Bone & Joint Journal最新文献

{"title":"Long-term outcome of nonoperative treatment of Perthes' disease : only 19% total hip arthroplasty at a mean follow-up of 48 years.","authors":"Anders Wensaas, Chiara Blatti, Terje Terjesen, Stefan Huhnstock","doi":"10.1302/0301-620X.107B6.BJJ-2024-1310.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1310.R1","url":null,"abstract":"<p><strong>Aims: </strong>The outcome in Perthes' disease deteriorates with increasing follow-up, ending with total hip arthroplasty (THA) in patients with severe complaints. The purpose of this study was to assess the prevalence of THA according to length of follow-up and to define risk factors for THA.</p><p><strong>Methods: </strong>Patients were recruited from the radiological archive at Oslo University Hospital HF. In total, 229 patients (244 hips) were included in the study (184 males). The mean age at diagnosis was 6.2 years (2.1 to 13.7). A total of 105 hips (43%) were classified as spherical, 93 (38%) as ovoid, and 46 (19%) as flat. The mean time from diagnosis to follow-up was 48 years (27 to 72). Inclusion criteria were patients with nonoperative treatment for Perthes' disease and ≥ 25 years' follow-up. Sphericity of the femoral head at the healing stage was classified with the modified Stulberg method, which is a three-group classification based on the shape of the femoral head: spherical, ovoid, or flat. Information regarding THA was provided by the Norwegian Arthroplasty Register.</p><p><strong>Results: </strong>Overall, 47 hips (19%) had undergone THA at a mean patient age of 46 years (22 to 72). The most important prognostic factors for THA were femoral head sphericity and age at onset. The frequency of THA was 3% in hips with spherical femoral heads, 25% in ovoid heads, and 46% in flat heads. Age ≥ six years was associated with THA more frequently than age < six years (28% and 10%, respectively). Kaplan-Meier survival analysis showed a survival rate at 50 years' follow-up of 99% (95% CI 96 to 100) in spherical hips, 76% (95% CI 66 to 86) in ovoid hips, and 48% (95% CI 29 to 67) in flat hips.</p><p><strong>Conclusion: </strong>After a mean follow-up of 48 years, 47 of 244 nonoperatively treated hips had undergone THA (19%). The results indicate that the aim of treatment should be to obtain a spherical femoral head.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"657-662"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-articular antibiotics : a direct approach to the treatment of infected cementless total hip arthroplasty.","authors":"Frans-Jozef Vandeputte, Mathieu Gevers, Hans Welters, Kristoff Corten","doi":"10.1302/0301-620X.107B6.BJJ-2024-0853.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-0853.R1","url":null,"abstract":"<p><strong>Aims: </strong>The use of intra-articular antibiotics in the treatment of periprosthetic joint infection (PJI) can achieve a concentration which is sufficient to eradicate a biofilm. This may mitigate the need for removal of infected but well-fixed cementless components of a total hip arthroplasty (THA). However, the use of percutaneous catheters might lead to multiresistance or persistent multiorganism infections. The aim of this study was to report the results of a series in which an intra-articular antibiotic infusion was added to a single-stage revision for infected cementless THAs.</p><p><strong>Methods: </strong>A total of 18 patients underwent 18 single-stage revision THAs which were performed for acute (n = 9) or chronic (n = 9) PJI, following a primary (n = 12) or revision (n = 6) cementless THA. After an extensive debridement, modular components were replaced, but all well-fixed components were retained. Two Hickmann catheters were introduced into the joint space, through which intra-articular antibiotics were introduced for two weeks. Intravenous antibiotics were also administered during this time, followed by oral antibiotics until three months after surgery.</p><p><strong>Results: </strong>At a mean follow-up of 5.4 years (3.3 to 7.19), all patients had a normal ESR and white blood cell count. The CRP remained slightly elevated in three patients, although they were pain-free and showed no signs of infection. No patient developed antibiotic-related renal or systemic dysfunction postoperatively.</p><p><strong>Conclusion: </strong>We found that for the treatment of an infected cementless THA, retention of well-fixed components was feasible, with the addition of intra-articular antibiotics to a standard single-stage regime. None of the 18 patients had persistent infection or catheter-induced drug resistance, at a mean follow-up of 5.4 years.