Revision hip arthroplasty dislocation risk calculator: when to select dual mobility, large heads, constrained liners, or a standard head size? Testing one hundred thousand hip revisions with artificial intelligence

Dual-mobility tripod cup for revision hip arthroplasty: long-term (five to fourteen years) evaluation of a new generation cementless implant

PURPOSE

The aims of this study were to evaluate the survivorships of a new generation cementless DMC with tripod additional fixation in revision total hip arthroplasty and complications at a minimum five year follow-up.

METHODS

One hundred and fifteen revisions (THA) treated with tripod DMC performed between 2009 and 2015 were included in this retrospective study. Acetabular defects were classified as Paprosky 1 (n = 38, 33%), 2 (n = 75, 65%) or 3 (n = 2, 2%). Unipolar or bipolar revision was performed for the following indications: aseptic acetabular loosening (63%), infection (14%), aseptic bipolar loosening (11%), instability (4%), aseptic femoral loosening (3%), ALVAL (3%) and iliopsoas impingement (2%). Mean follow-up was 9.4 years ± two (range, 5 to 14).

RESULTS

At the final follow-up, a single episode of dislocation occurred within three months after the procedure (0.8%) with no revision. Three cases of aseptic loosening were diagnosed (2.6%). Four infections (3.5%) required reoperation: three required a two stage bipolar revision; one was treated by DAIR procedure. At the latest follow-up, the survivorship of the acetabular cup for aseptic loosening was 98% [95% CI (91.2-99.4)] and for any reasons was 94.4% [95% CI (90.1%-98.9%)]; the mean HHS improved from 60 points (range, 18-94 points) to 83 points (range, 37-100 points) (p < .001).

CONCLUSION

This study reports a low complication rate in favour of the use of a tripod DMC in revision THA with a satisfactory survivorship at a ten year follow-up.

Outcomes and complications of Total Hip Arthroplasty in patients with a pre-existing pathologic spine-hip relation. A systematic review of the literature

BACKGROUND

There has been a growing interest in pathologic spine-hip relations (PSHR) in current literature, with the aim of reducing the risk of prosthetic impingement, dislocation, and edge loading in total hip arthroplasty (THA). The primary objective of this review is to determine the effect of different PSHR on primary THA outcomes and complication profile. The secondary objective is to stratify the risk of different subgroups of PSHR patients.

METHODS

A systematic review of the literature was performed in accordance with PRISMA guidelines. Randomised controlled trials, comparative cohort studies and case-control studies comparing outcomes and complication rates of primary THA in patients with and without a PSHR (spinal fusion; degenerative spinal conditions determining stiff spine and/or spinal misalignment) were included. The quality of the included studies and the risk of bias were assessed. The revision rate, complications, and clinical and radiological data were analysed. Complications included: aseptic loosening (AL), periprosthetic joint infections (PJI), hip dislocations and periprosthetic fractures (PF).

RESULTS

Fifteen articles were included with 3.306.342 THAs. The mean follow-up (FU) was 31.4 ± 21.7 months. The population was divided into three subgroups: spinal fusion patients (48.315 THAs); non-fused patients with spinal stiffness (106.110 THAs); non-fused patients with normal spines (3.151.917 THAs). A statistically significant risk stratification was observed about dislocation rate (5.98 ± 6.9% SF, 3.0 ± 1.9% non-SF Stiff and 2.26 ± 1.4% non-SF; p = 0.028). Similarly, about THA revision rate, a statistically significant risk stratification was also observed (7.3 ± 6.8% SF, 6.4 ± 3.1% non-SF Stiff and 2.7 ± 1.7% non-SF; p = 0.020). No statistically significant difference was observed when analysing AL, PJI and PF.

CONCLUSION

A statistically significant risk stratification of dislocation and revision rate was observed in the different PHSR, as theorised by the Bordeaux classification. Fused patients present a higher risk, degenerated and/or stiff spine an intermediate risk and mobile spines a lower risk profile. A standardised approach to THA candidate patients must consider the possible PSHR to improve clinical outcomes and reduce adverse events of THA.

Artificial intelligence-based three-dimensional templating for total joint arthroplasty planning: a scoping review

PURPOSE

The purpose of this review is to evaluate the current status of research on the application of artificial intelligence (AI)-based three-dimensional (3D) templating in preoperative planning of total joint arthroplasty.

METHODS

This scoping review followed the PRISMA, PRISMA-ScR guidelines, and five stage methodological framework for scoping reviews. Studies of patients undergoing primary or revision joint arthroplasty surgery that utilised AI-based 3D templating for surgical planning were included. Outcome measures included dataset and model development characteristics, AI performance metrics, and time performance. After AI-based 3D planning, the accuracy of component size and placement estimation and postoperative outcome data were collected.

RESULTS

Nine studies satisfied inclusion criteria including a focus on computed tomography (CT) or magnetic resonance imaging (MRI)-based AI templating for use in hip or knee arthroplasty. AI-based 3D templating systems reduced surgical planning time and improved implant size/position and imaging feature estimation compared to conventional radiographic templating. Several components of data processing and model development and testing were insufficiently covered in the studies included in this scoping review.

CONCLUSIONS

AI-based 3D templating systems have the potential to improve preoperative planning for joint arthroplasty surgery. This technology offers more accurate and personalized preoperative planning, which has potential to improve functional outcomes for patients. However, deficiencies in several key areas, including data handling, model development, and testing, can potentially hinder the reproducibility and reliability of the methods proposed. As such, further research is needed to definitively evaluate the efficacy and feasibility of these systems.