Search Results (71)

Background and Objectives: Total femoral replacement (TFR) was originally developed for limb salvage following the resection of malignant tumors. Over time, its indications have expanded, now serving as a reconstructive option for failed endoprosthetic replacements and severe trauma cases. Despite its advantages, TFR is a highly complex surgical procedure associated with significant complication rates. This study aims to analyze the management of complications and propose strategies to mitigate associated risks. Materials and Methods: This is a retrospective study conducted on patients from two independent hospitals who underwent TFR for different reasons. Results: Nineteen patients were included: eight underwent TFR for oncological indications, while 11 had the procedure as a revision following failed endoprosthetic arthroplasty or trauma. Postoperative complications were observed in 10 patients (53%), including hip dislocation (21%), mechanical implant failure (11%), infection (21%), wound healing complications (26%), and metal allergy symptoms (5%). Revision surgery was required in six patients (32%), but no cases necessitated amputation. Conclusions: TFR is associated with a high risk of complications, with infection and wound healing issues being the most prevalent. In our experience effective complication management strategies should include early intervention, considering TFR at an earlier stage in non-oncological patients to minimize multiple revision surgeries; allergy screening, assessing for potential metal hypersensitivity preoperatively; dislocation prevention, implementing dual mobility bearings to reduce instability; infection control, utilizing intraoperative local antibiotic therapy in revision cases; and wound management, applying vacuum-assisted closure (VAC) therapy postoperatively to enhance wound healing. Implementing these strategies may improve patient outcomes and reduce the burden of complications associated with TFR. Full article

Background: Surgical management of adult patients with post-dysplastic coxarthrosis using total hip arthroplasty is technically demanding and carries an increased risk of complications. In cases of high iliac dislocation classified as Crowe type IV, restoring the acetabular component to the anatomical hip centre often requires femoral shortening osteotomy to enable safe reduction in the prosthetic joint. Nevertheless, long-term evidence on functional outcomes and prosthesis survival with this approach is limited. Methods: A retrospective cohort study included 19 patients with 22 cases of Crowe type IV post-dysplastic hip osteoarthritis treated with uncemented total hip arthroplasty (Pinnacle/S-ROM, DePuy, Warsaw, IN, USA) combined with transverse subtrochanteric femoral shortening osteotomy. Patients underwent serial clinical follow-up, including assessment of range of motion, measurement of limb-length discrepancy, and functional evaluation using the Harris Hip Score and the WOMAC questionnaire. Radiological assessment included evaluation of osteotomy union, implant positioning, and osteolysis on standardized radiographs. Vertical distances of the centre of rotation (CR), the tip of the greater trochanter (GT), and the tip of the lesser trochanter (LT) from both reference lines were measured bilaterally, and inter-side differences were calculated. The reference lines consisted of the line connecting the inferior margins of the ischial bones and the teardrop (TD) line. Results: All osteotomies united at a mean of 5.57 months, with a mean follow-up of 129 months. Mean limb-length discrepancy decreased from 5.27 cm to 1.5 cm, and mean hip flexion improved from 82.9° to 106°. Functional outcomes improved significantly, with mean WOMAC increasing from 55.4 to 80.1 (p < 0.001) and mean Harris Hip Score from 49.8 to 84.66 at up to 3 years of follow-up (p < 0.001). Osteotomy length correlated strongly with lesser trochanter–teardrop distance (p = 0.00000048). Complications included distal femoral fissure (27.3%) and revision (18%), with no infection or permanent neurological deficit. Conclusions: Total hip arthroplasty combined with subtrochanteric femoral shortening osteotomy for Crowe type IV post-dysplastic hip osteoarthritis appears to be a feasible and effective procedure in an experienced centre, providing reliable osteotomy healing and significant early functional improvement that is sustained over time. Limb-length discrepancy was reduced and satisfactory biomechanical restoration was achieved, with an acceptable complication profile and implant survival of 81.3% at long-term follow-up. The LT–TD parameter was identified as a potential predictor of osteotomy length, enabling the proposal of a preoperative planning equation. However, given the limited sample size and lack of validation, these findings should be interpreted cautiously. Further studies are needed to confirm their broader applicability. Full article

