Summary Background Hip arthroplasty and revision surgery is growing exponentially in OECD countries, but rates vary between countries. Methods We extracted economic data and utilization rates data ...about hip arthroplasty done in OECD countries between 1990 and 2011. Absolute number of implantations and compound annual growth rates were computed per 100,000 population and for patients aged 65 years old and over and for patients aged 64 years and younger. Results In the majority of OECD countries, there has been a significant increase in the utilization of total hip arthroplasty in the last 10 years, but rates vary to a great extent: In the United States, Switzerland, and Germany the utilization rate exceeds 200/100,000 population whereas in Spain and Mexico rates are 102 and 8, respectively. There is a strong correlation between gross domestic product (GDP) and health care expenditures per capita with utilization rate. Utilization rates in all age groups have continued to rise up to present day. A seven fold higher growth rate was seen in patients aged 64 years and younger as compared to older patients. Conclusion We observed a 38-fold variation in the utilization of hip arthroplasty among OECD countries, correlating with GDP and health care expenditures. Over recent years, there has been an increase in the utilization rate in most countries. This was particularly evident in the younger patients. Due to increasing life expectancy and the disproportionally high use of arthroplasty in younger patients we expect an exponential increase of revision rate in the future.
Infrared excesses associated with debris disk host stars detected so far peak at wavelengths around approx, 100 micron or shorter. However, 6 out of 31 excess sources studied in the Herschel Open ...Time Key Programme, DUNES, have been seen to show significant-and in some cases extended-excess emission at 160 micron, which is larger than the 100 micron excess. This excess emission has been attributed to circumstellar dust and has been suggested to stem from debris disks colder than those known previously. Since the excess emission of the cold disk candidates is extremely weak, challenging even the unrivaled sensitivity of Herschel, it is prudent to carefully consider whether some or even all of them may represent unrelated galactic or extragalactic emission, or even instrumental noise. We re-address these issues using several distinct methods and conclude that it is highly unlikely that none of the candidates represents a true circumstellar disk. For true disks, both the dust temperatures inferred from the spectral energy distributions and the disk radii estimated from the images suggest that the dust is nearly as cold as a blackbody. This requires the grains to be larger than approx. 100 micron, even if they are rich in ices or are composed of any other material with a low absorption in the visible. The dearth of small grains is puzzling, since collisional models of debris disks predict that grains of all sizes down to several times the radiation pressure blowout limit should be present. We explore several conceivable scenarios: transport-dominated disks, disks of low dynamical excitation, and disks of unstirred primordial macroscopic grains. Our qualitative analysis and collisional simulations rule out the first two of these scenarios, but show the feasibility of the third one. We show that such disks can indeed survive for gigayears, largely preserving the primordial size distribution. They should be composed of macroscopic solids larger than millimeters, but smaller than a few kilometers in size. If larger planetesimals were present, then they would stir the disk, triggering a collisional cascade and thus causing production of small debris, which is not seen. Thus, planetesimal formation, at least in the outer regions of the systems, has stopped before "cometary" or "asteroidal" sizes were reached.
Purpose
Due to improved prosthesis designs and surgical techniques, indications for total hip arthroplasty (THA) now include younger and more active patients. Preserving bone stock and soft tissue in ...these patients is paramount to allow for future revision. Designed for anatomical reconstruction, short femoral stems have the potential to reduce adaptive bone loss and stress shielding. To confirm this, we evaluated bone remodeling around a short femoral stem and the accuracy of hip joint reconstruction.
Methods
This prospective observational study involved 46 patients with short-stem THA for clinical and radiographic analysis. We evaluated bone remodeling by Gruen zone using dual-energy X-ray absorptiometry in 45 patients and assessed the accuracy of hip joint reconstruction using caput-collum-diaphyseal angles. Additionally, we reported functional scores and pain.
Results
Patients were followed for a mean of 24.1 (SD 2.2) months. Bone mineral density increased mainly in the lateral region (Gruen zones 2 and 3) and in the distal-medial region (Gruen zone 5), suggestive of lateral loading. Most caput-collum-diaphyseal angles remained stable after surgery, especially in patients with varus hips. Harris Hip Scores improved significantly, from 57.2 (SD 20.0) pre-operatively to 97.2 (SD 4.0) at 24 months post-operatively (
P
< 0.0001). Finally, we encountered one peri-operative dislocation but no post-operative complications.
