bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHAT IS THE CONTEMPORARY MANAGEMENT OF ACETABULAR RETROVERSION?
Authors: Witt J. , Logishetty K. , Mazzoleni M. 
Published: July 2023

Acetabular retroversion (ARV) is a cause of femoroacetabular impingement leading to hip pain and reduced range of motion. We aimed to describe the radiological criteria used for diagnosing ARV in the literature and report on the outcomes of periacetabular osteotomy (PAO) and hip arthroscopy (HA) in its management.A systematic review using PRISMA guidelines was conducted on the MEDLINE, CINAHL, EMBASE, COCHRANE database in December 2022. English-language studies reporting outcomes of PAO, or open or arthroscopic interventions for ARV were included.From an initial 4203 studies, 21 non-randomised studies met the inclusion criteria.Eleven studies evaluated HA for ARV, with average follow-up ranging from 1 to 5 years, for a cumulative number of 996 patients. Only 3/11 studies identified ARV using AP standardized pelvic radiographs. The most frequent signs describing ARV identified were: Ischial Spine Sign (98% of patients), Posterior Wall Sign (PWS, 94%) and Crossover Sign (COS, 64%); with mean Acetabular Retroversion Index (ARI) ranging from 33% to 35%. 39% of HA patients had all three radiographic signs. Clinically significant outcomes were reached by 33–78% of patients.Eight studies evaluated PAO for ARV, with a follow-up ranging from 2 to 10 years, for a cumulative number of 379 patients. Five of the eight studies identified ARV using standardized radiographs. ISS, COS and PWS were positive in 54%, 97% and 81% of patients, respectively with 52% of PAO patients having all three radiographic signs. Mean ARI ranged from 36–41%. Clinically significant results were reported in 71%–78% of patients.The diagnostic criteria for ARV is poorly defined in the literature, and the quality of evidence is low. Studies on HA are more likely to have used lenient diagnostic criteria. It remains difficult to recommend which cases maybe more suitable for treatment by HA rather than PAO.
GANZ HEAD REDUCTION OSTEOTOMY FOR THE TREATMENT OF FEMORAL HEAD DEFORMITIES: RADIOLOGICAL AND FUNCTIONAL OUTCOMES
Authors: Massè A. , Giachino M. , Audisio A. , Donis A. , Secco D.C. , Turchetto L. , Limone B. , Via R. Giai , Aprato A. 
Published: July 2023

Ganz's studies made it possible to address joint deformities on both femoral and acetabular side brought by the Legg-Calvè-Perthes disease (LCPD). Femoral head reduction osteotomy (FHRO) was developed to improve joint congruency along with periacetabular osteotomy (PAO). The purpose of this study is to show the clinical and morphologic outcomes of the technique, and an implemented planning approach.From 2015 to 2023, 13 FHROs were performed on 11 patients for LCPD, in two centers. 11 of 13 hips had an associated PAO. A specific CT and MRI-based protocol for virtual simulation of the corrections was developed. Outcomes were assessed with radiographic parameters (sphericity index, extrusion index, integrity of the Shenton's line, LCE angle, Tonnis angle, CCD angle) and clinical parameters (ROM, VAS, Merle d'Aubigné-Postel score, modified-HHS, EQ5D-5L). Early and late complications were reported.The mean follow-up was 40 months. The mean age at surgery was 11,4 years. No major complications were recorded. One patient required a total hip arthroplasty. Femoral Head Sphericity increased from 45% to 70% (p < 0,001); LCE angle from 18° to 42,8° (p < 0,001); extrusion Index from 36,6 to 8 (p < 0,001); Tonnis Angle from 14,4° to 6,2° (p = 0.1); CCD Angle from 131,7 to 136,5° (p < 0,023). The VAS score improved from 3,25 to 0,75,(p = 0.06); Merle d'Aubigné-Postel score from 14.75 to 16 (p = 0,1); Modified-HHS from 65,6 to 89,05 (p = 0,02). The EQ 5D 5L showed significant improvements. ROM increased especially in abduction and extra-rotation.FHRO associated with periacetabular procedures is a safe technique that showed improved functional, clinical and morphologic outcomes in LCPD. The newly introduced simulation and planning algorithm may help to further refine the technique.
MID-TERM RESULTS OF AUTOLOGOUS MATRIX-INDUCED CHONDROGENESIS (AMIC) USED FOR LARGE CHONDRAL DEFECTS IN FEMOROACETABULAR IMPINGEMENT HIPS
Authors: Briem T. , Stadelmann V. A. , Rüdiger H. A. , Leunig M. 
Published: July 2023

