bluuebunny/crossref_metadata_2025_split huggingface dataset:
SHORT- AND LONG-TERM MORTALITY RISK OF TOTAL HIP ARTHROPLASTY IN OBESE PATIENTS: DOES IT CONSTITUTE THA CONTRAINDICATION?
Authors: Panzures Alexis , Param Aava , Van Vliet Rebecca , Akhtar Muhammad Adeel 
Published: July 2023

Osteoarthritis (OA) of the hip is the most common indication for total hip replacement (THR). Obesity is a risk factor for the development of OA and has recently resulted in patients requiring THRs at much younger ages to relieve pain at the joint capsule and restore mobility. However, the impact of obesity on THR mortality is not well understood.An updated systematic review was performed to identify whether an obese BMI should influence patient selection for surgery. Specifically, the impact of obesity on short-term mortality, long-term mortality, and peri- and post-operative complications was assessed with a particular focus on BMI classes.A comprehensive literature search of Ovid Medline and EMBASE in November 2022 identified relevant papers in accordance with PRISMA methodology. After removing duplicates, 2988 articles underwent strict inclusion and exclusion criteria, resulting in 12 papers for analysis.There was no statistically significant difference in mortality risk between obese and non-obese populations. Obesity was associated with a lower risk of short-term mortality than in the normal weight control group, however there was an increased mortality risk in obese patients long-term likely due to comorbidities. Obese patients were significantly younger than normal BMI and underweight patients. However, the paper found increased mortality risk in underweight and morbidly obese patients.Obese patients did not have an increased risk of mortality when compared to non-obese patients following THR. Obesity may have a protective effect on mortality up to a BMI of 40kg/m2, although this may be influenced by the obesity paradox which states only the healthiest obese individuals are selected for surgery, which could attribute to a lower mortality risk. The greatest risk of mortality and complication was associated with underweight patients. As a result, a BMI greater than 30kg/m2 may not necessitate a hip replacement contraindication. It is important surgeons apply careful consideration and comprehensive risk assessment on patients who require a THR, especially at the BMI extremes.
RECONSTRUCTION OF PAPROSKY 3B ACETABULAR DEFECTS WITH POROUS TANTALUM SHELLS AND AUGMENTS IN REVISION TOTAL HIP ARTHROPLASTY USING THE FOOTING TECHNIQUE
Authors: Hube R. , Zimmerer A. , Nonnenmacher L. , Najfeld M. , Fischer M. , Wassilew G. I. 
Published: July 2023

The use of trabecular metal (TM.) shells supported by two TM augments in the footing technique has been described as a potential option for the treatment of Paprosky 3B acetabular defects. The aim of this study was to assess the mid implant survivorship and radiological and clinical outcomes after acetabular revision using this technique.We undertook a retrospective, double-centre series of 39 hips in 39 patients (15 male, 24 female) treated with the footing technique using a TM shell supported by two TM augments, for severe acetabular bone loss between 2007 and 2020. The mean age at the time of surgery was 62,9 (28 to 86) years. The mean follow-up was 5,4 (1,5 to 15) years.The cumulative mid survivorship of the implant with revision for any cause was 89%. 3 hips (7,6%) required further revision due to aseptic loosening, and 1 (2,8%) required revision for infection. The mean Harris Hip Score improved significantly from 48 (29 to 65) preoperatively to 79 points (62 to 98) at the latest follow-up (p < 0.001).The reconstruction of Paprosky 3B acetabular defects with TM shells and two augments in footing-technique showed excellent mid-term results. This technique appears to be a viable option for treating these defects.
THIRTY YEARS’ FOLLOW-UP OF THREE COMMONLY USED FEMORAL STEMS IN THE NORWEGIAN ARTHROPLASTY REGISTER: 1987–2021
Authors: Furnes O. , Lygre S. H. Låstad , Hallan G. , Fenstad A. M. 
Published: July 2023

