Registry-based study of survivorship of cemented femoral components versus collared cementless femoral components in total hip arthroplasty in older patients with osteoarthritis.

Aims: In recent years, the use of a collared cementless femoral prosthesis has risen in popularity. The design intention of collared components is to transfer some load to the resected femoral calcar and prevent implant subsidence within the cancellous bone of the metaphysis. Conversely, the load transfer for a cemented femoral prosthesis depends on the cement-component and cement-bone interface interaction.

Excessive posterior pelvic tilt from preoperative supine to postoperative standing after total hip arthroplasty.

Aims: Excessive posterior pelvic tilt (PT) may increase the risk of anterior instability after total hip arthroplasty (THA). The aim of this study was to investigate the changes in PT occurring from the preoperative supine to postoperative standing position following THA, and identify factors associated with significant changes in PT.

Methods: Supine PT was measured on preoperative CT scans and standing PT was measured on preoperative and one-year postoperative standing lateral radiographs in 933 patients who underwent primary THA.

Total Hip Arthroplasty and the Spinopelvic Relationship: What's the Latest!

Although total hip arthroplasty (THA) has proved to be a successful surgical procedure, both prosthetic and bone impingement resulting in dislocation continue to occur. Studies have shown that spine pathology resulting in lumbar stiffness and hip arthritis often coexist. Spinopelvic mobility patterns during postural changes affect three-dimensional acetabular component position, which affects the incidence of prosthetic impingement and THA instability.

Birmingham Hip Resurfacing at 20 years.

Aims: The Birmingham Hip Resurfacing (BHR) arthroplasty has been used as a surgical treatment of coxarthrosis since 1997. We present 20-year results of 234 consecutive BHRs performed in our unit.

Methods: Between 1999 and 2001, there were 217 patients: 142 males (65.

Patient-reported impairment following TKA is reduced when a computationally simulated predicted ideal alignment is achieved.

Purpose: Joint dynamics following Total Knee Arthroplasty (TKA) may influence patient-reported outcome. Simulations allow many knee alignment approaches to a single patient to be considered prior to surgery. The simulated kinematics can be matched to patient-reported outcome to predict kinematic patterns most likely to give the best outcome.

Modular dual-mobility articulations in patients with adverse spinopelvic mobility.

Aims: Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk.

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.

Prevention of early complications following total hip replacement.

Total hip arthroplasty (THA) has been quoted as "the operation of the century", owing to its efficacy and the substantial improvements evidenced with respect to functional patient outcomes and quality of life. However, early postoperative complications are often inevitable, hence it is imperative to take every step to prevent them and minimise morbidity and mortality. This manuscript focuses on the most common early complications following THA, namely venous thromboembolism (VTE), prosthetic joint infection, periprosthetic fracture, instability, and leg length inequality.

Can TKA outcomes be predicted with computational simulation? Generation of a patient specific planning tool.

Background: Computer simulations of knee movement allow Total Knee Arthroplasty (TKA) dynamic outcomes to be studied. This study aims to build a model predicting patient reported outcome from a simulation of post-operative TKA joint dynamics.

Methods: Landmark localisation was performed on 239 segmented pre-operative computerized tomography (CT) scans to capture patient specific soft tissue attachments.

Spinopelvic mobility affects accuracy of acetabular anteversion measurements on cross-table lateral radiographs.

Aims: Cross-table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). The CTL measurements may differ by > 10° from CT scan measurements but the reasons for this discrepancy are poorly understood. Anteversion measurements from CTL radiographs and CT scans are compared to identify spinopelvic parameters predictive of inaccuracy.

The Effect of a Degenerative Spine and Adverse Pelvic Mobility on Prosthetic Impingement in Patients Undergoing Total Hip Arthroplasty.

Background: Despite the placement of acetabular components in the traditional "safe-zone", dislocations and all parts of the instability spectrum, including impingement, continue to be an issue. Recent research has established the importance of a degenerative spine and adverse pelvic mobility on functional acetabular orientation. The purpose of this study is to quantify the clinical consequences of a degenerative spine and adverse pelvic mobility on prosthetic impingement in patients undergoing total hip arthroplasty.

Prevalence of Risk Factors for Adverse Spinopelvic Mobility Among Patients Undergoing Total Hip Arthroplasty.

Background: Patients with adverse spinopelvic mobility have higher complication rates following total hip arthroplasty (THA). Risk factors include a stiff lumbar spine, standing posterior pelvic tilt ≤ -10°, and a severe sagittal spinal deformity (pelvic incidence minus lumbar lordosis mismatch ≥20°). The purpose of this study is to define the spinopelvic risk factors and quantify the prevalence of risk factors for pathologic spinopelvic mobility.

The effect of varus stem placement on joint offset during total hip arthroplasty: a virtual study.

Introduction And Aims: With total hip replacement (THR), varus alignment of an uncemented stem will increase offset which can have significant detrimental effects on muscular balance, leg length and overall satisfaction. Thus, we used 3D planning software to determine the change in joint offset with increasing varus stem placement.

