Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2024
Review Meta AnalysisThe effect of intraoperative fluoroscopy on acetabular component positioning and patient anatomy restoration during posterior or posterolateral approach total hip arthroplasty: a meta-analysis.
Positioning implant components and restoring patient anatomy during total hip arthroplasty (THA) are essential for joint stability, polyethylene liner wear, and range of motion. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during the posterior or posterolateral approach have reported conflicting results. This meta-analysis evaluated if intraoperative fluoroscopy improves component positioning and femoral component position compared to no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. ⋯ Even though intraoperative fluoroscopy was not related to an improvement in cup location or dislocation incidence. Our findings demonstrate that the restoration of leg lengths and femoral offset can be significantly improved by using intraoperative fluoroscopy to supplement good surgical skills in THA. The advantages of intraoperative fluoroscopy might become more apparent for surgeons with less experience. To ascertain whether intraoperative fluoroscopy for posterior or posterolateral approach total hip arthroplasty will have clinical benefits and improve the survival of prostheses, more well-powered and well-designed long-term follow-up studies were necessary.
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Arch Orthop Trauma Surg · Apr 2024
Mid-term results of a cementless hip stem in femoral revision: how much diaphyseal press-fit do we need?
The aim of this retrospective study was to analyze the clinical and functional outcome of a modular tapered revision hip stem after mid-term follow-up with a special focus on the length of the distal bicortical fixation of the cementless hip stem. ⋯ Clinicaltrials.gov registration: NCT04833634 registered on April 6, 2021.
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Arch Orthop Trauma Surg · Apr 2024
Social vulnerability adversely affects emergency-department utilization but not patient-reported outcomes after total joint arthroplasty.
Multiple studies demonstrate social deprivation is associated with inferior outcomes after total hip (THA) and total knee (TKA) arthroplasty; its effect on patient-reported outcomes is debated. The primary objective of this study evaluated the relationship between social vulnerability and the PROMIS-PF measure in patients undergoing THA and TKA. A secondary aim compared social vulnerability between patients who required increased resource utilization or experienced complications and those who didn't. ⋯ Despite an increased risk for 90-day ED returns, patients with increased social vulnerability still obtain good 1-year functional outcomes. Initiatives seeking to mitigate the effect of social deprivation on TJA outcomes should aim to provide safe alternatives to ED care during early recovery.
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Arch Orthop Trauma Surg · Apr 2024
Valgus stress radiographs have a minor additional value in detecting lateral cartilage wear when selecting patients for medial partial knee replacement.
A valgus stress radiograph, in addition to the weight-bearing fixed flexion posteroanterior radiograph (e.g., Rosenberg), is deemed useful to assess lateral cartilage wear by measuring lateral joint space width (JSW) in patients with medial knee osteoarthritis. This study aimed to assess: (1) the difference in measured lateral JSW between the Rosenberg and the valgus stress radiograph, and (2) the ability of the valgus stress radiograph to detect lateral cartilage wear (indicated by joint space narrowing) in patients where the Rosenberg radiograph showed full thickness cartilage (i.e., the additional value). ⋯ Although the valgus stress radiograph shows more lateral JSW narrowing compared to Rosenberg radiograph, it only has an additional value in 1 out of 17-25 patients with medial osteoarthritis. We, therefore, recommend a Rosenberg radiograph as routine radiographic assessment and only use an additional valgus stress radiograph in case of discrepancy between clinical and radiological findings.