Search Results (507)

Over 30,000 hip hemiarthroplasty (HA) operations are performed every year across England and Wales to treat fractured necks of the femur. HA reduces surgical and recovery time with lower complication rates; however, it may cause acetabular deterioration, which can lead to revision surgery and possible conversion to total hip arthroplasty (THA). This study assessed hip hemiarthroplasty under gait-representative loading in an anatomical hip simulator. Paired natural acetabula were tested against a CoCr femoral head with radial clearance (RC) of −0.75 mm (head larger than natural) and positive RCs of <0.6 mm (small), 2 mm–4 mm (large), and >4 mm (extra-large). Cartilage surface deterioration was quantified via photogrammetry. Cartilage surface changes were observed in all hemiarthroplasty groups, while no changes were observed in the control group. No statistically significant between-groups in the affected area were detected (Kruskal–Wallis, p > 0.29). The negative RC group showed statistically significant progressive worsening over time (Friedman: (χ²(2) = 8.00, p = 0.018). Groups differed in damage onset, location, intensity, and presence of delamination. Samples with negative RC (oversized head) produce earlier and progressive cartilage changes. The results highlight the importance of carefully measuring the native head diameter and choosing a femoral head size when performing HA. Full article

Background: Intraoperative vascular injuries during elective hip and knee arthroplasty are uncommon but limb-threatening complications. Real-world evidence on emergency on-call vascular management in this setting remains limited. We aimed to identify the intraoperative ischemia time threshold associated with progression to a more severe ischemic presentation (Rutherford IIb) at vascular consultation, in order to support early multidisciplinary activation and prevent irreversible ischemic limb damage. As a secondary aim, we described the clinical spectrum, treatment strategies, and 30-day outcomes of patients managed by a 24 h on-call vascular service (in-hospital coverage during working hours, formal on-call rota out of hours). Non-ischaemic events recorded in the series (e.g., isolated venous injuries and haemorrhagic complications) are documented as part of the overall clinical spectrum but were not the subject of specific time-related analysis. Methods: Single-centre retrospective analysis of 33 consecutive patients undergoing emergency vascular intervention for vascular injury during elective total knee (TKA) or total hip arthroplasty (THA) at a tertiary orthopaedic referral centre in Milan, Italy (January 2023—December 2025). The primary analytical objective was to identify the intraoperative ischemia time threshold associated with Rutherford IIb presentation at vascular consultation; 30-day limb salvage was the primary clinical outcome. Secondary outcomes included technical success, primary 30-day patency, postoperative ankle–brachial index (ABI), length of stay, and Clavien–Dindo complications. Non-ischaemic events (including isolated venous injuries and haemorrhagic complications) are documented as part of the clinical spectrum but were not subject to specific time-related analysis. Receiver operating characteristic (ROC) analysis assessed the discriminative role of intraoperative ischemia time for a Rutherford IIb presentation; univariate logistic regression explored predictors of postoperative complications. Results: Thirty-three patients (mean age 76.3 ± 6.3 years; 54.5% female; ≥2 comorbidities in 81.8%) underwent emergency vascular repair after TKA (60.6%) or THA (39.4%). Injuries were mixed arteriovenous (54.5%), purely venous (24.2%), or purely arterial (21.2%). Mean call-to-incision time was 45.4 ± 11.3 min. In the 25 ischemic cases, the mean intraoperative ischemia time was 130.4 ± 18.7 min. ROC analysis identified an optimal cut-off of 131 min for Rutherford IIb (AUC 0.851, 95% CI 0.679–0.982; p < 0.001), with sensitivity 81.8% and specificity 85.7%. Median ischemia time was significantly higher in IIb than IIa cases (144 vs. 124.5 min; p = 0.003). Technical success and 30-day limb salvage were 100% (95% CI 89.6–100); mean postoperative ABI 0.89 ± 0.03; primary 30-day patency 88.0% (95% CI 70.0–95.8), with secondary patency 100%. All postoperative complications were Clavien–Dindo grade 1; no Clavien–Dindo ≥ 2 events and no 30-day mortality were observed. Conclusions: A dedicated 24 h on-call vascular service achieves excellent 30-day limb salvage and patency in iatrogenic vascular injuries occurring during arthroplasty. An intraoperative ischemia threshold of 131 min identifies higher-risk presentations and supports rapid multidisciplinary activation in high-volume orthopaedic centres. Full article

