Abstract:Tourniquet is frequently used during total knee arthroplasty (TKA); however, its use is associated with increased pain, reduced function, and increased swelling in the early postoperative period. This study aims to evaluate the effects of tourniquet application on swelling, pain, knee function, and patient-reported outcomes. This nonrandomized single-center observational clinical trial included 84 primary TKAs, with assessment of tourniquet duration (minutes) and tourniquet pressure (mmHg). Swelling was quantitatively assessed through multiple circumferential measurements of the leg. Secondary outcome included pain intensity, knee flexion, and the Western Ontario and McMaster Universities Osteoarthritis Index score. Outcome was measured at multiple time points before TKA until 6 weeks after TKA. Overall swelling was less at 5 days (3.9 ± 0.75 L vs. 4.7 ± 1.0 L; p = 0.004) with low tourniquet pressure. The level of pain after surgery was lower in the tourniquet cementation group both at 2 days (2.9 ± 2.1 vs. 4.7 ± 2.5, p = 0.01) and at 5 days (2.7 ± 2.1 vs. 4.2 ± 2.5, p = 0.02) after surgery. Active knee flexion at 5 days after surgery was less with longer tourniquet application (65.4 ± 16.4 vs. 74.4 ± 16.7, p = 0.04). We recommend keeping the tourniquet cuff pressure around the thigh below 300 mm Hg to reduce swelling of the whole leg in the early postoperative period after TKA. Tourniquet duration should be kept as low as possible, ideally only during the cementation period, resulting in clinically relevant decreased postoperative pain and increased postoperative knee range of motion. In cases that require higher tourniquet pressures or longer duration of tourniquet, complete recovery from all negative effects can be expected at 6 weeks following TKA. The study provides therapeutic level III evidence.

To determine the prevalence of ischiofemoral impingement (IFI) in young patients evaluated for joint-preserving hip surgery and investigate its associations with osseous deformities and intra-articular pathologies. Retrospective study of 256 hips (224 patients, mean age 34 years) that were examined with radiographs and MR arthrography for hip pain. Quadratus femoris muscle edema was used to indicate IFI and measurements of ischiofemoral space were performed. Imaging analysis assessed cam deformity, femoral torsion, neck-shaft angle, ischial angle, acetabular coverage-/ version, and chondro-labral pathology. Prevalence of MRI findings consistent with IFI was calculated and univariate- and multivariate logistic regression identified associations between IFI and hip deformities. Quadratus femoris muscle edema consistent with IFI was present in 9

Abstract Background Hip arthroscopy with initial access to the peripheral compartment could reduce the risk of iatrogenic injury to the labrum and cartilage; furthermore, it avoids the need for large capsulotomies with separate portals for peripheral and central (intra-articular) arthroscopy. Clinical results of the peripheral-compartment-first technique remain sparse, in contrast to those of conventional hip arthroscopy starting in the intra-articular central compartment. The purpose of this study was to assess outcome of hip arthroscopy with the peripheral-compartment-first technique, including complication rates, revision rates and patient-reported outcome scores. Materials and methods This outcome study included 704 hips with femoroacetabular impingement. All arthroscopies were performed using the peripheral-compartment-first technique. A joint replacement registry and the institutional database were used to assess the revision and complication rates, while patient-reported outcome measures were used to assess functional outcomes and patient satisfaction. Results In total, 704 hips (615 patients) were followed up for a mean of 6.2 years (range 1 to 9 years). The mean age of the patients was 32.1 ± 9.2 years. During the follow-up period, 26 of 704 (3.7%) hips underwent total hip arthroplasty (THA) after a mean of 1.8 ± 1.2 years, and 18 of the 704 (2.6%) hips required revision hip arthroscopy after a mean of 1.2 ± 2.1 years. 9.8% of the hips had an unsatisfactory patient-reported outcome at final follow-up. Conclusions The results for the peripheral-compartment-first technique were promising. We recommend a well-conducted randomized controlled clinical trial to guide future therapeutic recommendations regarding the most favorable hip arthroscopy technique. Level of evidence: Level IV, therapeutic study. Trial registration: This study was registered at ClinicalTrials.gov (U.S. National Library of Medicine; ID: NCT05310240).

