Purpose:Periprosthetic joint infections (PJIs) resulting from total hip arthroplasty (THA) pose significant challenges. Partial two-stage exchange arthroplasty (TSEA) retains either the femoral stem or acetabular cup by preserving bone stock and soft tissue and offers a potential alternative to total TSEA. Our meta-analysis evaluated the pooled success rate of partial TSEA in treating late chronic PJIs in THA. Our study also focused on the outcomes associated with retained prosthetic implant (stem or cup) and the type of prior surgery (primary vs. revision arthroplasty) performed. Materials and Methods:We analyzed data from 355 hips of patients with PJI following THA across 11 studies using a random-effects model to estimate the success rate of partial TSEA and spacer dislocation that occurs during the interval between the first and second stages of partial TSEA. The heterogeneity between the subgroups was also calculated. Results:The overall pooled success rate of partial TSEA in the study cohort was 87% (95% confidence interval [CI] 83-91). Lacking statistical significance (P=0.904), the success rates were 88% for stem-retained and 90% for cup-retained implant cases. The partial TSEA success rates were 88% for primary arthroplasty and 80% for revision arthroplasty, although this was not statistically significant (P=0.193). Spacer dislocation occurred in only 5% of the cases (95% CI 1-9). Conclusion:Partial TSEA achieves high success rates comparable to those of total TSEA. Although revision arthroplasty cases carry a high risk of recurrence, partial TSEA remains a viable, tailored treatment option with a low complication rate.
Purpose:In the existing literature, isolated femoral head and polyethylene liner exchange is commonly performed in revision total hip arthroplasty (THA) for a variety of indications with mixed outcomes. The purpose of this study is to investigate patient outcomes following head-liner exchange and risk factors associated with failure in THA. Materials and Methods:A retrospective chart review from May 2016 to November 2023 was conducted on patients who underwent isolated head-liner exchange at two institutions. Patients had minimum 1-year follow-up periods. For each patient, data such as indication for revision, surgical approach, revision head size, immediate and short-term complications, postoperative disposition, 90-day readmissions, and re-operations were recorded. Results:Out of 175 patients, there were 24 readmissions/emergency department visits within 90 postoperative days (13.7%), 21 subsequent revision surgeries (12.0%), 21 postoperative dislocations (12.0%), and 20 immediate postoperative complications (11.4%). A statistically significant association was demonstrated between indication for revision and postoperative instability (P=0.04). Patients operated upon for instability had higher rates of postoperative instability. Furthermore, patients with reported preoperative dislocation events had higher incidences of postoperative dislocations. Patients discharged to skilled nursing facilities (SNF) were associated with an increased number of hospital readmissions within 90 days of surgery, reoperation, and postoperative dislocation (P<0.05). No statistically significant associations were found between surgical approach and complications. Conclusion:This study suggests that, in the context of isolated head-liner exchanges, factors such as preoperative dislocation history, indication for revision, and discharge to SNF are associated with poorer outcomes and complications.
Femoroacetabular impingement syndrome (FAIS) is a risk factor for future hip osteoarthritis and is prevalent in both athletic and non-athletic populations. This bibliometric review aimed to understand the history of FAIS and provide detailed information for future FAIS research. The Clarivate Analytics Web of Science Core Collection was used to search and obtain all studies between 2020 and 2025 using bibliometrix (ver. 3.0.4) and R package software. Between 2020 and 2025, 1,486 articles were published on FAIS. There was an overall 41.3% downward trend in published research during this period. Furthermore, recent key terms include "physical impairments" and "muscle strength". Institutions and surgical authors across North America, Europe, and Australia published the highest volume of research papers. Across keywords, femoroacetabular impingement and osteoarthritis had the strongest relationship. FAIS research continues to be led by surgical authors within surgical journals. While surgical key terms have been historically prevalent within the existing literature, research aligning with more conservative management has started to emerge. Despite an increase in physiotherapy researchers, inter-disciplinary collaboration remains limited and concentrated in western countries.
Purpose:When managing femoral neck fractures, National Institute for Health and Care Excellence guidelines (2023) recommend total hip arthroplasty (THA) for patients who are expected to independently perform activities of daily living (ADLs) beyond two years. These attempt to clarify the indication for THA versus hemiarthroplasty (HA). Frailty assessment tools, such as the Rockwood Frailty Scale (RFS), may provide surgeons a more objective means to assess patient function. The aim of this study is to ascertain whether frailty assessments are predictive of mortality associated with THA thus helping determine arthroplasty suitability. Materials and Methods:Single-center data was collected retrospectively between 2014 and 2020. Three hundred thirty-three cases were eligible for review. For the RFS, Johns Hopkins Frailty Assessment (JHFA) and Nottingham Hip Fracture Score (NHFS), frailty scores were generated and 2-year mortality was calculated for 'frail' and 'non-frail' patient cohorts. Results:Overall 2-year mortality was 8.4%. Mortality within two postoperative years was 0.8% for RFS <4 compared to 12.7% for scores ≥4. This highlights an approximate 17-times greater mortality risk between these groups (odds ratio [OR] 17.27, 95% confidence interval [CI] 2.32-128.82, P=0.005). For the JHFA, the 2-year mortality rate for 'frail' patients was over 6-times greater than those 'not frail' (OR 6.91, 95% CI 3.04-15.72, P<0.0001). Positive findings were noted by the NHFS (P=0.054). Conclusion:This study demonstrates that following THA for femoral neck fractures, preoperative frailty scores are predictive of 2-year postoperative mortality. Frailty assessments could objectively guide surgical decision making with respect to offering THA versus HA.
Purpose:This study aimed to determine complication-free survival rates by assessing Barthel Index (BI) grades at discharge and to identify prognostic factors following hip hemiarthroplasty for femoral neck fractures. Materials and Methods:This retrospective study analyzed 404 patients. We collected data on BI scores following surgery and at discharge, BI improvement rate (BI speed), postoperative complications (dislocations, thrombosis, death, infection, and nerve disorder), and peri-hip fractures (contralateral and periprosthetic fractures). Results:Cluster analysis categorized patients into low (<35, n=92), moderate (40-80, n=199), and high (>85, n=113) BI groups. The moderate BI group showed an intermediate BI speed (1.97±1.31/day, P<0.001) and a peri-hip fracture incidence of 11.1% (P=0.015). Four-year complication-free survival rates were 47.5% in the low, 45.9% in the moderate, and 74.7% in the high BI groups (P<0.001). Multivariate analysis identified BI speed as a significant prognostic factor for complications (hazard ratio 0.746, 95% confidence interval 0.560-0.994, P<0.05). Conclusion:BI speed is a significant prognostic indicator for complications following hip hemiarthroplasty. Although it does not predict peri-hip fractures, the high fracture incidence in the moderate BI group suggests the need for targeted preventive interventions in this population.