Background/Objectives: We compared long-term radiological femoral bone remodeling after total hip arthroplasty (THA) with either the VerSys Taper stem (T) or VerSys Midcoat stem (M). Methods: Of 206 patients who underwent unilateral primary THA, 157 (T group: 65; M group: 92) were followed up for >15 years. Stress shielding was evaluated according to Engh’s classification, cancellous condensation and cortical hypertrophy in each zone were assessed according to Gruen’s zone, and fixation was evaluated using Engh’s classification. We investigated the grade of each stem at each point in stress shielding. Results: Grade 3 or 4 stress shielding incidence was higher in the T group than in the M group, and stress shielding grades at each time point were significantly higher in the T group. The stress shielding grade showed progressively greater divergence in the T group, consistent with a significant stem × time interaction. The generalized linear mixed model showed significant zonal variation in cancellous condensation but no effects of stem type or stem × zone interaction. Similarly, cortical hypertrophy showed no significant effects of stem type, zone, or their interaction. There were no cases of unstable fixation in either group; however, 90.2% of patients in the M group had bone ingrowth, whereas 23.1% of patients in the T group had fibrous stability. There were no cases of revision owing to aseptic loosening in either group. Conclusions: These findings suggest that the primary long-term difference between the stem designs lies in the trajectory of stress-shielding progression rather than in zonal bone responses. Full article

Background/Objective: Hip osteoarthritis (HOA) is a major source of pain and disability worldwide. Although total hip arthroplasty (THA) provides substantial symptomatic improvement, a subgroup of patients remains ineligible because of severe comorbidities, frailty or elevated perioperative risk. Conservative treatments provide only temporary symptom control and transarterial periarticular embolization (TAPE) has emerged as a minimally invasive intervention targeting abnormal periarticular hypervascularity and inflammation. The aim was to compare clinical outcomes of TAPE and conservative care (CC) in patients with symptomatic HOA considered unsuitable for THA. Methods: A prospective non-randomized two-centre cohort study included consecutive adults aged ≥60 years with symptomatic HOA and baseline visual analogue scale (VAS) pain scores over 40. Patients were managed with either TAPE or structured CC. The primary endpoint was change in VAS pain score from baseline to 6 months. Secondary outcomes included Lower Extremity Functional Scale (LEFS), Timed Up-and-Go (TUG) and analgesic use. Patients were evaluated at baseline, 1, 3 and 6 months. Results: A total of 81 patients were screened, 69 were enrolled and 62 were included in the complete case longitudinal analysis. Baseline symptom severity was greater in the TAPE group, with higher VAS scores (73.6 ± 12.5 vs. 63.7 ± 14.1; p = 0.003) and lower-joint space width (1.37 ± 0.79 vs. 2.07 ± 0.89 mm; p < 0.001). The reduction in pain occurred during the first three months following embolization, after which symptom trajectories stabilized. Mean VAS pain in the TAPE group decreased from 73.6 ± 12.5 at baseline to 55.4 ± 13.0 at three months and 56.8 ± 13.6 at six months. LEFS improved in both groups throughout follow-up. Conclusions: TAPE was associated with symptom improvement and short-term safety in a small cohort of surgery-ineligible patients with HOA. The observed benefits appeared greatest within the first three months. Full article

Background: Chronic corticosteroids are commonly prescribed for autoimmune and inflammatory disorders, yet their impact on perioperative outcomes following elective total hip arthroplasty (THA) remains incompletely defined. This study evaluated the association between chronic corticosteroid use and postoperative complications and hospital outcomes after elective primary THA. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2021). Adult patients undergoing elective primary THA were identified using ICD-10-PCS codes. Chronic corticosteroid use was defined by ICD-10-CM code Z79.52. The primary outcome was any postoperative complication, including venous thromboembolism (VTE), major bleeding, acute kidney injury, myocardial infarction, stroke, or sepsis. Secondary outcomes included prolonged length of stay, high hospital charges, discharge to rehabilitation, and in-hospital mortality. Multivariable weighted logistic regression and 1:1 propensity score matching (PSM) was applied. Results: The weighted cohort represented approximately 600,000 hospitalizations, of which 0.91% involved chronic steroid use. Steroid users had a higher burden of comorbidities. After adjustment, chronic corticosteroid use was independently associated with increased odds of any postoperative complication (OR 1.32), major bleeding (OR 1.46), prolonged hospitalization (OR 1.26), discharge to rehabilitation (OR 1.06), and in-hospital mortality (OR 2.53). In the matched cohort (1079 pairs), steroid use remained significantly associated with overall complications (OR 1.84) and acute kidney injury (OR 2.10). Conclusions: Although uncommon, chronic corticosteroid use is associated with a clinically meaningful increase in perioperative morbidity after elective THA. These findings highlight chronic corticosteroid use as a marker of increased perioperative risk that warrants greater clinical recognition, and they provide hypothesis-generating evidence to inform future studies of perioperative management in this population. Full article

