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10 pages, 1592 KiB

Open AccessArticle

The Three-Dimensional Criteria of Developmental Dysplasia of the Hip Using the Functional Pelvic Plane Is More Useful Than That Using the Anterior Pelvic Plane

by Shinya Ibuchi, Norio Imai, Yoji Horigome, Hayato Suzuki and Hiroyuki Kawashima

J. Clin. Med. 2024, 13(9), 2536; https://doi.org/10.3390/jcm13092536 - 26 Apr 2024

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Abstract

Background: This retrospective cross-sectional study investigated the cutoff values (COVs) for developmental dysplasia of the hip (DDH) using a three-dimensional (3D) pelvic model reconstructed using computed tomography (CT). We included 107 healthy Japanese participants and 73 patients who had undergone curved periacetabular osteotomy [...] Read more.

Background: This retrospective cross-sectional study investigated the cutoff values (COVs) for developmental dysplasia of the hip (DDH) using a three-dimensional (3D) pelvic model reconstructed using computed tomography (CT). We included 107 healthy Japanese participants and 73 patients who had undergone curved periacetabular osteotomy (CPO) for DDH between 2012 and 2017. Methods: The hip CT images were adjusted to the anterior pelvic plane (APP), functional pelvic plane (FPP), sagittal anterior center-edge angle (ACEA), and sagittal posterior center-edge angle (PCEA). The lateral center-edge angle (LCEA), acetabular roof obliquity (ARO), anterior acetabular sector angle (AASA), and posterior acetabular sector angle (PASA) were measured. Receiver operating characteristic (ROC) curves were used to calculate the COVs, and the association between the parameters was analyzed using multiple logistic regression. Results: The ARO (≥10.2°) and LCEA (≤22.2°) were independent influencing factors for the APP, whereas the AASA (≤53.1°) and LCEA (≤24.5°) were independent influencing factors for the FPP. Conclusions: The 3D criteria for the diagnosis of DDH in Japanese individuals can identify DDH with insufficient anterior coverage, which anteroposterior plain radiographs cannot visualize, and can help determine indications for acetabular osteotomy. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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12 pages, 292 KiB

Open AccessArticle

Influence of Physical Activity and Cup Orientation on Metal Ion Release and Oxidative Stress in Metal-on-Metal and Ceramic-on-Metal Total Hip Arthroplasty

by Jorge Gómez-Álvarez, Ignacio Miranda, Alejandro Álvarez-Llanas, Juan F. Lisón, Francisco Bosch-Morell and Julio Doménech

J. Clin. Med. 2024, 13(2), 527; https://doi.org/10.3390/jcm13020527 - 17 Jan 2024

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Abstract

Background: Metal-on-metal (M-M) total hip arthroplasty (THA) has shown adverse reactions to metal debris, abnormal soft-tissue reactions, and high blood metal ion levels. This study aims to: (1) assess whether the toxicity of high levels of ions is related to altered oxidative stress [...] Read more.

Background: Metal-on-metal (M-M) total hip arthroplasty (THA) has shown adverse reactions to metal debris, abnormal soft-tissue reactions, and high blood metal ion levels. This study aims to: (1) assess whether the toxicity of high levels of ions is related to altered oxidative stress and (2) evaluate tribological factors related to increased blood levels of chromium (Cr) and cobalt (Co) ions. Methods: A cross-sectional analytical descriptive study was conducted on 75 patients. A total of 25 underwent M-M THA, 25 ceramic-on-metal (C-M) THA, and 25 were on the THA waiting list. Ion metallic levels in blood, oxidative stress, physical activity, and implant position were compared. Results: In the M-M group, Co and Cr levels were significantly higher than those found in the C-M group and the control group (p < 0.01). We found no differences in terms of oxidative stress between the groups. Also, we did not find a correlation between metal blood levels and oxidative stress indicators, the physical activity of the patients or the position of the implants between groups. Conclusions: The use of M-M bearing surfaces in THA raises the levels of metals in the blood without modifying oxidative stress regardless of the physical activity levels of the patients. Therefore, although patients with M-M bearings require close monitoring, it does not seem necessary to recommend the restriction of physical activity in patients with M-M or C-M arthroplasties. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

