Aims: This study aimed to assess the evaluation accuracy of an artificial intelligence (AI) algorithm using the hammering sound to assess initial press-fit fixation in cementless total hip arthroplasty (THA). The acoustic features of the hammering sounds during a press-fit cup fixation were recorded and analysed. Methods: 81 hips of 79 patients undergoing primary THA using the Trident HA acetabular system (Stryker, Kalamazoo, MI, USA) for treatment of osteoarthritis and osteonecrosis of the femoral head were included. After the fast Fourier transform analysis was performed on the hammering sound, 24 sound pressure (SP) features across 23 frequency bands were extracted and applied to binary classification. Support vector machine algorithms were used to classify the data using 2 models: Model A - SP only; Model B - SP + patient characteristics. Results: Among the 81 hips in 79 patients, the hammering sound of 348 impacts of 70 successful press-fit of 1st attempts in 70 hips and 80 impacts of 16 failed attempts in 11hips were analysed. The area under the curve for the test data was 0.9554 in Model A and 1.0 in Model B. The accuracy (accuracy/sensitivity/specificity/positive predictive value/negative predictive value) of each model in the test data was as follows: Model A, 0.849/1.000/0.188/0.843/1.000 and Model B, 0.965/1.000/0.813/0.959/1.000. Conclusions: The accuracy of an AI algorithm using hammering sounds to judge the success of initial press-fit fixation in cementless cup in THA was relatively high. Our results imply the possibility of a practical application for such a system to assist surgeons during the procedure.
Introduction: The effectiveness of percutaneous neuromodulation of the obturator nerve using pulsed radiofrequency ablation (PRF) in patients with hip osteoarthritis refractory to conservative treatment should be evaluated.Methods: 33 hips in 30 patients with radiographically confirmed hip osteoarthritis (Kellgren-Lawrence grades 2-4), underwent CT-guided pulsed radiofrequency ablation (PRF), targeting the obturator nerve. The mean age of patients was 69 (range 25-90) years. PRF was applied for 12 minutes. The effectiveness of the procedure was evaluated retrospectively based on a pain analog scale (VAS) prior and 1 week, 1, 3, 6 and 12 months post PRF. Paired samples t-test analysis was used to compare baseline and follow-up VAS scores. CIRSE classification system was used for complication reportingResults: A marked reduction in pain intensity was observed immediately following the procedure, with a mean decrease of approximately 9 points on the VAS scale. Patients with mild osteoarthritis seem to benefit more from the procedure with a reduction in pain scale of an average of 6 points at 6 months and an average of 4 points at 12 months. Cases with end-stage osteoarthritis (stage 4) had recurred pain at an average of 3 months post intervention. No complications were reported during or after the procedure.Conclusions: Percutaneous neuromodulation of the obturator nerve with the use of PRF ablation is an effective and safe procedure with durable pain relief in patients with mild-to-moderate osteoarthritis up to 12 months, whereas in severe disease (grade 4) disease the effect is predominantly short-term, with recurrence of pain after approximately 3 months.
Background: Acetabular defects can be restored using different surgical techniques. Excellent results have been observed with trabecular titanium (TT) which mimic the structure of trabecular bone. The aim of our study is to evaluate the mid-to-long-term outcome in revision surgery due to severe acetabular defect using TT cups. Materials and methods: We performed a retrospective analysis of patients undergoing revision with Paprosky IIa or higher using modular TT cup. We evaluated clinical outcomes using FJS, WOMAC, OHS, and WORQ. Radiolucency and integration were used to assess radiographic results. We collected information on complications and revisions. Results: Data from 217 consecutive patients was collected. Mean age was 71,01 +/- 11,40 years. In regard to diagnosis, patients were affected by: aseptic loosening (55,3%); debris-induced osteolysis (18%); infection (11,5%); PPF (7.8%); and dislocation (7.4%). At the final floow-up, we documented the following: OHS 35.06 +/- 4,31; WORQ 26.69 +/- 4.18; WOMAC 27.59 +/- 7.57; FJS of 55.3 +/- 10.39 (p-value < 0.005). Complication rate was 9.2%. The most frequent complication was dislocation, followed by deep infection and aseptic loosening. The Kaplan-Meier survivorship curve showed a 96.3% rate of acetabular implant survival at 12 years. Discussion and conclusions: This is the study with the largest population using TT for acetabular defects. We report good outcomes and an acceptable rate of complications, also due to implant modularity allowing stable fixation with secondary osseointegration.
Introduction: Intraprosthetic dislocation (IPD) is a rare but potentially catastrophic complication of dual-mobility (DM) implants, defined by dissociation of the inner femoral head from the polyethylene liner. Modular dual-mobility (MDM) designs were introduced to improve intraoperative flexibility and expand indications for DM technology. However, increasing reports of IPD have raised concerns that implant design and manufacturing differences may influence risk. The true incidence of IPD across MDM manufacturers remains unclear.Methods: A systematic search of PubMed, Embase, and Web of Science was performed. Studies reporting IPD incidence and stratified outcomes by implant manufacturer were included. A random-effects proportion meta-analysis was conducted to estimate pooled IPD incidence and revision rates overall and by manufacturer.Results: Of 523 identified articles, 32 met inclusion criteria, representing 3996 implants (2711 primary; 1285 revision). Mean follow-up was 3.48 years and mean age was 67.48 years. The overall IPD incidence was 0.38% (15/3996), with a pooled estimate of 0.1% (95% CI, 0-0.5%). Stratified analyses showed IPD rates of 0% for Stryker (95% CI, 0-0.7%), 0% for Zimmer (95% CI, 0-100%), and 0% for Groupe L & eacute;pine (95% CI, 0-100%). Reoperation rates were 1.4% (95% CI, 0.9-2.1%) in primary and 8.3% (95% CI, 6.0-11.3%) in revision THA.Conclusions: The incidence of IPD in MDM implants is low, with pooled rates remaining below 1%. Revision rates were modest and consistent with published data on complex hip arthroplasty. No significant differences between manufacturers were detected, though findings are limited by the small number of non-Stryker implants reported. These findings suggest that MDM designs appear safe with overall low numbers of IPD-related complications, however, larger registry-based studies are needed to better define potential design-related differences in IPD risk.
Introduction: Pelvic obliquity (PO) in dysplastic hip osteoarthritis may tilt upward (U-PO) or downward (D-PO) on the affected side. U-PO tends to persist more frequently after total hip arthroplasty (THA) than D-PO; however, the contributing factors remain unclear. This study investigated factors associated with residual PO after THA according to preoperative PO direction.Methods: This retrospective study included 116 patients (21 men, 95 women) who underwent unilateral THA for dysplastic hip osteoarthritis with preoperative PO >= 2 degrees. Patients were classified into U-PO (n = 35) or D-PO (n = 81). Pre- and postoperative radiographic parameters of the spine and legs were analysed to identify factors associated with residual PO.Results: In the U-PO group, leg lengthening was independently associated with residual PO (odds ratio [OR], 1.390; 95% confidence interval [CI], 1.010-1.910; p = 0.045). In the D-PO group, greater preoperative lumbar scoliosis angle (OR, 1.180; 95% CI, 1.030-1.360; p = 0.022) and reduced lumbar lateral bending mobility (OR, 0.681; 95% CI, 0.540-0.858; p = 0.001) were independently associated with residual PO.Conclusions: Direction-specific assessment of PO may help anticipate residual coronal malalignment after THA, with greater leg lengthening associated with residual U-PO and spinal deformity and reduced lumbar flexibility associated with residual D-PO.