Background: In children with cerebral palsy, bony acetabular deficiencies are common and may be associated with progressive hip subluxation, abnormal joint loading, and ultimately hip dislocation. Hip reconstruction surgery is typically performed to prevent dislocation, and this includes acetabular reshaping using acetabuloplasty. The location of acetabular deficiency may vary among individuals; however, only radiographs are used for planning and intraoperative correction in many centers. Precise reconstruction and preop planning are necessary for the accurate correction of acetabular coverage. This study compares conventional hip reconstruction with a 3D-guided technique using individual preop 3D planning and 3D-printed guides during surgery to determine which method allows for a more accurate correction. We hypothesize that the patient-specific 3D planning leads to more precise anatomical correction of acetabular coverage compared to conventional freehand osteotomy. Methods: This study was registered in the German Clinical Trial Register (DRKS-ID: DRKS00031356) on 14 July 2023. In a randomized controlled trial, various imaging-based parameters were used to assess the bony anatomy preoperatively and postoperatively. Preoperative and 6-week postoperative computed tomography (CT) scans are part of routine clinical care. Additionally, an immediate postoperative CT scan was performed. One hip was operated on using individualized 3D preoperative planning, while the other hip was corrected using a conventional surgical approach. A standardized subtrochanteric osteotomy was performed for the varisation, derotation, and shortening of the proximal femur. This osteotomy was followed by acetabuloplasty under fluoroscopic control. For the 3D-planned operation, patient-specific cutting and repositioning guides were produced based on preoperative CT imaging. Patients with bilateral cerebral palsy (GMFCS levels I–V), aged 4–18 years, with an open triradiate growth plate and a migration index ≥ 40% in at least one hip were included. In a preliminary retrospective part, this project reproduces the existing three-dimensional acetabular index (3-DAI) and compares it with established radiographic methods to determine the utility and reliability of a reconstructed 3D CT measurement technique. A further component of the retrospective part is the creation of an age-adjusted database of typically developed hips and the development of a 3D head coverage index (3D-HCI) as a new 3D parameter to express acetabular coverage; therefore, it will be used as a secondary parameter and correlated to the 3DAI in the prospective part. Conclusions: Improved precision may have meaningful clinical implications for long-term joint congruency, load distribution, pain, and mobility outcomes. Full article

Background: Periprosthetic joint infection and native hip infections often require staged surgical intervention due to extensive bone and soft tissue destruction. This study evaluates the clinical feasibility and mechanical reliability of a modified functional articulating hip spacer (FAHS) incorporating a cemented dual-mobility-bearing (DMB) metal liner. Methods: We retrospectively reviewed the cases of 20 patients who underwent a DMB-incorporated FAHS between March 2018 and December 2019. The technique involved cementing a DMB metal liner directly into the prepared acetabulum without a standard outer shell. Successful clinical outcome was defined as either transition to second-stage total hip arthroplasty (THA) or stable spacer retention, the latter including cases with definitive eradication or symptom-controlled chronic suppression therapy. Infection eradication required the clinical absence of infection for at least twelve months following the cessation of antimicrobial therapy. Construct-related mechanical complications and radiographic parameters were also analyzed. Results: The mean follow-up was 23.5 months, ranging from 6.0 to 62.6 months. Successful clinical outcome was achieved in 17 patients (85%), with seven (35%) transitioning to second-stage THA and ten (50%) opting for spacer retention. Within the retention group, seven achieved definitive eradication while three were maintained under chronic suppression therapy. Construct integrity was maintained in 80% of the cohort. Mechanical complications included two dislocations (10%) and two implant failures (10%). Radiographic analysis showed higher inclination and anteversion angles of the metal liner in the dislocation cases. Conclusions: The off-label use of DMB-incorporated FAHS represents a feasible option with acceptable mechanical performance in selected cases of PJI and native hip joint infection. However, as mechanical complications cannot be fully prevented, meticulous surgical techniques and careful patient selection remain essential. Full article