Background: Developmental dysplasia of the hip (DDH) is one of the leading causes of secondary hip osteoarthritis and frequently results in severe anatomical alterations that make total hip arthroplasty (THA) technically demanding. Restoration of hip biomechanics, limb length, and joint stability remains challenging, particularly in patients with moderate-to-severe dysplasia. Objective: To evaluate the clinical and radiographic outcomes of cementless total hip arthroplasty combined with soft-tissue balancing, with or without acetabular reconstruction using autologous femoral head graft, in patients affected by osteoarthritis secondary to DDH. Methods: A retrospective single-center case series was conducted on eight female patients (mean age 53.9 ± 14.6 years; range 33–80 years) who underwent primary cementless THA for DDH-related osteoarthritis between 2019 and 2025. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Radiographic evaluation included implant positioning, osteolysis, heterotopic ossification, bone graft incorporation, and leg-length discrepancy. Data normality was assessed using the Shapiro–Wilk test. Preoperative and postoperative outcomes were compared using paired Student’s t-test and confirmed with the Wilcoxon signed-rank test. Implant survival and revision-free status were recorded throughout the follow-up period. Results: At a minimum follow-up of 12 months (range 12 months–6 years), significant improvements were observed in all clinical outcome measures. Mean HHS increased from 49.3 ± 2.5 preoperatively to 90.4 ± 2.7 postoperatively (p < 0.001), while mean WOMAC decreased from 53.5 ± 5.6 to 7.4 ± 3.3 (p < 0.001). Mean SF-36 improved from 47.2 ± 3.8 to 89.9 ± 3.2 (p < 0.001). Wilcoxon analysis confirmed the statistical significance of these findings (all p = 0.0078). Radiographic assessment demonstrated satisfactory implant positioning and stable fixation in all patients, with no evidence of osteolysis or implant loosening. Minor complications included one intraoperative periprosthetic femoral fracture treated successfully with cerclage wiring, two cases of Brooker grade I–II heterotopic ossification, and one case of minimal graft resorption without clinical consequences. No revision procedures were recorded during follow-up, and implant survival was 100%. Conclusions: Cementless THA combined with selective soft-tissue balancing provides excellent clinical, functional, and radiographic outcomes in patients with osteoarthritis secondary to DDH. This approach significantly improves hip function and quality of life while ensuring stable implant fixation, low complication rates, and excellent mid-term implant survival. Full article

Background: Intraoperative periprosthetic femoral fractures (IPFF) represent a concerning and often under-recognized complication in total hip arthroplasty (THA). Although several risk factors have been reported, their association with specific femoral morphology and stem geometry has not been fully addressed. This study aimed to identify the incidence and risk factors for IPFF in THA using cementless tapered stems. Methods: A retrospective review was conducted on 3137 primary THAs (2622 patients) performed with cementless tapered stems at a single institution between February 2011 and August 2018. Femoral morphology was classified according to the Dorr types; A (1425 hips, 45.4%), B (1542, 49.2%), and C (170, 5.4%). Femoral stems were categorized as flat, rectangular, or quadrangular tapered designs. The occurrence of IPFF was identified through surgical records and postoperative radiographs. Multivariate regression analysis was performed to identify independent risk factors for IPFF. The mean age at THA was 55 years (range, 15–96), and 52.9% of the patients were women. Results: The overall incidence of IPFF was 2.2% (69 hips). Non-displaced cracks in the proximal metaphysis (58 hips, 84.1%) were the most common type of fracture. The incidence of IPFF was significantly higher in Dorr type A (3.0%) and type C (4.7%) femurs compared with type B (1.2%) femurs. Multivariate regression revealed that female sex (odds ratio [OR], 1.752; p = 0.032) and Dorr type A (OR, 2.898; p < 0.001) and type C (OR, 4.530; p < 0.001) were significantly associated with IPFF. Additionally, the use of quadrangular tapered stems was associated with a higher risk compared with flat tapered stems (OR, 7.382; p < 0.001). Conclusions: Dorr type A and C femurs, along with female sex and the use of quadrangular tapered stems, were significant risk factors for IPFF. Our findings suggest that preoperative consideration of individual femoral morphology and careful selection of stem design are essential to mitigate the risk of IPFF in THA using cementless tapered stems. Full article

