HIP International最新文献

{"title":"Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE) following hip fracture surgery: validation of the model that demonstrated good predictive power.","authors":"Maud A M Vesseur, Lars Quaedvlieg, Martijn G M Schotanus, Jasper Most, Lee H Bouwman, Raoul van Vugt, Bert Boonen","doi":"10.1177/11207000241312306","DOIUrl":"https://doi.org/10.1177/11207000241312306","url":null,"abstract":"<p><strong>Purpose: </strong>Proximal femoral fractures are common within the elderly population and are associated with a high risk of mortality and reduced quality of life. Hemiarthroplasty or osteosynthesis (extramedullary or intramedullary) is the primary treatment option for these fractures. However, within this fragile patient population many comorbidities, among others dementia, are seen. Therefore, predicting patients with a high mortality risk after surgery may lead to adopting alternative treatment options with less risks. This paper proposes a new model to distinguish patients with high postoperative mortality risk with adequate follow-up time in combination with a wide set of useful and available variables.</p><p><strong>Methods: </strong>Patients treated with hemiarthroplasty or osteosynthesis for proximal femoral fractures were studied, with a follow-up period of 6 months. Patients who died within this follow-up period were compared to survivors, and predicting variables were assessed in logistic regression: The Zuyderland Hip Inference for Survival and Lifetime Expectancy (ZHISLE). The model was validated internally against a held-out dataset. Furthermore, the model performance was compared against the Almelo Hip Fracture Score (AHFS) on the same sample.</p><p><strong>Results: </strong>Out of 2463 patients undergoing surgical treatment for proximal femoral fractures, 415 (16.8%) died within 183 days. Predictors for early mortality included old age, male sex, high heartbeat, KATZ-ADL and GFI scores, C-reactive protein and urea concentrations and low albumin concentration. Our model showed satisfactory predictive and discriminatory power (ROC curve = 0.81). Internal validation was good (ROC in validation dataset = 0.81), and better than the AHFS (ROC = 0.57).</p><p><strong>Conclusions: </strong>The ZHISLE model demonstrates good predictive power concerning mortality risk for old patients with a proximal femoral fracture. The model could benefit patients by indicating if a conservative, non-invasive policy might be a better option for those patients.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000241312306"},"PeriodicalIF":1.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxyapatite-coated total primary hip replacement: 28-year follow-up survivorship.","authors":"Manel Fa-Binefa, Julia Serra, Esther Moya, Xavier Crusi, Ignasi Gich-Saladich, Marius Valera","doi":"10.1177/11207000241306004","DOIUrl":"https://doi.org/10.1177/11207000241306004","url":null,"abstract":"<p><strong>Background: </strong>Survival at 25 years' follow-up for total hip arthroplasty (THA) has been reported at 5%-77%, with hydroxyapatite (HA) coating, due to its osteo-conductive properties, used to enhance implant fixation and survival. The progressive increase in life expectancy raises doubts regarding HA-coated THA survival and THA revision surgery risk. The aim of our study was to retrospectively analyse survival for primary uncemented fully HA-coated THA after 28 years' follow-up.</p><p><strong>Methods: </strong>Our cohort survival study of the JRI Furlong HA-coated system retrospectively included patients aged 18-75 years who had undergone THA between 1992 and 1998 at our centre and who were followed up according to clinical records by orthopaedic surgeons to 2022. Data on THA revision surgery and its causes, follow-up, and death were analysed using Kaplan-Meier survival and Cox regression modelling.</p><p><strong>Results: </strong>The cohort included 196 patients (268 hips) followed up to a maximum of 27.5 years (mean 15.54 (SD 6.01) years) with 62 patients (88 hips) >25 years. THA revision surgery was performed in 7.5% of cases, occurring a mean of 11.1 years following primary surgery. Aseptic loosening accounted for 4.4% of these revisions, affecting both the acetabular component (2.2%) and the femoral stem (1.3%). THA survival at 15 years', 20 years', and 27.5 years' follow-up was 95.5%, 88.3%, and 79.3%, respectively. According to the log-rank and Cox regression analysis, no significant relationships were found.</p><p><strong>Conclusions: </strong>Furlong HA-coated stem provides excellent long-term bone fixation for a long-term follow-up over 27.5 years with an aseptic loosening stem revision rate of 1.3%.