Hip & pelvis最新文献

Purpose: In a single health system (NYU Langone Health) with established management protocols, our study examined differences in postoperative outcomes among patients treated with non-arthroplasty hip fracture fixation by orthopedic trauma (OT), adult reconstruction (AR), and sports medicine (SM) subspecialists.

Materials and methods: We performed a retrospective review of 1,588 geriatric patients who underwent internal fixation for a hip fracture using a standard perioperative treatment protocol. Patients were assessed for in-hospital outcomes as well as readmissions and complications.

Results: Race/ethnicity, American Society of Anesthesiologists classification, ambulatory status, and energy of injury differed among subspecialty cohorts. The 30- and 90-day readmission rates were higher in the AR group than in the OT group (P=0.001, P=0.028). However, these differences were no longer significant after adjusting for baseline health, fracture type, and surgical construct. Mortality during admission, fracture-related infections, and revision surgery did not differ significantly across the 3 groups. Although the difference in the length of stay (LOS) (<1 day) across the groups was statistically significant (P=0.004), it was not clinically meaningful in adjusted analyses.

Conclusion: Within standardized care pathways, short-term outcomes did not meaningfully differ by fellowship background after adjustment. Surgical experience and consistency in care may be more influential, and future studies should account for surgeon case volume.

The challenging complication of recurrent dislocation following total hip arthroplasty (THA) is often attributed to component malposition, soft tissue imbalance, or spinopelvic pathology. We report a case of intractable recurrent dislocation following revision THA for a periprosthetic femoral fracture in a 91-year-old female. The patient experienced multiple painless dislocations despite performing component revision to enhance stability and confirming acceptable combined anteversion by computed tomography. We performed a comprehensive review of the patient's history and noted chronic, high-dose analgesic use, including the continuous use of a fentanyl patch for three years. Therefore, we hypothesized chronic opioid use contributed to the severe hyposensitivity to pain by eliminating the protective sensory feedback mechanisms essential to joint stability and mimicking the pathophysiology of Charcot arthropathy. Since potent analgesics can mask protective sensation and precipitate iatrogenic Charcot-like arthropathy, our case highlights the necessity to evaluate medication history in elderly patients with unexplained, painless recurrent instability.

Purpose: Our study hypothesizes that the prognostic value of sourcil-based lateral center-edge angle (LCEAS) measurements is superior to rim-based (LCEAR) measurements in predicting clinical outcomes of hip arthroscopy for femoroacetabular impingement (FAI). The purpose of our study is to compare these measurement techniques and to identify the threshold values that predict successful patient outcomes.

Materials and methods: We retrospectively analyzed 125 patients who underwent hip arthroscopy for FAI, with a minimum follow-up of two years. Using both sourcil- and rim-based techniques, we obtained lateral center-edge angle (LCEA) measurements from standardized pelvis anteroposterior radiographs. The modified Harris hip score (mHHS), Nonarthritic Hip Score (NAHS) and visual analog scale (VAS) for pain were used to evaluate clinical outcomes. We performed receiver operating characteristic (ROC) analyses to determine LCEA cutoffs associated with the Patient Acceptable Symptom State (PASS). Multivariate logistic regression analyses identified independent predictors of favorable outcomes.

Results: Postoperative LCEAS decreased from 31.1°±5.4° to 25.8°±6.6° (P=0.003), whereas postoperative LCEAR decreased from 38.7°±6.7° to 32.8°±6.4° (P=0.002). Overall, 80.8% of patients achieved PASS based on mHHS (≥83.3). ROC analysis identified postoperative LCEAS thresholds of ≤28.9° and ≤28.25° as predictors of PASS based on mHHS (AUC=0.702) and NAHS (AUC=0.740), respectively. Multivariate analysis confirmed postoperative LCEAS as an independent predictor of favorable clinical outcomes.

Conclusion: Postoperative LCEAS thresholds of around 28.9° are independently associated with favorable clinical outcomes following hip arthroscopy for FAI. The improved prognostic information provides the rationale for the use of LCEAS over LCEAR in surgical planning and outcome prediction.