Background: Intraoperative periprosthetic proximal femoral fractures (PPFFs) represent a significant complication during total hip arthroplasty (THA), especially when using cementless stems via a direct anterior approach (DAA). Methods: This retrospective case series evaluated 10 patients with Vancouver A2 PPFFs treated with 2.7 mm lag screws alone or in combination with plates during DAA THA or partial hip arthroplasty between January 2021 and March 2024. Results: All fractures healed. One patient experienced 1 cm of stem subsidence without the need for revision. The mean Harris Hip Score improved from 35.4 preoperatively to 85.6 postoperatively. Functional recovery and radiological stability were comparable between fixation methods, though the screw-only group experienced slightly more postoperative pain. Patients in the screw-and-plate group were significantly older than those in the screw-only group (p = 0.026). No significant differences were found between groups regarding surgical time (p = 0.62) or BMI (p = 0.82). Due to the limited number of subsidence events, the statistical comparison of subsidence rates was inconclusive. Conclusions: In this preliminary retrospective case series, the use of 2.7 mm lag screws and small locking plates appeared feasible and was associated with favorable short-term outcomes in selected Vancouver A2 intraoperative PPFFs during DAA. These findings are hypothesis-generating and require confirmation in larger, prospective comparative studies. Full article

Purpose: There is limited literature on the functional outcomes of robotics-assisted (RA) superior transverse atraumatic reconstruction approach (STAR) in total hip arthroplasty (THA). This study compares the early functional outcomes, patient satisfaction, expectation fulfilment and complication rates between STAR RA-THA and direct anterior approach (DAA) RA-THA. Methods: We retrospectively analyzed all primary RA-THA performed between January 2022 and December 2024 at a high-volume tertiary centre. Patients undergoing either the DAA or STAR THA with available 6-month outcomes were included. There was a total of 123 patients (74 DAA and 49 STAR). Propensity score matching was used to account for baseline differences, generating 49 matched pairs based on age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) grade. Postoperative patient-reported outcome measures (PROMs) and the proportion achieving minimum clinically important difference (MCID) were compared between groups. PROMs included were the Oxford Hip Score (OHS), Western Ontario and McMaster University Arthritic Index (WOMAC), Short-Form 36 Health Survey (SF-36) subscale, patient satisfaction score and expectation fulfilment score. Results: The DAA group demonstrated significantly better postoperative day one (POD1) ambulation distance (p = 0.00390). No differences in PROMs, MCID, patient satisfaction and expectation fulfilment scores were noted at last follow-up. The RA-DAA group had a higher incidence of meralgia paresthetica (p = 0.00260). Conclusions: The STAR RA-THA demonstrated early functional recovery comparable to DAA RA-THA. Although POD1 ambulation distance was greater in the DAA group, at six months, both approaches had similar functional outcomes, patient satisfaction and low complication rates. Full article

