Search Results (26)

Background: Patients awaiting total hip arthroplasty (THA), particularly those with hip osteoarthritis (OA), face an elevated risk of osteoporosis due to age and gender-related factors. Osteoporosis, indicated by low bone mineral density (BMD), can affect implant osteointegration, long-term stability, and increase the likelihood of periprosthetic fractures. Despite these risks, osteoporosis is often underdiagnosed and undertreated in THA candidates. While several studies have addressed this issue in Northern populations, data on Southern European cohorts, particularly Italian patients, remain limited. This study aims to evaluate the prevalence of osteoporosis and vitamin D deficiency, as well as the rates of related treatments, in patients with hip osteoarthritis scheduled for THA. Methods: This single-center, retrospective study was conducted at Policlinico Universitario di TorVergata, Italy, involving 66 hip OA patients (35 men, 31 women; mean age 67.5 years). BMD was assessed at the femoral neck, total femur, and lumbar spine via DEXA, alongside vitamin D and PTH levels. Demographic data, ongoing anti-osteoporotic therapies, Harris Hip Score (HHS), and handgrip strength were recorded. Statistical analysis included t-tests and Pearson’s correlation. Osteoporosis was defined per WHO criteria, with significance set at p < 0.05. Results: In this study of 66 patients with hip osteoarthritis (35 men, 31 women; mean age 67.5 years), women exhibited significantly lower bone mineral density (BMD) at the total femur (−0.98 ± 1.42 vs. −0.08 ± 1.04; p < 0.05) and lumbar spine (−0.66 ± 1.74 vs. 0.67 ± 1.59; p < 0.05) compared to men. Handgrip strength was also significantly reduced in females (17.1 ± 8.2 kg) versus males (27.3 ± 10.3 kg; p < 0.05). Vitamin D levels were below 30 ng/mL in 89.4% of patients, and 63.6% had levels below 20 ng/mL; PTH levels were elevated (>65 pg/mL) in 54.5% of cases, indicating frequent secondary hyperparathyroidism. Only 9 patients were receiving vitamin D supplementation and none were on anti-osteoporotic treatment. Conclusions: These findings highlight the frequent coexistence of low BMD, vitamin D deficiency, and reduced muscle strength in THA candidates, suggesting a pattern of musculoskeletal vulnerability that warrants clinical attention. Full article

The lumbar degenerative cascade is a pathological process that affects most of the aging adult population and has significant negative economic consequences. Lumbar fusion surgery remains a mainstay of treatment for refractory degenerative disease but carries significant long-term consequences. More recently, lumbar arthroplasty and motion-sparing technology has become an increasingly popular alternative surgical option in carefully indicated patients. Arthroplasty technology carries the theoretical benefits of spinal segment motion preservation and decreased degeneration of adjacent segments as compared to traditional fusion procedures. This article will review the lumbar degenerative cascade and its related anatomic considerations, current management strategies and the challenges surrounding lumbar spinal fusion, including adjacent segment disease. This article will also review the theoretical benefits of lumbar arthroplasty and motion preservation. Furthermore, this paper will highlight the current state of lumbar arthroplasty, including current concepts of implant design, limitations, outcomes and ongoing development. It will review the development and current state of artificial disk arthroplasty, total joint arthroplasty and posterior column motion-preserving implants, including flexible rods and facet joint replacement. Full article

The evolution of regional anesthesia in total hip arthroplasty (THA) has significantly impacted perioperative management, particularly in older adults, where age-related physiological vulnerability requires optimized strategies. Adequate pain control is crucial in enhancing recovery, minimizing opioid consumption, and reducing complications. Traditional nerve blocks such as lumbar plexus and femoral nerve blocks have long been the mainstay of analgesia. However, they are associated with significant motor impairments, which delay mobilization and increase the fall risks. Introducing motor-sparing regional anesthesia techniques represents a substantial advancement in optimizing postoperative pain management while preserving muscle function. Motor-sparing techniques, including the pericapsular nerve group (PENG) block, supra-inguinal fascia iliaca block (SI-FIB), erector spinae plane block (ESPB), and quadratus lumborum block (QLB), have been developed to provide adequate analgesia without compromising motor control. The PENG block selectively targets the articular branches of the femoral, obturator, and accessory obturator nerves, ensuring superior pain relief while minimizing quadriceps weakness. Similarly, the SI-FIB provides extensive sensory blockade with minimal motor involvement, allowing for earlier ambulation. The ESPB and QLB extend analgesia beyond the hip region while preserving motor function, reducing opioid consumption, and facilitating early rehabilitation. Compared to traditional motor-impairing blocks, these newer techniques align with Enhanced Recovery After Surgery (ERAS) protocols by promoting early mobility and reducing the hospital length of stay. Studies suggest that motor-sparing blocks lead to improved functional recovery, lower postoperative pain scores, and decreased opioid requirements, which are critical factors in geriatric THA patients. Moreover, these techniques present a safer alternative, reducing the risk of postoperative falls—a significant concern in elderly patients undergoing hip replacement. Despite their advantages, motor-sparing nerve blocks are still evolving, and further research is necessary to standardize the protocols, optimize the dosing strategies, and evaluate the long-term functional benefits. Integrating these techniques into routine perioperative care may significantly enhance patient outcomes and revolutionize pain management in geriatric THA. As regional anesthesia advances, motor-sparing techniques will improve postoperative recovery, ensuring patient safety and functional independence. Full article

