6 ultimately included in the review. These studies involved 198 patients with an average age of 65.0 years. Provocation CT demonstrated higher sensitivity and specificity than standard radiographs, particularly in cases with inconclusive X-rays. Additionally, the radiation dose for CT scans varied across studies, with effective doses ranging from 0.2 mSv to 4.5 mSv per scan. Compared to X-ray, CT-based methods showed comparable or superior performance in motion detection, though direct clinical comparisons with RSA remain lacking. Conclusions: Provocation CT-based analysis is a valuable diagnostic tool for early detection of implant loosening, offering a potentially feasible, accurate, and cost-effective alternative to traditional methods. However, standardized protocols, broader economic evaluations, and prospective multicenter trials are needed to confirm its routine clinical applicability. Full article