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"3-8"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Burch-Schneider Reinforcement Ring : 200 cases over a 40-year period with a mean follow-up of 11 years.","authors":"Darius Marti, Florine Petitat, Alexander F Heimann, Vlad Popa, Emanuel Gautier, Matthieu Hanauer, Julien Hirt, Joseph M Schwab, Moritz Tannast","doi":"10.1302/0301-620X.107B6.BJJ-2024-1106.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1106.R1","url":null,"abstract":"<p><strong>Aims: </strong>The Burch-Schneider Reinforcement Ring (BSRR) was developed to manage significant acetabular defects and prevent protrusion in complex primary and revision total hip arthroplasties. This study evaluates the long-term performance of the BSRR over four decades, focusing on survival, patient-reported outcomes, radiological evidence of loosening, complication rates, and factors associated with implant failure.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 200 hips treated with the BSRR at the Cantonal Hospital of Fribourg, Fribourg, Switzerland, from January 1974 to December 2018. Clinical and radiological data were reviewed, and patients were followed through clinical visits, questionnaires, and registry data. Outcomes were assessed using standardized scoring systems and radiological evaluations. Kaplan-Meier survival analysis and Cox proportional hazards modelling were used to identify factors associated with implant failure.</p><p><strong>Results: </strong>The cumulative survival of the BSRR was 72% (95% CI 50 to 100) at 20 years with any clinical or radiological failure as the endpoint, and 97% (95% CI 95 to 100) at 20 years for revision of the BSRR specifically. Clinical outcomes showed moderate improvements at final-follow-up, with a mean Harris Hip Score of 53.4 (SD 25.3) and a Hip disability and Osteoarthritis Outcome Score of 72.8 (SD 18.6). Radiologically at final follow-up, the BSRR demonstrated good stability, with 1.5% of cases (n = 2) showing probable loosening and low rates of osteolysis (3% acetabular (n = 4) and 14% femoral (n = 18)). The primary predictor of implant failure was the Paprosky Grade IV acetabular defect, with a hazard ratio of 4.4 (95% CI 1.2 to 15.7).</p><p><strong>Conclusion: </strong>The BSRR remains an effective solution for acetabular revision surgery, providing consistent long-term outcomes. Its durability makes it a valuable tool in orthopaedic surgery, especially when managing significant bone loss.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"23-30"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total hip arthroplasty in patients with angular proximal femoral deformities.","authors":"Louis Dagneaux, Matthew P Abdel, Rafael J Sierra, David G Lewallen, Robert T Trousdale, Daniel J Berry","doi":"10.1302/0301-620X.107B6.BJJ-2025-0305.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2025-0305.R1","url":null,"abstract":"<p><strong>Aims: </strong>An angular proximal femoral deformity, in association with osteoarthritis (OA) of the hip, considerably increases the technical complexity of primary total hip arthroplasty (THA). The aims of this study were to determine the long-term implant survival, the risk factors for failure, complications, and clinical outcomes of contemporary primary THA in this difficult group of patients.</p><p><strong>Methods: </strong>Our institutional total joint registry was used to identify 119 primary THAs performed in 108 patients with an angular proximal femoral deformity, between January 1997 and September 2017. The deformity was related to a previous femoral osteotomy in 102 THAs (86%), and developmental or metabolic disorders in 17 THAs (14%). A total of 62 hips (53%) had a predominantly varus deformity. The mean age of the patients was 44 years (SD 13), their mean BMI was 29 kg/m² (SD 6), and 70 (59%) were female. An uncemented femoral component with metaphyseal fixation was used in 35 THAs (30%), an uncemented femoral component with diaphyseal fixation in 34 (29%), an uncemented modular femoral component with a metaphyseal fixation sleeve in 29 (24%), and a cemented femoral component in 21 (18%). Simultaneous corrective femoral osteotomy was performed in 22 THAs (18%). Kaplan-Meier survival and Harris Hip Scores (HHSs) were reported. The mean follow-up was eight years (2 to 22).