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000241306004"},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The peri-articular muscle envelope of the hip (PAME) shows atrophy in patients with refractory groin pain after iliopsoas tenotomy.","authors":"Jonas Declercq, Frans-Jozef Vandeputte, Guillaume Clinckemaillie, Stijn Roose, Annick Timmermans, Kristoff Corten","doi":"10.1177/11207000241309600","DOIUrl":"https://doi.org/10.1177/11207000241309600","url":null,"abstract":"<p><strong>Background: </strong>Iliopsoas tenotomy is commonly used to address refractory groin pain resulting from iliopsoas tendinopathy. However, consensus and high-level research on its effectiveness are lacking, with concerns about poor outcomes and complications. Little is known of the effects of iliopsoas tenotomy on the peri-articular muscle envelope of the hip. As the iliopsoas loses its function as the most important hip flexor, the rectus femoris takes over its function, which makes the rectus prone to tendinopathy.</p><p><strong>Methods: </strong>A retrospective review of patients (<i>n</i> <i>=</i> 17) undergoing iliopsoas tenotomy between January 2016 and January 2021 was conducted. Pelvic MRI scans were evaluated for muscle quality and volume using a Quartile classification system and cross-sectional area (CSA) measurements. Reliability tests determined the most consistent reference points. Statistical analyses assessed changes between ipsilateral and contralateral sides.</p><p><strong>Results: </strong>Following iliopsoas tenotomy, significant reduced cross sectional area was seen in the psoas, iliacus, gluteus minimus, gluteus maximus, rectus femoris, piriformis, obturator internus and obturator externus. Significant increased fatty degeneration was seen in the psoas, iliacus, gluteus minimus, tensor fascia latae, piriformis, obturator internus and obturator externus. The gluteus medius was the only muscle where no difference was seen in the cross sectional area or the fatty degeneration. 15 patients (88%) presented with rectus tendinopathy and 8 of these patients had a surgical debridement of the rectus femoris.</p><p><strong>Conclusions: </strong>Our findings reveal that patients with persistent groin pain following iliopsoas tenotomy exhibit changes in the peri-articular muscle envelope, displaying atrophy or fatty degeneration in all muscles except the gluteus medius. Awareness of potential risks is crucial when contemplating iliopsoas tenotomy. Persistent groin pain after iliopsoas tenotomy may be linked to secondary rectus femoris tendinopathy. Caution is recommended in the consideration of iliopsoas tenotomy for patients with pre-existing iliopsoas tendinopathy.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000241309600"},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spherical periacetabular osteotomy via para-sartorial intermuscular approach with bikini incision for patients with acetabular dysplasia: surgical technique and preliminary results.","authors":"Toru Nishiwaki, Toshihiko Hara, Ayumi Kaneuji, Eiji Takahashi","doi":"10.1177/11207000241300061","DOIUrl":"https://doi.org/10.1177/11207000241300061","url":null,"abstract":"<p><strong>Purpose: </strong>This study introduces a new technique, spherical periacetabular osteotomy (SPO), performed via a para-sartorial intermuscular (PSIM) approach with a bikini incision, aiming to optimise the benefits of SPO, including preservation of muscles and providing cosmetic advantages.</p><p><strong>Methods: </strong>Overall, 57 joints of 52 patients (mean age 36 ± 17 years) underwent SPO via the PSIM approach. Preoperative osteoarthritis was classified according to Tönnis grade, with 34 and 23 hips categorised as grades 0 and 1, respectively.</p><p><strong>Results: </strong>The modified Harris Hip Scores significantly improved from 75 ± 10 to 96 ± 8 points at 6 months postoperatively. The lateral centre-edge angle improved from 6 ± 8° preoperatively to 30 ± 8° postoperatively, with a mean correctional angle of 24 ± 9°. Paresthetica of the lateral femoral cutaneous nerve occurred in 7 joints (12.3%) 3 months postoperatively. All cases except 1 achieved bone union within 3 months, and a nonunion case required additional surgery.</p><p><strong>Conclusions: </strong>Although the long-term results are not yet available, SPO via the PSIM approach demonstrates promising outcomes without significant complications. Furthermore, using the PSIM approach with a bikini incision has the advantages of muscle preservation and excellent cosmesis, which are delighted for young patients.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000241300061"},"PeriodicalIF":1.