Introduction: Management of trochanteric fractures in revision hip surgery has a high incidence of non-union and complications. Fixation devices are often bulky, prone to breakage, and necessitate reoperation. This study describes a novel soft tissue and bony abductor repair that reduces the forces on bony fragments without the need for prominent metalwork. Methods: This novel surgical technique involves fixation of the abductor mechanism with polyester and polyethylene sutures that are woven through the abductors and secured to the femoral shaft with a proprietary suture cerclage tape with cerclage wire supplementation in select cases. All patients undergoing fixation were retrospectively reviewed with a minimum follow-up period of 12 months. Outcomes relating to dislocation, reoperation, fracture union and the incidence of symptomatic Trendelenburg gait were recorded. Results: A total of 17 patients underwent this novel intervention. There were no dislocations or reoperations for prominent metalwork at the last follow-up. One patient had evidence of greater trochanter (GT) non-union, and three had GT displacement of over 3 mm. Eight (47.1%) patients were independently mobile and seven (41.2%) were mobile with only one walking aid. No patients required plate or bolt fixation. Conclusions: GT fractures and abductor deficiency are difficult to manage, with most reported methods utilising bulky metalwork to treat a soft tissue injury. We describe a novel combined soft tissue and bony fixation without the need for excessive metalwork. Our pilot study demonstrates satisfactory outcomes of this intervention that are technically reproducible and more appropriately addresses the deforming forces involved with a low complication profile. Full article

Background: Femoral neck fractures (FNFs) in the ageing population carry high risks of postoperative dislocation, with traditional total hip arthroplasty (THA) reporting rates up to 10%. Dual mobility THA (DM-THA) may provide enhanced stability, but evidence for third-generation implants like the Zimmer Biomet G7^® system remains limited. Methods: This retrospective cohort study evaluated 120 patients (mean age 71.6 years; 74% female) with acute displaced intracapsular FNF treated with DM-THA (2021–2023) using the G7^® system. Demographics, surgical details (cemented/uncemented stems), complications, and functional outcomes (Oxford Hip Score (OHS) at one year) were analysed against national benchmarks. Results: Zero dislocations and two peri-prosthetic fracture (0.8%, cemented stem) occurred. Thirty-day mortality was 0.8% (below national averages). Functional recovery was excellent (mean OHS: 41/48; 69% scoring ≥40). Surgical complications were minimal (one deep infection 0.8%). Medical complications (anaemia 6.6%, venous thromboembolism 4.2%) were significantly higher in high ASA groups (III-IV). Radiographs confirmed stable implants without loosening. Conclusions: The G7^® DM-THA system demonstrates exceptional stability and safety in FNF patients, with no dislocation risk and low peri-prosthetic fracture rates—even with cemented stems. These outcomes support its use in high-risk populations, though comparative studies with conventional THA are needed. Full article

The management of severely comminuted acetabular posterior wall fractures in young, active patients presents a significant surgical challenge. When anatomical open reduction and internal fixation (ORIF) is not feasible, primary total hip arthroplasty (THA) is often considered but is a suboptimal solution due to concerns over long-term implant survivorship and the inevitability of revision surgery. This single-patient technical note presents a novel joint-preserving technique for managing unreconstructible acetabular posterior wall fractures using with cement-augmented screw fixation via the Kocher–Langenbeck approach. A 28-year-old male sustained a left posterior hip dislocation with a comminuted acetabular posterior wall fracture involving >30% of the articular surface, alongside a tibial shaft fracture, following a high-energy motorcycle collision. Intraoperative assessment confirmed the posterior wall was unreconstructible, with six non-viable osteochondral fragments. A joint-preserving salvage procedure was performed. After debridement, a stable metallic framework was created using three screws anchored in the posterior column. Polymethylmethacrylate (PMMA) bone cement was then applied over this framework in its doughy phase, meticulously contoured to reconstruct the articular surface. The hip was reduced, and the tibia was fixed with an intramedullary nail. The patient was mobilized with weight-bearing as tolerated on postoperative day 3. At the 21-month follow-up, the patient reported no pain during daily activities and only mild discomfort during deep squatting. Radiographic and CT evaluations demonstrated a stable hip joint, concentric reduction, well-maintained joint space, and no evidence of implant loosening or osteolysis. Level of Evidence: V (Technical Note/single-patient Case report). For unreconstructible, comminuted fractures of the non-weight-bearing portion of the acetabular posterior wall in young patients, cement-augmented screw fixation offers a viable joint-preserving alternative to primary THA. This technique provides immediate stability, facilitates early mobilization, and preserves bone stock. While long-term outcomes require further study, this case demonstrates excellent functional and radiographic results at 21 months, presenting a promising new option for managing these complex injuries. Full article