Background/Objectives: Pelvic incidence (PI) is deeply related to spinal sagittal alignment. Previous reports have demonstrated a deep association between PI and anatomical sacral slope (a-SS), underscoring the utility of a-SS in estimating PI. The investigation of temporal changes in pelvic and spinal alignment in healthy individuals is crucial for conducting surgical interventions such as total hip arthroplasty; however, these changes remain undocumented. There have been a few Japanese reports on this topic. This study explores the relationship between aging-related changes and pelvic and spinal sagittal alignment. Methods: By employing the methodology from a study by Imai et al., we analyzed the anterior pelvic plane (APPA), PI, pelvic tilt (PT), sacral slope (SS), a-SS, anatomical pelvic tilt (a-PT), thoracic kyphosis angle (TK), and lumbar kyphosis angle (LL), to determine the degree of kyphosis in healthy individuals. Results: APPA decreased over time, SS altered gradually, and PT underwent more pronounced variations with age; however, PI did not change significantly. a-SS changed early and was lower in the younger group than in the older group. Moreover, a-PT decreased with age. Spinal sagittal alignment was similar between the younger and older groups, changing gradually in LL and earlier in TK than in LL. Conclusions: Pelvic changes are compensated for by the pelvis, and TK changes, i.e., spinal alignment changes, are compensated for by the LL. The posterior pelvic tilt progresses with age, moving from compensation at the sacroiliac joint to compensation at the sacrum. Full article

The anterior lumbar interbody fusion (ALIF) and lumbar disc arthroplasty (LDA) procedures are both commonly performed to improve the quality of life and pain in people with lower back pain. However, few recent studies have compared 30-day complications on a large scale. The objectives of this study were to compare the 30-day complications seen after ALIF and LDA and identify risk factors for these complications. The National Surgical Quality Improvement Program (NSQIP) database was queried between the years 2012–2021 (10 years in total) for records of patients who underwent either ALIF or LDA as a primary procedure. Patients in each group underwent a 1:1 propensity match for age, gender, BMI, ASA status, diabetes mellitus (DM), hypertension requiring medication, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), inpatient/outpatient status, smoking status, and bleeding disorders. Bivariate and multivariate analyses were performed to determine significant differences in complications and risk factors between these cohorts. A total of 1218 propensity-matched subjects, with 609 receiving ALIF and 609 receiving LDA, were included in the analyses of this study. The incidence of extended length of stay (LOS) (>4 days) was higher in the ALIF cohort compared to the LDA cohort (14.6% vs. 4.76%, p < 0.001). Multivariate analysis demonstrated that subjects who underwent LDA had lower odds (Odds Ratio [OR]: 0.457; 95% Confidence Interval [CI]: 0.283–0.738, p = 0.001) of experiencing extended LOS compared to the ALIF cohort. Longer operative times increased the odds of prolonged LOS in both cohorts. The results of this study suggest that ALIF is associated with longer LOS than LDA when baseline demographic data are controlled. Further, longer operative times increase the odds that subjects receiving either ALIF or LDA will experience a prolonged LOS. Besides extended LOS, ALIF and LDA produce a relatively similar 30-day complication profile. Full article

