Background: Acetabular morphology in hip dysplasia is typically assessed using computed tomography (CT) for bone coverage and magnetic resonance imaging (MRI) for soft tissues. However, agreement between CT and 3.0-T fast field echo (FFE) MRI for anterior and posterior acetabular sector angles (AASA, PASA) remains insufficiently defined. Hypothesis: FFE T1-weighted MRI measurements would strongly correlate with CT-based acetabular sector angles (ASAs). Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 65 symptomatic dysplastic hips were evaluated. Two independent observers measured on CT and 3.0-T MRI scans the lateral center-edge angle (LCEA), anterior and posterior acetabular wall indices (AWI, PWI), Tönnis angle, and pelvic signs. Equatorial, intermediate, and proximal AASA and PASA were obtained on each modality. CT-MRI agreement was assessed using Spearman rho (ρ). Results: Intermediate AASA demonstrated strong CT-MRI correlation (ρ = 0.807), whereas equatorial and proximal AASA correlations were moderate (ρ = 0.408 and 0.398, respectively). All PASA measurements showed good MRI-CT agreement (equatorial ρ = 0.766; intermediate ρ = 0.747; proximal ρ = 0.739). AWI correlated well with CT-AASAs but weakly with MRI-derived AASAs (equatorial ρ = 0.345; intermediate ρ = 0.325; proximal ρ = 0.255). Conclusion: T1-weighted FFE MRI cannot currently replace CT for measuring acetabular coverage of the femoral head. Although MRI and CT seemed to correlate better at the posterior level, they did not correlate accurately anteriorly; thus, the estimation of AWI by MRI with the current echo sequence alone may lead to misinterpretation. Given that the most common type of dysplasia in the setting of normal LCEA is that with an anterior wall defect only, the authors strongly recommend using CT (or other MRI sequences) to assess patients who are potential candidates for hip joint preservation surgery.