Total hip arthroplasty (THA) is a widely performed and successful surgical treatment for degenerative joint disease. With increasing use in younger and more active patients, the demand for durable, biocompatible, and low-wear implant materials has grown. Oxidized zirconium (Oxinium, Zr2.5Nb) was introduced as a promising femoral head material, combining the strength of metal with the low-friction properties of ceramic. Despite encouraging early results, clinical reports have documented complications including head wear, especially after dislocation, and metallosis. We present the case of a 64-year-old male who underwent primary THA in 2009 and required revision in 2021 due to severe metallosis. Notably, no dislocation was observed that could explain the damage to the Oxinium head. Surface and subsurface analyses using X-ray photoelectron spectroscopy (XPS) and micro-indentation hardness testing revealed wear and deformation inconsistent with Oxinium’s anticipated durability. These findings highlight the importance of the femoral head–polyethylene liner interface in implant longevity. Although Oxinium–XLPE articulations remain promising, risks such as damage to the femoral head, liner dislocation, impingement, and metallosis must be carefully considered. Surgical technique, liner placement, and locking mechanisms play critical roles in preventing failure. Further biomechanical and clinical studies are needed to optimize implant design and improve long-term outcomes. Full article

Background/Objectives: Spacer dislocation is among the most frequent mechanical complications after revision total hip arthroplasty for periprosthetic hip infection. Spacer dislocations may be managed conservatively, but there are no guidelines on the rehabilitation of these patients, and the restriction of weight bearing is still under debate. Methods: We first report the case of a patient with hip spacer cranial dislocation, judged unfit to be surgically treated once more for a medium period, who started a rehabilitation program with partial weight bearing. Results: After two weeks of inpatient rehabilitation, the patient started to maintain the standing position with partial weight bearing on the affected side. Following hospital discharge we continued rehabilitation in the outpatient clinic. Despite the finding of the denervation of the ipsilateral quadriceps, three months after admission, she was able to walk for short distances using a walker, initially with the help of a therapist and then with supervision. About one year later, she was able to undergo the reimplantation of the definitive prosthesis. Conclusions: Despite the spacer dislocation, walking short distances is a feasible goal, even with assistance, wearing a brace and using a walker. Future research is needed to confirm and expand upon this observation and to understand the mechanisms underlying the development of neurological complications to implement effective prevention strategies. 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

Open reduction and internal fixation (ORIF) is widely regarded as the primary treatment for acetabular fractures, but limitations arise in complex cases, leading to non-anatomical reductions and increased risk of post-traumatic osteoarthritis. Given the high incidence of secondary arthritis (12–57%) following ORIF, total hip arthroplasty (THA) is often necessitated, particularly in scenarios unsuitable for ORIF, such as extensive comminution or combined femoral head and neck fractures. The surgical landscape has shifted from a traditional “fix or replace” to a more integrated “fix and replace” approach, especially beneficial in managing elderly patients with osteoporotic bones. THA is applied across various timelines, including acute (0–3 weeks), delayed (3 weeks to 3 months), and late (beyond 3 months), each presenting distinct challenges and requiring specific strategies to optimize outcomes. The importance of precise bone defect classifications and the role of dual mobility cups in reducing dislocation risks are highlighted, alongside the use of modern surgical and fixation techniques to improve stability and patient outcomes. Enhanced recovery protocols and meticulous postoperative management are critical to addressing complications, such as infections and hardware interference, tailoring treatment approaches to each patient’s needs, and advancing care for complex acetabular fractures. Full article