Purpose:Manual lymphatic drainage (MLD) is a routine therapeutic technique used to decrease peripheral oedema by activating lymphatic drainage. Evidence for its efficacy remains sparse. Therefore, the purpose of this study was to evaluate the effect of MLD before and after total knee arthroplasty (TKA). Methods:This was a single-centre randomized, controlled and observer-blinded trial. 112 patients were randomly assigned to one of three groups: group 1 underwent MLD for 30 min daily on five consecutive days both before and after TKA; group 2 underwent MLD for 30 min daily on five consecutive days only after TKA; and the control group did not undergo MLD. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, range of knee motion, swelling and pain were assessed before TKA, after two days, five days and six weeks. Results:The overall age of the patients was 69.4 years (SD = 9.8, range = 41-87). The groups were well matched in terms of sex, age, height, weight, and body mass index. There was no statistically significant difference with regard to any of the outcome measures between the groups. Conclusions:The present results indicate that MLD had no significant benefits when applied either before or early after TKA. Therefore, we do not recommend the routinely use of MLD in the early period before or after TKA. Further studies should evaluate the effect of MLD after arthroscopic surgery. Level of evidence:Therapeutic Level II, Lower quality RCT with follow up <80.

Abstract Objectives To present our technique of diagnostic CT-guided ischiofemoral space injection and report on pain response, complications, and associated imaging findings in young patients with ischiofemoral impingement (IFI). Methods Retrospective case series of patients with a clinical diagnosis of IFI that underwent CT-guided IFS injection with local anesthetic in a prone position with the feet in maximum internal rotation between 06/2019 and 04/2021. The response was evaluated using maximum subjective pain evaluation on a 0–10 visual analog scale (VAS) during a standardized pre- and postinterventional clinical examination. Patient charts and radiographic imaging data were reviewed to report associated imaging findings and subsequent surgeries. Results Eleven patients (13 hips, 9 females) with a median age of 31 years (interquartile range; IQR: 25–37 years) were included. Median baseline VAS was 7 points (IQR: 5–8) with a pain reduction of 5 points (IQR: 5–7 points, p = 0.001) after the injection. One patient reported transient ischial nerve paresthesia, otherwise, no complications occurred. Quadratus femoris muscle edema was present in 85% (11 of 13 hips). Excessively high femoral torsion (11/13 hips, 85%) and cam deformities (8/13 hips, 62%) were the most common osseous deformities. Eight of 13 hips (62%) underwent subsequent surgery for IFI. Conclusion CT-guided diagnostic injection of the ischiofemoral space is safe and feasible. In young IFI patients, diagnostic IFS injections have the potential to improve the differential diagnosis of hip pain and to inform decision-making with regard to a possible benefit of joint-preserving hip surgery. Critical relevance statement In young patients with hip pain, diagnosis of IFI can be challenging due to concomitant pathologies. Furthermore, surgical treatment in these patients is controversial. In this context, CT-guided diagnostic infiltrations of the ischiofemoral space may facilitate not only the initial diagnosis of IFI, but could also improve surgical decision-making. Key Points CT-guided diagnostic injection of local anesthetic in the ischiofemoral space is safe. In young patients with IFI, it leads to subjective pain reduction. In young patients with concomitant osseous deformities, it may improve surgical decision-making. Graphical Abstract

Aims:Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. Methods:A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. Results:Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. Conclusion:We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity.