Osteoporosis is a systemic skeletal disorder characterized by low bone density and microarchitectural deterioration, both of which lead to increased risk of fracture, disability, institutionalization, and mortality. Dual-energy X-ray absorptiometry (DEXA) remains the gold standard for evaluating bone mineral density and establishing diagnostic thresholds. However, accurate interpretation requires more than the application of numerical cut-offs. Interpretation requires careful evaluation of graphical bands, artifact recognition, awareness of site discordance, and application of least significant change for precise longitudinal assessment. With a structured approach that distinguishes between universal screening from targeted testing, laboratory evaluation further complements imaging by identifying secondary causes. Although bone turnover markers offer additional value in monitoring therapeutic response, their use is limited by assay variability. From an orthopedic perspective, fragility fractures are sentinel events that highlight underlying skeletal fragility. Often the first to encounter these patients, orthopedic surgeons are uniquely positioned to initiate comprehensive evaluation and secondary prevention. This review synthesizes international guidelines and recent literature to provide a practical framework for DEXA interpretation, laboratory integration, and holistic management aimed at reducing refracture risk, improving functional outcomes, and lowering healthcare costs.

Purpose: The aim of our study is to identify the factors that influence hip fracture surgery in elderly patients within 48 hours of hospital admission.

Materials and methods: We retrospectively reviewed hip fracture databases of patients who underwent surgery for hip fracture between 2020 and 2023. We excluded patients with pathological fractures, coronavirus disease 2019 infection, multiple traumas, and who died without undergoing surgery. The final study cohort included 452 patients with hip fractures. From the total participants, 201 patients underwent hip surgery within 48 hours of admission. For data analysis, we performed multivariate logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. A P<0.05 was considered statistically significant.

Results: Multivariate logistic regression analysis revealed that lack of pretreatment with P2Y12 inhibitors (adjusted OR 3.23, 95% CI 1.41-7.41), absence of hematological disorders (adjusted OR 3.53, 95% CI 1.35-9.23), and absence of urinary tract infections (UTI) (adjusted OR 9.59, 95% CI 1.21-75.71) in geriatric patients with hip fracture were conducive to early surgery.

Conclusion: Lack of pretreatment with P2Y12 inhibitors, absence of hematological disorders, and absence of UTI were factors that influenced the timing of hip fracture surgery within 48 hours of admission.

Purpose: Offset measurement is critical in total hip arthroplasty (THA) for guiding restoration of native anatomy. However, measurements are time-consuming and measurer-dependent, creating obstacles for large cohort analyses. We aim to create an objective and reliable offset measurement algorithm using deep learning.

Materials and methods: Five hundred radiographs from the Osteoarthritis Initiative (OAI) were segmented with identification of the teardrop, femoral head, implant head, and femoral diaphysis. A U-Net convolutional neural network was trained to identify these landmarks and optimized using the multi-class Dice coefficient metric. Femoral axis and femoral/implant head center of rotation were calculated with the model predictions, and measurements of offset were compared against two trained readers on an independent testing cohort.

Results: The optimized model had a Dice coefficient of 0.96 and a foreground mask accuracy of 96.2%. The model measured femoral, acetabular, and global offset on both limbs at a rate of 1.67 sec/image. On an independent cohort (n=90), the intraclass correlation coefficient between readers and the algorithm was 0.86 (95% confidence interval [CI] 0.80-0.91) for femoral offset, 0.87 (95% CI 0.78-0.91) for acetabular offset, and 0.94 (95% CI 0.91-0.96) for global offset. When applied to the entire OAI cohort (n=4,188), all relevant anatomical features (femoral axis, implant/femoral center of rotation, inter-teardrop line) were correctly calculated in 83.0% of images.

Conclusion: We report the development of an accurate and rapid offset measurement model using deep learning that can be applied before and after THA. Future work will involve external model validation.

Purpose: The surgical approach used in performance of total hip arthroplasty (THA) is critical in determining the postoperative recovery process. The direct anterior approach (DAA) is a minimally invasive technique that preserves soft tissue, while the posterior approach (PA) is a traditional method providing a more extensive view of the hip joint. Length of stay (LOS) is an essential metric in assessing healthcare efficiency and patient recovery. The aim of this article is to compare LOS in patients undergoing THA via the DAA versus the PA.

Materials and methods: A retrospective matched pair analysis of THA patients undergoing either DAA or PA was conducted. Collected data from the hospital records focused on LOS and perioperative complications. Statistical analysis was performed to determine the significance of differences in LOS between the two approaches.

Results: Each group included 69 patients. The results of the analysis revealed that there was no difference in LOS between patients who underwent DAA as compared to those who underwent PA (P=0.16). No difference in perioperative complications was observed between the two the groups in terms of surgical duration (P=0.09) and blood loss (P=0.22).

Conclusion: Based on the results, we conclude that the DAA did not result in lower LOS compared with the conventional PA. This study also highlights the impact of hospital protocols, ERAS^® (Enhanced Recovery After Surgery) programs, and patient factors on LOS beyond the surgical approach alone. Further research including randomized controlled studies, evolving surgical technologies, personalized care and long term follow up is warranted.