Background:Intestinal dysbiosis and systemic microbial translocation potentially contribute to chronic joint inflammation. However, the role of the gut-joint axis in the genesis of osteoarthritis still needs to be elucidated. This investigation characterized taxonomic signatures and proinflammatory metabolic pathways within the hip joint to define their contribution to the pathophysiology of osteoarthritis relative to nonarthritic controls. Methods:A prospective cohort of 48 patients undergoing hip arthroplasty was enrolled. Specimens including synovial fluid, articular cartilage, and acetabular fossa tissue were collected from patients with primary hip osteoarthritis (n = 20) and femoral neck fracture (n = 20). Metagenomic profiling was performed using 16S-rRNA gene sequencing (V3-V4 region). Alpha and beta diversity, taxonomic composition, and predicted functional pathways (PICRUSt2) were compared based on diagnosis (arthritis vs. fracture) and sample location. Results:Osteoarthritic samples demonstrated reduced alpha diversity evenness compared with fracture controls (p = 0.031). While beta diversity was primarily driven by specimen type rather than diagnosis, significant taxonomic differences were observed at the genus level. Pseudomonas, Atopostipes, and Staphylococcus showed significant differential abundance between groups, both by specimen location and diagnosis. Functional predictive analysis revealed a marked enrichment of the KDO2-lipid A biosynthesis pathway in osteoarthritic specimens, specifically within the genus Pseudomonas. Key genes involved in lipopolysaccharide biosynthesis and export, including lpxB, lpxL, and lpxM, exhibited significantly higher median abundances in osteoarthritic joints compared with controls (p < 0.00000001). Conclusions:Patients with hip osteoarthritis exhibited specific taxonomic and predicted lipopolysaccharide-related pathways differences compared with nonarthritic controls, consistent with microbial molecular signatures in a noninfectious inflammatory joint environment, despite the absence of major diagnosis-driven community-level differences. Level of Evidence:Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PURPOSE:To analyze the patient-reported outcome measures and radiological results of patients with borderline hip dysplasia (BHD) treated with isolated periacetabular osteotomy (PAO) and to compare it with a control group of patients treated with PAO plus adjuvant hip arthroscopy. METHODS:We retrospectively analyzed PAO cases from 2016 to 2023, of which 73 were classified as BHD, defined as lateral center-edge angle >20°, anterior wall index ≤0.3, and/or posterior wall index ≤0.85, and any tomographic acetabular sector angle below the threshold proposed by Verhaegen et al. Patients were grouped depending on the use of concomitant hip arthroscopy or not at the time of PAO and subclassified using a modified Ottawa classification: anterior-wall-deficient, posterior-wall-deficient, and both-wall-deficient hips (anteroposterior-wall-deficient hips). Outcome measures included modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and University of California Los Angeles scores, angular correction, and postoperative complications (Clavien-Dindo classification). RESULTS:A total of 223 patients were initially analyzed, with 73 classified as BHD. Thirty-six patients were included in the arthroscopy group and 37 in the without-arthroscopy group. The mean follow-up of the concomitant arthroscopy group was 44.1 months (range, 37.2-52.1), whereas that of the nonarthroscopy group was 49.4 months (range, 36.6-66.7; P = .34). Significant postoperative improvements were observed in the modified Harris Hip Score (63.3 ± 8.8-93.1 ± 8.0), Hip Disability and Osteoarthritis Outcome Score (61.6 ± 8.3-92.3 ± 8.5), and University of California Los Angeles (7 [6.00; 7.00] to 9.00 [9.00; 9.00]) scores (all P < .01). Achievement rates for minimal clinically important difference and patient acceptable symptom state exceeded 95% for both modified Harris Hip score and Hip Disability and Osteoarthritis Outcome Score, whereas substantial clinical benefit was achieved by approximately 70% of patients. No significant differences were observed between the arthroscopy and nonarthroscopy groups across any clinical outcome or radiographic correction (all P > .05). Twenty-five complications occurred, with 3 reoperations for implant removal. CONCLUSIONS:PAO showed excellent early clinical and radiological outcomes in borderline dysplasia, regardless of the use of concomitant hip arthroscopy or anatomical subtype of BHD. LEVEL OF EVIDENCE:Level III, retrospective comparative case series.

METHODS:56 patients with severe acetabular bone defects with or without pelvic discontinuity were included. In the TCA group 31 patients and 25 in the 3D group with a minimum follow-up of 2 years were included. The main indication for revision surgery with acetabular bone defect was aseptic loosening in both groups. RESULTS:The mean follow-up was 57.21 ± 28.81 months. Implant survival rates were 90.32% in the TCA group and 100% in the 3D (P = 0.24). Functional outcomes improved in both groups based on the Merle D'Aubigné & Postel score, with greater improvement in the 3D group (9.24 ± 3.23 vs. 6.55 ± 2.59 points, P = 0.001). Pain levels improved equally in both groups. Surgical time was shorter in the 3D group (108 ± 34.5 vs. 129 ± 43.4 minutes, P = 0.047).There were no significant differences in reoperation rate, transfusion need, hospital stay, or mortality. CONCLUSIONS:Tantalum metal cups and augments and custom-made 3D-printed trabecular titanium implants demonstrated an excellent survival rate in the management of severe acetabular bone defects. The group of patients operated on with custom 3D-printed implants had better postoperative functional outcomes and a shorter surgical time.

