Contrast-Enhanced Ultrasound Reveals Superior Gluteus Medius Muscle Vitality After Total Hip Arthroplasty in a Minimally Invasive Anterolateral Versus Lateral Surgical Approach.

Objective: Total hip arthroplasty (THA) is essential for treating severe osteoarthritis. With various surgical approaches available, there has been a shift toward techniques that offer quicker recovery and fewer complications. In this study, contrast-enhanced ultrasound was used to evaluate the impact of the minimally invasive anterolateral versus conventional lateral approach in THA on the gluteus medius muscle, focusing on muscle vitality and functional outcomes.

Assessment Accuracy of 2D vs. 3D Imaging for Custom-Made Acetabular Implants in Revision Hip Arthroplasty.

Revision total hip arthroplasty (rTHA) presents significant challenges, particularly in patients with severe acetabular bone defects. Traditional treatment options often fall short, leading to the emergence of custom-made 3D-printed acetabular implants. Accurate assessment of implant positioning is crucial for ensuring optimal postoperative outcomes and for providing feedback to the surgical team.

Comparing Different Multimodal Analgesia Protocols for Primary Total Knee Arthroplasty-A Retrospective Cohort Analysis.

Several local regional anesthesia regimes have been described in the literature to reduce post-surgical pain following total knee arthroplasty (TKA), but it is unclear which regime has the best analgetic effect combined with the best motor function. The aim of this study was to determine if patients with infiltration between the popliteal artery and capsule of the posterior knee (IPACK) combined with an adductor canal block (SACB) had less pain, better motor function, and less opioid consumption after TKA than patients with a femoral nerve block (FNB) combined with a popliteal sciatic nerve block (PSB). In a retrospective cohort analysis, 342 patients following primary TKA were examined; 175 patients were treated with an IPACK combined with a SACB, and 167 patients with a femoral FNB combined with a PSB.

Change in cup orientation from supine to standing posture: a prospective cohort study of 419 total hip arthroplasties.

Background And Purpose: Arthroplasty surgeons traditionally assess cup orientation after total hip arthroplasty (THA) on supine radiographs. Contemporary hip-spine analyses provide information on standing, functional cup orientation. This study aims to (i) characterize cup orientations when supine and standing; (ii) determine orientation differences between postures; and (iii) identify factors associated with magnitude of orientation differences.

The Relationship of Cup Inclination and Anteversion in the Coronal Plane with Ante-Inclination in the Sagittal Plane: Exposing the Fallacy of Cup Safe Zones.

Background: This study aimed to establish an equation for calculating cup ante-inclination (AI) from radiographic cup inclination and anteversion, to validate this equation in a total hip arthroplasty (THA) cohort, and to test whether achieving previously described radiographic cup inclination and anteversion targets would also satisfy sagittal cup AI targets.

Methods: A mathematical equation linking cup AI, radiographic inclination (RI), and anteversion (RA) was determined: tan(AI) = tan(RA)/cos(RI). Supine and standing anteroposterior and lateral radiographs of 440 consecutive THAs were assessed to measure cup RI and RA and spinopelvic parameters, including cup AI, using a validated software tool.

Impact of Offset and Leg Length on Functional Outcomes Post-Total Hip Arthroplasty: How Accurate Should Coronal Reconstruction Be?

Background: Accurate hip reconstruction is associated with improved biomechanical behavior following total hip arthroplasty (THA). However, whether this is associated with improved patient-reported outcomes (PROs) is unknown.

Hypothesis/purpose: This study aimed to: 1) describe the ability to reconstruct coronal geometry during THA without advanced technology; 2) assess whether restoration of global offset (GO) and leg length (LL) is associated with improved PROs; and 3) investigate whether increased femoral offset (FO) to compensate for reduced acetabular offset (AO) influences PROs.

Elevated Blood Tantalum Concentrations in Patients Following Reconstruction of Severe Acetabular Defects in Total Hip Arthroplasty Using Modular Tantalum Augments in Combination With Uncemented Tantalum Cups.

Background: The reconstruction of acetabular defects in total hip arthroplasty (THA) can be challenging. An option to treat uncontained acetabular defects is to use modular tantalum augments in combination with cementless press-fit cups. However, modularity is associated with an increased risk of debonding and mechanical failure.

How Do Spinopelvic Characteristics Change Post-Total Hip Arthroplasty? A Longitudinal Assessment Raising Awareness of the Postoperative Period.

