HIP International最新文献

{"title":"Peak stresses within the cement mantle increase above the yield point of bone cement when the subsidence limit is reached in polished taper stems.","authors":"Mohamad Taufiqurrakhman, Alison Jones, Abdul Halim Abdullah, Mark Higgins, Benjamin V Bloch, Andrew R J Manktelow, Hemant G Pandit, Bernard H van Duren","doi":"10.1177/11207000261454261","DOIUrl":"https://doi.org/10.1177/11207000261454261","url":null,"abstract":"<p><strong>Background: </strong>Cemented polished taper-slip (PTS) stems are widely used in total hip arthroplasty but are associated with an increased risk of periprosthetic femoral fracture. Stem centralizers enable surgeons to achieve an even cement mantle and allow for controlled subsidence, which is essential for maintaining fixation, as this relies on the PTS implant's interaction with the surrounding cement mantle (known as a \"force-closed\" mechanism). However, if subsidence exceeds the centralizer's limit, the implant transitions to a configuration where fixation depends on direct mechanical interlocking with the cement mantle (a \"shape-closed\" mechanism), potentially increasing stresses within the cement mantle. The aim of this study was to quantify the stress distribution changes within the cement mantle when further subsidence is restricted using finite element analysis (FEA).</p><p><strong>Methods: </strong>Three commonly used PTS designs: C-Stem AMT (Johnson & Johnson MedTech, Warsaw, IN, USA), Exeter (Stryker, Kalamazoo, MI), and CPT (Zimmer Biomet, Warsaw, IN), were 3D scanned and modelled, incorporating cement mantle and centralizer gaps per manufacturer guidelines. FEA simulated loading conditions mimicking a stumble (6,900 N) with and without a distal gap to assess von Mises stress and deformation. Variations in stem materials (Stainless steel (SS316L) and Co-Cr alloys) and friction coefficient were also evaluated.</p><p><strong>Results: </strong>With subsidence allowance, peak von Mises stresses were concentrated in the medial calcar (Gruen zone 7), with CPT stems showing the highest stress (~45 MPa). When subsidence was restricted, stress shifted to the distal tip (zone 4), increasing by 49-102% depending on stem design and material. Co-Cr stems exhibited higher stress and displacement at the distal tip compared to SS316L stems.</p><p><strong>Conclusions: </strong>Restricting subsidence in PTS stems significantly increases distal cement mantle stress, which may elevate PPF risk. Stem design, material and implant-cement interface friction influence stress distribution and subsidence behavior, potentially affecting long-term implant stability.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261454261"},"PeriodicalIF":1.3,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701120","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":"Risk factors for avascular necrosis in Delbet type II paediatric femoral neck fractures: a case-control study.","authors":"Nirmal R Gopinathan, Akash K Ghosh, Jai P Khatri, Karthick Rangasamy, Vivek P Ksheerasagar, Pebam Sudesh","doi":"10.1177/11207000261471457","DOIUrl":"https://doi.org/10.1177/11207000261471457","url":null,"abstract":"<p><strong>Background and objectives: </strong>Paediatric femoral neck fractures (PFNFs) are rare but carry a significant risk of avascular necrosis (AVN) of the femoral head. Delbet type II fractures are the most common variant, yet specific predictors of AVN within this subgroup remain unclear. This study aimed to identify risk factors for AVN in Delbet type II PFNFs and evaluate the functional outcomes following management with weight-bearing restriction and bisphosphonate therapy.</p><p><strong>Methods: </strong>A retrospective case-control study conducted from June 2011 to May 2022 included a total of 15 Delbet type II fractures. 5 patients who developed AVN (cases) were matched in a 1:2 ratio with 10 patients who did not develop AVN (controls). Quality of reduction was quantified using the neck-shaft angle (AP view) and Southwick angle (lateral view). Functional outcomes were evaluated at final follow-up (mean 35.2 months) using the Ratliff criteria and modified Harris Hip Score (mHHS).</p><p><strong>Results: </strong>An increased Southwick angle was significantly associated with AVN (mean 14.8° vs. 5.95°, <i>p</i> = 0.012; OR 1.30, 95% CI, 1.01-1.68). Age >7 years and non-anatomic reduction showed high odds ratios (OR 6.00), but did not achieve statistical significance. Reduction method, type of fixation and injury-surgery interval were not significantly associated with AVN. 4 out of 5 AVN cases achieved good functional outcomes, and 1 achieved a fair outcome following a 12-month regimen of oral bisphosphonates and restricted weight-bearing.</p><p><strong>Conclusions: </strong>An increased Southwick angle following fracture reduction is a significant predictor of AVN in Delbet type II PFNFs, emphasising the critical importance of achieving anatomical reduction in the sagittal plane. If AVN develops, conservative management with oral bisphosphonates and protected weight-bearing yields favourable functional outcomes.