Femoroacetabular impingement is a prearthritic deformity frequently associated with early chondral damage. Several techniques exist for restoring larger cartilage defects. While AMIC proved to be an effective treatment in knee and ankle, there are only short-term data available in hip. This study aimed to investigate the mid-term clinical outcome of patients with chondral lesions treated by AMIC and evaluate the quality of repair tissue via MRI.This retrospective, single center study includes 18 patients undergoing surgical hip dislocation for FAI between 2013 and 2016. Inclusion criteria were: cam or pincer-type FAI, femoral or acetabular chondral lesions > 1 cm2, (IRCS III-IV). Due to exclusion criteria and loss-to-follow-up 9 patients (10 hips) could be included. Patient reported outcome measures included Oxford Hip Score (OHS) & Core Outcome Measure Index (COMI)). MRIs were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score.None of the patients underwent revision surgery except screw removals from the greater trochanter. Followup data indicate a satisfactory to good hip function at 5 years: PROMS improved from pre- to postop at 5 years: OHS from 38.1 to 43.4, COMI from to 1.8 and UCLA from 4 to 8.1 respectively. MOCART score was 67.5 postoperatively. Subgrouping showed slightly better results for acetabular defects (Ø 69.4) compared femoral defects (Ø 60).Based on the reported mid-term results, we consider AMIC as a valuable treatment option for larger chondral defects of the hip.
CARDIAC FUNCTION IS COMPROMISED IN PATIENTS WITH ELEVATED BLOOD COBALT LEVELS SECONDARY TO METAL-ON-METAL HIP IMPLANTS
Authors: Meek D. , Jenkinson M. , Macmillan S. , Tate R. , Grant H. , Currie S. 
Published: July 2023

Elevated blood cobalt secondary to metal-on-metal (MoM) hip arthroplasties has been shown to be a risk factor for developing cardiovascular complications including cardiomyopathy. Published case reports document cardiomyopathy in patients with blood cobalt levels as low as 13µg/l. Clinical studies have found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. The extent of cardiovascular injury, measured by global longitudinal strain (GLS), in patients with elevated blood cobalt levels has not previously been examined.Sixteen patients with prospectively collected blood cobalt ion levels above 13µg/l were identified and matched with eight patients awaiting hip arthroplasty with no history of cobalt implants. Patients underwent echocardiogram assessment including GLS.Patients with MoM hip arthroplasties had a mean blood cobalt level of 29µg/l compared to 0.01µg/l in the control group. There was no difference or correlation in EF, left ventricular (LV) end systolic dimension, LV end diastolic dimension, fractional shortening, ventricular wall thickness or E/e’ ratio. However, GLS was significantly reduced in patients with MoM hip arthroplasties compared to those without (−15.2% v −18%, (MoM v control) p= 0.0125). Pearson correlation demonstrated that GLS is significantly correlated with blood cobalt level (r= 0.8742, p=0.0009).For the first time, this study has demonstrated reduced cardiac function in the presence of normal EF as assessed by GLS in patients with elevated cobalt above 13µg/l. As GLS is a more sensitive measure of systolic function than EF, routine echocardiogram assessment including GLS should be performed in all patients with MoM hip arthroplasties and elevated blood cobalt.
METAL LEVELS AND GLOMERULAR FILTRATION RATE AFTER BIRMINGHAM HIP RESURFACING
Authors: Engh C. A. , Bhal V. , Hopper R. H. 
Published: July 2023

When the Birmingham Hip Resurfacing (BHR) metal-on-metal implant system was approved by the United States Food and Drug Administration in 2006, a multicenter, prospective, post-approval study (PAS) was required. This study uses data from the PAS to investigate metal level and glomerular filtration rate (GFR) trends over the first decade in vivo.Between October 2006 and March 2011, 290 primary BHR procedures were performed among 262 patients at 5 sites. Whole blood samples were sent to a single specialized laboratory to determine GFR, cobalt (Co) and chromium (Cr) levels. The population for this study consists of 117 unrevised unilateral patients with a mean age at surgery of 51.3±6.5 years who had pre-operative, 1-year, 4-year, 5-year and 10-year laboratory data. The mean follow-up for these patients that included 36 females was 10.1±0.2 years.Median metal levels at 1-year increased relative to pre-operative values for Co (by a factor of 9.7 from 0.13 to 1.26 ppb, p<0.001) and Cr (by a factor of 2.5 from 0. 60 to 1.50 ppb, p<0.001). Metal levels subsequently remained relatively constant over time with a median 10-year value of 1.12 ppb for Co and 1.29 ppb for Cr. Based on 585 blood samples from all 117 patients, there was no relationship between GFR and Co (→=−0.06, p=0.14) or Cr (→=0.05, p=0.27) levels. However, lower pre-operative GFR values were associated with larger increases in Co at 1-year relative to the pre-operative level (→=−0.26, p=0.005). There was no relationship between pre-operative GFR values and changes in Cr at 1 year (→=−0.13, p=0.15).Through the first decade in vivo, elevated whole blood metal levels for unilateral BHR patients do not appear to adversely affect GFR. However, patients with lower pre-operative GFR values tend to have larger increases in their Co level at 1-year.
IS A TYPE 2B SHORT STEM ADEQUATE IN PATIENTS WITH PROXIMAL FEMORAL DEFORMITIES?
Authors: Díaz-Dilernia F. , Slullitel P. , Zanotti G. , Comba F. , Buttaro M. 
Published: July 2023