Background: Spinopelvic characteristics, including sacral slope (SS), are commonly evaluated in different positions pre-total hip arthroplasty (THA). This study aimed to: 1) investigate the change in spinopelvic parameters at 7 days (early) and 1-year post-THA; and 2) identify patient characteristics associated with a change in SS of more than 7° post-THA.

Methods: We prospectively studied 250 patients who underwent unilateral THA [132 women, age 66 years (range, 32 to 88)] and underwent biplanar images preoperatively and at 7 days and 1-year post-THA.

Reply to Alt et al. Comment on "Lunz et al. Impact and Modification of the New PJI-TNM Classification for Periprosthetic Joint Infections. 2023, , 1262".

We greatly appreciate the comments made by Alt et al. [..

What Is the Correlation between Clinical and Radiographic Findings in Patients with Advanced Osteoarthritis of the Knee?

Knee range of motion and patient-reported outcome measures (PROMs) are often used as screening tools to assess the severity of knee osteoarthritis and guide the decision to refer patients to an arthroplasty clinic. However, there is little understanding regarding the correlation between these factors. Thus, the purpose of this study was to determine the correlation between patient-reported clinical function measured with the Oxford Knee Score (OKS), pain assessed using the visual analog scale (VAS), knee range of motion (ROM), and characteristic radiographic features in patients with advanced osteoarthritis of the knee.

How to Screen for Lumbar Spine Stiffness in Patients Awaiting Total Hip Arthroplasty.

Background: This study aimed to (1) define the prevalence of spinopelvic abnormalities among patients who have hip osteoarthritis (OA) and controls (asymptomatic volunteers) and (2) identify factors that reliably predict the presence of lumbar spine stiffness.

Methods: This is a prospective, cross-sectional, case-cohort study of patients who have end-stage primary hip OA, who underwent primary total hip arthroplasty (THA). Patients were compared with a cohort of asymptomatic volunteers, matched for age, sex, and body mass index (BMI), serving as a control group.

Minimum 20-year follow-up of a press-fit acetabular cup in cementless total hip replacement in young patients.

Purpose: We aimed to determine the minimum 20-year survival rates of a cementless press-fit cup in young patients.

Patients And Methods: This is a retrospective, single-center, multi-surgeon cohort study investigating the minimum 20-year clinical and radiological outcome of the first 121 consecutive total hip replacements (THRs) using a cementless, press-fit cup (Allofit, Zimmer, Warsaw, IN, USA) performed between 1999 and 2001. 28-mm metal-on-metal (MoM) and ceramic-on-conventionally not highly crosslinked polyethylene (CoP) bearings were used in 71% and 28%, respectively.

How is hip anatomy reconstruction and inlay wear associated up to 10 years after primary THA using ceramic on highly crosslinked polyethylene bearings?

Introduction: Conventional polyethylene (PE) wear has been reported to be associated with femoral offset reconstruction and cup orientation after THA. Thus, the present study aimed (1) to determine the polyethylene wear rate of 32 mm ceramic heads with highly cross-linked polyethylene (HXLPE) inlays up to 10 years postoperatively and (2) to identify patient and surgery-related factors affecting the wear rate.

Methods: A prospective cohort study was performed, investigating 101 patients with 101 cementless THAs and ceramic (32 mm) on HXLPE bearings after 6-24 months, 2-5 years and 5-10 years postoperatively.

Spinopelvic challenges in primary total hip arthroplasty.

There is no universal safe zone for cup orientation. Patients with spinal arthrodesis or a degenerative lumbar spine are at increased risk of dislocation. The relative contributions of the hip (femur and acetabulum) and of the spine (lumbar spine) in body motion must be considered together.

Fixed-bearing is superior to mobile-bearing in lateral unicompartmental knee replacement: a retrospective matched-pairs analysis.

Purpose: Due to low incidence of isolated lateral osteoarthritis (OA), there are limited data on whether a fixed-bearing (FB) or a mobile-bearing (MB) design is superior for lateral unicompartmental knee replacement (UKR). The aim of this matched-pairs analysis was to compare both designs in terms of implant survival and clinical outcome.

Methods: Patients who received MB-UKR (Group A) and FB-UKR (Group B) at a single centre were matched according to gender, age at time of surgery and body mass index (BMI).

Impact and Modification of the New PJI-TNM Classification for Periprosthetic Joint Infections.