Objectives To assess the feasibility of flexion-abduction-external rotation (FABER) magnetic resonance imaging (MRI) of the hip to visualize changes in the ischiofemoral interval and ability to provoke foveal excursion over the acetabular rim. Methods IRB-approved retrospective single-center study. Patients underwent non-contrast 1.5-T hip MRI in the neutral and FABER position. Two readers measured the ischiofemoral interval at three levels: proximal/distal intertrochanteric distance and ischiofemoral space. Subgroup analysis was performed for hips with/without high femoral torsion, or quadratus femoris muscle edema (QFME), respectively. A receiver operating curve with calculation of the area under the curve (AUC) for the prediction of QFME was calculated. The presence of foveal excursion in both positions was assessed. Results One hundred ten patients (121 hips, mean age 34 ± 11 years, 67 females) were evaluated. FABER-MRI led to narrowing (both p < .001) of the ischiofemoral interval which decreased more at the proximal (mean decrease by 26 ± 7 mm) than at the distal (6 ± 7 mm) intertrochanteric ridge. With high femoral torsion/ QFME, the ischiofemoral interval was significantly narrower at all three measurement locations compared to normal torsion/no QFME ( p < .05). Accuracy for predicting QFME was high with an AUC of .89 (95% CI .82–.94) using a threshold of ≤ 7 mm for the proximal intertrochanteric distance. With FABER-MRI foveal excursion was more frequent in hips with QFME (63% vs 25%; p = .021). Conclusion Hip MRI in the FABER position is feasible, visualizes narrowing of the ischiofemoral interval, and can provoke foveal excursion. Critical relevance statement FABER MRI may be helpful in diagnosing ischiofemoral impingement and detecting concomitant hip instability by overcoming shortcomings of static MR protocols that do not allow visualization of dynamic changes in the ischiofemoral interval and thus may improve surgical decision making. Key points • FABER MRI enables visualization of narrowing of the ischiofemoral interval proximal to the lesser trochanter. • Proximal intertrochanteric distance of ≤ 7 mm accurately predicts quadratus femoris muscle edema. • Foveal excursion was more frequent in hips with quadratus femoris muscle edema. Graphical Abstract

Background: The incidence of injuries on alpine ski slopes have been assessed using various methods. A decline in injury rate has been observed throughout the literature; however, the actual incidence remains unclear. The purpose of this study was therefore to evaluate the incidence of skiing and snowboarding injuries using largesample data from an entire geographic state. Methods: Data on alpine injuries over the course of five winter seasons between 2017 and 2022 were prospectively collected from the emergency service dispatch center of Tyrol (Austria). The incidence of injuries was assessed in relation to the number of skier days, which was obtained from the chamber of commerce. Results: A total of 43,283 cases were identified, and a total of 98.1 Mio skier days were registered during the inclusion period of our study, resulting in an overall incidence of 0.44 injuries per 1,000 skier days. This is significantly less than reported from previous studies. From 2017/18 to 2021/22 there was a slight increase in injuries per 1000 skier days with an exception only for the COVID-19 related season 2020/21. Conclusion: Our study showed a significant reduction in the incidence of alpine skiing and snowboarding injuries in comparison with previous studies and should be considered a benchmark for future studies. Long-term studies on the efficacy of safety gear, as well as the influence of ski patrol and air-borne rescues on patient outcome are warranted.

Objectives To identify preoperative degenerative features on traction MR arthrography associated with failure after arthroscopic femoroacetabular impingement (FAI) surgery. Methods Retrospective study including 102 patients (107 hips) undergoing traction magnetic resonance arthrography (MRA) of the hip at 1.5 T and subsequent hip arthroscopic FAI surgery performed (01/2016 to 02/2020) with complete follow-up. Clinical outcomes were assessed using the International Hip Outcome Tool (iHOT-12) score. Clinical endpoint for failure was defined as an iHOT-12 of < 60 points or conversion to total hip arthroplasty. MR images were assessed by two radiologists for presence of 9 degenerative lesions including osseous, chondrolabral/ligamentum teres lesions. Uni- and multivariate Cox regression analysis was performed to assess the association between MRI findings and failure of FAI surgery. Results Of the 107 hips, 27 hips (25%) met at least one endpoint at a mean 3.7 ± 0.9 years follow-up. Osteophytic changes of femur or acetabulum (hazard ratio [HR] 2.5–5.0), acetabular cysts (HR 3.4) and extensive cartilage (HR 5.1) and labral damage (HR 5.5) > 2 h on the clockface were univariate risk factors (all p < 0.05) for failure. Three risk factors for failure were identified in multivariate analysis: Acetabular cartilage damage > 2 h on the clockface (HR 3.2, p = 0.01), central femoral osteophyte (HR 3.1, p = 0.02), and femoral cartilage damage with ligamentum teres damage (HR 3.0, p = 0.04). Conclusion Joint damage detected by preoperative traction MRA is associated with failure 4 years following arthroscopic FAI surgery and yields promise in preoperative risk stratification. Clinical relevance statement Evaluation of negative predictors on preoperative traction MR arthrography holds the potential to improve risk stratification based on the already present joint degeneration ahead of FAI surgery. Key Points • Osteophytes, acetabular cysts, and extensive chondrolabral damage are risk factors for failure of FAI surgery. • Extensive acetabular cartilage damage, central femoral osteophytes, and combined femoral cartilage and ligamentum teres damage represent independent negative predictors. • Survival rates following hip arthroscopy progressively decrease with increasing prevalence of these three degenerative findings. Graphical Abstract