10 pages, 1190 KiB

Open AccessArticle

Survival Analysis and Failure Modes of Total Hip Arthroplasty Using a Cemented Semi-Retentive Acetabular Cup

by Gabriel Stan, Mihai Dan Roman, Horia Orban, Vlad Alexandru Georgeanu, Rares Stefan Deculescu, Lacramioara Aurelia Brinduse and Nicolae Gheorghiu

J. Clin. Med. 2023, 12(24), 7506; https://doi.org/10.3390/jcm12247506 - 5 Dec 2023

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Abstract

To reduce the incidence of total hip revisions, there have been continuous efforts to enhance prosthetic materials and designs to optimize implant survival. A primary implant with a constrained acetabular component is often used to minimize the risk of dislocations even though this [...] Read more.

To reduce the incidence of total hip revisions, there have been continuous efforts to enhance prosthetic materials and designs to optimize implant survival. A primary implant with a constrained acetabular component is often used to minimize the risk of dislocations even though this approach has some drawbacks as reported in the literature. To address these concerns, this study aimed to assess the survivorship and dislocation rate of a semi-retentive cemented acetabular cup when used as a primary implant. The specific cemented cup that we studied was not present in any study that we consulted, so to fill this gap, we conducted a retrospective examination of 527 cemented hip prostheses that utilized the semi-retentive cup between the years 2005 and 2012. We employed Cox multiple regression models for our statistical analysis. The revision due to dislocation occurred in 12.8% of all cases, with a lower incidence of 5% (14 cases) in age groups >70 years than in age groups <70 years (14%—32 cases) (p < 0.001). The survival rates of the semi-retentive cemented acetabular cup were 98.6% (520 cases) at 5 years and 92.2% (487 cases) at 10 years. The survival rates were significantly lower in women than men, with 1.9% (7 cases) toward 0% at 5 years and 8.1% (30 cases) toward 5% (7 cases) at 10 years (p = 0.002). The difference in failure rates between age groups over 70 years (2.3%—10 cases) and age groups under 70 years (11.5%—34 cases) was also statistically significant (p < 0.001). Our study indicates that the semi-constrained design may cause frequent damage to the polyethylene liner due to impingement and wear, which are the primary factors for failure. Also, this implant has a similar risk of revision due to dislocation as reported in studies and may be beneficial as a primary implant in elderly patients with low-demanding lifestyles, muscular insufficiency, and low compliance regarding hip prosthetic behavior, without a major effect on survivorship. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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12 pages, 2037 KiB

Open AccessArticle

Longitudinal Radiographic Bone Density Measurement in Revision Hip Arthroplasty and Its Correlation with Clinical Outcome

by Philip P. Roessler, Jakob Eich, Dieter C. Wirtz and Frank A. Schildberg

J. Clin. Med. 2023, 12(8), 2795; https://doi.org/10.3390/jcm12082795 - 10 Apr 2023

Viewed by 1477

Abstract

The subjective analysis of conventional radiography represents the principal method for bone diagnostics in endoprosthetics. Alternative objective quantitative methods are described but not commonly used. Therefore, semi-quantitative methods are tested using digital computation and artificial intelligence to standardize, simplify, and ultimately improve the [...] Read more.

The subjective analysis of conventional radiography represents the principal method for bone diagnostics in endoprosthetics. Alternative objective quantitative methods are described but not commonly used. Therefore, semi-quantitative methods are tested using digital computation and artificial intelligence to standardize, simplify, and ultimately improve the assessment. This study aimed to evaluate the correlation between relative density progressions and clinical outcomes. Radiographs and clinical examinations before and 24 and 48 weeks after surgery were obtained from sixty-eight patients with a modular hip stem. For the calculation of the relative bone density, the modal gray values of the Gruen zones were measured using ImageJ and were normalized by gray values of the highest and lowest ROI. The clinical outcomes were measured according to the Harris hip score before evaluating them for correlations. Analyses were performed separately for subgroups and bone regions. The Harris hip score increased from 44.15 ± 15.00 pre-operatively to 66.20 ± 13.87 at the latest follow-up. The relative bone density adjustment of Gruen zone 7 showed a significant correlation to its clinical outcome. Other bone adaptations could be realistically reproduced and differences by regional zones and patients’ histories visualized. Next to the simplicity and that no additional examination is required, the method provides good semi-quantitative results and visualizes adaptations, which make it suitable for use. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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14 pages, 1347 KiB

