bluuebunny/crossref_metadata_2025_split huggingface dataset:
MID-TERM RESULTS OF THE NEW ENDO-SPACER TECHNIQUE IN TWO-STAGE SEPTIC EXCHANGE SURGERY FOR PERIPROSTHETIC JOINT INFECTION OF THE HIP
Authors: Lausmann C. , Luck S. , Beil F. T. , Citak M. , Gehrke T. 
Published: August 2024

Mechanical failure due to dislocation, fracture and acetabular wear as well as persistence of infection are the main complications associated with the use of hip spacers in the treatment of periprosthetic joint infections (PJI).We have developed a novel, custom-made spacer as part of two-stage septic hip replacement and present the two- to five-year results after reimplantation.We prospectively examined a total of 73 patients over our study period in whom our new spacer technique was used. The technique includes a dual mobility inlay and a cemented straight stem in combination with antibiotic-loaded PMMA bone cement which allows full weight bearing meanwhile the interim period. The follow-up ranged between 24 and 60 months after reimplantation as second stage of a two-stage approach. The patients were contacted as part of the follow-up using a questionnaire concerning reoperation, reinfection as well as hip function by using the Harris Hip Score.72 patients (98,6%) could be reimplanted, one patient is still using the spacer prothesis for 45 months because of excellent functional results with a Harris Hip Score of 95, nevertheless reimplantation is planned. The reinfection rate was less than 7% after reimplantation. The dislocation rate was 5%, and in total there was an overall complication rate of less than 10%. The Harris Hip Score was significantly improved.The ENDO spacer surgical technique is a promising option in the treatment of periprosthetic joint infections (PJI) for two-stage septic exchange with a low dislocation rate and good infection control after reimplantation. In addition, it enables early mobilization with the possibility of full weight-bearing in the interval between spacer implantation and reimplantation.
EFFECTIVE TREATMENT OF SINGLE-STAGE REVISION USING NON-CONTACT LOW FREQUENCY ULTRASONIC DEBRIDEMENT IN TREATING PERIPROSTHETIC JOINT INFECTIONS: A PROSPECTIVE CLINICAL STUDY
Authors: Cao L. 
Published: August 2024

Traditional mechanical debridement can only remove visibly infected tissue and is unable to completely clear all the biofilm that hides within muscle crevices and nerves. This study aims to determine the results of single-stage revision using noncontact low frequency ultrasonic debridement in treating chronic periprosthetic joint infections (PJI).A prospective study of consecutive patients requiring single-stage revision for chronic PJI was performed since August 2021. After mechanical debridement, an 8‑mm handheld non‑contact low‑frequency ultrasound probe was used for ultrasonic debridement at a frequency of (25±5) kHz and power of 90% for 5 minutes. Each ultrasound lasted 10 seconds with 3‑seconds intervals. The probe was repeatedly sonicated among all soft tissue and bsingle interface. The distal femoral canal and the posterior capsule of the knee were fully sonicated with a special right‑angle probe. Chemical debridement was then performed to irrigation the whole operative area. Recurrence of infection, culture results and number of colonies 24 hours after ultrasonic debridement were recorded.A total of 45 patients (25 hips and 20 knees) were included and 43 of them (95.6%) were free of infection at a mean follow-up time of 29 months (24 to 33). There were no intraoperative complications related to ultrasonic debridement (neurovascular and muscle injury, poor wound healing and fat liquefaction). The culture‑positive rate of wound liquid before ultrasonic debridement was 40.0% (18/45), which significantly increased to 75.6% (34/45) after ultrasonic debridement (P=0.001). The median number of colonies 24 hours after ultrasonic debridement was 2372 CFU/ml (310 to 4340 CFU/ml), which was significantly higher than that before debridement (307 CFU/ml; 10 to 980 CFU/ml) (P=0.000).Single-stage revision with non‑contact low‑frequency ultrasonic debridement can fully expose bacteria within biofilm, increase the efficacy of chemical debridement and lead to a favorable short‑term outcome without related complications.
MORE REVISIONS DUE TO INFECTION WITH USE OF REFOBACIN BONE CEMENT R THAN WITH PALACOS R+G: ANALYSIS OF TOTAL HIP ARTHROPLASTIES IN THE SWEDISH ARTHROPLASTY REGISTER 2012 TO 2022
Authors: Kärrholm J. , Itayem R. , Angelomenos V. , Mohaddes M. , Rogmark C. , Rolfson O. 
Published: August 2024