Background/Objectives: Instability is a major reason for revision after total hip arthroplasty (THA), and acetabular cup placement in the “traditional” safe zone does not protect against dislocations. Spinopelvic mobility may play a role in impingement and dislocation after THA. Personalized acetabular cup placement that incorporates spinopelvic mobility is currently lacking in the literature. Methods: The spinopelvic motion of 116 patients was evaluated during preoperative planning. All patients underwent radiological assessments with an anteroposterior pelvis radiograph in the standing and supine positions and a lateral view of the lumbar spine and pelvis in the standing and sitting positions. The pelvic incidence, pelvic tilt, sacral slope, standing anterior pelvic plane tilt, sitting anterior pelvic plane tilt, and lumbar lordosis angle were measured, and the degree of pelvic motion from standing to sitting was calculated. The development of the patient-specific target for the acetabular cup was based on the mean mobility of the whole group and the specific posture of each patient. Results: The average pelvic incidence was 51.0 ± 13.1 degrees, the sacral slope was 35.0 ± 10.3 degrees, the pelvic tilt was 16.0 ± 13.3 degrees, the standing anterior pelvic plane tilt was 3.4 ± 12 degrees backward, and the degree of lumbar lordosis was 39.5 ± 11.3 degrees. The mean spinopelvic mobility was 27.3 ± 13.4 degrees. The measurements had good to excellent interobserver and intraobserver reliability. On the basis of these measurements, we developed a novel algorithm for a patient-specific target for acetabular cup placement. Conclusions: the evaluation of spinopelvic mobility has good to excellent interobserver and intraobserver reliability and can be used for personalized acetabular cup placement. Full article

Total hip arthroplasty (THA) has revolutionized patients’ lives with hip osteoarthritis. However, the increasing prevalence of THA in individuals with prior lumbar arthrodesis (LA) poses unique challenges. This review delves into the biomechanical alterations, complications, and surgical strategies specific to this patient subset, highlighting the need for tailored preoperative assessments and planning. Due to altered pelvic and spinal biomechanics, patients with LA undergoing THA face a higher risk of dislocation and revision. The complex interplay between spinal and hip biomechanics underscores the need for meticulous preoperative planning. Comprehensive clinical examination and radiographic evaluation are vital for understanding patient-specific challenges. Various radiographic techniques, including computed tomography (CT)/X-ray matching and standing/seated studies, provide insights into postural changes affecting pelvic and spinal alignment. Complications following THA in patients with LA highlight the necessity for personalized surgical strategies. Careful consideration of implant selection, the surgical approach, and component positioning are essential to prevent complications. In summary, THA in patients with prior LA demands individualized preoperative assessments and planning. This approach is crucial to optimize outcomes and mitigate the heightened risks of complications, underlining the importance of tailored surgical strategies. Full article

Spine and hip abnormalities frequently occur together in most of the orthopedic population; therefore, both of these abnormalities impact the outcomes of the modalities that are being used. Few studies have reported reduced dislocation and revision rates with the use of dual-mobility cups (DMCs) in high-risk lumbar spine fusion (LSF) patients undergoing primary total hip arthroplasty (THA). This study aims to clarify the relationship between pre-existing lumbar spinal fusion and the outcomes of THA with dual-mobility constructs. We systematically reviewed the current literature through several online databases following PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. We used the methodological index for non-randomized studies (MINORS) to evaluate the methodological quality of the included trials. Four studies examined the feasibility and effectiveness of dual-mobility cups in patients undergoing primary THA with prior LSF. Two studies were conducted in the United States, while the other two originated in Finland and France, respectively. The included studies enrolled 284 patients. Most of these patients had instrumented fusions. Seventy-eight percent of patients received one- or two-level fusions. The average age across the studies was 68.22 and the mean body mass index was 28. No cases of postoperative DMC implant dislocations were identified. The incidence of postoperative complications was 6% (10/173), including deep venous thrombosis, periprosthetic loosening, infection, and fracture, greater trochanteric fracture, and superficial wound infections. Most included studies had some methodological limitations, with an average MINORS score of 10.5 ± 5.8. The use of dual-mobility cups in these high-risk patients undergoing total hip arthroplasty may lead to reduced dislocation rates and postoperative complications. Further long-term follow-up studies are warranted to support these findings. Full article

Little is known about dynamic changes of femoral anatomy after total hip arthroplasty (THA), in particular about sagittal femoral bowing (SFB). A 3D CT study was designed to evaluate the chronological changes of SFB after cementless femoral stem implantation for primary THA. Ten patients who underwent unilateral primary THA with a cementless femoral stem, with 2 consecutive CT scans (extending from the fourth lumbar vertebra to the tibial plateaus), performed before THA and at least 3 years after THA, were enrolled. The 3D models of femurs were created using image segmentation software. Using the two CT scans, SFB values of the proximal and middle thirds were calculated on the replaced and untreated sides by two different observers. Eight anatomical stems and two conical stems were involved. The post-operative CT was performed at an average follow-up of 6.5 years after THA (range: 3–12.5). The measurements performed by the two observers did not differ in the proximal and middle regions. A significant difference between the pre-operative and post-operative SFB compared to the untreated side was found in the proximal femur segment (p = 0.004). Use of a cementless stem in THA induced chronological changes in SFB of the proximal femur, after a minimum timespan of 3 years. Full article