Open AccessArticle

Long-Term Results of a Phase I/II Clinical Trial of Autologous Mesenchymal Stem Cell Therapy for Femoral Head Osteonecrosis

by Juan F. Blanco, Francisco J. Garcia-Garcia, Eva M. Villarón, Carmen da Casa, Helena Fidalgo, Miriam López-Parra, José A. Santos and Fermín Sánchez-Guijo

J. Clin. Med. 2023, 12(6), 2117; https://doi.org/10.3390/jcm12062117 - 8 Mar 2023

Cited by 4 | Viewed by 2396

Abstract

(1) Background: Osteonecrosis of the femoral head (ONFH) is characterized by impaired vascularization with ischemia resulting in bone cell death, leading to the deterioration of the hip joint. Mesenchymal stem/stromal cells (MSCs) are an attractive potential therapeutic approach in this setting. The aim [...] Read more.

(1) Background: Osteonecrosis of the femoral head (ONFH) is characterized by impaired vascularization with ischemia resulting in bone cell death, leading to the deterioration of the hip joint. Mesenchymal stem/stromal cells (MSCs) are an attractive potential therapeutic approach in this setting. The aim of this study is to evaluate the clinical improvement in terms of pain and quality of life, as well as the safety of the procedure during the follow-up of patients. (2) Methods: A Phase I–II Open-Label Non-Randomized Prospective clinical trial was conducted. Eight patients with idiopathic ONFH and stage < IIC in the ARCO classification were included. Four weeks before therapy, 40 mL of autologous bone marrow was obtained, and MSCs were expanded under Good-Manufacturing-Practice (GMP) standards. Study medication consisted of a suspension of autologous BM-derived MSCs (suspended in a solution of 5–10 mL of saline and 5% human albumin) in a single dose of 0.5–1 × 10⁶ cells/kg of the patient, administered intraosseously with a trocar and under radioscopic control. Per-protocol monitoring of patients included a postoperative period of 12 months, with a clinical and radiological assessment that included the visual analog scale (VAS), the Harris scale, the SF-36, and the radiological evolution of both hips. In addition, all patients were further followed up for eight years to assess the need for long-term total hip replacement (THR) surgery. (3) Results: Median age of patients included was 48.38 ± 7.38 years, and all patients were men. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell administration. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 12.5% of patients improved at the end of follow-up, whereas 50% improved clinically. No adverse effects related to the procedure were recorded, and none of the patients needed THR surgery within the first year after MSC therapy. (4) Conclusions: The use of autologous MSCs for patients with ONFH disease is feasible, safe in the long term, and potentially effective. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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10 pages, 3397 KiB

Open AccessArticle

Radiologic Predictors for Clinical Improvement in PAO—A Perspective Study

by Kamil Kołodziejczyk, Adam Czwojdziński, Maria Czubak-Wrzosek and Jarosław Czubak

J. Clin. Med. 2023, 12(5), 1837; https://doi.org/10.3390/jcm12051837 - 24 Feb 2023

Cited by 1 | Viewed by 1254

Abstract

The aim of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy (PAO) and determine the values of radiological parameters that would allow us to obtain an optimal clinical result. Radiological evaluation [...] Read more.