We sought to determine the short to medium-term clinical and radiographic outcomes using a short stem in young adults with a proximal femoral deformity (PFD).We prospectively studied 31 patients (35 hips) with PFDs treated with an uncemented primary THA using a short stem with cervicometaphyseal fixation between 2011–2018. There were 19 male (23 hips) and 12 female (12 hips) patients, with a mean BMI of 26.7±4.1 kg/m2. Twelve cases had a previous surgical procedure, and six of them were failed childhood osteotomies. Mean age of the series was 44±12 years, mean follow-up was 81±27 months and no patients were lost to follow-up. PFDs were categorized according to a modified Berry´s classification. Average preoperative leg-length discrepancy (LLD) was −16.3 mm (−50 to 2).At a mean time of 81 months of follow-up, survival rate was 97% taking revision of the stem for any reason and 100% for aseptic loosening as endpoints. No additional femoral osteotomy was required in any case. Average surgical time was 66 minutes (45 to 100). There was a significant improvement in the mHHS score when comparing preoperative and postoperative values (47.3±10.6 vs. 92.3±3.7, p=0.0001). Postoperative LLD was in average 1 mm (−9 to 18) (p=0.0001). According to Engh's criteria, all stems were classified as stable without signs of loosening. Postoperative complications included 1 pulmonary embolism, 1 neurogenic sciatic pain, 1 transient sciatic nerve palsy that recovered completely after six months, and 2 acute periprosthetic joint infections. One patient suffered a Vancouver B2 periprosthetic femoral fracture 45 days after surgery and was revised with a modular distally fixed uncemented fluted stem.A type 2B short stem evidenced promising outcomes at short to medium-term follow up in young adult patients with PFDs, avoiding the need for corrective osteotomies and a revision stem.
DUAL-MOBILITY BEARINGS ARE NO PANACEA IN REVISION TOTAL HIP ARTHROPLASTY FOR RECURRENT DISLOCATION: A SINGLE-CENTRE EXPERIENCE OF 100 UNSTABLE HIPS
Authors: Scholz J. , Perka C. , Hipfl C. 
Published: July 2023

Dual-mobility (DM) bearings are effective to mitigate dislocation in revision total hip arthroplasty (THA). However, data on its use for treating dislocation is scarce. Aim of this study was to compare DM bearings, standard bearings and constrained liner (CL) in revision THA for recurrent dislocation and to identify risk factors for re-dislocation.We reviewed 100 consecutive revision THAs performed for dislocation from 2012 and 2019. 45 hips (45%) received a DM construct, while 44 hips (44%) and 11 hips (11%) had a standard bearing and CL, respectively. Rates of re-dislocation, re-revision for dislocation and overall re-revision were compared. Radiographs were assessed for cup positioning, restoration of centre of rotation, leg length and offset. Risk factors for re-dislocation were determined by cox regression analysis. Modified Harris hip scores (mHHS) were calculated. Mean follow-up was 53 months (1 to 103).DM constructs were used more frequently in elderly patients (p=0.011) and hips with abductor deficiency (p< 0.001). The re-dislocation rate was 11.1% for DM bearings compared with 15.9% for standard bearings and 18.2% for CL (p=0.732). Revision-free survival for DM constructs was 83% (95% CI 0.77 – 0.90) compared to 75% (95% CI 0.68 – 0.82) for standard articulations and 71% (95% CI 0.56 – 0.85) for CL (p=0.455). Younger age (HR 0.91; p=0.020), lower comorbidity (HR 0.42; p=0.031), smaller heads (HR 0.80; p=0.041) and cup retention (HR 8.23; p=0.022) were associated with re-dislocation. Radiological analysis did not reveal a relationship between restoration of hip geometry and re-dislocation. mHHS significantly improved from 43.8 points to 65.7 points (p<0.001) with no differences among bearing types.Our findings suggest that DM bearings do not sufficiently prevent dislocation in revision THA for recurrent dislocation. Reconstruction of the abductor complex may play a key role to reduce the burden in these high-risk patients.
BERNESE PERIACETABULAR OSTEOTOMY FOR SEVERE ACETABULAR DYSPLASIA: MID-TERM OUTCOMES ARE ENCOURAGING
Authors: Petrie J. R. , Nepple J. J. , Thapa S. , Schoenecker P. L. , Clohisy J. C. 
Published: July 2023