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 'Quartered Head Technique': a simple, reliable way of maintaining leg length and offset during total hip arthroplasty.","authors":"Oluwatobi O Onafowokan, Muhammad Haruna, Alasdair R Bott, Ewan Bigsby, Rory G Middleton, Gavin Holt","doi":"10.1177/11207000241302471","DOIUrl":"10.1177/11207000241302471","url":null,"abstract":"<p><strong>Introduction: </strong>Various techniques have been described for restoring leg length and offset during total hip arthroplasty (THA). We herein describe a novel \"Quartered Head Technique\" (QHT) involving a series of femoral osteotomies.</p><p><strong>Methods: </strong>124 hips were included in the analysis. An anterolateral approach was used in all cases. Leg length, and offset were assessed intraoperatively and reproduced using the QHT. A leg-length discrepancy (LLD) of <6 mm was chosen as acceptable based on previously published literature. Postoperative pelvic radiographs were assessed by two independent observers to ensure inter-observer reliability.</p><p><strong>Results: </strong>The mean absolute postoperative difference in leg length from the contralateral leg was +3.58 mm. 84% of patients had LLD within ±6 mm of the contralateral limb. Mean absolute postoperative difference in offset from the contralateral leg was +3.88 mm. 90% of patients were within ±6 mm offset of the contralateral limb. There was no statistical difference noted between observer measurement.</p><p><strong>Conclusions: </strong>The QHT provides a simple, inexpensive, yet effective method of maintaining femoral leg length and offset during total hip arthroplasty.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"33-40"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes associated with hip preservation using osteochondral allograft transplants and acetabular labrum reconstruction.","authors":"Kylee Rucinski, James L Cook, Cory R Crecelius, Brett D Crist","doi":"10.1177/11207000241288445","DOIUrl":"10.1177/11207000241288445","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral allograft (OCA) transplantation with or without labral reconstruction is considered a hip preservation surgical treatment option for young, active patients. This study aims to report early outcomes for use of OCA and labrum allograft transplants for patients treated for symptomatic femoral head chondral damage and/or acetabular labrum deficiency after implementation of a comprehensive joint restoration approach.</p><p><strong>Methods: </strong>33 patients from a lifelong registry were included for analysis. Outcomes were compared for statistically significant (<i>p</i> < 0.05) differences based on graft preservation methodology (standard preservation [SP] vs. Missouri Osteochondral Preservation System [MOPS]), and based on surfaces treated (femoral head only, labrum only, or femoral head and labrum).</p><p><strong>Results: </strong>Mean follow-up duration was 44.8 (range 12-95) months. Success was documented in 28 (84.8%) patients. For the SP cohort, successful outcomes were documented in 5 cases (50%), while all 23 MOPS cases (100%) were deemed successful at least 1 year after surgery. Hip preservation surgeries performed using MOPS grafts were associated with significantly (<i>p</i> = 0.001; OR = 47x) higher success rates, including significant and clinically meaningful improvements in PROMs at 1 and 2 years after surgery. Revision was performed in 2 patients in the SP cohort and failure requiring total hip arthroplasty was documented in 3 SP patients. Mean time to revision or failure was 23.6 (range 4-43) months. The surfaces treated were significantly associated with failure when comparing patients undergoing a femoral head OCA with or without labral reconstruction to those undergoing labral reconstruction only (<i>p</i> = 0.03; OR = 8.3x).</p><p><strong>Conclusions: </strong>Patients with symptomatic femoral head cartilage loss and/or irreparable acetabular labrum deficiency undergoing femoral head OCA transplantation and/or labral reconstruction with meniscus allografts using MOPS-preserved tissues experienced statistically significant and clinically meaningful improvements in pain and function through at least 2 years after surgery.