The Norwegian Arthroplasty Register (NAR) started collecting data on total hip arthroplasty (THA) in 1987. Very long-term results of implants for THA are scarce. We aimed to show long-term results for the three most used femoral stems, operated from 1987.We included the uncemented Corail femoral stem (n=66,309) and the cemented Exeter stem (n=35,050) both of which are currently in frequent use. In addition, we included the Charnley stem (n=32,578, in use until 2014). To ensure comparable conditions, stems fixated with low viscosity cement and stems revised due to infections were excluded. Differences in risk of revision (all reasons and stem revisions) were assessed with Kaplan-Meier and Cox regression analyses with adjustment for possible confounding from age, sex and diagnosis (OA, other). Stem revision was defined as a revision caused by loosening of the stem, dislocation, osteolysis in the femur, or periprosthetic femur fracture, and in which the femoral component was removed or exchanged.The median and max follow-up for Corail, Exeter and Charnley were 6.3 (33.1), 8.0 (34.2) and 13.1 (34.3) respectively. Thirty years survival estimates for Corail, Exeter and Charnley stems were 88.6% (CI:85.8–90.9%), 86.7% (83.7–89.2%) and 87.1% (85.4–88.5%) respectively with stem revision as endpoint, and 56.1% (CI:53.1–59.1%), 73.3% (70.5–76.1%) and 80.2% (78.4–82.0%) with all THA revisions as endpoint. Compared to the Corail, the Exeter (HRR=1.3, CI:1.2–1.4) and the Charnley (HRR=1.9, CI:1.7–2.1) had a significant higher risk of stem revision. Women 75 years and older had better results with the cemented stems. Analyses accounting for competing risk from other causes of revision did not alter the findings.The uncemented Corail stem performed well in terms of stem revisions for stem-related revision causes compared to two frequently used cemented stems with very long follow-up. The differences between the three stems were small.
PRE-ARTHRITIC HIP DISEASE: ISOLATED LABRAL PATHOLOGY IS A VALID DIAGNOSIS
Authors: Ricard M.-A. , Pacheco L. , Koorosh K. , Poitras S. , Carsen S. , Grammatopoulos G. , Wilkin G. , Beaulé P. E. 
Published: July 2023

Our understanding of pre-arthritic hip disease has evolved tremendously but challenges remain in categorizing diagnosis, which ultimately impacts choice of treatments and clinical outcomes. This study aims to report patient reported outcome measures (PROMs) comparing four different condition groups within hip preservation surgery by a group of fellowship-trained surgeons.From 2018 to 2021, 380 patients underwent hip preservation surgery at our center and were classified into five condition groups: dysplasia: 82 (21.6%), femoro-acetabular impingement (FAI): 173 (45.4%), isolated labral tear: 103 (27.1%), failed hip preservation: 20 (5.3%) and history of childhood disease/other: 2 (0.5%). International hip outcomes Tool 12 (IHOT-12), numeric pain score and patient-reported outcomes measurement information system (PROMIS) were collected pre-operatively and at 3 months and 1 year post-operatively, with 94% and 82% follow-up rate respectively.Arthroscopy (75.5%) was the most common procedure followed by peri-acetabular osteotomy (PAO) (22.4%) and surgical dislocation (2.1%). Re-operation rate were respectively 18.3% (15), 5.8% (10), 4.9% (5), 30% (6) and 0%. There were 36 re-operations in the cohort, 14 (39%) for unintended consequences of initial surgery, 10 (28%) for mal-correction leading to a repeat operation, 8 (22%) progression of arthritis, and 4 (11%) for incorrect initial diagnosis/intervention. Most common re-operations were hardware removal 31% (7 PAO, 3 surgical hip dislocation and 1 femoral de-rotational osteotomy), arthroscopy 31% (11) and arthroplasty 28% (10). All groups had significant improvements in their IHOT-12 as well as PROMIS physical and numerical pain scales, except those with failed hip preservation. Dysplasia group showed a slower recovery.Overall, this study demonstrated a clear relation between the condition groups, their respective intervention and the significant improvements in PROMs with isolated labral pathology being a valid diagnosis. Establishing tertiary referral centers for hip preservation and longer follow-up is needed to monitor the overall survivorship of these various procedures.
MONOBLOC DUAL MOBILITY CUP VERSUS LARGE FEMORAL HEADS: A COMPARATIVE STUDY OF 1,940 CONSECUTIVE PRIMARY TOTAL HIP ARTHROPLASTIES
Authors: Lustig S. , Cotte M. , Foissey C. , Asirvatham R. , Servien E. , Batailler C. 
Published: July 2023