Background: Return to play (RTP) after total hip arthroplasty (THA) is increasingly expected by younger and more physically active patients. Current activity recommendations remain heterogeneous and are largely derived from expert opinion and indirect biomechanical modelling approaches, rather than direct in vivo biomechanical evidence. The aim of this article is to systematically map and synthesize the evidence from instrumented hip implant studies and to clarify how direct in vivo telemetry data can inform RTP counselling after THA. Methods: A scoping review was conducted according to a predefined Open Science Framework protocol and reported following PRISMA-ScR guidelines. MEDLINE (PubMed) and Scopus were searched from inception. Peer-reviewed clinical studies reporting direct in vivo biomechanical measurements obtained from instrumented hip implants were included. Conference proceedings, technical notes, reviews, and in vitro or computational-only studies were excluded. Data were extracted and synthesized descriptively according to activity domain, biomechanical variables, and implant technology. Results: Fifty studies met the inclusion criteria. Early investigations established feasibility and evolved from wired strain-gauge systems to fully implantable telemetric prostheses capable of measuring three-dimensional forces, moments, and friction-related parameters. Across cohorts, level walking consistently produced peak hip contact forces of approximately 2–3 times body weight, serving as a clinically meaningful reference loading envelope. Several recreational activities—including cycling, aquatic exercise, Nordic walking, and most gym-machine exercises—generally remained within or close to this range when performed with controlled technique. In contrast, certain rehabilitation tasks, forward-bent postures, lifting maneuvers, and perturbation events generated loads equal to or exceeding those observed during walking. Importantly, frictional moments and load direction showed substantial variability and may be more relevant to implant fixation than peak force magnitude alone. Conclusions: Instrumented hip implants provide objective biomechanical benchmarks that support principle-based and individualized RTP counselling, grounded in directly measured mechanical exposure rather than sport classification alone. Full article

Background: Venous thromboembolism (VTE) remains a clinically relevant complication following major orthopaedic procedures, particularly total hip arthroplasty (THA), total knee arthroplasty (TKA), and fracture surgery. Although low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) are widely regarded as standard pharmacological options, aspirin (acetylsalicylic acid, ASA) has gained renewed attention because of its low cost, oral administration, and favourable bleeding profile. However, the available evidence is heterogeneous, and its interpretation is complicated by differences in patient selection, timing and duration of prophylaxis, diagnostic methodology, aspirin dosing regimens, and the increasing adoption of modern fast-track arthroplasty pathways. Methods: A structured evidence-based review was conducted in accordance with PRISMA 2020 principles. PubMed, Embase, Web of Science, and the Cochrane Library were searched through September 2025 for randomised controlled trials (RCTs), major international clinical practice guidelines, and selected high-level studies relevant to the interpretation of aspirin-based orthopaedic thromboprophylaxis. Nine RCTs, four major guideline documents, and sixteen additional Level I–II studies were included. Outcomes of interest were symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality. Risk of bias was assessed using the Cochrane ROB 2 framework. Owing to marked methodological heterogeneity, no formal pooled meta-analysis was undertaken. Results: The available RCT evidence suggests that aspirin may perform adequately within structured sequential or risk-stratified prophylaxis strategies, but not in all clinical settings. In arthroplasty, EPCAT II demonstrated non-inferiority of aspirin when introduced after an initial five-day course of rivaroxaban, whereas CRISTAL showed higher early symptomatic VTE rates when aspirin was used as sole primary prophylaxis from postoperative day 0. Importantly, thromboembolic events in CRISTAL occurred earlier in the aspirin cohort, supporting the concept that anticoagulant therapy remains important during the immediate postoperative hypercoagulable phase. In trauma surgery, PREVENT CLOT established non-inferiority of aspirin compared with LMWH for 90-day mortality; however, the predominantly young study population and the inclusion of upper-extremity fractures limit extrapolation to elderly hip fracture patients. Several smaller RCTs reported no major differences between aspirin and anticoagulants, but these studies were frequently underpowered and relied on less sensitive diagnostic strategies. Historical and contemporary guidelines remain heterogeneous, and evidence from modern fast-track arthroplasty pathways suggests that current trial-based conclusions may not be directly generalisable to short-duration prophylaxis settings. Conclusions: Aspirin may have a role in orthopaedic thromboprophylaxis when used within structured, risk-adapted or sequential protocols, particularly in standard-risk arthroplasty patients and selected trauma populations. However, current evidence does not support its universal use as sole primary prophylaxis in major orthopaedic surgery, especially during the early postoperative hypercoagulable phase or in high-risk patients. Furthermore, the available literature does not permit definitive recommendations regarding the optimal aspirin dose or duration of prophylaxis. The generalisability of the existing literature is further limited by methodological heterogeneity and by the absence of RCTs directly evaluating ultra-short anticoagulant regimens versus prolonged aspirin prophylaxis in modern fast-track arthroplasty. Further high-quality, standardised trials are required. Full article