INTRODUCTION:Spinal epidural hematoma is a rare condition that most commonly occurs as a complication of spinal surgery. For patients with neurological deficits, surgical decompression can generally provide good outcome. CASE:A 56-year-old, otherwise healthy, patient was admitted to the orthopedic emergency department with a pelvic ring fracture. Over the course of 4 days, a lumbar spinal epidural hematoma developed, with the patient complaining of pain radiating to the S1 dermatome and saddle paresthesia. The hematoma was surgically decompressed, and the patient had a complete recovery. DISCUSSION:To our knowledge, this is the first report of a spinal epidural hematoma after pelvic ring fracture. The etiology of spinal epidural hematoma is diverse, but it is most frequently observed after spinal surgery. It has rarely been observed after lumbar spinal fractures, nearly exclusively in patients with ankylosing spondylitis. CONCLUSION:Pelvic ring fracture might result in spinal epidural hematoma. The presence of neurological deficits after such fractures is an indication for lumbosacral MRI. Surgical decompression will generally resolve the neurological symptoms.

To compare image quality and diagnostic performance of preoperative direct hip magnetic resonance arthrography (MRA) performed with gadolinium contrast agent and saline solution. IRB-approved retrospective study of 140 age and sex-matched symptomatic patients with femoroacetabular impingement, who either underwent intra-articular injection of 15–20 mL gadopentetate dimeglumine (GBCA), 2.0 mmol/L (“GBCA-MRA” group, n = 70), or 0.9

BACKGROUND:Outcome reports for Alpha Ankle Arthroplasty (AAA), a third-generation implant relying on a mobile bearing design for total ankle replacement, are sparse. This retrospective study evaluated the midterm survivorship, clinical, and radiologic outcomes after implantation of this implant.METHODS:For 64 patients who received 65 Triple A ankle implants between 2009 and 2020, implant survival was calculated using the Kaplan-Meier curve. Clinical outcomes were evaluated by measuring the range of motion, stability, Western Ontario and McMaster Universities Osteoarthritis Questionnaire score (WOMAC), and American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The average pain level and satisfaction with the postoperative result were rated on a numeric rating scale (0-10). Additionally, radiologic analysis was performed using anteroposterior and lateral radiographs and tibiotalar alignment was assessed.RESULTS:The implant-survival rate was 61.5% at a mean follow-up of 8.2 years. Twenty-five patients (38.5%) required revision surgery (average time to revision, 3.1 years, 95% CI 2.1-4.1 years). For patients without revisions, the average range of motion in dorsiflexion and plantarflexion were 3.6 ± 4.2 degrees and 21.9 ± 7.8 degrees, respectively. The mean WOMAC and AOFAS scores were 44.7 ± 47.5 and 75.1 ± 14.0, respectively. The average pain and subjective satisfaction scores were 2.0 ± 1.7 and 8.5 ± 1.9, respectively. Mean alignment values did not differ significantly for patients who required revision surgery.CONCLUSION:We found a high revision rate with use of the AAA. However, patients who did not require revision surgery had, on average, high satisfaction and good functional outcomes.LEVEL OF EVIDENCE:Level IV, case series.

Purpose Arthroplasty registries gained increasing importance to the re-certification of orthopaedic implants according to the European Union (EU) Medical Device Regulation (MDR) adopted in 2017. Until recently, several European countries only had regional arthroplasty registries. Whether regional registries deliver data quality comparable with national registries remained unclear. Therefore, the purpose of this study was to validate the Austrian Tyrolean Hip Arthroplasty Registry (THAR) and to evaluate if this regional registry showed adequate adherence, completeness and correctness when compared with well-established national registries. Methods A consecutive series of 1100 primary total hip arthroplasties were identified from our institution’s medical database. Patients were interviewed by phone and completed questionnaires after a mean follow-up period of 8.05 years and were asked if they had had revision surgeries. The data were compared to the corresponding dataset from the THAR. Results Adherence was 97.91% for primary total hip arthroplasty. Clinical follow-up identified 10 missing cases, resulting in adherence of 81.48% for revisions. Completeness of patient-reported outcome measurements was 78.55% before surgery and 84.45% 1 year after surgery. Correctness was 99.7% for demographic data, 99.54% for implant specifications, and 99.35% for mode of fixation. Conclusion The data of this study showed that regional arthroplasty registries can deliver data quality comparable with well-established national registries. The main reason for unrecorded revision cases and wrongly recoded implants was human error. Further digitalization with more automatic data submission may have the potential to reduce these failure rates in the future. Overall, the THAR represents a valid data source for re-certification of medical implants according to the EU’s MDR.