Background: There is a paucity of data regarding the post-operative influence of total hip arthroplasty (THA) on the axial and coronal alignments of the ipsilateral knee. A CT study was designed to assess the post-THA changes in axial and coronal knee alignments in low-grade dysplastic hips. Methods: Forty Crowe I–II dysplastic hips in 37 patients were assessed: a pre-operative CT scan from the fourth lumbar vertebra to the tibial plateaus was compared to a similar post-operative CT scan performed after a minimum of 2 years after THA. Results: THA implantation caused significant post-operative changes in terms of the rotation height (2 mm lowering; p = 0.003); center of rotation medialization (10 mm medialization; p < 0.001); femoral offset (11 mm increase; p < 0.001); femoral antetorsion (22° internal rotation; p < 0.001), and hip internal rotation (9° internal rotation; p < 0.001). The femoral axis angle deviated in the valgus (5.5° ± 1.1°, p < 0.001) and the mechanical lateral distal femoral angle deviated in the varus (86° ± 2.7°, p = 0.001). The pelvic–tibial alignment changed from 88.2° ± 11.7° to 96° ± 9.3° (p < 0.001). Patellar alignment was not influenced. Conclusions: In conclusion, THA imposes significant changes in low-grade dysplastic hips: all the modifications tend to neutralize the coronal alignment and, mostly, the rotational alignment, without substantial and durable variations of the patellofemoral joint. Large clinical trials should confirm whether radiological changes impact anterior knee pain and patellar stability. Full article

Background: The increasing number of late complications described after cesarean sections is prompting a reexamination of the indications for them in pregnant women. The high percentage of pregnancies terminated by preventive cesarean section for non-obstetric reasons also largely involves orthopedic conditions. A challenge for obstetricians is pregnant patients with orthopedic conditions both before and during pregnancy. Pregnant women with a history of orthopedic surgery require special attention. The lack of consensus in this area, physicians’ fear of patients’ claims and the skewing of patients’ requests for surgical termination of pregnancy have prompted an analysis and systematization of existing knowledge in this field. Methods: References published up to 30 June 2023 in five databases Pubmed, Embase are included. Keywords have been checked for the following: pubic symphysis diastasis, lumbar disc herniation, past hip arthroplasty and fractures in the pelvic bones. In the described conditions complicating pregnancy, the mode of delivery was taken into account. Results: All included studies were screened and reviewed by at least two authors until an overall consensus of 50 articles was reached. Conclusions: Orthopedic indications for cesarean section in many cases should not be treated imperatively, since natural delivery after correct fusion of a pelvic fracture, implantation of a hip endoprosthesis or a limited dissection of the pubic symphysis is possible and is not associated with a higher risk of obstetric or orthopedic complications. Extra-obstetric indications for cesarean section should be determined individually for each pregnant woman in a multidisciplinary team, since orthopedic conditions may overlap with obstetric pathology in the pelvis. Full article

Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between the popliteal artery and capsule of the posterior knee (IPACK) block is a regional anesthesia technique that targets the posterior innervation of the knee capsule. This retrospective study aimed to compare the analgesic effects of SIFIB and SIFIB + IPACK on patients undergoing TKA under spinal anesthesia. Materials and Methods: This retrospective study revealed the data collected from a tertiary hospital. Patient data were gathered for individuals who underwent unilateral TKA under spinal anesthesia during the period between 1 January 2023 and 1 September 2023. Inclusion criteria comprised patients falling within ASA class I–III, those following a standardized perioperative analgesia regimen, and individuals receiving opioids via a patient-controlled analgesia device (PCA) as part of their postoperative pain management strategy. Patients were grouped as SIFIB and SIFIB + IPACK according to the performed regional anesthesia technique. Results: In the study, the data of 88 patients in total, 61 in the SIFIB group and 27 in the IPACK group, were analyzed. The 24 h cumulative morphine consumption was similar in the SIFIB and SIFIB + IPACK groups (10.62 ± 6.58 mg vs. 12.55 ± 8.84 mg, respectively; p: 0.258). The NRS scores of the groups were similar in all time frames. Conclusions: Our study reveals that combining IPACK with SIFIB in the multimodal analgesia plan does not provide additional benefits in terms of postoperative opioid consumption and pain scores in patients undergoing unilateral THA under spinal anesthesia. Full article

