Hip Surgery: Clinical Treatment and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 November 2023) | Viewed by 9787

Special Issue Editor

Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
Interests: adult joint reconstruction; knee surgery; lower limb trauma; osteoarthritis
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Special Issue Information

Dear Colleagues,

Hip surgery affects all age groups, from developmental dysplasia of the hip in the pediatric population to hip fracture management in the geriatric population. The management of hip disorders has seen tremendous advancement within the last few decades. Total hip replacement can be considered as the most successful surgery of the last century. Still, further developments have been made in either surgical approaches, implant design or perioperative management, such as the use of tranexamic acid. Revision arthroplasty including management of periprosthetic infections and fractures is becoming more relevant due to a continuous increase in the number of primary total hip replacements. In pediatrics, the screening for developmental dysplasia has become an integral part of practice. The identification of femoroacetabular impingement has led to the development of diagnostic measures and, subsequently, techniques for its treatment. A relationship between spine and hip disorders has been identified and is currently being studied extensively. Due to demographic changes, an increase in hip fracture incidence is seen and challenges health care systems worldwide. This Special Issue is covering the broad field of hip surgery, the diagnostic approaches to various hip disorders and their specific management.

Dr. Lukas A. Holzer
Guest Editor

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Keywords

  • total hip replacement
  • revision total hip replacement
  • femoroacetabular impingement
  • hip fracture
  • hip–spine relationship
  • developmental dysplasia of the hip

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Published Papers (10 papers)

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Editorial

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3 pages, 168 KiB  
Editorial
Total Hip Arthroplasty: So Hip It Hurts
by Lukas A. Holzer
J. Clin. Med. 2023, 12(11), 3849; https://doi.org/10.3390/jcm12113849 - 05 Jun 2023
Viewed by 924
Abstract
Total hip arthroplasty (THA) has become a standard surgical intervention for patients with hip joint disorders [...] Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)