The aim of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy (PAO) and determine the values of radiological parameters that would allow us to obtain an optimal clinical result. Radiological evaluation included determining the center-edge angle (CEA), medialization, distalization, femoral head coverage (FHC), and ilioischial angle as measured on a standardized AP radiograph of the hip joints. Clinical evaluation was based on the HHS, WOMAC, Merle d’Aubigne–Postel scales and Hip Lag Sign. The results of PAO presented decreased medialization (mean 3.4 mm), distalization (mean 3.5 mm), and ilioischial angle (mean 2.7°); improvement in femoral head bone cover; an increased CEA (mean 16.3°) and FHC (mean 15.2%); clinically increased HHS (mean 22 points) and M. Postel–d’Aubigne (mean 3.5 points) scores; and a decrease in WOMAC (mean 24%). HLS improved in 67% of patients after surgery. Qualification of patients with DDH for PAO should be based on the following values of three parameters: CEA < 26°, FHC < 75%, and ilioischial angle >85.9°. To achieve better clinical results, it is necessary to increase the average CEA value by 11° and the average FHC by 11% and reduce the average ilioischial angle by 3°. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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9 pages, 1042 KiB

Open AccessArticle

Aesthetic Results, Functional Outcome and Radiographic Analysis in THA by Direct Anterior, Bikini and Postero-Lateral Approach: Is It Worth the Hassle?

by Alberto Di Martino, Matteo Brunello, Valentino Rossomando, Davide Pederiva, Francesco Schilardi, Niccolò Stefanini, Giuseppe Geraci and Cesare Faldini

J. Clin. Med. 2023, 12(3), 1072; https://doi.org/10.3390/jcm12031072 - 30 Jan 2023

Cited by 6 | Viewed by 1692

Abstract

Total hip arthroplasty (THA) can be performed by several approaches such as direct anterior (DAA), direct lateral (DL) and postero-lateral (PL). Our study was conducted to compare among different approaches, such as DAA, bikini (BK) and PL, the aesthetic impact of the scar, [...] Read more.

Total hip arthroplasty (THA) can be performed by several approaches such as direct anterior (DAA), direct lateral (DL) and postero-lateral (PL). Our study was conducted to compare among different approaches, such as DAA, bikini (BK) and PL, the aesthetic impact of the scar, differences in the position of prosthetic components and differences in functional rehabilitation outcomes. Materials and methods: Population, composed by 240 patients, was collected among patients treated for primary total hip arthroplasty (THA) from 1 January 2017 to 31 December 2021 and divided by surgical approach. Of these, 160 female patients were included in the current analysis, leaving 58 DAA, 52 BK patients and 50 PL patients. Demographic and clinical parameters were retrospectively collected: age, BMI, time of surgery, length of stay, Harris Hip Score (HHS) before and after surgery at 6 months and patient, intra/post-surgical complications and Patient and Observer Scar Assessment Scale (POSAS). Results and Discussion: Our results showed a better aesthetical result in BK group compared to DAA group and faster rehabilitation with the DAA compared to PL. Optimal cup positioning was reached both in PL approach and DAA approach. DAA showed no increase in complications compared to PL approach and offered a faster recovery. Bikini approach is an alternative to the standard DAA approach and can be proposed for patients where a better aesthetic result is desired in addition to better functional recover. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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11 pages, 787 KiB

Open AccessArticle

Clinical Outcomes for Total Hip Arthroplasty with and without Previous Curved Periacetabular Osteotomy

by Koichi Kinoshita, Hajime Seo, Taiki Matsunaga, Kenichiro Doi and Takuaki Yamamoto

J. Clin. Med. 2023, 12(2), 694; https://doi.org/10.3390/jcm12020694 - 15 Jan 2023

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Abstract

There are currently no reports on the clinical outcomes after total hip arthroplasty (THA) with previous curved periacetabular osteotomy (CPO), although the outcomes after THA with non-CPO types of periacetabular osteotomy have been reported. This study aimed to clarify the differences in clinical [...] Read more.

