Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hip 725 articles


Ceramic Heads Decrease Metal Release Caused by Head-taper Fretting and Corrosion

Sevi B. Kocagoz BS, Richard J. Underwood PhD, Daniel W. MacDonald MS, Jeremy L. Gilbert PhD, Steven M. Kurtz PhD

Metal release resulting from taper fretting and corrosion is a clinical concern, because wear and corrosion products may stimulate adverse local tissue reactions. Unimodular hip arthroplasties have a conical taper between the femoral head (head bore taper) and the femoral stem (stem cone taper). The use of ceramic heads has been suggested as a way of reducing the generation of wear and corrosion products from the head bore/stem cone taper junction. A previous semiquantitative study found that ceramic heads had less visual evidence of fretting-corrosion damage compared with CoCr heads; but, to our knowledge, no studies have quantified the volumetric material loss from the head bore and stem cone tapers of a matched cohort of ceramic and metal heads.

The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures

Tym Frank MD, Georg Osterhoff MD, Sheila Sprague PhD, Alisha Garibaldi MSc, Mohit Bhandari MD, PhD, Gerard P. Slobogean MD, MPH

The Radiographic Union Score for Hip (RUSH) is a previously validated outcome instrument designed to improve intra- and interobserver reliability when describing the radiographic healing of femoral neck fractures. The ability to identify fractures that have not healed is important for defining nonunion in clinical trials and predicting patients who will likely require additional surgery to promote fracture healing. We sought to investigate the utility of the RUSH score to define femoral neck fracture nonunion.

Does Teriparatide Improve Femoral Neck Fracture Healing: Results From A Randomized Placebo-controlled Trial

Mohit Bhandari MD, PhD, Ling Jin MD, Kyoungah See PhD, Russel Burge PhD, Nigel Gilchrist MBChB, FRACP, Richard Witvrouw MD, Kelly D. Krohn MD, Margaret R. Warner PhD, DVM, Qasim I. Ahmad MD, Bruce Mitlak MD

There is a medical need for therapies that improve hip fracture healing. Teriparatide (Forteo/ Forsteo, recombinant human parathyroid hormone) is a bone anabolic drug that is approved for treatment of osteoporosis and glucocorticoid-induced osteoporosis in men and postmenopausal women at high fracture risk. Preclinical and preliminary clinical data also suggest that teriparatide may enhance bone healing.

What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

Kishore Mulpuri MBBS, MS(Ortho), MHSc(Epi), Emily K. Schaeffer PhD, Janice Andrade BSW, Wudbhav N. Sankar MD, Nicole Williams BMedSc, FRACS(Ortho), Travis H. Matheney MD, MLA, Scott J. Mubarak MD, Peter J. Cundy MBBS, FRACS, Charles T. Price MD, FAAP

Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poorly understood, and clearly defining an associated set of factors will aid in screening, detection, and prevention of this condition.

Does Surgical Approach Affect Patient-reported Function After Primary THA?

Sara C. Graves MD, MS, Benjamin M. Dropkin MD, Benjamin J. Keeney PhD, Jon D. Lurie MD, MS, Ivan M. Tomek MD

Total hip arthroplasty (THA) relieves pain and improves physical function in patients with hip osteoarthritis, but requires a year or more for full postoperative recovery. Proponents of intermuscular surgical approaches believe that the direct-anterior approach may restore physical function more quickly than transgluteal approaches, perhaps because of diminished muscle trauma. To evaluate this, we compared patient-reported physical function and other outcome metrics during the first year after surgery between groups of patients who underwent primary THA either through the direct-anterior approach or posterior approach.

Is Local Infiltration Analgesia Superior to Peripheral Nerve Blockade for Pain Management After THA: A Network Meta-analysis

José H. Jiménez-Almonte MD, Cody C. Wyles BS, Saranya P. Wyles BS, German A. Norambuena-Morales MD, Pedro J. Báez BS, Mohammad H. Murad MD, MPH, Rafael J. Sierra MD

Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy.

Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?

Matthew R. Boylan ScB, Dean C. Perfetti BA, Randa K. Elmallah MD, Viktor E. Krebs MD, Carl B. Paulino MD, Michael A. Mont MD

Systemic corticosteroids are commonly used to treat autoimmune and inflammatory diseases, but they can be associated with various musculoskeletal problems and disorders. There currently is a limited amount of data describing the postoperative complications of THA associated specifically with chronic corticosteroid use.

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

Alpesh Kothari MRCS, MSc, George Grammatopoulos FRCS (Tr & Orth), DPhil, Sally Hopewell DPhil, Tim Theologis MSc, PhD

Anterior open reduction is commonly used to treat hip subluxation or dislocation in developmental dysplasia of the hip (DDH) in walking-age children. Pelvic and/or femoral osteotomy may be used in addition, but it is unclear how this affects avascular necrosis (AVN) risk and radiological and clinical results.

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Eduardo N. Novais MD, Mary K. Hill BA, Patrick M. Carry BA, Patricia C. Heyn MS, PhD

Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH.

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Huiwu Li MD, Xinhua Qu MD, Yuanqing Mao MD, Kerong Dai MD, Zhenan Zhu MD

Revision THA is particularly challenging in hips with severe acetabular bone loss. When the extent or geometry of the acetabular bone loss precludes more-straightforward techniques such as jumbo hemispheric cementless shells, reconstruction with morselized allograft protected by a custom cage may offer an alternative, but, to our knowledge, few series have reported on results with this approach.