A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants

Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes

BACKGROUND

Hip osteoarthritis (OA) is common in patients with adult spinal deformity (ASD). Limited data exist on the prevalence of hip OA in patients with ASD, or on its impact on baseline and postoperative alignment and patient-reported outcome measures (PROMs). Therefore, this paper will assess the prevalence and impact of hip OA on alignment and PROMs.

METHODS

Patients with ASD who underwent L1-pelvis or longer fusions were included. Two independent reviewers graded hip OA with the Kellgren-Lawrence (KL) classification and stratified it by severity into non-severe (KL grade 1 or 2) and severe (KL grade 3 or 4). Radiographic parameters and PROMs were compared among 3 patient groups: Hip-Spine (hip KL grade 3 or 4 bilaterally), Unilateral (UL)-Hip (hip KL grade 3 or 4 unilaterally), or Spine (hip KL grade 1 or 2 bilaterally).

RESULTS

Of 520 patients with ASD who met inclusion criteria for an OA prevalence analysis, 34% (177 of 520) had severe bilateral hip OA and unilateral or bilateral hip arthroplasty had been performed in 8.7% (45 of 520). A subset of 165 patients had all data components and were examined: 68 Hip-Spine, 32 UL-Hip, and 65 Spine. Hip-Spine patients were older (67.9 ± 9.5 years, versus 59.6 ± 10.1 years for Spine and 65.8 ± 7.5 years for UL-Hip; p < 0.001) and had a higher frailty index (4.3 ± 2.6, versus 2.7 ± 2.0 for UL-Hip and 2.9 ± 2.0 for Spine; p < 0.001). At 1 year, the groups had similar lumbar lordosis, yet the Hip-Spine patients had a worse sagittal vertebral axis (SVA) measurement (45.9 ± 45.5 mm, versus 25.1 ± 37.1 mm for UL-Hip and 19.0 ± 39.3 mm for Spine; p = 0.001). Hip-Spine patients also had worse Veterans RAND-12 Physical Component Summary scores at baseline (25.7 ± 9.3, versus 28.7 ± 9.8 for UL-Hip and 31.3 ± 10.5 for Spine; p = 0.005) and 1 year postoperatively (34.5 ± 11.4, versus 40.3 ± 10.4 for UL-Hip and 40.1 ± 10.9 for Spine; p = 0.006).

CONCLUSIONS

This study of operatively treated ASD revealed that 1 in 3 patients had severe hip OA bilaterally. Such patients with severe bilateral hip OA had worse baseline SVA and PROMs that persisted 1 year following ASD surgery, despite correction of lordosis.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Mid-term results of a cementless hip stem in femoral revision: how much diaphyseal press-fit do we need?

INTRODUCTION

The aim of this retrospective study was to analyze the clinical and functional outcome of a modular tapered revision hip stem after mid-term follow-up with a special focus on the length of the distal bicortical fixation of the cementless hip stem.

MATERIALS AND METHODS

Follow-up examination was carried out for all patients with implantation of the Prevision hip stem between 2014 and 2019 to collect demographic, functional, and radiographic data.

RESULTS

44 patients with stem in situ were examined, and 61 patients could be included in the Kaplan-Meier survival analysis. Oxford's hip score was 37.3 at the mean follow-up of 4.0 years. Two hip stem revisions were performed due to periprosthetic infection, which resulted in a hip stem survival rate of 96.7% (CI: 87.4-99.1%) at the final follow-up of 7.5 years. No aseptic hip stem revision was required. The length of bicortical distal fixation was in the interquartile range of 6.8 to 9.0 cm, which was associated with good bone healing and a low rate of subsidence (4.5%). Implant-associated complications were observed in 10 cases (21.7%).

CONCLUSIONS

The modular revision hip stem provides promising results at medium-term follow-up, with satisfactory clinical and functional outcomes comparable to other modular revision hip stems. The presented length of bicortical distal fixation shows the practice of the study center and was associated with good implant survival, bone healing and radiological results.

REGISTRATION

Clinicaltrials.gov registration: NCT04833634 registered on April 6, 2021.

Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design

Purpose

The treatment of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is still under debate. Two-stage exchange arthroplasty is the most common surgical procedure performed. This study analyzed a new functional articulating hip spacer called "Spaceflex" regarding the mechanical-related complications, the recurrent/persistent infection during the interval period, the overall infection-free survivorship after reimplantation, the overall complication/reoperation after reimplantation and the evaluation of patient-reported outcome measures (PROMs) at three intervals of time: before the first stage, during the interval period, and at the final follow-up after reimplantation.

Methods

A consecutive series of 56 patients with chronic hip PJI undergoing two-stage prosthetic revision using a new intraoperatively molded articulating hip spacer design implanted by the same experienced surgeons was examined from January 2017 to December 2021. The demographic and clinical characteristics of the included patients were analyzed. Specifically, PROMs before the first stage, during the interval period, and at the final follow-up after reimplantation and complications reported during the interval period and after reimplantation were examined.

Results

The new functional articulating hip spacer was characterized by a low mechanical complication rate (5.8%) and an overall two-stage procedure success rate of 90.6% at the last follow-up. PROMs improved with the spacer during the interval period and at the final follow-up. Furthermore, the reinfection rate was in line with other case series with different spacer designs. Finally, low postoperative complication rates after reimplantation have been demonstrated.

Conclusions

Two-stage revision performed with a modular articulating spacer allows patients to preserve satisfactory functional and quality-of-life outcomes in the postoperative period, with a low risk of mechanical complications and without increasing the reinfection rate.