There are currently no reports on the clinical outcomes after total hip arthroplasty (THA) with previous curved periacetabular osteotomy (CPO), although the outcomes after THA with non-CPO types of periacetabular osteotomy have been reported. This study aimed to clarify the differences in clinical outcomes and radiographic features after THA with or without previous CPO. We performed a retrospective case–control with individual matching study. The participants were 10 patients with 11 hips that underwent cementless THA between October 1998 and October 2018 with previous CPO (osteotomy group). For the control group, we matched age, sex, and follow-up period, and included 32 patients with 33 hips that underwent cementless THA without previous CPO at a 1:3 ratio. The Harris Hip Score (HHS), cup size, position, and alignment, global offset (GO), operative time, perioperative blood loss, frequency of osteophyte removal, and major complications were compared between the two groups. The osteotomy group had no cases with revision surgery and dislocation. No significant differences were found between the two groups as follows: mean HHS, 94.9 points in the osteotomy group versus 92.7 points in the control group at the final follow-up; mean GO, 70.1 mm in the osteotomy group versus 71.4 mm in the control group; cup size, position, and alignment after THA; operative time; and perioperative blood loss. The frequency of osteophyte removal was higher in the osteotomy group. The take-home messages were that the clinical outcomes, including HHS, and radiographic features, including GO, after THA were equivalent in the two groups. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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11 pages, 1773 KiB

Open AccessArticle

Predictors of Total Hip Arthroplasty Following Pediatric Surgical Treatment of Developmental Hip Dysplasia at 20-Year Follow-Up

by Ernest Young, Christina Regan, Todd A. Milbrandt, Emmanouil Grigoriou, William J. Shaughnessy, Anthony A. Stans and A. Noelle Larson

J. Clin. Med. 2022, 11(23), 7198; https://doi.org/10.3390/jcm11237198 - 3 Dec 2022

Cited by 6 | Viewed by 1753

Abstract

Long-term outcomes of surgical treatment for pediatric developmental dysplasia of the hip (DDH) are not well defined. The purpose of this study was to report long-term radiographic and clinical outcomes, survivorship free of total hip arthroplasty (THA), and predictors of subsequent THA following [...] Read more.

Long-term outcomes of surgical treatment for pediatric developmental dysplasia of the hip (DDH) are not well defined. The purpose of this study was to report long-term radiographic and clinical outcomes, survivorship free of total hip arthroplasty (THA), and predictors of subsequent THA following childhood treatment of DDH. This study was a single-institution retrospective review of hips treated for DDH with closed or open reduction at a minimum 10-year follow-up. 107 patients (119 hips) were included with a mean patient age of 3.3 years at childhood treatment. At mean 30.5 years follow-up, 24 hips had undergone THA (20%). Mean patient age at time of THA was 33.5 years. None of the hips treated with closed reduction alone required THA, whereas 8 hips treated with open reduction (25%) underwent THA. Hips with patient age > 4 years at the time of treatment had lower survivorship at 35 years follow-up (50% vs. 85%; p < 0.001). Additionally, femoral osteotomy (OR 2.0, p < 0.001), and previous treatment elsewhere (27% vs. 16%; p < 0.01) were associated with subsequent THA. Early referral and appropriate intervention may prove important, as age and prior treatment were predictive of subsequent THA. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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13 pages, 814 KiB

Open AccessArticle

An Observational Prospective Clinical Study for the Evaluation of a Collagen-Hydroxyapatite Composite Scaffold in Hip Revision Surgery

by Pietro Cimatti, Isabella Andreoli, Maurizio Busacca, Marco Govoni, Leonardo Vivarelli, Nicolandrea Del Piccolo, Alessandra Maso, Cesare Stagni and Giovanni Pignatti

J. Clin. Med. 2022, 11(21), 6372; https://doi.org/10.3390/jcm11216372 - 28 Oct 2022

Cited by 4 | Viewed by 1604

Abstract

One of the greatest challenges of hip revision surgery is the need to restore extensive bone loss by creating a stable reconstruction with long-term durability. The present observational, investigator-initiated prospective study was carried out to evaluate the clinical and radiological results of the [...] Read more.