Purpose: Proximal femur fractures are commonly treated with cephalomedullary nails (CMN), dynamic hip screws (DHS), or closed reduction with percutaneous pinning (CRPP). Conversion total hip arthroplasty (cTHA) may be required for complications of these procedures. We compared cTHA outcomes with primary THA (pTHA).

Materials and methods: This retrospective study included 140 patients (70 cTHA, 70 pTHA) at Brown University Health Hospitals between September 2022 and February 2024. cTHA patients had prior failed DHS, CMN, or CRPP fixation. pTHA patients underwent surgery for degenerative joint disease rather than trauma. Demographics, perioperative data, and postoperative outcomes were compared, and logistic regression identified predictors of complications.

Results: cTHA patients were older (71.6 vs. 66.3 years, P<0.01), more often female (75.7% vs. 55.7%, P=0.01), with longer surgical times (140.7 vs. 79.2 minutes, P<0.01), higher estimated blood loss (EBL) (378.1 vs. 224.3 mL, P<0.01), longer hospital stays (3.6 vs. 1.8 days, P<0.01), and higher complication rates (40.0% vs. 15.7%, P<0.01). Transfusions (14.3% vs. 2.9%, P=0.02) and skilled nursing facility discharges (42.9% vs. 17.1%, P<0.01) were also higher. Ninety-day emergency department visits, readmissions, reoperations, and dislocations were similar. High American Society of Anesthesiologists score (odds ratio [OR] 4.03, P=0.04), longer length of stay (OR 1.57, P<0.01), older age (OR 1.09, P<0.01), and higher EBL (OR 1.00, P=0.04) were independently associated with adverse outcomes.

Conclusion: cTHA is associated with higher perioperative morbidity and greater resource utilization than pTHA, despite similar short-term reoperation and readmission rates. These findings support risk stratification and tailored perioperative management for cTHA patients.

Purpose: This study aimed to determine complication-free survival rates by assessing Barthel Index (BI) grades at discharge and to identify prognostic factors following hip hemiarthroplasty for femoral neck fractures.

Materials and methods: This retrospective study analyzed 404 patients. We collected data on BI scores following surgery and at discharge, BI improvement rate (BI speed), postoperative complications (dislocations, thrombosis, death, infection, and nerve disorder), and peri-hip fractures (contralateral and periprosthetic fractures).

Results: Cluster analysis categorized patients into low (<35, n=92), moderate (40-80, n=199), and high (>85, n=113) BI groups. The moderate BI group showed an intermediate BI speed (1.97±1.31/day, P<0.001) and a peri-hip fracture incidence of 11.1% (P=0.015). Four-year complication-free survival rates were 47.5% in the low, 45.9% in the moderate, and 74.7% in the high BI groups (P<0.001). Multivariate analysis identified BI speed as a significant prognostic factor for complications (hazard ratio 0.746, 95% confidence interval 0.560-0.994, P<0.05).

Conclusion: BI speed is a significant prognostic indicator for complications following hip hemiarthroplasty. Although it does not predict peri-hip fractures, the high fracture incidence in the moderate BI group suggests the need for targeted preventive interventions in this population.

Purpose: In the existing literature, isolated femoral head and polyethylene liner exchange is commonly performed in revision total hip arthroplasty (THA) for a variety of indications with mixed outcomes. The purpose of this study is to investigate patient outcomes following head-liner exchange and risk factors associated with failure in THA.

Materials and methods: A retrospective chart review from May 2016 to November 2023 was conducted on patients who underwent isolated head-liner exchange at two institutions. Patients had minimum 1-year follow-up periods. For each patient, data such as indication for revision, surgical approach, revision head size, immediate and short-term complications, postoperative disposition, 90-day readmissions, and re-operations were recorded.

Results: Out of 175 patients, there were 24 readmissions/emergency department visits within 90 postoperative days (13.7%), 21 subsequent revision surgeries (12.0%), 21 postoperative dislocations (12.0%), and 20 immediate postoperative complications (11.4%). A statistically significant association was demonstrated between indication for revision and postoperative instability (P=0.04). Patients operated upon for instability had higher rates of postoperative instability. Furthermore, patients with reported preoperative dislocation events had higher incidences of postoperative dislocations. Patients discharged to skilled nursing facilities (SNF) were associated with an increased number of hospital readmissions within 90 days of surgery, reoperation, and postoperative dislocation (P<0.05). No statistically significant associations were found between surgical approach and complications.

Conclusion: This study suggests that, in the context of isolated head-liner exchanges, factors such as preoperative dislocation history, indication for revision, and discharge to SNF are associated with poorer outcomes and complications.