The periacetabular osteotomy (PAO) is a well-described procedure for symptomatic acetabular dysplasia. For severe acetabular deformities, the efficacy of acetabular reorientation remains controversial and the literature on mid to long-term outcomes is limited. The purpose of this study was to analyze average 10-year clinical and radiographic results of the PAO for severe acetabular dysplasia.We retrospectively analyzed a consecutive series of patients undergoing PAO for severe acetabular dysplasia as defined by LCEA < 5˚. Patient demographics, radiographic measurements, modified Harris Hip score (MHHS), UCLA activity, SF-12, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed.Sixty-eight patients (82 hips; 54 females) with an average age 20.7 and BMI of 24.4 kg/m2 were included. Mean follow-up was follow up was 10.3 years. . The LCEA and ACEA improved a mean of 32.8˚ (8.4˚ to 24.4˚, p<0.0001) and 31.6˚ (−4.9˚ to 26.7˚, p< 0.0001), respectively. MHHS improved an average of 17.5 points (64.6 to 82.3, p<0.0001), WOMAC Pain subscore improved an average of 21.1 points (65.7 to 85.0, p = 0.004), and SF-12 physical improved 11.8 points (from 40.3 to 50.6, p = 0.006). Activity improved as indicated by a 1.5-point increase in the UCLA Activity score (6.4 to 7.9, p=0.005). Six hips (9.1%) converted to THA at average 6.8 years post-PAO. Kaplan-Meier survival analysis with THA as the endpoint was 92% at 15 years (95% confidence interval [CI] (81%–96%). Multivariable linear regression analysis revealed concurrent osteochondroplasty was associated with a decreased risk of PAO failure.PAO is an effective treatment for severe acetabular dysplasia. At average 10.3 years, clinical and radiographic outcomes demonstrate pain relief, improved hip function, and major deformity correction. We observed minimal clinical deterioration over time.
PERIACETABULAR OSTEOTOMY USING CT-BASED NAVIGATION: PREOPERATIVE PLANNING AND ACCURACY EVALUATION
Authors: Inaba Y. , Tezuka T. , Choe H. , Ike H. 
Published: July 2023

Rotational acetabular osteotomy (RAO), one of periacetabular osteotomies, is an effective joint-preserving surgical treatment for developmental dysplasia of the hip. Since 2013, we have been using a CT-based navigation for RAO to perform safe and accurate osteotomy. CT-based navigation allows precise osteotomy during surgery but cannot track the bony fragment after osteotomy. Thus, it is an issue to achieve successful reorientation in accordance with preoperative planning. In this presentation, we introduce a new method to achieve reorientation and evaluate its accuracy.Thirty joints in which CT-based navigated RAO was performed were included in this study. For the first 20 joints, reorientation was confirmed by tracing the lateral aspect of rotated fragment with navigation and checked if it matched with the preoperative planning. For the latter 10 joints, a new method was adopted. Four fiducial points were made on lateral side of the acetabulum in the preoperative 3-dimensional model and intraoperatively, rotation of the osteotomized bone was performed so that the 4 fiducial points match the preoperative plan.To assess the accuracy of position of rotated fragment in each group, preoperative planning and postoperative CT were compared. A total of 24 radial reformat images of postoperative CT were obtained at a half-hour interval following the clockface system around the acetabulum. In every radial image, femoral head coverage of actual postop- and planned were measured to evaluate the accuracy of acetabular fragment repositioning.The 4-fiducial method significantly reduced the reorientation error. Especially in the 12:00 to 1:00 position of the acetabulum, there were significantly fewer errors (p<0.01) and fewer cases with under-correction of the lateral acetabular coverage.With the new method with 4 reference fiducials, reorientation of the acetabulum could be obtained as planned with lesser errors.
DOES THE FALSE PROFILE VIEW REALLY SHOW ANTERIOR COVER?
Authors: Koller T. , Reisinger C. , Beck M. 
Published: July 2023