Research

Jump to: Editorial

12 pages, 1221 KiB  
Article
Level of Disability after Total Hip Replacement in Patients with Some COMT Gene Polymorphism
by Alina Jurewicz, Violetta Dziedziejko, Monika Rać, Marta Białecka, Krzysztof Safranow, Mateusz Kurzawski, Damian Malinowski, Mateusz Bosiacki, Katarzyna Leźnicka, Andrzej Bohatyrewicz, Monika Białecka, Marek Droździk and Anna Machoy-Mokrzyńska
J. Clin. Med. 2023, 12(24), 7652; https://doi.org/10.3390/jcm12247652 - 13 Dec 2023
Viewed by 702
Abstract
Background: The COMT gene encodes the enzyme catechol-O-methyltransferase, which is a key modulator of dopaminergic and adrenergic neurotransmission. Hip osteoarthritis is accompanied by reduced mobility and some level of disability. In our study, we analyzed the association between some COMT gene polymorphisms and [...] Read more.
Background: The COMT gene encodes the enzyme catechol-O-methyltransferase, which is a key modulator of dopaminergic and adrenergic neurotransmission. Hip osteoarthritis is accompanied by reduced mobility and some level of disability. In our study, we analyzed the association between some COMT gene polymorphisms and reduced mobility in patients after total hip replacement (THR). Methods: The operative procedures were performed on 195 patients with symptomatic and radiologically advanced hip osteoarthritis. In the postoperative follow-up, we assessed hip function with the Harris Hip Score (HHS) and the degree of disability with the Oswestry Disability Index (ODI). These procedures were repeated three times at defined intervals (one week, six weeks, and six months) after the total hip replacement. Genomic DNA was extracted from peripheral blood. SNPs in the COMT genes rs4680:A>G, rs6269:A>G, rs4633:C>T, and rs4818:C>G were genotyped. Results: Our findings suggest an association between COMT gene variability and the level of disability measured by the Oswestry Disability Index (ODI) in patients after total hip replacement (THR). Conclusions: A higher number of COMT G alleles (rs4818) is an independent factor in a significant reduction in disability degree at both one week and six months after total hip replacement (THR), regardless of age or gender. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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8 pages, 389 KiB  
Article
Comparison of Intravenous Acetaminophen and Intravenous Patient-Controlled Analgesia Fentanyl after Total Hip Arthroplasty: A Multicenter Randomized Controlled Trial
by Yoshinori Sakai, Norio Imai, Dai Miyasaka, Hayato Suzuki, Yoji Horigome, Yasuhito Takahashi and Hiroyuki Kawashima
J. Clin. Med. 2023, 12(23), 7445; https://doi.org/10.3390/jcm12237445 - 30 Nov 2023
Viewed by 584
Abstract
Background: Opioids often need to be discontinued because they cause nausea, whereas the administration of intravenous acetaminophen (APAP) causes less nausea and vomiting. This study aimed to compare the effects of fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and intravenous APAP on pain and nausea [...] Read more.
Background: Opioids often need to be discontinued because they cause nausea, whereas the administration of intravenous acetaminophen (APAP) causes less nausea and vomiting. This study aimed to compare the effects of fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and intravenous APAP on pain and nausea after total hip arthroplasty (THA). Methods: We prospectively investigated primary THA patients who underwent the anterolateral supine approach at four centers between October 2021 and October 2022. The patients (n = 178) were divided randomly into IV-PCA (n = 88) and APAP groups (n = 90). Rest pain, motion pain, and nausea were assessed using NRS scores. Results: Compared with the APAP group, the IV-PCA group experienced significantly greater resting pain and nausea on postoperative day 1. A correlation was found between preoperative and postoperative pain. Postoperative nausea at 8 h was significantly correlated with pain at rest at 4 h (r = 0.193), 8 h (r = 0.194), day 1 (r = 0.245), and day 2 (r = 0.188) after surgery. Early postoperative pain and nausea correlated with subsequent pain and nausea. Conclusions: Intravenous APAP is associated with less pain and nausea and is superior to IV-PCA. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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10 pages, 1386 KiB  
Article
Total Hip Arthroplasty for Low-Grade Developmental Hip Dysplasia Changes the Ipsilateral Knee Alignment on the Axial and Coronal Planes
by Stefano Lucchini, Francesco Castagnini, Francesco Perdisa, Giuseppe Filardo, Francesco Pardo and Francesco Traina
J. Clin. Med. 2023, 12(23), 7347; https://doi.org/10.3390/jcm12237347 - 27 Nov 2023
Viewed by 542
Abstract
Background: There is a paucity of data regarding the post-operative influence of total hip arthroplasty (THA) on the axial and coronal alignments of the ipsilateral knee. A CT study was designed to assess the post-THA changes in axial and coronal knee alignments in [...] Read more.