Conclusion
Short femoral stems successfully limited stress shielding and minimized periprosthetic bone loss without compromising primary stability. We were able to accurately reconstruct anatomical relationships in most patients. Finally, excellent clinical outcomes and low complication rates confirmed the favourable results of short-stem THA.
Trial registration: DRKS00017076
One goal of THA is to restore the anatomic hip center, which can be achieved in hips with developmental dysplasia by placing cups at the level of the native acetabulum. However, this might require ...adjuvant procedures such as femoral shortening osteotomy. Another option is to place the cup at the high hip center, potentially reducing surgical complexity. Currently, no clear consensus exists regarding which of these cup positions might offer better functional outcomes or long-term survival.
We performed a systematic review to determine whether (1) functional outcomes as measured by the Harris hip score, (2) revision incidence, and (3) complications that do not result in revision differ based on the position of the acetabular cup (high hip center versus anatomic hip center) in patients undergoing THA for developmental dysplasia of the hip (DDH).
We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, including studies comparing the functional outcomes, revision incidence, and complications of primary THA in dysplastic hips with acetabular cups placed at the high hip center versus those placed at the anatomic hip center, over any time frame. The review protocol was registered with PROSPERO (registration number CRD42020168183) before commencement. Of 238 records, eight comparative, retrospective nonrandomized studies of interventions were eligible for our systematic review, reporting on 207 hips with cups placed at the high hip center and 268 hips with cups at the anatomic hip center. Risk of bias within eligible studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool. Due to low comparability between studies, data could not be pooled, so these studies were assessed without summary effects.
Six studies compared Harris hip scores, two of which favored high hip center cup placement and three of which favored anatomic hip center cup placement, although none of the differences between cohorts met the minimum clinically important difference. Five studies reliably compared revision incidence, which ranged from 2% to 9% for high hip center at 7 to 15 years and 0% to 5.9% for anatomic hip center at 6 to 16 years. Five studies reported intra- and postoperative complications, with the high hip center being associated with higher incidence of dislocation and lower incidence of neurological complications. No clear difference was observed in intraoperative complications between the high hip center and anatomic hip center.
No obvious differences could be observed in Harris hip score or revision incidence after THA for osteoarthritis secondary to DDH between cups placed at the anatomic hip center and those placed at the high hip center. Placement of the acetabular cup in the high hip center may lead to higher risk of dislocation but lower risk of neurologic complications, although no difference in intraoperative complications was observed. Surgeons should be able to achieve satisfactory functional scores and revision incidence using either technique, although they should be aware of how their choice influences hip biomechanics and the need for adjunct procedures and associated risks and operative time. These recommendations should be considered with respect to the several limitations in the studies reviewed, including the presence of serious confounding factors and selection biases, inconsistent definitions of the high hip center, variations in dysplasia severity, small sample sizes, and follow-up periods. These weaknesses should be addressed in well-designed future studies.
Level III, therapeutic study.
In the article titled ‘The history of the development of the regular straight stem in hip arthroplasty’, Wellauer et al. published in this journal, the history of femoral stems in total hip ...arthroplasty (THA) is presented very clearly (1). Of the different types of stems, the authors describe the global tissue-sparing (GTS) stem.
Background
The Bernese periacetabular osteotomy (PAO) continues to be a commonly performed nonarthroplasty option to treat symptomatic developmental hip dysplasia, but there are few long-term ...followup studies evaluating results after PAO.
Questions/purposes
(1) What is the long-term survivorship of the hip after PAO? (2) What were the validated outcomes scores among patients who had PAO more than 14 years ago? (3) What factors are associated with long-term failure?