Introduction: Periacetabular osteotomy (PAO) has a recognized success for the treatment of hip dysplasia with lateral center-edge angle (LCEA) ≤20°. In cases of mild or so-called ‘borderline’ hip dysplasia with (LCEA>20°;<25°), there is no clear consensus on the definitive treatment, for which either arthroscopy or PAO were proposed. We aimed to report the radiologic and functional outcomes of patients with so-called ‘borderline’ dysplasia treated with PAO. Methods: We retrospectively analyzed 123 cases undergoing PAO between 2016-2023, of which 73 (94.6% females) were classified as ‘mild’ dysplasia, defined as LCEA>20°, anterior wall index (AWI) ≤0.3 and/or posterior wall index (PWI) ≤0.85, and any tomographic anterior (AASA) or posterior acetabular sector angle (PASA) below the corresponding threshold value proposed by Verhaegen et al (superior ASA 116°; proximal-AASA 133°; proximal-PASA 142°; intermediate-AASA 66°; intermediate-PASA 102°; equatorial-AASA 57°; equatorial-PASA 96°). Mean follow-up was 22.1(12.2;31.2) months. Demographic data were recorded, and two observers measured baseline radiographic measurements, with all Bland-Altman plots within 95% agreement. Patients were classified according to a modified-Ottawa classification using both radiographic (AWI,PWI) and tomographic (AASAs/PASAs) wall measurement: anterior-wall-deficient-hips (n=17), posterior-wall-deficient-hips (n=44), and both-walls-deficient-hips (n=15); with the latter including only LCEAs >20°. Outcome measures included delta-angular correction, delta-UCLA score and postoperative complications as per the Dindo-Clavien classification. Results: The 3 groups were significantly different in terms of preoperative radiographic measurements (p>0.05). Mean preoperative LCEA, Tönnis angle, AWI, PWI, of the anterior-wall-deficient-group were 22°[21.3°;24.8°], 10.9±1.7°, 0.28±0.09, and 1.07±0.09, respectively. Mean preoperative values of the posterior-wall-deficient-group were 24.6°[22°;28°], 10.8±2°, 0.48±0.12, and 0.81±0.11, respectively. Mean preoperative values of the both-walls-deficient-group were 22.3°[20.8°;27°], 10±1.2°, 0.38±0.16, and 0.97±0.09, respectively. Significant differences were found after PAO in all groups. Postoperative LCEA, AWI, PWI, of the anterior-wall-deficient-group were 34.4±4.88°(p<0.001), 0.44±0.19(p=0.003) and 0.98±0.16(p=0.024). Postoperative LCEA, AWI, PWI, of the posterior-wall-deficient-group were 35.1±4.92°(p<0.001), 0.55±0.16(p=0.013) and 0.93±0.1(p<0.001). Postoperative LCEA, AWI, PWI, of the both-walls-deficient-group were 32.1±5.67°(p=0.001), 0.54±0.28(p=0.025) and 1.03±0.13(p=0.184). Statistically significant differences were found between preoperative-postoperative UCLA values (7.00[6.00;7.00] vs 9.00 [9.00;9.00];p<0.001). Seven complications were recorded (all grades 1-2), one of which required additional surgical intervention. Conclusion: PAO showed excellent early clinical-radiological outcomes in mild-dysplasia cases, independently of the dysplasia subtype.

BACKGROUND:To report the association between os acetabuli and relevant radiologic measurements in a series of surgically treated hip preservation patients. METHODS:We retrospectively reviewed 654 hips who underwent preservation surgery between 2012 and 2019, identifying 50 cases with os acetabuli (7.64%). We included 300 hips (277 patients) with radiographs and CT-scans obtained during preoperative assessment, after which the cohort was divided into two groups (with and without os acetabuli). Mean age of the study population was 35 (interquartile range [IQR] 28-42) years old, with 192 (62%) being males. 2 observers measured demographic and radiologic variables. A mixed-effects logistic regression tested the ability of radiologic measurements to predict the presence of os acetabuli. RESULTS:No between-group differences were found in terms of sex (156/250 vs. 36/50 males, p = 0.197), alpha angle (64 ± 13° vs. 65 ± 14°, p = 0.372), Tönnis angle (8 ± 7° vs. 7 ± 7°, p = 0.152), neck-shaft angle (132 ± 6° vs. 131 ± 5°, p = 0.199) and CT-acetabular version (16 ± 7° vs. 15 ± 6°, p = 0.221). Significant differences were found in terms of age (34 ± 9 vs. 39 ± 7 years, p = 0.002), lateral centre-edge angle (LCEA) (31 ± 9° vs. 34 ± 7°, p = 0.045), anterior wall index (AWI) (0.45 [IQR 0.37-0.54] vs 0.5 [IQR 0.39-0.6], p = 0.046), CT-femoral version (17 ± 5° vs. 8 ± 4°, p < 0.001), cross-over sign (96/250 vs. 28/50, p = 0.032) and baseline diagnosis (184/250 vs. 44/50 FAIs, p = 0.043), with the os acetabuli-group being older, with more FAI diagnosis/cross-over sign, and with higher LCEA, higher AWI, and a lower femoral version. After adjusting for confounders, only CT-femoral version (odds ratio 0.32; 95% CI. 0.14-0.73, p < 0.007) was associated with presence of os acetabuli. CONCLUSIONS:Presence of acetabular rim fragments was significantly associated with a lower femoral version. Above 20° of femoral version, the likelihood of os acetabuli was almost zero. Treatment of os acetabuli (i.e., fixation vs. removal) should be adjusted for the underlying diagnosis.