The benefit of dual mobility cup (DMC) for primary total hip arthroplasties (THA) is still controversial. This study aimed to compare 1) the complications rate, 2) the revisions rate, 3) the survival rate after monobloc DMC compared to large femoral heads (LFH) in primary THA.Between 2010 and 2019, 2,075 primary THA using cementless DMC or LFH were included. Indications for DMC were patients older than 70 years old or with high risk of dislocation. Every other patient received a LFH. Exclusion criteria were cemented implants, femoral neck fracture, a follow-up of less than one year. 1,940 THA were analyzed: 1,149 DMC (59.2%), 791 LFH (40.8%). The mean age was 73 ±9.2 years old in DMC group and 57 ±12 in LFH group. The complications and the revisions have been assessed retrospectively.The mean follow-up was 41.9 months ±14 [12–134]. There were significantly fewer dislocations in DMC group (n=2; 0.17%) compared to LFH group (n=8; 1%) (p=0.019). The femoral head size had no impact on the dislocations rate in LFH group (p=0.70). The overall complication rate in DMC (n=59; 5.1%) and LFH (n=53; 6.7%) were not statistically different (p=0.21). No specific complication was attributed to the DMC. In DMC group, 18 THA (1.6%) were revised versus 15 THA in LFH group (1.9%) (p= 0.71). There was no statistical difference for any cause of revisions in both groups. The cup aseptic revision-free survival rates at 5 years were 98% in DMC group and 97.3% in LFH group (p=0.78).Monobloc DMC had a lower risk of dislocation in a high-risk population than LFH in a low-risk population at the mid-term follow-up. There was no significant risk of specific complications or revisions for DMC in a large cohort. Monobloc DMC can be safely used in a selected high-risk population.
LONG-TERM OUTCOMES OF REVISION TOTAL HIP ARTHROPLASTY WITH A MODULAR REVISION HIP SYSTEM: A HIGH-VOLUME SINGLE-CENTRE EXPERIENCE
Authors: Garbuz D. S. 
Published: July 2023

The purpose of this study was to determine long-term survival free from all-cause revision and stem-related failure, as well as radiographic and functional outcomes of the ZMR stem in revision THA.We retrospectively identified all patients in our institutional database who underwent revision THA using the ZMR Revision Hip system from the year 2000 to 2007 (minimum two-year follow-up). Of the 112 ZMR hips (110 patients) identified, a total of 106 hips (104 patients) met inclusion criteria. The mean study follow-up 13.9 years (range 2–22). Indications for index ZMR revision included aseptic loosening (72.1%), periprosthetic joint infection (17.3%), periprosthetic fracture (9.6%), and stem fracture (1.0%). Kaplan-Meier analysis was used to determine the all-cause and stem-related failure revision-free survival. Validated patient reported outcomes were collected and available radiographs were reviewed to determine implant stability.A total of 17 hips (16.0%) underwent a re-revision of any component. The indications for re-revision were stem failure (35.3%), infection (29.4%), instability (29.4%), and aseptic loosening of the acetabular component (5.9%). The five- and 15-year all-cause survivorship was 89.5% (95% CI 86.5–92.5) and 83.0% (95% CI 79.2–86.8), respectively. There were six re-revisions for stem failure (5.7%); five for stem fracture and one for aseptic loosening. The average time to stem failure was 4.6 years (range 1.3–8.2). The five- and 15-year survivorship free from stem-related failure was 97.2% (95% CI 95.6–98.8) and 93.9% (95% CI 91.5–96.3), respectively. At final follow-up the mean Oxford hip score was 36.9 and all surviving ZMR stems were well fixed on radiographs.Femoral revision with the ZMR stem offers satisfactory long-term survivorship and promising clinical outcomes. Although uncommon, stem fracture was the most common reason for stem-related failure.
NO DIFFERENCE IN SUBSIDENCE BETWEEN MODERN MONOBLOCK AND MODULAR TITANIUM FLUTED TAPERED FEMORAL STEMS
Authors: McCalden R. , Pomeroy E. , Naudie D. , Vasarhelyi E. , Lanting B. , MacDonald S. , Howard J. 
Published: July 2023