Methods
One hundred fifty-eight dysplastic hips (133 patients) underwent PAO between May 1991 and September 1998 by a single surgeon. Of those, 37 hips (34 patients 26%) were lost to followup; an additional seven patients (5% eight hips) had not been seen in the last 5 years. The 121 hips (in 99 patients) were retrospectively evaluated at a mean of 18 years (range, 14–22 years). Survivorship was assessed using Kaplan-Meier analysis with total hip arthroplasty (THA) as the endpoint. Hips were evaluated for activity, pain, and general health using the UCLA Activity Score, modified Harris hip score, WOMAC, and Hip disability and Osteoarthritis Outcome Score (HOOS). Failure was defined as a WOMAC pain subscale score ≥ 10 or having undergone THA. Hips were divided into three groups: asymptomatic (did not meet any failure criteria at any point in time), symptomatic (met WOMAC pain failure criteria at previous or most recent followup), and replaced (having undergone THA). A multinomial logistic regression model using a general estimating equations approach was used to assess factors associated with failure.
Results
Kaplan-Meier analysis with THA as the endpoint revealed a survival rate (95% confidence interval CI) of 74% (66%–83%) at 18 years. Twenty-six hips (21%) underwent THA at an average of 9 ± 5 years from the surgery. Sixty-four hips (53%) remained asymptomatic and did not meet any failure criteria at most recent followup. Thirty-one hips (26%) were symptomatic and considered failed based on a WOMAC pain score of ≥ 10 with a mean ± SD of 11 ± 4 out of 20 at most recent followup. Although some failed initially by pain, their most recent WOMAC score may have been < 10. Of the 16 symptomatic hips that failed early by pain (reported a WOMAC pain subscale score ≥ 10 in the prior study), two were lost to followup, two underwent THA at 16 and 17 years, four still failed because of pain at most recent followup, and the remaining eight had WOMAC pain scores < 10 at most recent followup. Asymptomatic hips reported better UCLA Activity Scores (asymptomatic: mean ± SD, 7 ± 2; symptomatic: 6 ± 2, p = 0.001), modified Harris hip scores (pain, function, and activity sections; asymptomatic: 80 ± 11; symptomatic: 50 ± 15, p < 0.001), WOMAC (asymptomatic: 2 ± 2, symptomatic: 11 ± 4, p < 0.001), and HOOS (asymptomatic: 87 ± 11, symptomatic: 52 ± 20, p < 0.001) compared with symptomatic hips at long-term followup. Age older than 25 years at the time of PAO (symptomatic: odds ratio OR, 3.6; 95% CI, 1.3–9.8; p = 0.01; replaced: OR, 8.9; 95% CI, 2.6–30.9; p < 0.001) and a preoperative joint space width ≤ 2 mm (replaced: OR, 0.3; 95% CI, 0.12–0.71; p = 0.007) or ≥ 5 mm (replaced: OR, 0.121; 95% CI, 0.03–0.56; p = 0.007) were associated with long-term failure while controlling for poor or fair preoperative joint congruency.
Conclusions
This study demonstrates the durability of the Bernese PAO at long-term followup. In a subset of patients, there was progression to failure over time. Factors of progression to THA or more severe symptoms include age older than 25 years, poor or fair preoperative hip congruency, and a preoperative joint space width that is less than 2 mm or more than 5 mm. Future studies should focus on evaluating the two failure groups that we have identified in our study: those that failed early and went on to THA and those that are symptomatic at long-term followup.
Level of Evidence
Level III, therapeutic study.
Several methods using simple anteroposterior (AP) radiographs have been suggested for the measurement of anteversion of the cup component after total hip arthroplasty. Herein, we compared six widely ...used anteversion measurement methods using two different types of AP radiograph, the conventional pelvis AP and hip-centered AP radiographs, to identify the measurement method and the type of radiograph that would provide the highest accuracy and reliability.
We developed two custom-made bi-planar anteversion measurement models for the validation test. The models were designed for pelvis AP and hip-centered AP radiographs, respectively. The radiographs were acquired using the inclination angles of both models, changing from 10° to 70° at 10° increments. For each inclination angle, anteversion was changed from 0° to 30° at 5° increments. The measurements were obtained independently by two orthopedic surgeons blinded from each other's measurements, using the methods of 1) Pradhan et al., 2) Lewinnek et al., 3) Widmer et al., 4) Liaw et al., 5) Hassan et al., and 6) Ackland et al. The measurements were repeated after 2 months. The accuracy, compared with that of the reference angle, and intra-observer and inter-observer reliabilities of each method were calculated.