Aims:We aimed to develop a predictive model for abnormal postoperative laboratory tests in patients undergoing primary total hip arthroplasty (THA) to aid clinical decision-making. Methods:We analyzed 4,000 patients undergoing primary THA from 1 January 2016 to 31 December 2020, excluding 1,773 due to incomplete records and 63 for being one-stage bilateral THAs. The final cohort comprised 2,164 patients (60.55% female; mean age 70 years (SD 13)). Abnormal laboratory results were defined as values requiring medical intervention. Univariate analyses were performed, followed by model generation with a generation cohort (n = 1,499) and a validation cohort (n = 665). The model's discriminatory performance was measured using the time-dependent area under the receiver operating characteristic (AUROC) curve. The calibration-in-the-large (CITL) was calculated as the logistic regression model intercept. A score was created calculating each point's sensitivity and specificity to determine the best cut-off value. Results:Variables such as American Society of Anesthesiologists (ASA) grade III to IV, diabetes, and preoperatively altered potassium, sodium, blood glucose, and serum creatinine were statistically significant predictors (all p < 0.05) of postoperative abnormal laboratory tests. The model had AUROCs of 0.74 and 0.71 in the generation and validation cohorts, respectively. The Cox calibration had a slope of 1 (95% CI 0.86 to 1.13) and a CITL of 0 (95% CI -0.14 to 0.14) in the generation cohort, and a slope of 1 (95% CI 0.77 to 1.22) and a CITL of 0 (95% CI -0.024 to 0.24) in the validation cohort. A scoring system was developed (AUROC, 0.71; slope, 1; CITL, 0) to assess risk based on these variables. A score of 1.5 yielded 58.22% sensitivity and 76.71% specificity for predicting laboratory abnormalities. Conclusion:The proposed model accurately predicted abnormal postoperative laboratory findings in THA patients, highlighting the significance of specific preoperative factors together. It seems appropriate to recommend a postoperative laboratory test whenever a patient's score is ≥ 1.5 points.

Aims: Two preoperative risk models have been designed to predict debridement, antibiotics, and implant retention (DAIR) failure: KLICC and CRIME-80 scores. However, external validation of both scores is scarce. We aimed to validate these scores in an external cohort and to create a new model with additional risk factors. Methods: We retrospectively evaluated 96 patients with early acute periprosthetic hip infection treated with DAIR. At a two-year cut-off, failure was defined as the need for second DAIR, implant removal, or 90-day infection-related death. Association between demographic variables and failures was tested. The model discriminatory performance was measured using the time-dependent receiver operating characteristic (ROC) curve and Harrell concordance index (C-index). The ‘calibration in the large’ (CITL) was calculated as the logistic regression model intercept. A modified KLICC score was created by adding the variable time from onset of symptoms to DAIR. Results: The 24-month cumulative incidence of failure was 23.96% (95% CI 15.9 to 32.8). KLICC’s area under receiver operating characteristic (AUROC) was 0.79 (95% CI 0.67 to 0.90), with a CITL of -0.57 (95% CI -1.16 to -0.01) and a slope of 0.68 (95% CI 0.35 to 1.02). CRIME-80’s AUROC was 0.63 (95% CI 0.51 to 0.76), with a CITL of -1.66 (95% CI -2.13 to -1.19) and a slope of 0.35 (95% CI -0.14 to 0.85). The difference between both AUROCs was statistically significant (p = 0.0138), with the KLICC score performing better. As compared with the original KLICC score, the modified-KLICC improved the AUROC to 0.85 and the beta-slope and α intercept to 1.24 and -0.07, respectively (p = 0.020). Conclusion: KLICC was superior to CRIME-80 in predicting DAIR failure. The modified-KLICC score improved the model prediction and could be useful to help indicate alternatives to DAIR when the predictive failure is high. Cite this article: Bone Jt Open 2025;6(12):1532–1541.