One of the greatest challenges of hip revision surgery is the need to restore extensive bone loss by creating a stable reconstruction with long-term durability. The present observational, investigator-initiated prospective study was carried out to evaluate the clinical and radiological results of the use of a commercial biomimetic collagen–hydroxyapatite composite biomaterial (RegenOss) applied in hip revision surgery. Thirty-three patients who underwent hip revision were included in this study, and 29 received up to 2 years of follow-up. The acetabulum was reconstructed using an uncemented hemispherical shell both with or without an iliac fixation stem. Functional recovery was assessed according to the Harris Hip Score (HHS) at the pre-hospitalisation check-up, and at 6-, 12-, and 24-month follow-ups. Radiological evaluation consisting of X-ray analyses (6, 12, and 24 month follow-ups) and CT scan exams (within 10 weeks post-surgery and at 12-month follow-up) were performed to evaluate the reduction in bone defect and new bone regeneration. All the patients reported a complete recovery and a considerable improvement in functional outcome assessed by the HHS, which was significantly higher at all the follow-ups than at pre-hospitalisation. Moreover, radiological assessments revealed good scaffold integration. Overall, collected data suggest that RegenOss is a valid and safe alternative to restoring acetabular bone loss in revision hip arthroplasty. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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14 pages, 2566 KiB

Open AccessArticle

Utilizing Three-Dimensional Head-Lesser Trochanter Distance Could Further Reduce Leg Length Inequality in Primary Bipolar Hemiarthroplasty

by Seungbae Oh, Yong-Sik Kim, Soon-Yong Kwon, Young-Wook Lim, Hyunwoo Park, Jongwoo Park and Joo-Hyoun Song

J. Clin. Med. 2022, 11(21), 6303; https://doi.org/10.3390/jcm11216303 - 26 Oct 2022

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Abstract

Background: The aim of this study was to investigate whether the use of three-dimensional (3-D) computed tomography (CT)-based head-lesser trochanter distance (HLD) could reduce leg length discrepancy (LLD) more than the use of a two-dimensional (2-D) plain film method in primary bipolar hemiarthroplasty. [...] Read more.

Background: The aim of this study was to investigate whether the use of three-dimensional (3-D) computed tomography (CT)-based head-lesser trochanter distance (HLD) could reduce leg length discrepancy (LLD) more than the use of a two-dimensional (2-D) plain film method in primary bipolar hemiarthroplasty. Methods: Propensity score matching (PSM) analysis was used to adjust the confounding factors. A retrospective comparative analysis of 128 patients was performed. In the control group, the leg length was equalized using the 2-D, plain film-based HLD. In the study group, primary bipolar hemiarthroplasty was performed using the 3-D CT-based HLD method. Postoperative LLDs were compared between the two groups using the method of Ranawat. In addition, the Harris hip score (HHS) was evaluated and compared at one year after surgery. Results: A significant difference was observed in mean postoperative LLD between the 2-D HLD group and the 3-D CT HLD group: 1.6 ± 1.2 mm (range, 0.1–6.0 mm) and 1.1 ± 1.2 mm (range, 0.1–5.1 mm), respectively (p < 0.05). Additionally, a higher percentage of patients in the 3-D CT HLD group had an LLD of less than 2 mm. The mean HHS at one year after surgery showed no significant difference between the two groups. Conclusions: To minimize the occurrence of LLD, HLD measurement from a CT scanner may be more accurate than an X-ray. The 2-D and 3-D HLD differences in the 3-D CT HLD group were statistically significant. Using a 3-D, CT-based HLD method might decrease the possibility of an LLD over 2 mm. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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11 pages, 1928 KiB

Open AccessArticle

Patients with Small Acetabular Cartilage Defects Caused by Femoroacetabular Impingement Do Not Benefit from Microfracture

by Moritz Riedl, Ingo J. Banke, Jens Goronzy, Christian Sobau, Oliver Steimer, Steffen Thier, Wolfgang Zinser, Leopold Henssler, Volker Alt and Stefan Fickert

J. Clin. Med. 2022, 11(21), 6283; https://doi.org/10.3390/jcm11216283 - 25 Oct 2022

Cited by 3 | Viewed by 1653

Abstract

Objective: According to current recommendations, large cartilage defects of the hip over 2 cm² are suggested to undergo autologous chondrocyte transplantation (ACT), while small defects should be treated with microfracture. We investigated if patients with small chondral defects of the hip joint [...] Read more.