Background: There is a paucity of data regarding the post-operative influence of total hip arthroplasty (THA) on the axial and coronal alignments of the ipsilateral knee. A CT study was designed to assess the post-THA changes in axial and coronal knee alignments in low-grade dysplastic hips. Methods: Forty Crowe I–II dysplastic hips in 37 patients were assessed: a pre-operative CT scan from the fourth lumbar vertebra to the tibial plateaus was compared to a similar post-operative CT scan performed after a minimum of 2 years after THA. Results: THA implantation caused significant post-operative changes in terms of the rotation height (2 mm lowering; p = 0.003); center of rotation medialization (10 mm medialization; p < 0.001); femoral offset (11 mm increase; p < 0.001); femoral antetorsion (22° internal rotation; p < 0.001), and hip internal rotation (9° internal rotation; p < 0.001). The femoral axis angle deviated in the valgus (5.5° ± 1.1°, p < 0.001) and the mechanical lateral distal femoral angle deviated in the varus (86° ± 2.7°, p = 0.001). The pelvic–tibial alignment changed from 88.2° ± 11.7° to 96° ± 9.3° (p < 0.001). Patellar alignment was not influenced. Conclusions: In conclusion, THA imposes significant changes in low-grade dysplastic hips: all the modifications tend to neutralize the coronal alignment and, mostly, the rotational alignment, without substantial and durable variations of the patellofemoral joint. Large clinical trials should confirm whether radiological changes impact anterior knee pain and patellar stability. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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16 pages, 1467 KiB  
Article
GS Hip Nail versus Affixus Hip Fracture Nail for the Intramedullary Nailing of Intertrochanteric Fractures
by Seungcheol Kwon, Minjae Lee, Heeyeon Lee and Jihyo Hwang
J. Clin. Med. 2023, 12(21), 6720; https://doi.org/10.3390/jcm12216720 - 24 Oct 2023
Viewed by 868
Abstract
Background: Intertrochanteric fractures are a global health concern, especially in aging populations like the Republic of Korea. Surgical treatments like intramedullary nailing are preferred for their benefit. Various hip nails are used worldwide, each with unique features and challenges. This study aims to [...] Read more.
Background: Intertrochanteric fractures are a global health concern, especially in aging populations like the Republic of Korea. Surgical treatments like intramedullary nailing are preferred for their benefit. Various hip nails are used worldwide, each with unique features and challenges. This study aims to compare the GS hip nail with the Affixus hip fracture nail for the treatment of intertrochanteric fractures. Material and Methods: This retrospective study, conducted at a single center, included 179 patients who underwent intramedullary nailing for intertrochanteric fractures using the GS hip nail or the Affixus hip fracture nail. Excluding specific cases, 43 patients in the GS group and 46 in the Affixus group met the minimum 6-month follow-up criteria. Result: The GS group exhibited a significantly shorter mean operation time (43.26 min) compared to the Affixus group (51.11 min). Radiographically, both groups showed no significant differences in their reduction quality, tip, and apex distance (TAD), or Cleveland index in the immediate postoperative window. However, the GS group achieved a greater valgus reduction based on the contralateral femoral neck shaft angle (NSA). At 6 months post-operation, there were no significant differences in TAD or advancement and sliding distances. Complication rates were similar between the two groups, with no implant breakages. Clinical outcomes, as measured via mHHS and EQ-5D-5L, showed no significant differences. Despite a slightly higher implant cost, the GS group had a lower total hospital cost than the Affixus group, but this was not statistically significant. Conclusions: This study highlights the efficiency of the GS hip nail in reducing the operation time compared to the Affixus hip fracture nail with comparable radiologic and clinical outcomes. Further research with long-term follow-up and larger patient studies are needed to fully assess its effectiveness in improving patient outcomes in hip fracture treatment. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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11 pages, 1741 KiB  
Article
Two-Year Results of Injectable Matrix-Associated Autologous Chondrocyte Transplantation in the Hip Joint: Significant Improvement in Clinical and Radiological Assessment
by Moritz Riedl, Henriette Bretschneider, Michael Dienst, Klaus-Peter Günther, Stefan Landgraeber, Jörg Schröder, Siegfried Trattnig and Stefan Fickert
J. Clin. Med. 2023, 12(17), 5468; https://doi.org/10.3390/jcm12175468 - 23 Aug 2023
Viewed by 741
Abstract
Purpose: Articular cartilage defects are a prevalent consequence of femoroacetabular impingement (FAI) in young active patients. In accordance with current guidelines, large chondral lesions of the hip joint over 2 cm2 are recommended to be treated with matrix-associated, autologous chondrocyte transplantation (MACT); [...] Read more.