This study aimed to assess the long-term results of THA patients who received a cementless short stem regarding clinical outcomes, bone changes, complications, and incidence of femoral revision. A retrospective evaluation of the first 100 THA employing a type 2B cementless stem (Mini hip stem, Corin, Cirencester, United Kingdom) by the same surgeon at one institution. We only include patients with 18 years or more, and with a minimum follow up of 8 years. Patient’s Harris hip score (HHS), the University of California, Los Angeles activity score (UCLA), and radiographic outcomes were evaluated. A total of 100 primary hip arthroplasties with Mini Hip stems were performed on 84 patients, with an average age of 47 years old. The median follow-up was 120 months (IQR 57.5-136.5), with 47 patients having a minimum 10-year follow-up. The patient’s HHS improved significantly (p < 0.001) and UCLA’s score was 7 (SD 1.7) at the final follow-up. Only one patient suffered an intraoperative lateral cortical perforation, which was treated on the same day with revision of the short stem to a conventional metaphysodiaphyseal fixation stem. Three incomplete fractures of the calcar occurred intraoperative, of which only one required wire cerclage and unloading partial during the 30 days after surgery. No osteolysis, radiolucency, thigh pain, periprosthetic or ceramic fractures were observed. Only 6

La extracción de un tallo femoral no cementado fijo en la cirugía de revisión es una tarea desafiante para los cirujanos, aun en manos experimentadas. La técnica más difundida y ampliamente utilizada es la osteotomía trocantérica extendida, la cual no está exenta de complicaciones. Dicho esto, el objetivo de esta nota técnica es realizar una descripción de la técnica de osteotomía en ranura para la extracción de tallos no cementados fijos, como una alternativa menos invasiva, pero, a su vez, muy útil, a la osteotomía trocantérica extendida.

BACKGROUND:Short stems are designed with a bone preservation philosophy in mind. This study aims to compare the outcomes/complications and survival of a collarless fully hydroxyapatite (HA)-coated conventional tapered stem and a HA-coated partial neck-retaining uncemented short stem in patients ⩽55 years old at medium-term follow-up.METHODS:We retrospectively studied 247 uncemented THAs operated between 2010 and 2014, comparing 146 patients treated with the fully HA-coated collarless stem (Group A) with 101 patients treated with a partial neck preserving, HA-coated short stem (Group B). 87 and 62 males were in groups A and B, respectively (p = 0.11). The mean age of the series was 46 years (17-55) (p =0.16). The mean follow-up of groups A and B were 9.9 (7-12) years and 9.7 (7-12) years, respectively (p =0.21).RESULTS:Mean Harris Hip Score improved from 55 to 92 in group A (p <0.001) and from 54 to 95 in group B (p <0.001), without differences between groups. Mean femoral neck length preservation in groups A and B was 13.6 (0-28) mm and 26 (11-38) mm, respectively (p =0.001). 13 (8.9%) and 1 (1%) patients in groups A and B presented postoperative complications, respectively (p =0.008). The conventional stem group had more aseptic loosening (Group A 3.4% vs. Group B 0%, p =0.06) along with more Symptomatic radiolucent lines (Group A 3.4% vs. Group B 0%, p =0.06).CONCLUSIONS:Both conventional and short stems showed excellent implant survival rates and functional outcomes at a mean follow-up of 9.8 years. However, complications and radiolucent lines were more frequent with a collarless conventional-length stem. Bone preservation of the femoral neck and diaphysis may be preferred in active young patients.