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"9-17"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse spinopelvic mobility in patients undergoing total hip arthroplasty is associated with high mobility of the hip in a flexed seated position.","authors":"Thomas Aubert, Aurelien Halle, Philippe Gerard, Guillaume Riouallon, Guillaume Auberger, Luc Lhotellier","doi":"10.1177/11207000241284260","DOIUrl":"10.1177/11207000241284260","url":null,"abstract":"<p><strong>Purpose: </strong>Adverse spinopelvic mobility from a standing to a flexed seated position of more than 20° of the spinopelvic tilt (∆SPT) has been shown to have a high risk of dislocation. If hypermobility of the hip analysed with the pelvic femoral angle (∆PFA) has a high risk of impingement, the correlation between the range of motion of the hip from a standing to a flexed seated position and its implication in adverse spinopelvic mobility has not been described.</p><p><strong>Methods: </strong>A series of 337 patients treated with primary THA underwent lateral x-ray in standing and flexed seated positions to analyse ∆SPT, ∆PFA and spinopelvic parameters. The objectives were to establish a ∆PFA threshold associated with a ∆SPT ⩾20° and to subsequently investigate its influence in conjunction with spinopelvic risk factors on the occurrence of adverse spinopelvic mobility.</p><p><strong>Results: </strong>The area under the curve was 0.904 (95%CI, 0.864-0.945) for ∆PFA to predict ∆SPT ⩾ 20°; it was predicted by ∆PFA ⩾ 95° with a sensitivity of 91.7% and a specificity of 74.4% at the Youden optimal threshold. Patients with a ∆SPT < 20° (277 patients) had a mean ∆PFA of 83° compared to 110° if ∆SPT ⩾ 20° (60 patients) (<i>p</i> < 0.001). Patients with a ∆PFA < 95° (203 patients) had a mean ∆SPT of -6° compared to 18° if ∆PFA ⩾ 95° (134 patients) (<i>p</i> < 0.001). ∆PFA ⩾ 95° rates were 95% (57/60) and 27.8% (77/200) in patients with ∆SPT ⩾ 20° and ∆SPT < 20°, respectively (OR 49.35; CI, 15.01-162.28; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>High mobility of the hip (∆PFA ⩾ 95°) seems to be a necessary condition for adverse spinopelvic mobility. A preoperative analysis of patients with lower hip mobility, associated with spinopelvic risk factors, might identify patients with abnormal spinopelvic mobility after the restoration of femoral flexion.</p><p><strong>Trial registration: </strong>IDRCB 2023-A01390, CNIL MR004 2225508 (07/06/2023), retrospectively registered.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"47-53"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and radiological outcomes and complications of Bernese periacetabular osteotomy through modified Stoppa approach.","authors":"Deniz Akbulut, Mehmet Coskun","doi":"10.1177/11207000241280951","DOIUrl":"10.1177/11207000241280951","url":null,"abstract":"<p><strong>Background: </strong>The Smith-Peterson approach and its modifications provide an extensive exposure and allow osteotomies through a single incision. However, the risk of complications increases when the quadrilateral surface, ischial and pubic osteotomy sites cannot be seen. This study aimed to evaluate the surgical characteristics, complications, and functional and radiological outcomes of patients with acetabular dysplasia who underwent Bernese periacetabular osteotomy (PAO) through modified Stoppa approach and plate-screw fixation.</p><p><strong>Methods: </strong>The study included 31 patients (41 hips) who had undergone PAO using a modified Stoppa approach. The characteristics of patients and the surgical procedure were described. The lateral centre-edge angle (LCEA) and Tönnis roof angle were evaluated in the radiological outcome evaluation. The modified Harris Hip Score (mHHS) was used to evaluate functional outcome. Furthermore, complications were described.</p><p><strong>Results: </strong>The mean age of the patients was 20.4 ± 9.0 years. Of the 31 patients, 21 underwent unilateral Bernese PAO and 10 underwent bilateral Bernese PAO. The mean follow-up period was 25.1 ± 8.8 months. Postoperatively, the mean mHHS improved significantly (68.8 ± 9.4 vs. 88.8 ± 10.0, <i>p</i> < 0.001). Postoperatively, the mean LCEA and Tönnis roof angle improved significantly (17.7 ± 6.0 vs. 42.2 ± 4.8, <i>p</i> < 0.001 for LCEA and 18.3 ± 5.5 vs. 8.0 ± 2.2, <i>p</i> < 0.001 for Tönnis roof angle). There was no significant correlation between preoperative to postoperative improvement in LCEA or Tönnis roof angle and improvement and mHHS (<i>p</i> > 0.005). 5 complications were identified: 1 transient sciatic nerve palsy, 1 external iliac vein injury, 1 infection, and 2 screw irritations of acetabulum.</p><p><strong>Conclusions: </strong>Performing Bernese PAO through a modified Stoppa approach with plate-screw fixation results in acceptable complication rates, immediate early weight-bearing opportunity, and improved functional and radiological outcomes in patients with acetabular dysplasia.