In 2022, approximately 60% of inserted cups and stems in Sweden utilized cemented fixation. Two predominant brands, Refobacin Bone Cement R and Palacos R+G, both incorporating gentamicin, were employed in over 90% of primary cemented Total Hip Arthroplasties (THAs) between 2012 and 2022. This study investigates whether the choice between these cement types affects the risk of revision.The five most frequently used cemented cups and the three most common stems were studied. Inclusion criteria encompassed hips with non-tumour diagnoses, operated through a direct lateral or posterior incision, featuring a 28–36 mm metal or ceramic head. Outcomes were assessed for cup revisions (n=55,457 Refobacin, 37,210 Palacos), stem revisions (n=51,732 Refobacin, 30,018 Palacos), and all-cemented THAs with either brand (n=45,265 Refobacin, 26,347 Palacos). Kaplan-Meier life tables and hazard ratios (HR) utilizing Cox regression were computed, adjusting for age, sex, diagnosis, implant type, femoral head size, and material.Over a 10-year period, the cumulative percent revision with Refobacin was consistently higher than Palacos in all three analyses (cups: Refobacin 2.4 (2.3–2.5), Palacos 2.1 (2.0–2.2); stems: Refobacin 2.6 (2.5–2.7), Palacos 2.1 (2,0–2,2); all-cemented: Refobacin 3.2 (2.9–3.5), Palacos 2.9 (2.6–3.2)). Both unadjusted and adjusted HR were 13–25% lower with Palacos. In the analysis of all-cemented THAs, the adjusted HR for Palacos was 0.85 (0.76–0.95). Separating revisions into infectious and non-infectious reasons revealed a lower risk of infectious revisions with Palacos in all three analyses (all-cemented: adjusted HR infection 0.66 (0.56–0.78); non-infectious 1.10 (0.94–1.28)).Hips cemented with Refobacin may face an increased risk of infection, potentially due to a smaller release of antibiotics into surrounding tissues. Unaccounted factors like different mixing systems or unknown biases could also influence outcomes, emphasizing the need for further investigation.
THE ROLE OF ANTIBACTERIAL HYDROGEL COATING ON COMPLICATION RISKS AFTER COMPLEX PRIMARY AND CEMENTLESS HIP REVISION ARTHROPLASTY: A RETROSPECTIVE MATCHED COHORT STUDY
Authors: Zagra L. , Ding B. , Sciamanna L. , D'Apolito R. 
Published: August 2024

This study aimed to verify the hypothesis that an antibiotic loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).This was a retrospective study matched cohort study of 238 patients, treated with cementless implants with and without DAC. A sub-group analysis of patients undergoing 2nd stage revision THA for prosthetic joint infection (PJI) was also conducted. Re-infection rates within 2 years, complications necessitating surgical intervention and radiographic analysis for aseptic loosening was assessed.The mean age was 68.3±11.5 years, with 39 (32.8%) Macpherson class A, 64 (53.8%) class B and 16 (13.4%) class C patients. 4 (3.4%) patients in the DAC group developed complications including 1 PJI and 1 delayed wound healing, while 13 (10.9%) patients in the control group developed complications including 5 PJIs and 3 delayed wound healing (p=0.032). PJI rates (p=0.136) and delayed wound healing rates (p=0.337) were not statistically significant. For 2nd stage revision THA for PJI there were 86 patients in the DAC group and 45 in the control group. 1 (1.2%) patient in the DAC group developed complications with no recurrences of infection or delayed wound healing, while 10 (22.2%) patients in the control group developed complications including 4 recurrent PJI and 1 delayed wound healing (p=0.003). Recurrent PJI rates were statistically significant (p=0.005) while delayed wound healing rates were not (p=0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% vs 6.7%; p=0.015).Antibiotic impregnated hydrogel coatings on cementless implants showed decreased complication rates after complex primary or revision THA. In 2nd stage revision THA for PJI, it was associated with reduced risk of re-infection and aseptic loosening.
A STANDARD OF CARE IN HIP ARTHROPLASTY: ROUTINE USE OF THE TENDON-SPARING SPAIRE TECHNIQUE WITH MAKO ROBOTIC ASSISTANCE
Authors: Timperley A. J. 
Published: August 2024