BACKGROUND The ExeterTM Universal cemented femoral component is widely used for total hip replacement surgery. Although there have been few reports of femoral component fracture, removal of a broken femoral stem can be a challenging procedure. CASE SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary ExeterTM stem, two years after receiving a revision using a cement-within-cement technique (CWC) through an extended trochanteric osteotomy (ETO). The technical problems related to the CWC technique and the ETO played a major role in the stem fatigue refracture. We performed revision surgery and removed the distal cement using a cortical femoral window technique, followed by re-implantation with an uncemented, modular, distally-fixed uncemented stem. The patient experienced an uneventful postoperative recovery. CONCLUSION Re-fracture of a modern femoral ExeterTM stem is a rare event, but technical complications related to revision surgery can lead to this outcome. The cortical window osteotomy technique can facilitate the removal of a broken stem and cement, allowing for prosthetic re-implantation under direct vision and avoiding ETO-related complications.

We sought to determine the short to medium-term clinical and radiographic outcomes using a short stem in young adults with a proximal femoral deformity (PFD). We prospectively studied 31 patients (35 hips) with PFDs treated with an uncemented primary THA using a short stem with cervicometaphyseal fixation between 2011–2018. There were 19 male (23 hips) and 12 female (12 hips) patients, with a mean BMI of 26.7±4.1 kg/m 2 . Twelve cases had a previous surgical procedure, and six of them were failed childhood osteotomies. Mean age of the series was 44±12 years, mean follow-up was 81±27 months and no patients were lost to follow-up. PFDs were categorized according to a modified Berry´s classification. Average preoperative leg-length discrepancy (LLD) was −16.3 mm (−50 to 2). At a mean time of 81 months of follow-up, survival rate was 97% taking revision of the stem for any reason and 100% for aseptic loosening as endpoints. No additional femoral osteotomy was required in any case. Average surgical time was 66 minutes (45 to 100). There was a significant improvement in the mHHS score when comparing preoperative and postoperative values (47.3±10.6 vs. 92.3±3.7, p=0.0001). Postoperative LLD was in average 1 mm (−9 to 18) (p=0.0001). According to Engh's criteria, all stems were classified as stable without signs of loosening. Postoperative complications included 1 pulmonary embolism, 1 neurogenic sciatic pain, 1 transient sciatic nerve palsy that recovered completely after six months, and 2 acute periprosthetic joint infections. One patient suffered a Vancouver B2 periprosthetic femoral fracture 45 days after surgery and was revised with a modular distally fixed uncemented fluted stem. A type 2B short stem evidenced promising outcomes at short to medium-term follow up in young adult patients with PFDs, avoiding the need for corrective osteotomies and a revision stem.