Background: Total Knee Arthroplasty (TKA) is one of the most commonly performed orthopedic procedures, and patients complain of severe pain in the postoperative period. The supra-inguinal fascia iliaca block (SIFIB) works as an anteriorly applied lumbar plexus block and is frequently used in hip surgeries. In this study, we evaluated the effect of SIFIB in patients undergoing TKA under spinal anesthesia. Methods: This study is a prospective, randomized, assessor-blinded feasibility study conducted in a tertiary hospital. Eighty-six patients with ASA I-III were initially enrolled, and after exclusions, 80 patients were randomized into two equal groups (SIFIB and control groups). The standard multimodal analgesia was applied to the control group, while SIFIB was additionally applied to the block group. The study measured the morphine requirement in PCA and pain intensity using Numeric Rating Scores between the two groups. Results: the 24-h cumulative morphine consumption was lower in Group SIFIB. Although there was a decrease in NRS at rest scores in the SIFIB group during some time periods, pain was moderate, and no differences in pain scores were recorded during exercise in all patients. Conclusions: In patients undergoing TKA under spinal anesthesia, a single shot of SIFIB results in a significant reduction in the amount of morphine consumed in hours. This effect was most likely related to a decrease in pain at rest in the SIFIF group. Full article

Hip arthroplasty is a very effective medical procedure. The optimal positioning of the components and the functioning of the endoprosthesis are influenced, among other things, by the mobility and balance of the spine. The aim of the study was to analyze the factors influencing the mobility of the lumbar–pelvic–iliac complex (spinopelvic mobility) together with the assessment of sagittal spinal alignment in patients prior to THA (total hip arthroplasty). Patients who underwent hip replacement surgery due to advanced osteoarthritis of the hip were enrolled in the study (n = 103). The sociodemographic characteristics, BMI, radiological advancement of the degenerative disease, quality of life, and range of joint mobility were completed using a proprietary questionnaire, the EQ-5D-5L questionnaire, and a clinical examination. X-ray images were analyzed: AP of the pelvis standing up, lateral of the spine standing and sitting. Key parameters were measured as ∆SS—change in sacrum angle value when changing from standing to sitting position and pelvic incidence (PI)—lumbar lordosis (LL) mismatch—sagittal lumbar pelvic balance measured in standing position. The patients were assigned to the appropriate groups according to the Hip-Spine Classification: normal group: 1A (n = 65; 63.1%), abnormal groups: 1B (n = 17; 16.5%), 2A (n = 16; 15.5%), 2B (n = 5; 4.9%). A correlation was shown between the abnormal groups and the individual components of PROMs in the scope of the self-service and normal activities categories (EQ-5D and EQ-VAS). However, the strength of the relationship turned out to be moderate, and the remaining components of the survey were statistically insignificant. The remaining factors analyzed, i.e., age, BMI, the range of hip motion, the presence of contracture in the joint in a clinical examination, and the radiological advancement of osteoarthritis on the Tonnis scale, do not predict abnormal relationships between the spine and the pelvis in our patients waiting for THA. Therefore, further investigations are needed to evaluate the correlation between preoperative factors and the lumbar–pelvic–iliac complex in patients prior to planned hip arthroplasty. Full article

Hip arthrosis and total hip arthroplasty (THA) can alter a patient’s balance and spinopelvic mobility. In this study, we hypothesized that lumbar, pelvic, and hip mobility and their inter-relations are affected by THA and that their study could give an insight in our understanding of postoperative balance and mobility. A total of 165 patients with hip arthrosis and with an indication for THA were included in this single-center prospective cohort. Sagittal radiographs were acquired in four positions: free-standing, standing extension, relaxed-seating and flexed-seating preoperatively and at 6 and 12 months. Spinopelvic parameters were measured (pelvic tilt and incidence, sacral slope, lumbar lordosis, pelvic-femoral angle). Standing spinopelvic parameters did not significantly change postoperatively. However, the postural changes occurring between positions were significantly altered after THA. In particular, pelvic and lumbar mobility was significantly reduced postoperatively, while hip mobility was increased. Correlations were observed between the changes in lumbar, pelvic and hip mobility before and after THA. This study confirmed that there is a relationship between lumbar, pelvic and hip mobility in osteoarthritis, and that this relationship is modified by the postoperative compensation mechanisms deployed by the patient in dynamic postures. Hence, surgeons should consider these relationships when planning surgery, in order to obtain a physiological pelvic tilt postoperatively and to account for the potential increased risk of impingement and dislocation with hip hypermobility. Full article