Objective: According to current recommendations, large cartilage defects of the hip over 2 cm² are suggested to undergo autologous chondrocyte transplantation (ACT), while small defects should be treated with microfracture. We investigated if patients with small chondral defects of the hip joint (≤100 mm²) actually benefit from microfracture. Design: In this retrospective multicenter cohort study 40 patients with focal acetabular cartilage defects smaller than 100 mm² and of ICRS grade ≥2 caused by femoroacetabular impingement were included. Twenty-six unrandomized patients underwent microfracture besides treatment of the underlying pathology; in 14 patients cartilage lesions were left untreated during arthroscopy. Over a mean follow-up of 28.8 months patient-reported outcome was determined using the iHOT33 (international hip outcome tool) and the VAS (visual analog scale) for pain. Results: The untreated group showed a statistically significant improvement of the iHOT33 after 12 (p = 0.005), 24 (p = 0.019), and 36 months (p = 0.002) compared to the preoperative score, whereas iHOT33 in the microfracture group did not reveal statistically significant changes over time. There was no significant difference between both groups on any time point. Regarding pain both groups did not show a significant improvement over time in the VAS. Conclusion: The subjective outcome of patients with small cartilage defects of the hip (≤100 mm²) improves 12 months after arthroscopic FAIS surgery without any cartilage treatment. However, no improvement could be seen after microfracture. Therefore, a reserved surgical treatment for small cartilage defects of the hip under preservation of the subchondral bone is recommended especially if a simultaneous impingement correction is performed. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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11 pages, 1151 KiB

Open AccessArticle

Multiple Drilling with Recombinant Human Bone Morphogenetic Protein-2 in Korean Patients with Non-Traumatic Osteonecrosis of the Femoral Head: A Prospective Randomized Pilot Study with a Minimum Two-Year Follow-Up

by Jun Young Park, Byung Woo Cho, Hyuck Min Kwon, Woo-Suk Lee and Kwan Kyu Park

J. Clin. Med. 2022, 11(19), 5499; https://doi.org/10.3390/jcm11195499 - 20 Sep 2022

Cited by 2 | Viewed by 1301

Abstract

We sought to determine whether multiple drilling (MD) combined with the injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) and β-tricalcium phosphate (β-TCP) could improve survival of the femoral head in pre-collapse lesions of non-traumatic osteonecrosis of the femoral head (ONFH) as compared [...] Read more.

We sought to determine whether multiple drilling (MD) combined with the injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) and β-tricalcium phosphate (β-TCP) could improve survival of the femoral head in pre-collapse lesions of non-traumatic osteonecrosis of the femoral head (ONFH) as compared with MD alone. We conducted a single-site, off-label, comparative and prospective cohort study between November 2017 and May 2019. We enrolled 25 hips (25 patients) with non-traumatic ONFH (Ficat–Arlet stage 2A or less). We performed a survival analysis, and the primary outcome was the occurrence of femoral head collapse on follow-up radiograph. Our cohort consisted of 11 men and 9 women of age 52.5 ± 8.8 years and a body mass index of 24.3 ± 3.0 kg/m². The femoral heads were preserved in 9 hips (45.0%) and collapsed in 11 hips (55.0%) at the final follow-up; mean survival to collapse was 6.9 (range 2.8–13.5) months. There were no significant differences in the survival of the femoral head between the MD alone group and the MD with rhBMP-2 and β-TCP group (five hips survived, 50% vs. four hips survived, 40%, respectively; p = 0.83). MD combined with the injection of rhBMP-2 and β-TCP did not improve femoral head survival compared to MD alone in the pre-collapse non-traumatic ONFH lesion. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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Review