Background: No consensus is available regarding which radiographic measurement most accurately correlates with anterior coverage of the femoral head. Purpose: (1) To determine the correlation between 2 measurements of anterior wall coverage: total anterior coverage (TAC) calculated from radiographs and equatorial anterior acetabular sector angle (eAASA) calculated from computed tomography (CT) scans; (2) to define the correlation between anterior center-edge angle (ACEA) and anterior wall index (AWI) with TAC and eAASA; and (3) to investigate what other radiographic metrics may help predict anterior coverage. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: The authors retrospectively reviewed 77 hips (48 patients) for which radiographs and CT scans were obtained for reasons other than hip-related pain. Mean age of the population was 62 ± 22 years; 48 (62%) hips were from female patients. Two observers measured lateral center-edge angle (LCEA), AWI, Tönnis angle, ACEA, CT-based pelvic tilt, and CT-based acetabular version, with all Bland-Altman plots within 95% agreement. Correlation between intermethod measurements was estimated with a Pearson coefficient. Linear regression was used to test the ability of baseline radiographic measurements to predict both TAC and eAASA. Results: Pearson coefficients were r = 0.164 (ACEA vs TAC; P = .155), r = 0.170 (ACEA vs eAASA; P = .140), r = 0.58 (AWI vs TAC; P = .0001), and r = 0.693 (AWI vs eAASA; P < .0001). Multiple linear regression model 1 showed that AWI (β = 17.8; 95% CI, 5.7 to 29.9; P = .004), CT acetabular version (β = −0.45; 95% CI, −0.71 to −0.22; P = .001), and LCEA (β = 0.33; 95% CI, 0.19 to 0.47; P = .001) were useful to predict TAC. Multiple linear regression model 2 revealed that AWI (β = 25; 95% CI, 15.67 to 34.4; P = .001), CT acetabular version (β = −0.48; 95% CI, −0.67 to −0.29; P = .001), CT pelvic tilt (β = 0.26; 95% CI, 0.12 to 0.4; P = .001), and LCEA (β = 0.21; 95% CI, 0.1 to 0.3; P = .001) accurately predicted eAASA. Model-based estimates and 95% CIs using 2000 bootstrap samples from the original data were 6.16 to 28.6 for AWI in model 1 and 15.1 to 34.26 for AWI in model 2. Conclusion: There was a moderate to strong correlation between AWI and both TAC and eAASA, whereas ACEA correlated weakly with the former measurements, thus not being useful to quantify anterior acetabular coverage. Other variables such as LCEA, acetabular version, and pelvic tilt may also help predict anterior coverage in asymptomatic hips.

Introduction The performance of total hip arthroplasty in elderly patients, especially nonagenarians, is challenging due to higher patient frailty and medical comorbidities. We compared 90-day postoperative complications and unplanned readmissions between nonagenarians and octogenarians undergoing elective THA. Methods One hundred and eleven patients undergoing elective, unilateral THA were retrospectively analyzed. Forty-four patients were nonagenarians (Group A), and 67 patients were octogenarians (Group B). Demographic data included age, gender, body mass index (BMI), ASA score and Charlson Comorbidity Index (CCI). Frailty was defined according to the Rockwood Frailty Index. All patients underwent a thorough preoperative assessment through a specific institutional clinical pathway created for this matter. Postoperative adverse events were grouped into major or minor. A regression model was used to evaluate independent risk factors for the development of complications. Results There were no differences in the ASA score (65.9% vs. 53.7% ASA III-IV), prevalence of frailty (1% vs. 9%) and comorbidities between both groups ( p > .05). The CCI was higher in nonagenarians ( p = 0.007). Nonagenarians had more in-hospital complications, although most were minor ( p = 0.002), none of which resulted in mortality. Ninety-day unplanned readmissions were similar between groups, with 4 (9.1%) and 6 (9%) in groups A and B, respectively ( p = 1). Although age was a factor associated with the development of postoperative complications in the univariate regression model (OR 3.81, 95% CI 1.31 to 11.11, p = 0.014), it lost significance after performing the multivariate analysis (OR 2.48, 95% CI 0.78 to 7.90, p = 0.125). Conclusion The age of 90 years old was not a barrier to perform elective THA safely. Nonagenarians had higher in-hospital minor complications when compared to the younger cohort. However, age over 90 years was not an independent risk factor for unplanned readmissions or mortality. Multimodal protocols of perioperative care are paramount for improving outcomes after THA in very old patients.