Total hip arthroplasty (THA) is among the most effective orthopedic interventions for osteoarthritis, yet post-operative rehabilitation is frequently delayed due to informational and organizational barriers. Geographic information system (GIS) technology offers a promising approach to improving rehabilitation access coordination, though its integration into patient-facing mobile platforms remains insufficiently studied. This two-arm, parallel-group, superiority randomized controlled trial enrolled 142 adult patients (≥18 years) within seven days of primary THA at the National Research Oncology Center LLC, Astana, Kazakhstan. Participants were randomized 1:1 to the GIS-integrated Health-GIS mobile coordination platform (experimental group) or standard general practitioner (GP)-mediated referral (control group). Key exclusion criteria included severe cognitive or visual impairment, absence of smartphone access or digital literacy, and medical contraindications to rehabilitation. The primary outcomes were time to second-stage rehabilitation initiation and health-related quality of life assessed by the SF-12 (Physical and Mental Component Summaries). Secondary outcomes included the Harris Hip Score (HHS), Visual Analogue Scale (VAS) for pain, System Usability Scale (SUS), and quality-adjusted life years (QALYs) over a 12-month follow-up. Of 142 randomized participants (61% male, 39% female), 131 completed follow-up and were included in the modified intention-to-treat analysis (experimental: n = 66; control: n = 65). The experimental group initiated second-stage rehabilitation significantly earlier (median 43 vs. 59 days; p = 0.021). At 12 months, the experimental group demonstrated superior SF-12 Physical Component Summary scores (48.21 vs. 42.84; p < 0.001), while Mental Component Summary scores did not differ significantly between groups (46.96 vs. 47.05; p = 0.669). Quality-adjusted life years were significantly higher in the experimental group (0.74 ± 0.04 vs. 0.72 ± 0.04; p = 0.008). Harris Hip Scores were significantly better in the experimental group at 6 weeks (p < 0.001) and 6 months (p = 0.009), converging by 12 months (p = 0.068). No statistically significant between-group differences in pain intensity (VAS) were observed at any time point (baseline: p = 0.814; 6 weeks: p = 0.336; 6 months: p = 0.066; 12 months: p = 0.105). Platform usability was rated as good-to-excellent by clinicians (SUS: 86.9 at 6 months) and acceptable by patients (mean SUS: 71.4). A GIS-integrated mobile coordination platform significantly reduced time to rehabilitation initiation and improved physical health-related quality of life and health utility following THA compared to standard referral practice. These findings support platform-based care coordination as an effective complement to surgical care, with important implications for rehabilitation access policy. Future multi-center studies and formal cost-effectiveness analyses are warranted to establish generalizability. Trial Registration: ClinicalTrials.gov, NCT07201116, registered 23 September 2025. Full article

Background: Postoperative rehabilitation following Total Knee or Hip arthroplasty (TKA, THA respectively) for end-stage osteoarthritis is frequently characterized by oxidative stress and chronic-inflammation-induced muscle atrophy. This study investigated the efficacy of a milk protein concentrate supplement (MCPS) on oxidative stress, inflammation markers, and functional regains in patients undergoing TKA or THA. Methods: 88 participants (aged 55–80 years) were allocated to either an Intervention Group (IG, n = 44), receiving the MPCS, or a Control Group (CG, n = 44), following conventional nutrition for 15 weeks. Appendicular skeletal muscle mass (ASMM) was measured using bioelectrical impedance analysis and functionality through handgrip strength, gait speed, and static balance. 8-Isoprostane levels were quantified in plasma samples using the Enzyme-Linked Immunosorbent Assay(ELISA) method. C Reactive Protein (CRP) levels in serum specimens were measured. Data analysis was conducted, with adjustments made for age, gender, and comorbidities. Results: The IG demonstrated a significant increase in ASMM (Adj. mean change, Δ = +2.34 kg, 95% CI: 1.99 to 2.69, p < 0.001) and ASMM Index (Δ = +0.82 kg/m², 95% CI: 0.64 to 1.00, p < 0.001) compared to the CG. Functional measurements also showed significant improvements in the IG, including Handgrip Strength (Δ = +4.40 kg, p < 0.001), Gait Speed (Δ = +0.23 m/s, p < 0.001), and the 2-Minute Walk Test (Δ = +12.02 m, p = 0.026). Regarding biochemical markers, the IG showed a significant reduction in plasma F2-isoprostane levels (Δ = −29.19, p < 0.001), CRP levels (Δ = −0.69 mg/L, p = 0.004), and PTH levels (Δ = −27.41 pg/mL, p < 0.001). A negative association between lipid peroxidation (8-isoprostanes) and ASMM was confirmed. Conclusions: Structural nutritional intervention can effectively mitigate catabolic stress triggered by surgical treatment. Implementing such strategies into orthopedic care offers a practical approach to treat challenges often associated with postoperative muscle loss. Full article