The comprehensive "PJI-TNM classification" for the description of periprosthetic joint infections (PJI) was introduced in 2020. Its structure is based on the well-known oncological TNM classification to appreciate the complexity, severity, and diversity of PJIs. The main goal of this study is to implement the new PJI-TNM classification into the clinical setting to determine its therapeutic and prognostic value and suggest modifications to further improve the classification for clinical routine use.

Physical Activity of Young Patients following Minimally Invasive Lateral Unicompartmental Knee Replacement.

Unicompartmental knee replacement (UKR) has increased in popularity in recent years, especially in young patients with high demands on their athletic ability. To date, there are no data available on the physical activity of young patients following lateral UKR. The aim of this study was to demonstrate return-to-activity rate and sporting activity of patients aged 60 years or younger following lateral UKR with a fixed-bearing (FB) prosthesis.

Cup orientation following posterior approach THA - the effect of different visual aids and pelvic supports.

Introduction: This study aims to compare cup inclination achieved (1) Using two orientation guides, whilst using the same 3-point pelvic positioner and (2) Using two types of pelvic positioners, whilst measuring intra-operative cup inclination with an inclinometer.

Materials And Methods: This is a prospective, diagnostic cohort study of a consecutive series of 150 THAs performed through a posterior approach. Two types of 3-point pelvic positioners were used (Stulberg and modified Capello Hip Positioners) and the cup was positioned freehand using one of two orientation guides (mechanical guide or digital inclinometer).

Minimally invasive Oxford medial unicompartmental knee replacement in patients 50 years of age or younger.

Introduction: The aim of the present study was to assess clinical outcome and mid-term survivorship of mobile-bearing unicompartmental knee arthroplasty in patients 50 years of age or younger.

Methods: This study reports the results of 119 patients (130 knees) following mobile-bearing medial UKA. Primary indication was advanced osteoarthritis or avascular necrosis of the femoral condyle.

Defining "Normal" Static and Dynamic Spinopelvic Characteristics: A Cross-Sectional Study.

Unlabelled: Spinopelvic characteristics influence the hip's biomechanical behavior. However, there is currently little knowledge regarding what "normal" characteristics are. This study aimed to determine how static and dynamic spinopelvic characteristics change with age, sex, and body mass index (BMI) among well-functioning volunteers.

Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics.

Acetabular component orientation and position are important factors in the short- and long-term outcomes of total hip arthroplasty. Different definitions of inclination and anteversion are used in the orthopaedic literature and surgeons should be aware of these differences and understand their relationships. There is no universal safe zone.

Which Safe Zone Is Safe in Total Hip Arthroplasty? The Effect of Bony Impingement.

"Safe zones" for cup position are currently being investigated in total hip arthroplasty (THA). This study aimed to evaluate the impact of bony impingement on the safe zone and provide recommendations for cup position in THA. CT scans were performed on 123 patients who underwent a cementless THA.

Sacral Slope Change From Standing to Relaxed-Seated Grossly Overpredicts the Presence of a Stiff Spine.

Background: Several authors propose that a change in sacral slope of ≤10° between the standing and relaxed-seated positions (ΔSS) identifies a patient with a stiff lumbar spine and has suggested the use of dual-mobility bearings for such patients undergoing a total hip arthroplasty (THA). The aim of this study was to assess how accurately ΔSS can identify patients with a stiff spine.

Methods: A prospective, multicentre, consecutive cohort series of 312 patients had standing, relaxed-seated, and flexed-seated lateral radiographs prior to THA.

Spinopelvic Characteristics Normalize 1 Year After Total Hip Arthroplasty: A Prospective, Longitudinal, Case-Controlled Study.

Background: The presence of hip osteoarthritis is associated with abnormal spinopelvic characteristics. This study aimed to determine whether the preoperative, pathological spinopelvic characteristics normalize at 1 year after total hip arthroplasty (THA).

Methods: This was a prospective, longitudinal, case-control, matched cohort study.

Does Additive Pressurized Carbon Dioxide Lavage Improve Cement Penetration and Bond Strength in Cemented Arthroplasty?

The modern cementing technique in cemented arthroplasty is a highly standardized and, therefore, safe procedure. Nevertheless, aseptic loosening is still the main reason for revision after cemented total knee or cemented total hip arthroplasty. To investigate whether an additional carbon dioxide lavage after a high-pressure pulsatile saline lavage has a positive effect on the bone-cement interface or cement penetration, we set up a standardized laboratory experiment with 28 human femoral heads.