The highest accuracy was found when the method of Liaw et al. was used with hip-centered AP radiographs, which showed a difference of 1.37° ± 1.73 from the reference angle. Moreover, regardless of the type of radiograph, the methods by Pradhan et al., Lewinnek et al., and Liaw et al. showed excellent correlations with the reference anteversion. However, substantial differences were found when the methods by Widmer et al., Hassan et al., and Ackland et al. were used, regardless of the type of radiograph used. When anteversion was measured in an inclination between 30° and 50°, the method of Pradhan et al., when used with pelvis AP radiographs, showed the highest accuracy (1.23° ± 0.92°). We also found no significant difference in anteversions between the measurements made on pelvic and hip-centered AP radiographs. Both interobserver and intraobserver reliabilities were high for all the measurements tested.
The methods by Pradhan et al., Liaw et al., and Lewinnek et al. may provide relatively accurate anteversion measurements with high reliability, regardless of the type of radiograph.
Background
A high hip center total hip arthroplasty (THA) for dysplasia allows more complete socket coverage by native bone at the expense of abnormal hip biomechanics. Despite poor results with ...cemented components, intermediate-term results with cementless cups at a high hip center have been promising, but there are few reports at long-term followup without bone graft.
Questions/purposes
The purpose of this study was to examine (1) survivorship; 2) radiographic results; and 3) hip scores at a minimum of 10 years for patients treated with high hip center cementless THA for Crowe II and III dysplasia without bone graft.
Methods
We reviewed charts and radiographs of 32 patients with Crowe II or III dysplasia who were treated with high hip center cementless THA; at a mean followup of 12 years (range, 10–21 years), 23 patients (27 hips) were available for review. We sought to medialize cups to the inner table to achieve bony coverage of > 75%. At final followup, the WOMAC and Harris hip scores were recorded. Radiographic analysis including computerized wear evaluation was performed. Radiographic parameters were compared with a control group of 23 patients with Crowe I dysplasia who had cementless cups placed at an anatomic hip center; among the high hip center reconstructions, we also compared wear between those in the superolateral and superomedial quadrants.
Results
Kaplan-Meier survivorship for all-cause revisions was 97% (95% confidence interval, 79%–99%) in the high hip center group; this was no different from the anatomic hip center group. There were no revisions for acetabular loosening. Wear rates did not differ significantly between the high hip center and the control group, but lateralized high hip centers were associated with higher (p = 0.002) wear. Hip scores were excellent in both groups.
Conclusions
In Crowe II and III dysplasia, a high hip center cementless cup obviates the need for bone graft and provides durable fixation beyond 10 years. Medialization of these reconstructions seems important to decrease wear.
Level of Evidence
Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
The monograph comprehensively presents the research on the prototype of the biomimetic Multi-Spiked Connecting Scaffold (MSC-Scaffold) for cementless fixation of the components of a new generation of ...resurfacing arthroplasty (RA) endoprostheses. This research, carried out by a bioengineering-surgical team from three Polish universities, includes bioengineering design, rapid prototyping, manufacturing in selective laser melting, functionalization, surface modification, numerical studies, experimental in vitro studies, and pilot surgical experiments in an animal model. Features: Presents the prototype of the multi-spiked connecting scaffold for a new generation of resurfacing endoprostheses of the knee and the hip Explains this prototype scaffold as the first worldwide design of the biomimetic fixation of components of diarthrodial joints resurfacing endoprostheses Insights into the entire process of bioengineering design and research on this novel way of resurfacing endoprostheses fixation Reviews main results of the scaffold prototyping and SLM manufacturing, structural and osteoconductive functionalization, and surface modification Reports experimental and numerical investigations of mechanical behavior of the scaffold-bone system, cell culture studies, and pilot surgical experiments in animal models This book is aimed at professionals and graduate students in biomedical engineering, biomaterials engineering, and bone & joint surgery. The Open Access version of this book, available at http://www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives (CC-BY-NC-ND) 4.0 license.
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