The SPAIRE technique (Saving Piriformis And Internus, Repair Externus) was first described in 2016 and an approach to the hip in the interval between the inferior gemellus and quadratus femoris can be used for both hemi- and total hip arthroplasty.The HemiSPAIRE technique in hip hemiarthroplasty for displaced intracapsular fractures has been compared with the standard lateral approach (advocated by NICE) in a pragmatic, superiority, multicentre, randomised controlled trial into postoperative mobility and function. This NIHR funded study was recruited between November 2019 and April 2022 and the results are reported in this presentation.The author has used the SPAIRE technique in 1026 routine primary total hip replacements since February 2016. The technique is described along with results from NJR data.SPAIRE is most challenging in patients with small anatomy, reduced offset, with an external rotation deformity. Particularly in these, but in all cases, MAKO robotic assistance facilitates accurate implantation of prostheses and precise recreation of biomechanics. The MAKO robot has been used in all cases since 2018 and SPAIRE/MAKO is now the standard of care in the author's practice.To evaluate whether robotic-assisted tendon-sparing posterior approaches (piriformis sparing and SPAIRE), improve patient outcomes in total hip arthroplasty compared with a robotic-assisted standard posterior approach, the NIHR Efficacy and Mechanism Evaluation Programme has recently funded the HIPSTER trial (HIP Surgical Techniques to Enhance Rehabilitation). This is a single-centre, double-blinded, parallel three-arm, randomised, controlled, superiority trial; recruitment is in progress.The greatest value of robotic assistance may be when it is used in combination with tendon-sparing surgery. Data is being gathered to evaluate whether the SPAIRE/MAKO technique confers benefits with regard the speed of post-op mobilisation as well as accelerated return to unrestricted function.
RIM-POINT-COLUMN-ORIENTED ALGORITHM IN CEMENTLESS ACETABULAR RECONSTRUCTION IN REVISION TOTAL HIP ARTHROPLASTY: A MINIMUM FIVE-YEAR FOLLOW-UP STUDY
Authors: Zhou Y. 
Published: August 2024

The Paprosky acetabular bone defect classification system and related algorithms for acetabular reconstruction cannot properly guide cementless acetabular reconstruction in the presence of porous metal augments.We aimed to introduce a rim, points, and column (RPC)-oriented cementless acetabular reconstruction algorithm and its clinical and radiographic outcomes.A total of 123 patients (128 hips) were enrolled. A minimum 5-year radiographic follow-up was available for 96 (75.8%) hips. The mean clinical and radiographic follow-up durations were 6.8±0.9 (range: 5.2–9.2) and 6.3±1.9 (range: 5.0–9.2) years, respectively.Harris hip score (HHS) improved significantly from 35.39±9.91 preoperatively to 85.98±12.81 postoperatively (P<0.001). Among the fixation modes, 42 (32.8%) hips were reconstructed with rim fixation, 42 (32.8%) with three-point fixation without point reconstruction, 40 (31.3%) with three-point fixation combined with point reconstruction, and 4 (3.1%) with three-point fixation combined with pelvic distraction. Complementary medial wall reconstruction was performed in 20 (15.6%) patients. All acetabular components were radiographically stable. Nine-year cumulative Kaplan–Meier survival rates for 123 patients with the endpoint defined as periprosthetic joint infection, any reoperation, and dissatisfaction were 96.91% (confidence interval [CI]: 86.26%, 99.34%), 97.66% (CI: 92.91%, 99.24%), and 96.06% (CI: 86.4%, 98.89%), respectively.Cup stability in cementless acetabular reconstruction depends on rim or three-point fixation. The continuity of the anterior and posterior columns determines whether the points provide adequate stability to the cup. Medial wall reconstruction is an important complementary fixation method for rim or three-point fixation. The patients who underwent cementless acetabular reconstruction guided by the RPC decision-making algorithm demonstrated satisfactory mid-term clinical function, satisfaction levels, radiographic results, and complication rates.
FIVE-YEAR RESULTS OF THE NEW-GENERATION CUSTOM-MADE ACETABULAR TRIFLANGE FOR LARGE ACETABULAR DEFECTS: A PROSPECTIVE CASE SERIES
Authors: Hellemondt van G. G. , Colo E. , Faraj S. S. A. , Hooff van M. , Spruit M. 
Published: August 2024