BACKGROUND:Assessment of risk factors is crucial for lowering complication rates and costs of hip and knee arthroplasty. The objective of this study was to assess if members of the Argentinian Hip and Knee Association (ACARO) are influenced by such risk factors when planning surgery.METHODS:In 2022, a survey was distributed as an electronically based questionnaire to 370 members of the ACARO. A descriptive analysis was performed on 166 proper answers (44.9%).RESULTS:There were 68% of the respondents who were specialists in joint arthroplasty and 32% practiced general orthopedics. A large number had large volumes at private hospitals without service/residents and 48.2% had been in practice for more than 15 years. Of the responding surgeons, 99% routinely performed a preoperative reversible risk factors evaluation that considered diabetes, malnutrition, weight, and smoking, and 95% canceled/postponed the surgery for abnormalities. Malnutrition was important for 79% of the polled with blood albumin being used by 69.3%. Fall risk assessment was performed by 60.2% of the surgeons. Only 44% of the surgeons felt free to choose the implant for the arthroplasty, possibly because 69.9% work for a capitated system. Important delays for surgery were reported by 63.9 and 84.3% had waiting lists. 74.7% of the polled noted physical or psychological deterioration during such delays.CONCLUSION:Socioeconomic factors firmly impact on the accessibility to arthroplasty in Argentina. Despite these barriers, the qualitative analysis of this poll let us demonstrate greater awareness of preoperative risk factors, especially diabetes as the most reported comorbidity.

Case: In the setting of a total hip arthroplasty performed in a patient with a proximal femoral deformity, atraumatic periprosthetic femoral stress fracture may arise as a complication. We report a rare case of a late periprosthetic femoral stress fracture around a cemented stem in a patient with a history of fibrous dysplasia of the proximal femur. After a 10-year uneventful period, the patient complained about a subtle, subacute pain in his left thigh induced by exercise but not with daily axial load. Diagnosis of a nondisplaced, incomplete (i.e., only compromising the lateral femoral cortex) periprosthetic femoral stress fracture was made with plain radiographs, blood work, and bone scintigraphy. Surgical treatment consisted of a minimally invasive plate osteosynthesis bridging the femoral deformity plus percutaneous osteoperiosteal decortication. At 5-year follow-up, the patient was asymptomatic with full return to physical activity, with radiographs evidencing callus formation. Conclusion: Stress fractures around well-fixed femoral stems, while infrequent, should be addressed in patients with a history of severe proximal femur deformity experiencing atraumatic thigh pain.

Total hip arthroplasty, one of the most successful orthopaedic procedures, is influenced by several variables. Corrosion at the modular junction is known as trunnionosis. Despite being reported infrequently, corrosion between the femoral head and the Morse taper can result in severe complications. Fracture of the femoral component in primary metal-on-metal (MoM) total hip arthroplasty at the Morse taper is an extremely rare event and can be associated with several risk factors. We report a case of corrosion at the Morse taper in a hybrid primary MoM total hip arthroplasty, resulting in Morse taper fracture with consequent femoral head entrapment inside the acetabular component. We hypothesise that some risk factors, such as age over 60years, active male patients, body mass index above 30kg/m2, large femoral heads, high-offset stems, 9/10 Morse taper and MoM-bearing surfaces, are associated with this mode of failure.

Patients with lower limb amputation (LLA) are prone to greater physical demands. Retrospective studies reported 5 to 61% of ipsilateral or contralateral hip osteoarthritis after LLA. Total hip arthroplasty (THA) has proven effective in improving the quality of life of patients with hip osteoarthritis. Its incidence after ipsilateral LLA is reported to be 0.067%. There is little information on the technical aspects and results of this procedure in such patients. The objective of this study is to report a patient with bilateral LLA and ipsilateral hip arthritis treated with THA, highlighting the challenges of the surgical technique and the postoperative protocol. After Internal Review Board approval (IRB00010193), we present a 64-year-old male patient with bilateral infrapatellar amputation who underwent left THA where the surgical challenge lies in being able to perform an adequate osteotomy of the femoral neck, obtaining an adequate exposure of the femoral canal, and achieving a correct implant placement. Wide release of the psoas and gluteus maximus tendons was necessary to ease femoral preparation and intraoperative maneuverability of the lower extremity. Although THA is a common procedure, when performed in an unusual patient and in the absence of therapeutic guidelines or consensus when dealing with this association, an appropriate preoperative plan should be followed. This case provides a perioperative approach focused on the search for possible intraoperative scenarios that may occur in patients who will undergo a THA after LLA.