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"83-91"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The L1 spino-pelvic (L1SP) angle: a simplified approach for the assessment of the PI-LL mismatch in hip surgery.","authors":"A Mounir Boudali, Yuan Chai, John E Farey, Jonathan Vigdorchik, William L Walter","doi":"10.1177/11207000241282984","DOIUrl":"10.1177/11207000241282984","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic incidence - lumbar lordosis (PI-LL) mismatch is often considered when assessing spinopelvic alignment in the sagittal plane. The mismatch is conventionally obtained by measuring 2 separate angles on lateral spinopelvic radiographs. This study describes a simplified approach for assessing spinopelvic mobility and measuring the PI-LL mismatch through the evaluation of the L1-spinopelvis angle (L1SP).</p><p><strong>Methods: </strong>96 standing lateral radiographs were obtained from consecutive patients presenting for total hip arthroplasty between November 2020 and July 2021. 3 operators were recruited to annotate landmarks on digital radiographs. Correlation analysis and error analysis were applied. Measurement reproducibility was assessed using intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>The correlation coefficients of the 3 variables were respectively 0.87 for PI, 0.94 for LL, and 0.96 for L1SP. The normalised root mean square error between the 2 measurement sets was 9.96% for PI, 5.97% for LL, and 4.41% for L1SP. The absolute error was 3.49° ± 4.63° for PI, 3.23° ± 3.78° for LL, 2.68° ± 3.19° for PI-LL conventional, and 2.35° ± 2.88° for PI-LL via L1SP, respectively. In terms of reproducibility, measurement of L1SP outperformed that of PI and LL (ICC = 0.97 versus 0.83 and 0.93, respectively).</p><p><strong>Conclusion: </strong>The simplified L1SP method, through the measurement of a single angle, produced similar measurements to the conventional PI-LL method. The measurement repeatability between operators was improved using the L1SP method. From a clinical practice perspective, both methods are equivalent. The new method is readily reproducible using commercially available PACS software during preoperative templating.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"41-46"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142285865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same same but different: Introduction of a classification system in calcar-guided short-stem total hip arthroplasty.","authors":"Karl P Kutzner","doi":"10.1177/11207000241286259","DOIUrl":"10.1177/11207000241286259","url":null,"abstract":"<p><strong>Background: </strong>The concept of calcar-guided short-stem THA (ssTHA) has largely emerged over the last decade, especially in Europe, and today modern calcar-guided short stems are among the most successful primary femoral implants in terms of complications and revision rates as indicated by multiple registry data. The philosophy originally comprised an individualised reconstruction of the hip anatomy by following the calcar of the femoral neck providing bone- and soft-tissue-sparing characteristics. However, as the stem design allows either metaphyseal fixation alone or additional diaphyseal anchoring, depending on the stem alignment and indication, distinct knowledge is required regarding the implantation technique, the broad variation of positioning and fixation and its potential clinical consequences.</p><p><strong>Aim: </strong>To report on and highlight the characteristics of different ways of performing calcar-guided ssTHA as well as to introduce a classification in order to systematically account for the variety of strategies and the respective implications on the type of fixation.</p><p><strong>Surgical technique: </strong>Already when templating preoperatively, surgeons need to weigh up the different fixation types taking into account a number of patient-related factors. Intraoperatively, by individually controlling the level of osteotomy, the intended type of anchorage can be implemented. Intraoperative radiography to confirm the result, is mandatory.</p><p><strong>Results: </strong>Despite numerous options of stem alignment, depending on the patient's anatomy, the bone quality or the indication for operation, a total of 4 categories were identified to characterise different fixation strategies in calcar-guided ssTHA.</p><p><strong>Conclusions: </strong>The classification system should be used for the preoperative determination of the intended type of anchorage. Whenever a short-stem philosophy with metaphyseal fixation (Type I (M)) is possible, it should be pursued.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"54-61"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}