Background:Hip resurfacing arthroplasty (HRA) is needed for certain patients, such as those with in situ metal work and abnormal anatomy, and/or other needs that are not well-served by total hip replacement (THR). Over the last 20 years, almost all HRAs have been performed using Metal-on-Metal (MoM) bearings, but metal wear debris generated over time has now ended their continued use. Cemented highly cross-linked polyethylene (XLPE) acetabular bearings have shown excellent survivorship for use in THR and the aim of this study is to determine if this also applied to HRA. Methods:This prospective cohort study evaluated extending the use of cemented XLPE acetabular bearings to HRA. There were 122 HRA patients who received a cemented XLPE acetabular component. They were followed for a mean 15 years (range, 10-20 years). There were 65 women (53%) and 57 men (47%). The mean age at surgery was 49.2 years (range, 21-68 years) the mean body mass index (BMI) was 26 kg/m2. Clinical outcomes and survivorship were determined. Analyses of implants retrieved during revision or postmortem were performed to evaluate consequences of wear debris. Results:The 10-year survival rate for 122 hips was 93.5% [95% confidence interval (CI): 91.7-98.1%] for all-cause revision. Six acetabular bearings failed, requiring revision for: loosening [2], polyethylene wear [2], and dislocation [2]. Four additional well-functioning XLPE bearings were retrieved postmortem. Two well-functioning cemented acetabular bearings were also retrieved; one was an explant for an infection after 9 years and the other was retrieved during revision to THR because of femoral head avascular necrosis at 6 years. Analysis of the 12 retrievals found signs of limited anterior/superior wear in all bearings along with minimal wear in the dome of 10 bearings. Only two retrieved bearings had more than 50% of the anterior/superior area worn and these were after 15 and 20 years of use. Two of the retrieved implants had no signs of wear. Conclusions:Cemented all XLPE acetabular bearings produced successful clinical outcomes initially in all patients. Six (4.9%) patients required revision for acetabular failure. Anterior/superior wear was found in the retrievals, but dome wear was limited. Cementing an XLPE acetabular component is a reasonable approach in HRA, but since it does not allow adjunct screw fixation that a metal-backed two-piece component can offer, it is not a solution for every HRA.
Reliable lateral decubitus positioning is critical for safe and effective lateral lumbar interbody fusion (LLIF); however, traditional patient stabilization with adhesive taping can be time-consuming, inconsistent, and associated with skin shear or breakdown, particularly in high body mass index (BMI) or elderly patients. In this technical report, we describe the use of a mechanical patient positioning system as a tape-free method of stabilization designed to provide counter-pressure at the iliac crest, thoracic cage, and/or greater trochanter while allowing for fine adjustments in alignment. The system is mounted directly to the operating table and uses adjustable support arms with anatomically contoured pads to improve control of pelvic tilt, trunk rotation, and coronal balance during positioning Conceptually, this approach enables controlled, reproducible support at fixed bony landmarks and may facilitate positioning optimization during fluoroscopic imaging. Compared with traditional taping techniques, this system is intended to reduce reliance on variable manually applied tension and instead provide adjustable mechanical support. Potential advantages include improved positioning consistency, decreased dependence on skin-based traction, and the ability to make intraoperative adjustments after draping. In addition, the technique may streamline operating room (OR) workflow by reducing repeated repositioning maneuvers and minimizing setup variability between surgical teams. The ability to fine-tune patient alignment after preparation may be particularly useful in multilevel LLIF procedures and in patients with increased soft-tissue mobility. This report aims to: (I) outline the rationale for mechanical positioning in LLIF; (II) describe the technical application of a table-mounted positioning system; and (III) discuss its potential advantages and limitations relative to conventional taping methods. No quantitative outcome data are presented, and further study is required to evaluate clinical impact.
Background:Complex hip-spine syndrome combined with hip ankylosis is clinically challenging to manage. Traditional surgeries are associated with insufficient precision and significant trauma, which easily lead to poor lumbar-pelvic-hip alignment and affect prognosis. With the development of digitalized and intelligentized surgical techniques, the integration of artificial intelligence (AI), computer navigation, and minimally invasive techniques has provided a new solution for such complex cases, enabling optimized surgical outcomes through precise planning and operation in line with the damage-control philosophy. Case Description:A young male patient with severe hip-spine deformity and hip ankylosis underwent treatment. The first-stage hip surgery was performed using AI, computer navigation and minimally invasive total hip arthroplasty. The second-stage scoliosis correction was conducted based on simulation planning with a three dimensional (3D) printed model. At the 30-month postoperative follow-up, the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short-Form Health Survey (SF-36) scores increased by 75, 143, and 350 points, respectively. The patient's overall quality of life was significantly improved. Spinal function parameters including cervical balance vertical axis (CBVA), Scoliosis Research Society-22 questionnaire (SRS-22), and Oswestry Disability Index (ODI) were also significantly enhanced. Radiological examinations (anteroposterior pelvic and standing full-length X-rays) showed that the inclination and anteversion of the acetabular component were consistent with AI's preoperative predictions, reflecting favorable lumbar-pelvic-hip adaptation. Conclusions:In the treatment of hip ankylosis in complex hip-spine syndrome, the application of AI combined with navigation technology can significantly improve surgical precision, reduce trauma, promote coordinated lumbar-pelvic-hip alignment, and effectively enhance patients' joint/spinal function and quality of life. It provides a new digitalized and intelligentized solution for the surgical management of such complex cases.