Subsidence remains a concern when utilizing modern tapered fluted titanium (TFT) femoral stems and may lead to leg length discrepancy, impingement, instability and failure to obtain stem osseointegration. This study aims to compare stem subsidence across three modern TFT stems. Our secondary aim was to investigate the influence of bicortical contact or ‘scratch fit’ on subsidence, as well as the role of intraoperative imaging in maximizing this bicortical contact and preventing stem subsidence.A retrospective review of 271 hip arthroplasties utilizing modern TFT stems in a single institution was performed. Three stem designs were included in the analysis: one monoblock TFT stem (n=91) and two modular TFT stems (Modular A [n=90]; Modular B [n=90]). Patient demographics, Paprosky femoral bone loss classification, bi-cortical contact, utilization of intra-operative imaging and stem subsidence (comparison of initial post-operative radiograph to the latest follow up radiograph - minimum three months) were recorded.There was no statistically significant difference in the amount of subsidence between the three stems (Monoblock: 2.33mm, Modular A: 3.43mm, Modular B: 3.02mm; p=0.191). There was no statistical difference in subsidence >5mm between stems (Monoblock: 9.9%, Modular A: 22.2%, Modular B: 16.7%). Subgroup analysis based on femoral bone loss grading showed no difference in subsidence between stems. Increased bicortical contact was strongly associated with reduced subsidence (p=0.004). Intra-operative imaging was used in 46.5% (126/271) of cases; this was not correlated with bicortical contact (p=0.673) or subsidence (p=0.521). Across all groups, only two stems were revised for subsidence (0.7%).All three modern TFT stems were highly successful and associated with low rates of subsidence, regardless of modular or monoblock design. Surgeons should select the stem that they feel is most clinically appropriate.
COMPARISON OF TOTAL HIP ARTHROPLASTY VERSUS HEMIARTHROPLASTY IN PATIENTS WITH FEMORAL NECK FRACTURES
Authors: Adeyemo E. A. , Riepen D. W. , Collett G. A. , Au B. K. , Huo M. H. 
Published: July 2023

The current evidence favors replacement for the treatment of displaced femoral neck fractures in the older patients. Controversies remain whether total hip replacement (THR), or hemiarthroplasty (HA) would result in better outcomes. The purpose of this study is to compare the outcomes, and the complications in patients who underwent THR or HA for displaced femoral neck fractures.There were 345 consecutive patients who had undergone either a THR or HA at a single institution. THR was done in 137, and HA was done in 208 patients, respectively. Standard peri-operative data were collected.The mean values for the data in the THR group are: age 69 years, ASA 2.7, OR time was 99 minutes, estimated blood loss 354 ml, and the length of stay 8 days. The mean values for the data in the HA group are: age 75 years, ASA 3.0, OR time 88 minutes, estimated blood loss 200 ml, and the length of stay 10 days. The overall complications were 8.8% (THR), and 9.1% (HA), respectively. The mortality rates for the patients were: at the 1-year (9.5% THR vs 16.3% HA), at the 3-year (15.3% THR vs 24.0% HA), and at the 5-year (19.7% THR vs 26.9% HA), respectively.Our data demonstrated similar peri-operative data and short-term complications between the two groups. There was a difference in the mortality rates between the two groups at all 3-time intervals following the surgery. This could be a reflection of the patient selection bias for each of the operations.
EFFECTS OF ABALOPARATIDE OR PLACEBO ON BONE MINERAL DENSITY IN ACETABULAR REGIONS CORRESPONDING TO DELEE AND CHARNLEY ZONES IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS
Authors: Sheth N. , Bostrom M. , Winzenrieth R. , Humbert L. , Pearman L. , Caminis J. , Wang Y. , Boxberger J. , Krohn K. 
Published: July 2023

To evaluate the effects of 6 and 18 months of abaloparatide (ABL) compared with placebo (PBO) on bone mineral density (BMD) in the acetabular regions of postmenopausal women with osteoporosis (OP).Acetabular bone loss, as may occur in OP, increases risk of acetabular fragility fracturesa. In total hip arthroplasty (THA), low acetabular BMD adversely affects primary stability, osseointegration, and migration of acetabular cups.c ABL is an osteoanabolic agent for the treatment of men and postmenopausal women with OP at high risk for fracture. Effects of ABL on acetabular BMD are unknown.Hip DXA scans were obtained at baseline, 6, and 18 months from a random subgroup of postmenopausal women (aged 49–86 y) from the phase 3 ACTIVE trial randomized to either ABL 80 µg/d or PBO (n=250/group). Anatomical landmarks were identified in each DXA scan to virtually place a hemispherical shell model of an acetabular cup and define regions of interest corresponding to DeLee & Charnley zones 1 (R1), 2 (R2), and 3 (R3). BMD changes compared to baseline were calculated for each zone. Statistical P values were based on a repeated mixed measures model.BMD in all zones were similar at baseline in the ABL and PBO groups. BMD significantly increased in the ABL group at 6 and 18 months compared with PBO (all P<0.0001 vs PBO). BMD in the PBO group was relatively stable over time.ABL treatment resulted in rapid and progressive increases in BMD of all 3 acetabular zones. Increasing acetabular BMD has the potential to improve acetabular strength, which may reduce risk of acetabular fragility fractures. In bone health optimization prior to THA, increased acetabular BMD via ABL may provide better primary stability and longevity of acetabular cups in postmenopausal women with OP.
EVALUATIONS OF MINS SCREENING IN HIP ARTHROPLASTY PATIENTS
Authors: MacDonald S. J. , Alatassi R. , Somerville L. , Howard J. L. 
Published: July 2023