Background and Objectives: Discharge planning after hip-related fracture surgery may depend on both the surgical method and functional recovery achieved during convalescent rehabilitation. This single-center retrospective cohort study aimed to determine whether discharge pathways differed according to surgical procedure and whether functional recovery patterns differed according to surgical procedure and discharge pathways among patients admitted for convalescent rehabilitation after hip-related fracture surgery. Materials and Methods: This retrospective cohort study reviewed the EMRs of patients admitted to a convalescent rehabilitation hospital between January 2021 and June 2025 after hip-related fracture surgery. Surgical groups were hip hemiarthroplasty (HA), total hip arthroplasty (THA), and internal fixation (IF). Discharge pathways were classified into three categories: home discharge, transfer to an acute-care hospital, and transfer to a long-term care hospital. In this study, home discharge was operationally defined as discharge to the patient’s home or transfer to a nursing hospital. Functional outcomes included the functional ambulation category (FAC), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE); complete-case analysis was applied for functional outcomes. Results: In the overall postoperative cohort (N = 445), discharge pathway distributions differed across surgical groups. In the complete-case traumatic hip-related fracture cohort (N = 243), all groups showed significant improvements from admission to discharge in FAC, BBS, MBI, and MMSE. Between-group comparisons of change scores by surgical method were generally modest. In contrast, discharge pathways showed clearer associations with recovery. Patients achieving home discharge demonstrated greater improvements in FAC, BBS, and MBI measures than those transferred to acute care or nursing homes. Conclusions: Functional recovery was observed across all surgical groups during convalescent rehabilitation. Discharge disposition appeared to be more closely associated with recovery in gait, balance, and ADL performance than with surgical method alone; however, this finding should be interpreted cautiously because discharge decisions may also be influenced by patient and social factors. Full article

Background/Objectives: Total hip arthroplasty (THA) is a common orthopedic procedure, and with projected growth in both primary and revision surgical volumes, robust implant performance data is necessary to inform surgical decision-making. To ensure successful outcomes in primary THA (pTHA) and revision THA (rTHA), surgeons need versatile implant systems that can address patient-specific surgical challenges. This study aimed to evaluate the outcomes of a next-generation acetabular system used for various indications in both pTHA and rTHA. Methods: We retrospectively reviewed 319 patients who underwent either pTHA or rTHA using a modern acetabular system at a single urban academic center between 2014 and 2023 with at least 18 months of follow-up. Baseline characteristics and the patient-reported Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) were collected. A total of 284 patients who underwent pTHA and 35 patients who underwent rTHA were included. Median follow-up was 2.6 years (range: 1.5–8.4 years). Results: The most common indication was osteoarthritis (90%) for pTHA and instability (46%) for rTHA. Most rTHAs utilized a dual-mobility construct (74%), compared to pTHAs (22%). There were ten all-cause acetabular revisions in the entire cohort (eight in pTHA, two in rTHA), four of which were aseptic (three in pTHA, one in rTHA). All-cause and aseptic acetabular survivorship of the pTHA cohort was 97.2% and 98.7%, respectively, and of the rTHA cohort was 94.3% and 97.1%, respectively. Improvement in the median HOOS, JR score was 21.5 points at one year and 25.5 points at two years among pTHAs. Conclusions: The findings with this system support adequate mid-term acetabular component survivorship in pTHA and rTHA, along with clinically meaningful functional improvement following pTHA. Given the retrospective, observational nature of this study, further prospective research with extended follow-up and larger sample sizes, particularly in the rTHA cohort, is needed to better assess long-term outcomes. Full article