Background: The effectiveness of hip hemiarthroplasty in managing femoral neck fractures in individuals with cerebral palsy has seldom been reported. Objectives: Given the complex neuromuscular issues associated with cerebral palsy (CP), this retrospective study aims to document the outcomes and characterize the complications of hip hemiarthroplasty for fractures of the femoral neck in a series of patients with CP, emphasizing the role of precision medicine in management. Methods: Six cases of hip hemiarthroplasty in six male patients with cerebral palsy and displaced femoral neck fractures have been reviewed in this study. The patients’ mean age at the time of surgery was 55.6 ± 14.1 years (range, 33–71). All the patients were independent indoor ambulators before their femoral neck fracture and had various medical comorbidities. Five patients had intellectual disabilities. Results: The mean clinical and radiographic follow-ups for the patients included in this series were 91.5 and 71.3 months, respectively. All the patients developed significant heterotopic ossification (HO) around the operated hip, which was observed as early as the second week postoperatively on radiographs. HO progressed throughout the follow-up for all the patients. One patient had an early postoperative dislocation with femoral stem loosening, which was managed by implant revision. Another patient had an acetabular protrusion, leading to the loss of their weight-bearing ability and mobility due to pain. Four patients were deceased at a mean of 86.5 months after the index surgery. Conclusions: After considering the preliminary evidence provided with this small case series, this study suggests the overall guarded outcomes of hip hemiarthroplasty in patients with CP. Given the 100% rate of heterotopic ossification, a precision medicine framework with consideration for HO prophylaxis may be recommended after hip hemiarthroplasty in patients with CP. It may also be reasonable to scrutinize a personalized risk assessment approach in this patient subset regarding decision making, surgical approach, and rehabilitation program. The clinical outcomes and the risks of complications following hemiarthroplasty should be sensibly presented to patients with cerebral palsy and their caregivers to achieve reasonable postoperative expectations. Full article

Purpose: The purpose of this scoping review was to systematically identify and summarize the existing literature on non-spinal clinical applications of EOS imaging and identify related evidence gaps. Method: The study followed the PRISMA-ScR guidelines. A systematic literature search was conducted in Embase, MEDLINE, CINAHL, Scopus, Cochrane, Academic Search Premier, and OpenGrey databases in November 2022 and updated in December 2023. Original research from 2003 to 2023 was eligible if in English, Danish, French, German, Norwegian, or Swedish. Two authors screened articles by title and abstract, while data extraction from full texts was performed by seven authors using a structured template. Results: A total of 8176 articles were identified, with 1350 selected for full-text review and 268 included in data extraction. Among adults, 187 articles were included, with 88 focused on surgical applications like hip arthroplasty or osteotomy. In pediatrics, 68 general and 13 surgery-related articles were included. Lower extremity analysis was the most frequent topic, with other uses identified, such as rib cage geometry, patellar dislocation, and X-linked hypophosphatemia. Conclusions: Key clinical applications of EOS imaging include lower extremity analysis, e.g., leg length assessment and knee/hip arthroplasty planning), pelvic and spinal alignment studies, and emerging uses in rib cage geometry. Evidence gaps include limited research on the diagnostic accuracy of EOS for cerebral shunt placement, reliability in bone age estimation, and an unclear role in foot and ankle morphology. Full article

Hip joint reconstruction is often necessary for children and adolescents with conditions like developmental dysplasia of the hip (DDH), neurogenic dislocation of the hip (NDH), or Legg–Calvé–Perthes disease (LCPD) when non-surgical treatments are ineffective. Background: Post-operative immobilization after hip reconstruction in children is crucial to promote proper healing and reduce the risk of complications. While spica casting has been the traditional method, it can lead to various issues. Foam splinting has emerged as an alternative approach. This study aimed to compare the effectiveness and satisfaction of the patient and the caregivers of spica casting and foam splinting after pelvic osteotomies in young patients with DDH, NDH, and LCPD. Methods: A prospective randomized clinical trial included patients aged 3 to 16 undergoing pelvic reconstruction (iliac and proximal femoral osteotomy, open reduction, and soft tissue procedures). Participants were randomized into two groups: one receiving spica casts and the other foam splints, both for a six-week period post-surgery. Quality of life (QOL) assessments like CPCHILD, SF-36, and EQ-5D were conducted using various scores to measure patient and caregiver satisfaction preoperative and at six and twelve weeks postoperative. The surgical techniques were consistent across both groups. Results: The study included 34 patients, with one excluded due to non-adherence. The spica cast group experienced statistically significant declines in QOL scores, while the foam splint group showed decreases that were not statistically significant. Complications were reported in 11 patients, with a higher prevalence in the spica cast group. Conclusions: The foam splint group demonstrated superior satisfaction levels and fewer complications, which leads to the conclusion that foam splinting should be the preferred option to spica casting for post-operative immobilization in these cases. Full article