</p><p><strong>Results: </strong>The ten-year survival free of femoral loosening, any femoral revision, any revision and any reoperation was 95%, 93%, 90%, and 88%, respectively. A total of 13 revisions were undertaken, for aseptic femoral loosening in three, fracture of the femoral component in two, dislocation in two, aseptic acetabular loosening in two, polyethylene liner exchange in two, and infection in two. A preoperative varus deformity was associated with a higher risk of any revision (hazard ratio (HR) 12.5, p = 0.020), and those with a simultaneous osteotomy had a higher risk of any reoperation (HR 3.6, p = 0.023). The mean HHSs improved significantly from 52 preoperatively to 82 at ten years (p < 0.001).</p><p><strong>Conclusion: </strong>In the largest series to date of primary THAs in patients with hip OA and an angular proximal femoral deformity, we found a good ten-year survival free from any revision. Varus deformities, particularly those treated with a simultaneous osteotomy due to the magnitude or location of the deformity, had a higher rate of further surgery.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"101-108"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging innovation to implementation in artificial intelligence fracture detection : a commentary piece.","authors":"Mohammed Khattak, Patrick Kierkegaard, Alison McGregor, Daniel C Perry","doi":"10.1302/0301-620X.107B6.BJJ-2024-1567.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1567.R1","url":null,"abstract":"<p><p>The deployment of AI in medical imaging, particularly in areas such as fracture detection, represents a transformative advancement in orthopaedic care. AI-driven systems, leveraging deep-learning algorithms, promise to enhance diagnostic accuracy, reduce variability, and streamline workflows by analyzing radiograph images swiftly and accurately. Despite these potential benefits, the integration of AI into clinical settings faces substantial barriers, including slow adoption across health systems, technical challenges, and a major lag between technology development and clinical implementation. This commentary explores the role of AI in healthcare, highlighting its potential to enhance patient outcomes through more accurate and timely diagnoses. It addresses the necessity of bridging the gap between AI innovation and practical application. It also emphasizes the importance of implementation science in effectively integrating AI technologies into healthcare systems, using frameworks such as the Consolidated Framework for Implementation Research and the Knowledge-to-Action Cycle to guide this process. We call for a structured approach to address the challenges of deploying AI in clinical settings, ensuring that AI's benefits translate into improved healthcare delivery and patient care.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"582-586"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durom hip resurfacing at 15 years : predictive factors for failure.","authors":"Thomas R Williamson, Ian W Kennedy, Mark R J Jenkinson, Ben Wheelwright, Nicholas Kane, R M Dominic Meek","doi":"10.1302/0301-620X.107B6.BJJ-2024-1045.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1045.R1","url":null,"abstract":"<p><strong>Aims: </strong>A range of metal-on-metal hip resurfacing (MoM-HR) implants have shown good functional outcomes, but some have been associated with adverse reactions to metal debris (ARMD) and early failure, requiring regular follow-up and monitoring of the blood metal ion levels. The aim of this study was to report the minimum 15-year survival of the Durom hip resurfacing system (Zimmer Biomet, USA), the functional outcome, and factors which were predictive of failure.</p><p><strong>Methods: </strong>A consecutive series of patients undergoing Durom MoM-HR at a single centre between January 2000 and December 2008 were included. Demographic variables, the size of the implant, radiological parameters, and the most recent blood metal ion levels were collected. The primary outcome measure was failure; secondary outcome measures included the Oxford Hip Score (OHS). Multivariable logistic regression was used to predict failure and identify the factors most strongly associated with failure.</p><p><strong>Results: </strong>A total of 695 hips in 597 patients, 61.2% of whom were male, were included. The mean age of the patients was 51.5 years (SD 8.7). Survival at a mean follow-up of 15.2 years (SD 1.9) was 86.6% (602 of 695 hips). Implant survival was significantly increased in males (92.2% (95% CI 89.7 to 94.8) vs 77.8% (95% CI 72.8 to 82.7); p < 0.001) and with femoral components sized ≥ 50 mm (91.7% (95% CI 88.7 to 94.7) vs 82.3% (95% CI 78.4 to 86.2); p < 0.001). Failure was mostly due to aseptic loosening (42 hips; 6%) and ARMD (27 hips; 3.9%). The mean postoperative OHS was 31.9 (SD 13.5) for patients requiring revision and 41.8 (SD 9.2) for those not requiring revision (p < 0.001). Predictive factors of failure in the regression model included sex, the angle of inclination and migration of the acetabular component, the postoperative OHS and the blood chromium ion levels (Pseudo-R² 0.279). Standardized regression coefficients were greatest for migration of the acetabular component (0.855) and OHS (-0.606).