Purpose: Articular cartilage defects are a prevalent consequence of femoroacetabular impingement (FAI) in young active patients. In accordance with current guidelines, large chondral lesions of the hip joint over 2 cm2 are recommended to be treated with matrix-associated, autologous chondrocyte transplantation (MACT); however, the conditions in the hip joint are challenging for membrane-based MACT options. Injectable MACT products can solve this problem. The purpose of the trial was to assess clinical and radiological outcomes 24 months after injectable MACT of focal chondral lesions caused by FAI. Methods: We present data of 21 patients with focal cartilage defects of the hip [3.0 ± 1.4 cm2 (mean ± SD)], ICRS Grade III and IV caused by CAM-type impingement, who underwent arthroscopic MACT (NOVOCART® Inject) and FAI correction. The outcome was evaluated with the patient-reported outcome instruments iHOT33 and EQ-5D-5L (index value and VAS), whilst graft morphology was assessed based on the MOCART score over a follow-up period of 24 months. Results: The iHOT33 score increased significantly from 52.9 ± 21.1 (mean ± SD) preoperatively to 85.8 ± 14.8 (mean ± SD; p < 0.0001) 24 months postoperatively. The EQ-5D-5L index value (p = 0.0004) and EQ-5D VAS (p = 0.0006) showed a statistically significant improvement as well. MRI evaluation after 24 months showed successful integration of the implant in all patients with a complete defect filling in 11 of 14 patients. Conclusions: Injectable MACT for the treatment of full-thickness chondral lesions of the hip joint due to FAI in combination with FAI correction improved symptoms, function, and quality of life in the treated cohort. Alongside the treatment of the underlying pathology by the FAI correction, the developed cartilage defect can be successfully repaired by MACT, which is of considerable clinical relevance. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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13 pages, 3046 KiB  
Article
How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery
by Antongiulio Bruschetta, Michelangelo Palco, Domenico Fenga, Gabriele Giuca, Lukas A. Holzer, Angelo Alito, Giorgio Cacciola, Federico De Meo and Pietro Cavaliere
J. Clin. Med. 2023, 12(14), 4809; https://doi.org/10.3390/jcm12144809 - 21 Jul 2023
Viewed by 948
Abstract
Background: Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal [...] Read more.
Background: Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal ions locally and systemically, which may cause adverse local reactions in nearby tissues. The aim of this study is to describe a series of patients with painful local adverse tissue reactions secondary to corrosion at the modular neck–body interface, to document the clinical presentation, diagnostic workup, and surgical findings of our research, and to search for a possible correlation between metallosis and infection. Methods: A retrospective study of patients with adverse local tissue reactions due to metal surface corrosion was performed. Blood samples were collected to identify erythrocyte sedimentation rate, C reactive protein, and procalcitonin, and a magnetic resonance imaging protocol was performed. Results: Serum cobalt and chromium levels of the 43 patients tested were significantly higher on average. However, both erythrocyte sedimentation rate and C-reactive protein were significantly elevated. Magnetic resonance imaging showed adverse reactions to metal debris with large soft tissue masses and surrounding tissue damage. Conclusions: Corrosion in hip prosthesis can lead to the release of metal ions and debris locally and systemically, resulting in local soft tissue changes. A “tumor-like” debridement can reduce this complication. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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12 pages, 1163 KiB  
Article
Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study
by Giorgio Cacciola, Fabio Mancino, Lukas A. Holzer, Federico De Meo, Ivan De Martino, Antongiulio Bruschetta, Salvatore Risitano, Luigi Sabatini and Pietro Cavaliere
J. Clin. Med. 2023, 12(13), 4544; https://doi.org/10.3390/jcm12134544 - 07 Jul 2023
Cited by 1 | Viewed by 761
Abstract
Background: C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this [...] Read more.
Background: C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this study was to establish a potential association between CAR and 30-day mortality and to assess if the CAR Receiving Operating Characteristics curve (ROC) can be a reliable predictor of early mortality. Methods: We retrospectively reviewed the charts of 676 patients (>65 years) treated for hip fracture between 2006 and 2018. All hip fractures were included. Treatment strategies included closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty, or total joint arthroplasty. Statistical analysis included T-test, Pearson correlation for CAR and other markers, ROC curves and area under the curve, Youden Model, and Odds Ratio. Results: The 30-day mortality rate analysis showed that higher preoperative levels of CAR were associated with higher early mortality. When analyzing the area under the ROC curve (AUROC) for 30-day mortality, the reported value was 0.816. The point of the ROC curve corresponding to 14.72 was considered a cut-off with a specificity of 87% and a sensibility of 40.8%. When analyzing values higher than 14.72, the 30-day mortality rate was 17.9%, whilst, for values lower than 14.72, the 30-day mortality rate was 1.8%. Conclusions: Patients older than 65 years affected by a hip fracture with increased preoperative levels of CAR are associated with higher 30-day mortality. Despite a moderate sensibility, considering the low cost and the predictivity of CAR, it should be considered a standard predictive marker. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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11 pages, 1028 KiB  
Article
Metal-on-Metal Hips: Ten-Year Clinical and Radiographic Outcomes of the ADEPT Metal-on-Metal Hip Resurfacing and Modular Total Hip Arthroplasty
by Fabio Mancino, Michael A. Finsterwald, Christopher W. Jones, Gareth H. Prosser and Piers J. Yates
J. Clin. Med. 2023, 12(3), 889; https://doi.org/10.3390/jcm12030889 - 22 Jan 2023