Jump to: Research

16 pages, 321 KiB

Open AccessReview

Clinical Applications of “In-Hospital” 3D Printing in Hip Surgery: A Systematic Narrative Review

by Ignacio Aguado-Maestro, Clarisa Simón-Pérez, Manuel García-Alonso, Juan José Ailagas-De Las Heras and Elena Paredes-Herrero

J. Clin. Med. 2024, 13(2), 599; https://doi.org/10.3390/jcm13020599 - 20 Jan 2024

Cited by 2 | Viewed by 1602

Abstract

Introduction: Interest in 3D printing for orthopedic surgery has been increasing since its progressive adoption in most of the hospitals around the world. The aim of the study is to describe all the current applications of 3D printing in patients undergoing hip [...] Read more.

Introduction: Interest in 3D printing for orthopedic surgery has been increasing since its progressive adoption in most of the hospitals around the world. The aim of the study is to describe all the current applications of 3D printing in patients undergoing hip surgery of any type at the present time. Materials and Methods: We conducted a systematic narrative review of publications indexed in MedLine through the search engine PubMed, with the following parameters: 3D printing AND (orthopedics OR traumatology) NOT tissue engineering NOT scaffold NOT in vitro and deadline 31 July 2023. After reading the abstracts of the articles, papers were selected according to the following criteria: full text in English or Spanish and content related to hip surgery. Those publications involving experimental studies (in vitro or with anatomical specimens) or 3D printing outside of hospital facilities as well as 3D-printed commercial implants were excluded. Results are presented as a reference guide classified by disease, including the used software and the steps required for the development of the idea. Results: We found a total of 27 indications for in-house 3D printing for hip surgery, which are described in the article. Conclusions: There are many surgical applications of 3D printing in hip surgery, most of them based on CT images. Most of the publications lack evidence, and further randomized studies should be encouraged to assess the advantages of these indications. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

21 pages, 4853 KiB

Open AccessReview

Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis

by Alvin Kai-Xing Lee, Tsung-Li Lin, Chin-Jung Hsu, Yi-Chin Fong, Hsien-Te Chen and Chun-Hao Tsai

J. Clin. Med. 2022, 11(18), 5258; https://doi.org/10.3390/jcm11185258 - 6 Sep 2022

Cited by 9 | Viewed by 2334

Abstract

Three-dimensional printing and fracture mapping technology is gaining popularity for preoperative planning of fractures. The aim of this meta-analysis is to further understand for the effects of 3D printing and fracture mapping on intraoperative parameters, postoperative complications, and functional recovery on pelvic and [...] Read more.

Three-dimensional printing and fracture mapping technology is gaining popularity for preoperative planning of fractures. The aim of this meta-analysis is to further understand for the effects of 3D printing and fracture mapping on intraoperative parameters, postoperative complications, and functional recovery on pelvic and acetabular fractures. The PubMed, Embase, Cochrane and Web of Science databases were systematically searched for articles according to established criteria. A total of 17 studies were included in this study, of which 3 were RCTs, with a total of 889 patients, including 458 patients treated by traditional open reduction and internal fixation methods and 431 patients treated using 3D printing strategies. It was revealed that three-dimensional printing and fracture mapping reduced intraoperative surgical duration (RoM 0.74; 95% CI; 0.66–0.83; I² = 93%), and blood loss (RoM 0.71; 95% CI; 0.63–0.81; I² = 71%). as compared to traditional surgical approaches. In addition, there was significantly lower exposure to intraoperative imaging (RoM 0.36; 95% CI; 0.17–0.76; I² = 99%), significantly lower postoperative complications (OR 0.42; 95% CI; 0.22–0.78; I² = 9%) and significantly higher excellent/good reduction (OR 1.53; 95% CI; 1.08–2.17; I² = 0%) in the three-dimensional printing and fracture mapping group. Further stratification results with only prospective studies showed similar trends. Three-dimensional printing and fracture mapping technology has potential in enhancing treatment of complex fractures by improving surgical related factors and functional outcomes and therefore could be considered as a viable tool for future clinical applications. Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Updates and Perspectives)

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