The objective of this study was to assess the clinical and radiological results of patients who were revised using a new generation custom-made triflange acetabular component (CTAC) for component loosening and large acetabular defect (Paprosky 3A and 3B) after previous total hip arthroplasty (THA). New generation CTACs involve the use of patient-specific drill guides and incorporate three-dimensional printed bone models, enhancing precision during surgical implantation.Data were extracted from a single centre prospective database of patients with large acetabular defects who were treated with a new generation CTAC. Patients were included if they had a minimum follow-up of five years. The modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at two- and five-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance (p<0.05).A total of 49 (70%) of 70 patients with a mean age of 73.5 years (SD 7.7) had a complete follow-up of 5 years. A significant improvement was found in HOOS, mOHS, EQ-5D-3L utility and NRS, VAS pain rest and activity between baseline and final follow-up. Complications included 8 cases with loosening screws, 4 with bony fractures, 4 periprosthetic infections and 2 cases with dislocation. One patient with bilateral pelvic discontinuity had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage.New generation CTAC in patients with THA acetabular loosening and massive acetabular bone loss (Paprosky 3A and 3B) can result in stable constructs and significant improvement in functioning and health-related quality of life at five years’ follow-up.
THE ASSOCIATION OF BEARING SURFACE MATERIALS WITH THE RISK OF REVISION FOLLOWING PRIMARY TOTAL HIP ARTHROPLASTY: A COHORT ANALYSIS OF 1,026,481 HIP ARTHROPLASTIES FROM THE NATIONAL JOINT REGISTRY
Authors: Whitehouse M. R. , Patel R. , French J. , Beswick A. , Navvuga P. , Marques E. , Blom A. , Lenguerrand E. 
Published: August 2024

We investigated the revision rates of primary total hip replacement (THR) reported in the National Joint Registry (NJR) by types of bearing surfaces used.We analysed THR procedures across all orthopaedic units in England and Wales. Our analyses estimated all-cause and cause-specific revision rates. We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with head and shell/liner combinations. We used flexible parametric survival models to estimate adjusted hazard ratios (HR).A total of 1,026,481 primary THRs performed between 2003–2019 are included in the primary analysis (Monobloc: n=378,979 and Modular: n=647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n=7,381 and Modular: n=13,488).Compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the all-cause risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome or stainless steel head and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any post-operative period.Compared to patients with a cobalt chrome head and HCLPE liner primary THR, the all-cause risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic or oxidised zirconium head and HCLPE liner had a lower risk of revision throughout the entire post-operative period.The all-cause and indication-specific risk of prosthesis revision, at different time points following the initial implantation, is lower for implants with a delta ceramic or oxidised zirconium head and a HCLPE liner/cup than commonly used alternatives such as cobalt chrome heads and HCLPE liner/cup.
INFLUENCE OF MANUFACTURING CHARACTERISTICS OF HIGHLY CROSS-LINKED POLYETHYLENE ON FEMORAL HEAD PENETRATION IN TOTAL HIP ARTHROPLASTY: A TEN- TO 20-YEAR FOLLOW-UP STUDY
Authors: Garcia-Rey E. 
Published: August 2024

Highly cross-linked polyethylene (HXLPE) has decreased wear and revision rates in total hip replacement (THR) at a long-term. However, the effect of HXLPE manufacturing characteristics on femoral head penetration has not been clearly defined yet. We report this single-institution study to investigate the clinical and radiological results of different HXLPE liners in THR.In this retrospective cohort analysis of our prospective database, we identified 904 THRs performed between 2000 and 2013. Seven different HXLPE liner types were assessed: remelted (3), annealed (2), sequentially annealed (1) and vitamin E-infused (1). The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Roman Software v1.70 package.Thirty hips were revised for the following reasons: aseptic loosening (11), dislocation (12), periprosthetic femoral fracture (6), and infection (1). No hip was revised for wear or osteolysis. 741 THRs were evaluated for a mean follow-up of 15 years (range, 10 to 20). The mean total penetration 15 years after THR was 0.17 mm in the sequentially annealed, and 0.16 mm in the vitamin E-infused groups, whereas it was 0.26 mm in the melted 95 kGy, 0.27 mm in the melted 5 Mrad and 0.25 mm in the melted 100 kGy groups (p=0.001). From one to 15 years after surgery, the mean wear was 0.206 mm in cups with an acetabular inclination greater than 50º and 0.105 mm in those placed between 35º and 50º (p<0.001).Although HXLPE characteristics can result in a different wear performance in patients undergoing THR at a mean follow-up of 15 years, the clinical results are excellent. The position of the acetabular component can influence on the femoral head penetration of modern HXLPEs. Nevertheless, these patients should continue to be monitored to detect future problems.
BERNESE PERIACETABULAR OSTEOTOMY TO TREAT DEVELOPMENTAL HIP DYSPLASIA: THE LONG-TERM BOSTON EXPERIENCE
Authors: Millis M. B , Maroyan A. , Mendola L. , Matheney T. 
Published: August 2024