To quantify the acetabular coverage of the femoral head, Lequesne's vertical-center-anterior edge (VCA) angle is used on the false profile view. Lateral coverage is determined by Wiberg's lateral-center-edge (LCE) angle on an ap pelvic view. The delimitation of the weightbearing area is defined by the end of the subchondral sclerosis line for both views. To our knowledge the exact anatomic location of the points used for measurement on the acetabular rim are not known.Six hips from three cadaver pelvises (3 male and 3 female) were investigated. The anterior and lateral points of interested were identified radiographically using fluoroscopy and marked with 1mm ceramic bullets. Standard false profile views and ap pelvic views in neutral inclination and rotation were taken to check the correct location of the ceramic bullets. A CT of each pelvis was made to locate the ceramic bullets and to define the exact anatomic location of the measurement points on the o'clock position. 6 o‘clock was defined as the midpoint between anteroinferior and the posteroinferior rim edges. Values were normalized for a right hip.The mean clockface location for the VCA was 1:33 (range, 1:15 to 1:40) and for the LCE 0:38 (range, 0:20 to 0:50).The LCEA is slightly anterior to the 12 o'clock position and remains useful to quantify the lateral coverage. Surprisingly, the point used for measuring the VCA is only about 30° (1h) anterior of the point used for measuring the LCEA. Its value for determining anterior cover has to be questioned. The discrepancy to other studies in the literature is because this study identifies and measures the end of the weight bearing zone, and not the border of the bony acetabulum.
INCIDENCE AND CLINICAL OUTCOME OF LATERAL FEMORAL CUTANEOUS NERVE INJURY AFTER PERIACETABULAR OSTEOTOMY: A PROSPECTIVE THREE-YEAR FOLLOW-UP STUDY
Authors: Yamamoto T. , Fujita J. 
Published: July 2023

Injury of the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) using anterior approach. We previously reported that the incidence of LFCN injury was 48% at 1 year after PAO. However, there was no study examining the sequential changes of LFCN injury status. In this study, we performed a prospective over 3-year follow-up study as to the incidence of LFCN injury as well as its clinical outcomes.This study included 40 consecutive hips in 40 patients (3 males and 37 females) who underwent PAO from May 2016 to July 2018. The mean age at surgery was 36.7 years (17 to 60). The mean observation period was 47.3 months (36 to 69). The incidence and severity of LFCN injury was evaluated, while clinical scores, including the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), were also investigated.At 3 years after PAO, LFCN injury was observed in 13 of 40 (33%) patients, in which 7 patients who had a symptom at 1 year have completely recovered. There was no significant difference in the HHS and SF-36 between patients with and without LFCN injury at 3 years. Regarding the JHEQ, a significant difference was recognized in the patient satisfaction and mental score between patients with and without LFCN injury, but there were no significant differences in the other clinical scores.The incidence of LFCN injury gradually decreased to 33% at 3 years after CPO. LFCN injury did not influence the clinician-reported outcome, while it had a negative impact on patient satisfaction and mental score based on the patient-reported outcome.
THE INCIDENCE OF SUBSEQUENT HIP ARTHROSCOPY AFTER RECTUS-SPARING PERIACETABULAR OSTEOTOMY: SHOULD WE BE LOOKING IN THE JOINT?
Authors: Anderson L. A. , Wylie J. D. , Erickson J. A. , Blackburn B. E. , Peters C. L. 
Published: July 2023

Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular work such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary PAO cohort with no intra-articular work performed at the time of PAO.From June 2012 to March 2022, 368 rectus sparing PAOs were performed and followed for a minimum of one year (mean 5.9 years). The average age was 24 (range 14–46) and 89% were female. Patients were evaluated at last follow-up for patient-reported outcomes (PROMs). Clinical records were reviewed for complications or subsequent surgery. Radiographs were reviewed for the following acetabular parameters: LCEA, ACEA, AI, and the alpha-angle (AA). Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics were used to analyze risk factors for HA.16 hips (15 patients) (4.4%) underwent subsequent HA with labral repair and femoral osteochondroplasty most common. For those with a minimum of two years of follow-up, 5.3% underwent subsequent HA. No hips underwent THA; one revision PAO was performed. 14 hips experienced a complication and 99 underwent hardware removal. All PROMs improved significantly post-operatively. Radiographically 80% of hips were in goal for acetabular correction parameters with no significant differences between those who underwent subsequent HA and those who did not.Rectus sparing PAO is associated with a low rate of subsequent HA for intra-articular pathology at 5-year follow-up. Acetabular correction alone may be sufficient as the primary intervention for the majority of patients with symptomatic acetabular dysplasia.