</p><p><strong>Conclusion: </strong>This study presents the longest reported follow-up for the Durom MoM-HR, with excellent survival and functional outcomes at 15 years' follow-up in males and with ≥ 50 mm femoral components. Most failures were due to aseptic loosening. Migration of the acetabular component and symptomatology (OHS) were the factors which most strongly predicted failure.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"55-61"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral head reduction osteotomy with simultaneous periacetabular osteotomy for severe femoral head deformities.","authors":"Paulo Rego, Ines Mafra, Rui Viegas, Carlos Silva, Reinhold Ganz","doi":"10.1302/0301-620X.107B6.BJJ-2024-1009.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1009.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to describe femoral head reduction osteotomy (FHRO) and review its safety, the radiological correction which may be obtained, and the clinical results at a minimum follow-up of two years.</p><p><strong>Methods: </strong>A total of 12 patients (12 hips) with a severe deformity of the femoral head, mainly from Perthes' disease, underwent FHRO using the surgical hip dislocation technique with an extended retinacular flap. Their mean age was 17 years (12 to 25). Radiographs were obtained before and after surgery to evaluate morphological parameters, articular congruence, and cartilage damage. Preoperative arthro-MRI was used to evaluate the condition of the cartilage and the spatial distribution of the damage. The clinical outcome was assessed using the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS).</p><p><strong>Results: </strong>At a mean follow-up of 4.6 years (2 to 9), all osteotomies had healed unremarkably and no patient had symptomatic avascular necrosis. The mean femoral head size index changed significantly from 120% (SD 10) before surgery to 100% (SD 10) after surgery (p = 0.004). The mean femoral head sphericity index also changed significantly from 71% (SD 10) to 91% (SD 7) (p = 0.002). The mean femoral head extrusion index changed significantly from 37% (SD 17) to 9% (SD 6) (p = 0.002). The mean NAHS score improved significantly from 41 (SD 18) to 69 points (SD 9) (p = 0.002). The mean HOS score also improved significantly from 56 (SD 24) to 83 (SD 17) (p = 0.010) and the mean mHHS score improved significantly from 46 (SD 15) to 76 points (SD 13) (p = 0.004).</p><p><strong>Conclusion: </strong>Thus far, in this series, FHRO could be considered to be a safe surgical procedure with considerable potential for correcting severe deformities of the hip and improving patient-reported outcome measures.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"76-83"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving a neutral hip-to-calcaneus axis in kinematically aligned total knee arthroplasty equalizes coronal hindfoot pressure balance at initial ground contact in the gait cycle.","authors":"Yuma Onoi, Tomoyuki Kamenaga, Naoki Nakano, Masanori Tsubosaka, Yuichi Kuroda, Shinya Hayashi, Ryosuke Kuroda, Tomoyuki Matsumoto","doi":"10.1302/0301-620X.107B6.BJJ-2024-1191.R1","DOIUrl":"10.1302/0301-620X.107B6.BJJ-2024-1191.R1","url":null,"abstract":"<p><strong>Aims: </strong>Evaluating plantar pressure distribution and coronal lower limb alignment, including the hindfoot, using the hip-to-calcaneus axis, known as the ground mechanical axis (GA), is valuable in total knee arthroplasty (TKA). This study aimed to compare postoperative changes in plantar pressure distribution and lower limb alignment between mechanically aligned TKA (MA-TKA) and ground kinematically aligned TKA (gKA-TKA), targeting neutral GA.</p><p><strong>Methods: </strong>After 1:1 propensity score matching, 35 pairs of patients with end-stage osteoarthritis of the knee, who underwent gKA-TKA and MA-TKA with similar preoperative disability between September 2019 and March 2022, were compared. Plantar pressure distribution during walking and unipedal stance was measured preoperatively and one year postoperatively using a pressure plate. The hip-knee-calcaneus angle (HKC) (positive values = valgus) and the percentage of the GA passing position at the knee joint (%GA; medial edge, 0%; lateral edge, 100%) were assessed on long-leg radiographs in unipedal stance.