Objectives: Injuries on alpine ski slopes have been described in cohorts of a reasonable sample size, but constant improvements in safety gear, increased use of airborne rescue, and safety measures during the coronavirus disease 2019 (COVID-19) pandemic mandate re-evaluation. Therefore, the purpose of this study was to evaluate skiing and snowboarding injuries, effectiveness of airborne rescue, and impact of the COVID-19 pandemic on a large sample size. Methods: Data on alpine injuries were prospectively collected from the state emergency services dispatch center in the state of Tyrol (Austria). A total of 10,143 patients were identified, with an average age of 33.5 years (SD = 20.36). The ski patrol was involved in 8,606 cases (84.9%) and some patients (n = 1,536; 15.1%) required helicopter rescue. Results: A total of 10,143 patients were identified from the dataset of the emergency dispatch center. The most frequently injured region was the knee (30.2%), and it was followed by the shoulder (12.9%), the lower leg (9.5%), and the head/skull (9.5%). Conclusion: The present findings indicate that the most frequent site of injuries on alpine slopes is the knee, and life-threatening injuries are rare. Airborne rescue is very time-effective, however clinical studies with patient follow-up should be emphasized to determine the impact of airborne rescue on patient outcome. The present findings indicate that the duration of all rescue operations has been prolonged as a result of the introduction of safety measures during the COVID-19 pandemic.

Background Pelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical outcome of pelvic fracture. Methods We performed a retrospective analysis of data of patients registered in the German Pelvic Registry between January 2003 and December 2017. Clinical characteristics, surgical parameters, and outcomes were compared between patients with isolated pelvic fracture (group A) and patients with pelvic fracture plus spine injury (group B). We also compared apart patients with isolated acetabular fracture (group C) versus patients with acetabular fracture plus spine injury (group D). Results Surgery for pelvic fracture was significantly more common in group B than in group A (38.3% vs. 36.6%; p = 0.0002), as also emergency pelvic stabilizations (9.5% vs. 6.7%; p < 0.0001). The mean time to emergency stabilization was longer in group B (137 ± 106 min vs. 113 ± 97 min; p < 0.0001), as well as the mean time until definitive stabilization of the pelvic fracture (7.3 ± 4 days vs. 5.4 ± 8.0 days; p = 0.147). The mean duration of treatment and the morbidity and mortality rates were all significantly higher in group B ( p < 0.0001). Operation time was significantly shorter in group C than in group D (176 ± 81 min vs. 203 ± 119 min, p < 0.0001). Intraoperative blood loss was not significantly different between the two groups with acetabular injuries. Although preoperative acetabular fracture dislocation was slightly less common in group D, postoperative fracture dislocation was slightly more common. The distribution of Matta grades was significantly different between the two groups. Patients with isolated acetabular injuries were significantly less likely to have neurological deficit at discharge (94.5%; p < 0.0001). In-hospital complications were more common in patients with combined spine plus pelvic injuries (groups B and D) than in patients with isolated pelvic and acetabular injury (groups A and C). Conclusions Delaying definitive surgical treatment of pelvic fractures due to spinal cord injury appears to have a negative impact on the outcome of pelvic fractures, especially on the quality of reduction of acetabular fractures.

Primary total hip arthroplasty with cementless stems has numerous advantages over cemented total hip arthroplasty in patients with good bone quality. To enhance osseointegration with ingrowth into the implant, various surface treatments have been proposed. Multiple biomechanical studies in animals have shown that bioactive coatings enhance osseointegration and increase construct stability. Bony ingrowth in humans can only be assessed in rare instances of periprosthetic femoral fractures. In this case report, we describe the findings after a periprosthetic fracture mandating stem exchange in a patient who experienced a fall 8 weeks after implantation. The retrieved proximal Bonit (DOT GmbH, Rostock, Germany) coated stem showed substantial macroscopically visible trabecular bone. This finding supports results from animal studies that showed enhanced metaphyseal bone ingrowth with Bonit coating of implants.