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261471457"},"PeriodicalIF":1.3,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701118","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":"What causes cup inclination outliers in primary total hip arthroplasty when using a digital inclinometer? A prospective cohort study.","authors":"Geert Meermans, Willem J Van Doorn, Jan-Jaap Kats, Moritz Innmann, George Grammatopoulos","doi":"10.1177/11207000261461259","DOIUrl":"https://doi.org/10.1177/11207000261461259","url":null,"abstract":"<p><strong>Background: </strong>A suboptimal radiographic inclination (RI) angle of the cup has been associated with worse short- and long-term outcomes after primary total hip arthroplasty (THA). There are several factors that lead to RI outliers including cup version, pelvic orientation at time of cup impaction and angle of the cup introducer relative to the floor. The primary aim of this study was to analyse if a digital inclinometer helps achieving a target RI of cups in primary THA and what factors increase the risk of having a cup inclination outside the target zone.</p><p><strong>Patients and methods: </strong>In this prospective study, we included 200 consecutive patients undergoing primary THA. Preoperatively, the surgeon determined the target intraoperative inclination (IOI). The IOI was measured with the aid of a digital inclinometer after seating of the acetabular component. Anteroposterior pelvic radiographs were made to measure the RI of the acetabular component. The target zone for inclination was defined as 35-45° of RI.</p><p><strong>Results: </strong>The mean RI was 37.9° SD 4.7. There were 53 outliers (26.5%) for the 35-45° zone. The mean absolute ΔIOI_cup-IOI_target was 1.2° SD 1.0. The absolute ΔIOI_cup-IOI_target was <1° in 108 patients (54%), <2° in 160 patients (80%) and <3° in 186 patients (93%). The absolute deviation from the mean ΔOI_math-IOI_cup, which corresponds with pelvic motion, was significantly higher in RI outliers compared with non-outliers for the 35-45° inclination zone (4.7°, SD 2.8 vs. 2.5°, SD 2.0 respectively) (<i>p</i> < 0.0001).</p><p><strong>Conclusions: </strong>Using a digital inclinometer allowed the surgeons to intraoperatively put the cup within 3° of the IOI_target in 93% of cases. This led to 74% of the acetabular components being placed within an RI target zone of 35°- 45°. The remaining outliers were caused by more of less than average deviation of the pelvic position at time of impaction.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261461259"},"PeriodicalIF":1.3,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701113","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 with use of a modular, cementless, tapered and fluted femoral prosthesis in revision hip arthroplasty with mid-term follow-up.","authors":"Conor Hughes, Brian Lim, Scott R Morrison, Muhammad Adeel Akhtar, Phil Walmsley, James A Ballantyne","doi":"10.1177/11207000261463754","DOIUrl":"https://doi.org/10.1177/11207000261463754","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing demand for revision hip arthroplasty (rTHA), particularly among patients with longer life expectancy, necessitates durable femoral implants. The Link MP modular fluted tapered stem lacks granular mid- and longer-term outcome data.</p><p><strong>Methods: </strong>A retrospective review of 125 rTHA procedures using the Link MP stem was conducted at a UK centre from 2011 to 2025. Demographics, operative details, complications, radiographic migration, and clinical outcomes were analysed, and Kaplan-Meier survival analysis assessed implant survivorship.</p><p><strong>Results: </strong>Median follow-up was 57 months, with 100 followed up for at least 2 years. Aseptic loosening was the primary revision indication (<i>n</i> = 85, 68%). Extended trochanteric osteotomy (<i>n</i> = 71, 56.8%) and cortical windowing (<i>n</i> = 35, 28%) were common adjuncts, with 98.1% union rate across the osteotomy cohort. Median stem migration was 3 mm; 36% had >5 mm migration without correlation to reduced mobility (<i>p</i> = 0.273). Overall, 12 cases (9.6%) returned to theatre; stem-related reoperation occurred in 5 cases (4%). Infection was the most common reason for return to theatre (<i>n</i> = 4, 33.3%), with instability, fractures, and device issues also noted. Kaplan-Meier analysis showed 96% stem survival at 166 months (95% confidence interval from 89.1% to 100%, with 4 hips at risk at that period. 96 cases (76.8%) returned to baseline mobility, 7 (5.6%) of cases suffered an intraoperative complication.</p><p><strong>Conclusions: </strong>The Link MP stem demonstrates excellent survivorship in complex revision scenarios. Early stem migration appears benign. Mechanical complications at the modular junction were rare but clinically important, requiring return to theatre. This study supports the implant's reliability and provides technical insight into its use.