Cited by 1 | Viewed by 1408
Abstract
Background: The aim of this study is to update the 10-year follow-up survivorship and metal ions levels of a cohort of metal-on-metal (MoM) hip resurfacing (HR) and large-diameter-head (LDH) total hip arthroplasty (THA). Methods: The study is a retrospective analysis of prospectively collected [...] Read more.
Background: The aim of this study is to update the 10-year follow-up survivorship and metal ions levels of a cohort of metal-on-metal (MoM) hip resurfacing (HR) and large-diameter-head (LDH) total hip arthroplasty (THA). Methods: The study is a retrospective analysis of prospectively collected data that compared the outcomes of 24 MoM HR (21 patients) and 15 (11 patients) modular LHD MoM THA at >10 years follow-up. Baseline characteristics as well as intraoperative and postoperative information were collected, including complications, revisions, clinical and radiographic outcomes, and serum metal ions level (Cobalt, Chromium). Metal ion levels were compared using a two-tailed unpaired t-test and Wilcoxon signed-rank test (jamovi v2.3.3.0, Sydney, NSW, AU). Results: No significant differences were detected in gender, BMI, and ASA score between the two groups. Patients in the modular THA group were significantly older (57 years vs. 46 years; p < 0.05). The HR overall survivorship was 91.7% (22 of 24 hips) with survivorship from implant failure and/or aseptic loosening and/or metal debris related 100% of problems. The modular THA overall survivorship was 86.7% (13 of 15 hips) with survivorship from implant aseptic loosening and metal ions complications of 93.4% (14 of 15 hips). No significant difference was noted when comparing clinical outcomes. Metal ions were significantly lower in the HR group (Co 25.8 nmol/L vs. 89 nmol/L; p < 0.001–Cr 33.5 nmol/L vs. 55.2 nmol/L; p = 0.026). Conclusion: Both implants reported excellent and comparable clinical outcomes at >10 years follow-up. The Adept HR reported remarkable survivorship, in line with the registry data, proving once again its reliability in young active males. The modular LDH THA, despite being discontinued, presented higher reliability and a lower failure rate when compared with similar withdrawn MoM implants. Trunnionosis did not appear to be a significant problem in this particular modular design. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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14 pages, 1474 KiB  
Article
Effect of Total Hip Arthroplasty with Ceramic Acetabular Component on Clinical, Radiographic and Functional Parameters in Older Patients with Hip Osteoarthritis: Two-Year Follow-Up
by Alexandre Penna Torini, Carlos Eduardo Barsotti, Rodrigo Mantelatto Andrade, Luiz Henrique da Silva Nali and Ana Paula Ribeiro
J. Clin. Med. 2023, 12(2), 670; https://doi.org/10.3390/jcm12020670 - 14 Jan 2023
Cited by 1 | Viewed by 1460
Abstract
Background: Total hip arthroplasty (THA) is a widely used surgical procedure to reduce pain and improve function and quality of life in patients with hip disorders. The most common condition that leads to THA is osteoarthritis, with most surgeries being performed to treat [...] Read more.
Background: Total hip arthroplasty (THA) is a widely used surgical procedure to reduce pain and improve function and quality of life in patients with hip disorders. The most common condition that leads to THA is osteoarthritis, with most surgeries being performed to treat severe osteoarthritis with pain and functional limitations. Despite the evident success of THA, the search for its improvement and better results, especially in the long term, continues, especially in older patients, for which there is still little scientific evidence. Objective: To evaluate the clinical, radiological, and functional aspects preoperatively and two years after THA with a ceramic acetabular component device in older patients with hip osteoarthritis. Methods: A retrospective cohort study was conducted to evaluate 65 older individuals who underwent THA of the hip with an acetabular component (MD® ceramic head with a ceramic acetabular insert) associated with the MD6® Phenom® femoral rod type, in Hospital of the Luz, São Paulo/SP, between 2018 and 2019. Anthropometric and clinical information about the operative procedure and two years follow-up were collected from the patients’ medical records. For the clinical-functional evaluation, the Harris Hip Score (HHS) questionnaire and hip movement goniometry were applied. For the radiographic parameters, the following were evaluated: the positioning of the acetabular component, the Zone of DeLee and the offset of the femoroacetabular component. Results: There was a higher prevalence of performing THA in males (53.8%). Preoperative and two-year postoperative radiographic parameters of surgical treatment for THA showed maintenance of the acetabular (p = 0.083) and femoral (p = 0.102) positioning angles and increased functionality (p < 0.001) and joint mobility of the hip (p = 0.001) with reduced pain after two years of THA. Complications related to dislocation, loosening, infection, and inadequate positioning of the implant were low, ranging from 1.5 to 3%. Conclusion: Older people who underwent cementless THA with an ceramic acetabular component device, in a two-year follow-up, showed effectiveness in improved clinical, radiological, and functional aspects. Full article
(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)
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