Methods: Eight patients undergoing THR had routine computed tomography (CT) scans to allow for 3D hip planning.

The Majority of Total Hip Arthroplasty Patients With a Stiff Spine Do Not Have an Instrumented Fusion.

Background: Total hip arthroplasty (THA) patients with limited lumbar flexion (LF) have increased rates of dislocation. An instrumented spinal fusion is a well-recognized cause whose risk increases with increasing number of levels fused. However, many patients without an instrumented fusion (IF) also exhibit abnormal spinopelvic mobility.

Prevalence of Sagittal Spinal Deformity Among Patients Undergoing Total Hip Arthroplasty.

Background: The important relationship between sagittal spinal alignment and total hip arthroplasty (THA) is becoming well recognized. Prior research has shown a significant relationship between sagittal spinal deformity (SSD) and THA instability. This study aims at determining the prevalence of SSD among preoperative THA patients.

Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates.

Background: Recent research has demonstrated that patients with reduced pelvic mobility from standing to sitting have higher rates of dislocation after total hip arthroplasty (THA). This study evaluates the effect of sagittal spinal deformity, defined by pelvic incidence-lumbar lordosis mismatch (PI-LL), on postural changes in pelvic tilt (PT).

Methods: A multicenter database of 1100 preoperative THA patients was queried.

A systematic approach to the hip-spine relationship and its applications to total hip arthroplasty.

There remains confusion in the literature with regard to the spinopelvic relationship, and its contribution to ideal acetabular component position. Critical assessment of the literature has been limited by use of conflicting terminology and definitions of new concepts that further confuse the topic. In 2017, the concept of a Hip-Spine Workgroup was created with the first meeting held at the American Academy of Orthopedic Surgeons Annual Meeting in 2018.

Variation in femoral anteversion in patients requiring total hip replacement.

Background: Optimal implant alignment is important for total hip replacement (THR) longevity. Femoral stem anteversion is influenced by the native femoral anteversion. Knowing a patient's femoral morphology is therefore important when planning optimal THR alignment.

Prevalence of Anterior Femoral Neck Osteophyte in a Total Hip Arthroplasty Population: Analysis of Preoperative Surgical Plans.

Despite strongly positive results of total hip arthroplasty (THA), patients remain at risk for complications including dislocation. Spinopelvic motion and the hip-spine relationship have been recognized as important factors in surgical planning and implant positioning in THA. Periarticular osteophytes are one of the hallmark pathoanatomic features of osteoarthritis and may influence implant positioning and joint stability; residual osteophytes at the anterior femoral neck may cause anterior impingement and posterior instability.

Medial ball and socket total knee arthroplasty: five-year clinical results.

Aims: Between 15% and 20% of patients remain dissatisfied following total knee arthroplasty (TKA). The SAIPH knee system (MatOrtho, Surrey, United Kingdom) is a medial ball and socket TKA that has been designed to replicate native knee kinematics in order to maximize the range of movement, stability, and function. This system is being progressively introduced in a stepwise fashion, with this study reporting the mid-term clinical and radiological outcomes.

Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty.

Aims: It is important to consider sagittal pelvic rotation when introducing the acetabular component at total hip arthroplasty (THA). The purpose of this study was to identify patients who are at risk of unfavourable pelvic mobility, which could result in poor outcomes after THA.

Patients And Methods: A consecutive series of 4042 patients undergoing THA had lateral functional radiographs and a low-dose CT scan to measure supine pelvic tilt, pelvic incidence, standing pelvic tilt, flexed-seated pelvic tilt, standing lumbar lordotic angle, flexed-seated lumbar lordotic angle, and lumbar flexion.

Is Cemented or Cementless Femoral Stem Fixation More Durable in Patients Older Than 75 Years of Age? A Comparison of the Best-performing Stems.

Background: There is ongoing debate concerning the best method of femoral fixation in older patients receiving primary THA. Clinical studies have shown high survivorship for cemented and cementless femoral stems. Arthroplasty registry studies, however, have universally shown that cementless stems are associated with a higher rate of revision in this patient population.

Safety, tolerability, clinical, and joint structural outcomes of a single intra-articular injection of allogeneic mesenchymal precursor cells in patients following anterior cruciate ligament reconstruction: a controlled double-blind randomised trial.

Background: Few clinical trials have investigated the safety and efficacy of mesenchymal stem cells for the management of post-traumatic osteoarthritis. The objectives of this pilot study were to determine the safety and tolerability and to explore the efficacy of a single intra-articular injection of allogeneic human mesenchymal precursor cells (MPCs) to improve clinical symptoms and retard joint structural deterioration over 24 months in patients following anterior cruciate ligament (ACL) reconstruction.

Methods: In this phase Ib/IIa, double-blind, active comparator clinical study, 17 patients aged 18-40 years with unilateral ACL reconstruction were randomized (2:1) to receive either a single intra-articular injection of 75 million allogeneic MPCs suspended in hyaluronan (HA) (MPC + HA group) (n = 11) or HA alone (n = 6).