Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hip 712 articles

Articles

Exchangeable Femoral Neck (Dual-Modular) THA Prostheses Have Poorer Survivorship Than Other Designs: A Nationwide Cohort of 324,108 Patients

Sandrine Colas MSc, MPH, Assia Allalou MSc, Antoine Poichotte MD, Philippe Piriou MD, PhD, Rosemary Dray-Spira MD, PhD, Mahmoud Zureik MD, PhD

Exchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb length) and reduce the risk of dislocation. However exchangeable necks have been reported to result in adverse effects such as stem fractures and acute local tissue reaction. Whether they result in a net improvement to or impairment of reconstructive survivorship remains controversial.

High Survivorship and Little Osteoarthritis at 10-year Followup in SCFE Patients Treated With a Modified Dunn Procedure

Kai Ziebarth MD, Milan Milosevic MD, Till D. Lerch MD, Simon D. Steppacher MD, Theddy Slongo MD, Klaus A. Siebenrock MD

The modified Dunn procedure has the potential to restore the anatomy in hips with slipped capital femoral epiphyses (SCFE) while protecting the blood supply to the femoral head and minimizing secondary impingement deformities. However, there is controversy about the risks associated with the procedure and mid- to long-term data on clinical outcomes, reoperations, and complications are sparse.

Does N-terminal Pro-brain Type Natriuretic Peptide Predict Cardiac Complications After Hip Fracture Surgery?

Hiroki Ushirozako MD, Tsuyoshi Ohishi MD, PhD, Tomotada Fujita MD, Daisuke Suzuki MD, PhD, Kazufumi Yamamoto MD, PhD, Tomohiro Banno MD, Hiroyuki Takase MD, PhD, Yukihiro Matsuyama MD, PhD

Elderly patients with hip fracture are at risk for cardiac complications. N-terminal pro-brain type natriuretic peptide (NT-proBNP) has been shown to predict cardiac complications in surgical patients; however, to our knowledge, only two studies have evaluated the utility of this test in patients with hip fracture. We believe it is important to assess a more accurate cutoff value of NT-proBNP with exclusion of patients with renal failure.

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Arthur L. Malkani MD, Brian Dilworth MD, Kevin Ong PhD, Doruk Baykal PhD, Edmund Lau MS, Theresa N. Mackin BA, Gwo-Chin Lee MD

As life expectancy increases, more elderly patients with end-stage hip arthritis are electing to undergo primary THA. Octogenarians undergoing THA have more comorbidities than younger patients, but this is not reflected in risk adjustment models for bundled care programs. The burden of care associated with THA in octogenarians has not been well characterized, and doing so may help these value-based programs make adjustments so that this vulnerable patient population does not risk losing access under accountable care models.

Periacetabular Osteotomy Provides Higher Survivorship Than Rim Trimming for Acetabular Retroversion

Corinne A. Zurmühle MD, Helen Anwander MD, Christoph E. Albers MD, Markus S. Hanke MD, Simon D. Steppacher MD, Klaus A. Siebenrock MD, Moritz Tannast MD

Acetabular retroversion can cause impaction-type femoroacetabular impingement leading to hip pain and osteoarthritis. It can be treated by anteverting periacetabular osteotomy (PAO) or acetabular rim trimming with refixation of the labrum. There is increasing evidence that acetabular retroversion is a rotational abnormality of the entire hemipelvis and not a focal overgrowth of the anterior acetabular wall, which favors an anteverting PAO. However, it is unknown if this larger procedure would be beneficial in terms of survivorship and Merle d’Aubigné scores in a midterm followup compared with rim trimming.

One-third of Hips After Periacetabular Osteotomy Survive 30 Years With Good Clinical Results, No Progression of Arthritis, or Conversion to THA

Till Dominic Lerch MD, Simon Damian Steppacher MD, Emanuel Francis Liechti MD, Moritz Tannast MD, Klaus Arno Siebenrock MD

Since its first description in 1984, periacetabular osteotomy (PAO) has become an accepted treatment for hip dysplasia. The 30-year survivorship with this procedure has not been reported. Because these patients are often very young at the time of surgery, long-term followup and identification of factors associated with poor outcome could help to improve patient selection.

Are Readmissions After THA Preventable?

Douglas S. Weinberg MD, Matthew J. Kraay MD, Steven J. Fitzgerald MD, Vasu Sidagam MD, Glenn D. Wera MD

Readmissions after total joint arthroplasty have become a key quality measure in elective surgery in the United States. The Affordable Care Act includes the Hospital Readmission Reduction Program, which calls for reduced payments to hospitals with excessive readmissions. This policy uses a method to determine excess readmission ratios and calculate readmission payment adjustments to hospitals, however, it is unclear whether readmission rates are an effective quality metric. The reasons or conditions associated with readmission after elective THA have been well established but the extent to which readmissions can be prevented after THA remains unclear.

Three Patterns of Acetabular Deficiency Are Common in Young Adult Patients With Acetabular Dysplasia

Jeffrey J. Nepple MD, Joel Wells MD, MPH, James R. Ross MD, Asheesh Bedi MD, Perry L. Schoenecker MD, John C. Clohisy MD

Detailed recognition of the three-dimensional (3-D) deformity in acetabular dysplasia is important to help guide correction at the time of reorientation during periacetabular osteotomy (PAO). Common plain radiographic parameters of acetabular dysplasia are limited in their ability to characterize acetabular deficiency precisely. The 3-D characterization of such deficiencies with low-dose CT may allow for more precise characterization.

Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA

Kazuhiro Hasegawa MD, Tamon Kabata MD, PhD, Yoshitomo Kajino MD, PhD, Daisuke Inoue MD, Hiroyuki Tsuchiya MD, PhD

Periprosthetic fractures of the acetabulum occurring during primary THA are rare. Periprosthetic occult fractures are defined as those not identified by the surgeon during the procedure which might be missed on a routine postoperative radiograph. However, it is unclear how frequently these fractures occur and whether their presence affects functional recovery.

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Michael Wyatt FRACS, Jan Weidner MD, Dominik Pfluger PhD, Martin Beck PD, MD

The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-making—specifically, a tool that might be associated with instability—therefore would be very helpful for this group of patients.