The periacetabular osteotomy(PAO) is an effective common hip-preserving procedure to treat symptomatic acetabular dysplasia of the hip (DDH). The literature regarding truly long-term patient outcomes after PAO remains limited. We sought to evaluate our patient cohort treated by PAO 25 to 33 years ago to identify factors positively and negatively associated with durable therapeutic success.219 dysplastic hips (183 patients) underwent PAO between August 1991 and December 1999 by a single surgeon. 164 hips in 134 patients were retrospectively evaluated at minimum of 25 years and maximum of 33 years post-operatively. Hips were evaluated using the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) postoperatively. Osteotomy failure was defined as WOMAC pain score of >/=10 or the need for total hip arthroplasty (THA). 7 patients (7 hips) had died - none of whom had THR. 142/176 remaining patients were located. All patients returned questionnaires; some were seen in person with images.Of patients analyzed to date, 109 hips (63%) were asymptomatic/mildly symptomatic with a preserved hip. 58 hips (33%) had undergone THA. 7 preserved hips (5%) were symptomatic (WOMAC>10). Patients with THA were slightly older than asymptomatic patients (54 ± 8 years vs. 50 ± 11 years; p=0.08), as they had been at time of PAO. Most patients were female (83%), with 89% of hip replacement patients being female. 4/58 replaced hips had been revised - 3 for instability and 1 for acetabular loosening. Data collection is ongoing as more patients are located and reviewed.Long-term follow-up of patients is challenging. Review after minimum of 25 years of the Boston cohort treated with PAO after minimum of 25 years dysplasia reveals that most at long-term follow-up report high levels of function, whether or not they had required arthroplasty, although 33% had required interim treatment with THA.
MIXED-REALITY GUIDANCE FOR PELVIC OSTEOTOMY AND ACETABULAR REALIGNMENT: PROOF OF CONCEPT
Authors: Heimann A. F. , Kowal J. H. , Lane P. M. , Amundson A. J. , Tannast M. , Murphy S. B. 
Published: August 2024

Mixed Reality has the potential to improve accuracy and reduce required dissection for the performance of peri-acetabular osteotomy. The current work assesses initial proof of concept of MR guidance for PAO.A PAO planning module, based on preoperative computed tomography (CT) imaging, allows for the planning of PAO cut planes and repositioning of the acetabular fragment. 3D files (holograms) of the cut planes and native and planned acetabulum positions are exported with the associated spatial information. The files are then displayed on mixed reality head mounted device (HoloLens2, Microsoft) following intraoperative registration using an FDA-cleared mixed reality application designed primary for hip arthroplasty (HipInsight). PAO was performed on both sides of a bone model (Pacific Research). The osteotomies and acetabular reposition were performed in accordance with the displayed holograms. Post-op CT imaging was performed for analysis. Cutting plane-accuracy was evaluated using a best-fit plane and 2D angles (°) between the planned and achieved supra (SA)- and retroacetabular (RA) osteotomy and retroacetabular and ischial osteotomies (IO) were measured.To evaluate the accuracy of acetabular reorientation, we digitized the acetabular rim and calculated the acetabular opening plane. Absolute errors of planned and achieved operative inclination and anteversion (°) of the acetabular fragment, as well as 3D lateral-center-edge (LCE) angles were calculated.The mean absolute difference between the planned and performed osteotomy angles was 3 ± 3°.The mean absolute error between planned and achieved operative anteversion and inclination was 1 ± 0° and 0 ± 0° respectively. Mean absolute error between planned and achieved 3D LCE angle was 0.5 ± 0.7°.Mixed-reality guidance for the performance of pelvic osteotomies and acetabular fragment reorientation was feasible and highly accurate. This solution may improve the current standard of care by enabling reliable and precise reproduction of the desired acetabular realignment.