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261463754"},"PeriodicalIF":1.3,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701196","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":"Distinct recovery phenotypes after hip arthroscopy reveal dissociation between daily function and sports performance.","authors":"Miguel Vázquez, Roberto Seijas, Pedro Alvarez-Díaz, Patricia Laiz, Lorenzo Escutia-Mari, Alfred Ferré-Aniorte, Ramón Cugat","doi":"10.1177/11207000261464126","DOIUrl":"https://doi.org/10.1177/11207000261464126","url":null,"abstract":"<p><strong>Background: </strong>Hip arthroscopy outcomes for femoroacetabular impingement remain heterogeneous. The Hip Outcome Score (HOS) comprises 2 distinct subscales measuring activities of daily living and sports performance, yet their dissociation after surgery remains poorly characterised.</p><p><strong>Purpose: </strong>To identify distinct recovery phenotypes after hip arthroscopy using unsupervised machine learning and determine preoperative predictors of phenotype membership.</p><p><strong>Methods: </strong>We analysed 326 consecutive patients with complete 1-year HOS-ADL and HOS-Sports data. K-means clustering was performed on 5 outcome variables with Gaussian Mixture Model validation. Multinomial logistic regression identified preoperative predictors.</p><p><strong>Results: </strong>4 phenotypes emerged: Complete Responders (41.7%), ADL-Dominant Responders (27.3%), Slow Progressors (19.0%), and Non-Responders (12.0%). ADL-Dominant phenotype was predicted by age >40 years (OR 3.42, <i>p</i> < 0.001), Tegner <5 (OR 2.87, <i>p</i> = 0.001), and Outerbridge III-IV (OR 2.41, <i>p</i> = 0.005).</p><p><strong>Conclusions: </strong>4 robust recovery phenotypes exist, with 27% demonstrating ADL-sports dissociation predicted by older age, lower activity, and greater chondral damage. Recognition enables personalised preoperative counselling.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261464126"},"PeriodicalIF":1.3,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701174","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":"Proximal femoral replacement for non-oncologic reconstruction: functional outcomes and survivorship in 30 patients.","authors":"Edgar Manuel Bodu Lamberti, Gary Monclou, Camila Karduss Preciado","doi":"10.1177/11207000261459288","DOIUrl":"https://doi.org/10.1177/11207000261459288","url":null,"abstract":"<p><strong>Background: </strong>Proximal femoral replacement (PFR) is a useful salvage option for reconstruction after massive proximal femoral bone loss. However, functional outcomes in non-oncologic cases remain underreported. The purpose of this study was to evaluate postoperative function, complications, and implant survival after PFR performed for non-oncologic indications.</p><p><strong>Methods: </strong>We retrospectively reviewed 63 consecutive non-oncologic PFRs performed between 2018 and 2023. After applying exclusion criteria and accounting for duplicates and patients lost to follow-up, 30 participants were available for final evaluation. The primary outcome was the postoperative modified Harris Hip Score (mHHS). Secondary outcomes included postoperative complications, infection-free survival, and revision-free arthroplasty survival. Univariate linear regression analyses were performed to identify factors associated with postoperative mHHS.</p><p><strong>Results: </strong>The study cohort included 30 patients (63.3% female) with a mean age of 64.4 ± 13.6 years and mean follow-up of 31.4 months. The mean postoperative mHHS was 54.0 ± 22.4. Male patients demonstrated higher unadjusted mHHS than females (69.2 ± 18.5 vs. 45.2 ± 19.8; <i>p</i> = 0.003). The Kaplan-Meier estimated infection-free survival was 96.4% (95% CI, 89.8-100%) at 12 months, 91.4% (95% CI, 80.4-100%) at 24 months, and 73.1% (95% CI, 46.3-100%) at 60 months. Revision arthroplasty survival was 85.1% (95% CI, 68%, 100%) at 12 and 24 months, and 49.7% (95% CI, 25.6-96.3%) at 60 months. Overall complications occurred in 15 patients (50%), with periprosthetic joint infection being the most frequent (<i>n</i> = 4, 13.3%).</p><p><strong>Conclusions: </strong>PFR for non-oncologic indications provides modest limb salvage and functional outcomes, although complications remain common. Functional recovery appears multifactorial and not solely dependent on implant design or fixation method. These findings may support the use of PFR as a salvage option in carefully selected non-oncologic cases, while emphasizing the need for larger prospective studies to improve patient selection and outcomes.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261459288"},"PeriodicalIF":1.