The Canadian Cardiovascular Society (CCS) recommends performing daily troponin testing on postoperative days 0 through 3 for noncardiac surgical patients to decrease the mortality rate due to myocardial injury. Indications for testing include:->65 yo-45-64 yo with significant cardiovascular disease-a Revised Cardiac Risk Index score (RCRI) > 1Troponin elevation > 30 ng/L is termed “myocardial injury after noncardiac surgery” (MINS).The study objective was to determine the prognostic relevance of applying CCS recommendations.669 patients undergoing THA were included in the study. Based on the CCS recommendation there were 4 patient Groups depending on whether or not they met the MINS screening protocol criteria and whether or not it was applied:-A - met & applied (n=181)-B - met & not applied (n=248)-C – not met & applied (n=10)-D – not met & not applied (n=230)307 (45.8%) males and 363 (54.2%) females with an average age of 67.8 years were included. Group A- 24% incidence (43 patients) of troponin rise & 5% incidence (9 patients) of cardiac complications. Group B- 0.4% incidence (1 patient) of cardiac complications.Groups A + B – representing all patients who should have had the MINS screening protocol applied according to the CCS recommendations − 10 (2.3%) patients developed cardiac complication and one (0.2%) patient deathMINS screening protocol group (A & C) LOS was 4.0 days compared to 1.4 days for those not screened (p-value: <0.001).Applying the CCS MINS screening protocol to elective THA patients added no benefit in predicting/preventing postoperative cardiac events but was associated with a significant increase in LOS. Following current CCS recommendations without more specifications and clinical evidence is unwarranted.
HOST FACTORS AND RISK OF PIN SITE INFECTION IN EXTERNAL FIXATION: A LITERATURE REVIEW EXAMINING AGE, BODY MASS INDEX, SMOKING, AND COMORBIDITIES INCLUDING DIABETES
Authors: Fridberg M. , Bue M. , Duedal Rölfing J. , Kold S. , Ghaffari A. 
Published: July 2023

An international Consensus Group has by a Delphi approach identified the topic of host factors affecting pin site infection to be one of the top 10 priorities in external fixator management. The aim of this study was to report the frequency of studies reporting on specific host factors as a significant association with pin site infection. Host factors to be assessed was: age, smoking, BMI and any comorbidity, diabetes, in particular. The intention was an ethological review, data was extracted if feasible, however no meta-analysis was performed.A systematic literature search was performed according to the PRISMA-guidelines. The protocol was registered before data extraction in PROSPERO. The search string was based on the PICO criterias. A logic grid with key concept and index terms was made. A search string was built assisted by a librarian. The literature search was executed in three electronic bibliographic databases, including Embase MEDLINE (1111 hits) and CINAHL (2066 hits) via Ovid and Cochrane Library CENTRAL (387 hits). Inclusion criteria: external fixation, >1 pin site infection, host factor of interest, peer-reviewed journal. Exclusion criteria: Not written in English, German, Danish, Swedish, or Norwegian, animal or cadaveric studies, location on head, neck, spine, cranium or thorax, editorials or conference abstract. The screening process was done using Covidence.A total of 3564 titles found. 3162 excluded by title and abstract screening. 140 assessed for full text eligibility. 11 studies included for data extraction. The included studies all had a retrospective design. Three identified as case-control studies. Generally the included studies was assessed to have a high risk of bias. A significant associations between pin site infection for following host factors: a) increased HbA1C level in diabetic patients; b) congestive heart failure in diabetic patients; c) less co-morbidity; d) preoperative osteomyelitis was found individually.This systematic literature search identified a surprisingly low number of studies examining for risk of pin site infection and host factors. Thus, this review most of all serves to demonstrate a gap of evidence about correlation between host factors and risk of pin site infection, and further studies are warranted.