BACKGROUND:Shorter double-taper stems with reduced lateral shoulders facilitate implantation via the muscle-sparing direct anterior approach and are becoming increasingly popular. We observed an unusually high number of cases of aseptic loosening with the use of a modified stem. Therefore, the aim of this prospective single-center study was to assess safety and efficacy of this cementless stem. METHODS:A total of 486 consecutive patients receiving 517 primary total hip arthroplasties using the MonoconMIS stem were prospectively followed up for a mean period of 5.29 years (standard deviation [SD], 1.47). Surgical and clinical data, complications, and revision surgeries were analyzed. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was recorded before surgery and at one year and five years after surgery. RESULTS:The overall 5-year implant survival rate was 95.2%. The individual component survival rates were 96.1% for the stem, 99.4% for the acetabular cup, and 99.0% for the isolated mobile component exchange. The most common reasons for revision were periprosthetic fracture (1.5%), aseptic stem loosening (1.4%), and infection (1.0%). The WOMAC score improved significantly from 49.57 (SD, 21.42) at baseline to 13.33 (SD, 16.47) at one year and 9.84 (SD, 14.45) at five years after surgery. Aseptic stem loosening occurred only in patients with Dorr type A proximal femur morphology. CONCLUSION:The evaluated femoral stem is associated with revision rates higher than what has been reported for other implants. The WOMAC scores suggest adequate efficacy. Our data do not support the use of the MonoconMIS for primary total hip arthroplasty in patients with Dorr type A proximal femur morphology.

Background: Ceramic-on-ceramic bearings are becoming increasingly popular in primary total hip arthroplasty (THA). To enhance ceramic-on-ceramic liner exchange in case of revision surgery, metal backed liner systems have been proposed. Little is known about the clinical performance of these implants. The purpose of this study is to evaluate a metal-backed liner implant system for primary THA. Methods: A total of 422 patients (with 468 consecutive THAs) were followed over a mean period of 10 years. All arthroplasties were performed with a cementless stem, a press -fit cup, and a metal-backed liner system. Surgical and clinical data, complications, and revisions were analyzed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before surgery and at 1 and 10 years after surgery were compared. Results: The overall 10-year implant survival rate was 93.8%. The survival rate was 97.0% for heads and liners, 97.5% for stem, and 99.3% for acetabular cup. The most common reason for revision was ceramic breakage (2.4%) of the third-generation (BIOLOX forte) acetabular liner. Mean WOMAC score improved significantly from 50.1 before surgery to 13.2 at 1 year after surgery. There was no difference in WOMAC scores between surgical approach and type of bearing at 1 and 10 years after surgery. Conclusion: THA using cementless stem, press -fit cup, and metal-backed liner system provides satisfactory long-term outcomes, with revision rate comparable to that with other systems available in the market. The metal-backed liner system has low risk of mal-seating. Third-generation ceramic liners should be avoided as they seem to be more prone to breakage. (c) 2021 Elsevier Inc. All rights reserved.

The purpose of this study was to evaluate pain, functional impairment, mental health, and daily activity in patients with end-stage hip and knee osteoarthritis (OA) during the COVID-19 lockdown. The study included 63 patients, with hip or knee OA, who had been scheduled for arthroplasty that was postponed because of COVID-19. Patients were evaluated by telephone interviews during the first week after lockdown, in the fourth week, and again at the end of the lockdown. Patients rated their pain level on the basis of a visual analog scale (VAS) and completed WOMAC, SF-12 and Tegner activity scale (TAS) questionnaires. VAS and WOMAC scores increased significantly during lockdown, while physical activity significantly decreased. At the final evaluation, VAS and WOMAC showed a significant negative correlation with TAS. The SF-12 subscale scores showed a significant decrease of the physical component during the lockdown, while the mental component remained largely unchanged. Patients with knee OA showed a faster progress of pain compared to those with hip OA. 50 patients (79%) stated they wished to have arthroplasty as soon as possible. The COVID-19 lockdown had a significant impact on pain, joint function, physical function, and physical activity in patients with end-stage hip and knee OA. II (Prospective cohort study).