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673578","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":"A Systematic Review and Meta-Analysis of Regenerative Therapies for Hip Cartilage Lesions and Their Outcomes.","authors":"Ben Woodhouse, Ravi Patel, Charlotte Hulme, Jan-Herman Kuiper, Larissa Rix, Rajpal Nandra, Karina Wright, Geraint Thomas","doi":"10.1177/11207000261460814","DOIUrl":"https://doi.org/10.1177/11207000261460814","url":null,"abstract":"<p><strong>Background: </strong>Chondral lesions of the hip in young, active patients are a recognised cause of pain, functional limitation, and early osteoarthritis. Although regenerative cartilage repair techniques are well established in the knee, hip-specific evidence remains limited. This systematic review and meta-analysis evaluated clinical outcomes and predictors of success following surgical and biologically augmented treatments for hip cartilage lesions.</p><p><strong>Methods: </strong>A systematic search of PubMed, OVID MEDLINE, and EBSCOHost was conducted in December 2024 to identify prospective and retrospective case series and comparative studies reporting outcomes following surgical or biologic interventions. Functional outcome was primarily assessed using the modified Harris Hip Score (mHHS), and failure was defined as conversion to total hip arthroplasty (THA). Random-effects meta-regression was used to evaluate predictors of endpoint mHHS and change-from-baseline mHHS (ΔmHHS), while failure outcomes were analysed using Kaplan-Meier survival analysis and Cox proportional hazards regression. 27 studies comprising 30 intervention arms and 1059 patients were included.</p><p><strong>Results: </strong>Cell-based and scaffold-assisted techniques, including autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, autologous matrix-induced chondrogenesis, and micro-fragmented adipose tissue transplantation, demonstrated the highest adjusted endpoint mHHS values (>87). In contrast, microfracture and commercial fibrin glue were associated with inferior functional outcomes and higher THA conversion rates (7.1-12.9%). Meta-regression identified intervention type as the primary determinant of outcome, with increasing defect size independently associated with poorer endpoint mHHS. Improvements in ΔmHHS were influenced by age, defect size, and follow-up duration, although findings were limited by potential model overfitting. Survival analyses demonstrated high overall THA-free survivorship, with increasing age emerging as the consistent predictor of failure.</p><p><strong>Conclusions: </strong>Biological restoration techniques appear to outperform reparative strategies for short-term functional outcomes in hip cartilage lesions. Intervention type, defect size, and patient age remain key determinants of success, underscoring the need for high-quality comparative studies with long-term follow-up.PROSPERO registration:CRD420250644934.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261460814"},"PeriodicalIF":1.3,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584198","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":"Survivorship of the C-Stem in cement-in-cement revision hip arthroplasty.","authors":"Amit Kumar Yadav, Mohammed As-Sultany, Paul Siney, Ishmita Paul, Asim Rajpura, Peter Kay","doi":"10.1177/11207000261453803","DOIUrl":"https://doi.org/10.1177/11207000261453803","url":null,"abstract":"<p><strong>Introduction: </strong>Cement-in-cement (CiC) is a well-established technique in revision hip arthroplasty. It involves cementing a new femoral stem into an existing intact cement mantle. It is less invasive than the conventional technique of removing well-fixed cement. This study evaluates the clinical and radiological outcomes of the C-Stem in CiC revision hip arthroplasty at the design centre.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using a prospectively maintained database of CiC revision hip arthroplasties performed between July 2015 and 2023. Inclusion criteria included patients undergoing CiC femoral revision with a C-Stem and have a minimum of 1 year follow-up. Patients with a disrupted cement mantle, infection at index surgery, or less than 1 year of follow-up were excluded. Data on indications, complications, radiographs and survivorship were analysed. Kaplan-Meier survival analysis was performed with revision for any cause as the endpoint.</p><p><strong>Results: </strong>There were 102 cases, of which 78 had at least 1 year of clinical and radiological follow-up. The average patient age was 71 years (47-90). The mean follow-up was 41 (25-72) months. The 3 most common reasons for revision surgery were cup loosening (60%), dislocation (16%) and stem loosening (11%). Following revision arthroplasty using the CiC technique, there were a total of 11.8% stem revisions. Kaplan-Meier survival analysis was 86% (95% confidence interval 76-96) at 8 years for all-cause stem revisions. There were no re-revisions of the femoral stem for aseptic loosening. The majority of cases (93%) maintained their preoperative Barrack grading.