</p><p><strong>Results: </strong>MA-TKA showed a medial loading pattern in the hindfoot. gKA-TKA exhibited a nearly equal pressure distribution in the coronal plane of the hindfoot. Postoperative centre-of-pressure path length during unipedal stance was significantly better for gKA-TKA than MA-TKA (p = 0.043). Furthermore, mean HKC angle and mean %GA of the MA-TKA were 2.0° (SD 2.4°) and 54.2% (SD 9.0%), respectively; those of the gKA-TKA were -0.2° (SD 1.0°) and 49.6% (SD 5.0%), respectively. Significant correlations were observed between the HKC angle (r = 0.391 (95% CI 0.172 to 0.573)) or %GA (r = 0.343 (95% CI 0.117 to 0.535)) and the hindfoot plantar pressure pattern in the coronal plane, indicating that postoperative lower limb valgus deformity in the hip-to-calcaneus axis results in a medial loading pattern.</p><p><strong>Conclusion: </strong>gKA-TKA can provide more neutral weightbearing in the GA, more equal coronal hindfoot pressure during walking, and improved stability in unipedal stance compared with MA-TKA.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"604-614"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing surgical practice.","authors":"Fares S Haddad","doi":"10.1302/0301-620X.107B6.BJJ-2025-0543","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2025-0543","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6","pages":"579-581"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of 1.5-stage stem hybrid fixation versus two-stage exchange arthroplasty for periprosthetic hip infection : is a 1.5-stage exchange equivalent?","authors":"Jesus M Villa, Shayan Hosseinzadeh, Katherine Rajschmir, Jorge Manrique-Succar, Carlos A Higuera-Rueda, Aldo M Riesgo","doi":"10.1302/0301-620X.107B6.BJJ-2024-1088.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-1088.R1","url":null,"abstract":"<p><strong>Aims: </strong>Two-stage exchange arthroplasty is frequently used to treat periprosthetic hip infection. Nevertheless, particularly in high-risk patients, there has been increased attention towards single-surgery options such as 1.5-stage exchange. Therefore, we sought to compare 1.5- and two-stage patients and determine: 1) baseline demographic details, comorbidities, infection, surgical, and inpatient characteristics; 2) re-revision rates and causes, hip pain and implant loosening of surviving implants, success/failure according to the Musculoskeletal Infection Society (MSIS) outcome reporting tool, and mortality at latest follow-up; and 3) whether the type of surgery (1.5- vs two-stage) is a re-revision predictor.</p><p><strong>Methods: </strong>We undertook a retrospective review of 73 patients who underwent either 1.5-stage stem hybrid fixation (n = 43) or two-stage exchange hip arthroplasty (n = 30) at a single institution (March 2019 to May 2023). Demographic information and variables of interest were compared between groups. Predictors of re-revision were assessed with logistic regression. The mean follow-up was 454 days (23 to 1,620).</p><p><strong>Results: </strong>Our cohorts were not significantly different, except for a higher proportion of 1.5-stage patients classified as American Society of Anesthesiologists (ASA) grade III or IV (77% vs 50%; p = 0.025). There were more prior revisions among 1.5-stage patients (mean 1.5 vs 0.7; p = 0.012), whereas mean length of follow-up and mean operating time were significantly longer among two-stage patients (650 vs 317 days, p = 0.002; and 501.3 (360 to 660) vs 267.2 mins (150 to 420), p < 0.001, respectively). In the 1.5-stage group, there was a significantly higher proportion of periprosthetic infections as a cause of re-revision (80% vs 0%; p = 0.011). Postoperative success or failure (MSIS outcome) and mortality rates were not statistically significantly different. The type of surgery was not a significant re-revision predictor.</p><p><strong>Conclusion: </strong>Our preliminary data suggest that our selective prescription of 1.5-stage revision was associated with significantly more re-revisions due to infection when compared with two-stage patients. We acknowledge the potential benefits of the 1.5-stage strategy, especially among high-risk patients, as it involves a single operation; however, higher reinfection rates must be considered when counselling these patients.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"62-69"},"PeriodicalIF":4.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}