</p><p><strong>Conclusions: </strong>This largest single study demonstrates favourable medium-term implant survival with the C-Stem in CiC revision hip arthroplasty. This technique remains viable in carefully selected revision cases since it is associated with a much lower complication and risk profile. Further studies with longer follow-up and functional outcome scores are warranted.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261453803"},"PeriodicalIF":1.3,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519933","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":"Utilisation of total hip arthroplasty in the United States by settlement type: is there equity of access?","authors":"Nickelas Huffman, Precious C Oyem, Oluwapeyibomi I Runsewe, Michael S Ramos, Ignacio Pasqualini, Shujaa T Khan, Pedro J Rullán, Ahmed Siddiqi, Nicolas S Piuzzi","doi":"10.1177/11207000261460375","DOIUrl":"https://doi.org/10.1177/11207000261460375","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) volumes continue to increase. However, little information exists regarding the number of orthopaedic surgeons and THAs performed by settlement type. This study aimed to quantify orthopaedic surgeons performing THAs across different settlement types in the United States and correlate the volume of THA per surgeon in each settlement type.</p><p><strong>Methods: </strong>The Medicare Provider Utilization and Payment Data: Physician and Other Practitioners Dataset was queried to quantify all orthopaedic surgeons performing primary or revision THA from 2013 to 2020. Patients were classified into 4 settlement types (urban/metropolitan, micropolitan [large town], small town, and rural) using Rural-urban commuting area (RUCA) codes. 2-sided Mann-Kendall tests were used to correlate surgeons' THA volumes by settlement type.</p><p><strong>Results: </strong>The number of surgeons billing for primary or revision THAs ranged from 4096 to 4694 over the study period. On average, 88.1% of THAs occurred in urban/metropolitan areas, 9.6% in micropolitan areas, 1.8% in small towns, and 0.4% in rural areas. The number of orthopaedic surgeons billing for THAs significantly increased in urban/metropolitan areas over the study period. Additionally, an increasing number of THAs were performed in each settlement over the study period.</p><p><strong>Conclusions: </strong>While an increasing number of THAs were performed annually in each settlement type, there remains a mismatch between the proportion of the population residing in rural areas (20% of the United States population) and the number of surgeons performing THAs in these areas. Further research is required to understand THA surgeon distribution in the context of the projected growth of THA demand.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000261460375"},"PeriodicalIF":1.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375258","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":"Conversion total hip arthroplasty following failed proximal femoral fixation: current concepts review.","authors":"Amaan A Merchant, Elliot Onochie, Babar Kayani, James Donaldson, John G Stammers, John A Skinner","doi":"10.1177/11207000261415598","DOIUrl":"10.1177/11207000261415598","url":null,"abstract":"<p><strong>Introduction: </strong>Failed internal fixation of proximal femoral fractures is associated with significant morbidity, mortality, and financial burden. Conversion total hip arthroplasty (THA) is a technically demanding salvage procedure associated with high risks of periprosthetic joint infection and instability.</p><p><strong>Methods: </strong>Independent searches of MEDLINE, EMBASE, and the Cochrane library were performed for studies published from 1990 onwards regarding conversion THA in adults following failed proximal femur fixation. Following screening, 34 studies were included in this review.</p><p><strong>Results: </strong>Predictors of failure include female sex, smoking, and tip-apex distance >25 mm. Preoperative screening for occult, extra-articular infection is vital, as pathogens often reside near hardware rather than within the joint. CT, ultrasound, and SPECT-CT are essential for assessing bone stock and identifying fluid collections. Dual-mobility cups effectively reduce dislocation rates to 0-3%. Functional scores improve significantly, though 10-year survivorship is approximately 86%.</p><p><strong>Discussion: </strong>Conversion THA provides substantial functional recovery but carries a 7-fold higher infection risk than primary THA. Success requires meticulous screening tailored to previous hardware sites and selecting femoral fixation based on bone quality and cortical defects. Specialised implants are essential for optimising long-term outcomes in this high-risk population.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"594-601"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364893","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}