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Current Trends in Hip Surgery
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Current Trends in Hip Surgery

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

Deadline for manuscript submissions: 15 July 2024 | Viewed by 4156

Special Issue Editors

Prof. Dr. Cesare Faldini

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Guest Editor
1. Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, 40125 Bologna, Italy
2. 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, 40125 Bologna, Italy
Interests: orthopaedic surgery; spine; hip; knee; foot and ankle; paediatric orthopaedics
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Alberto Di Martino

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Guest Editor
1. Orthopedic and Traumatology Department, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
2. Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
Interests: hip; spine; musculoskeletal oncology; orthopedics; musculoskeletal disorders
Prof. Dr. Francesco Traina

E-Mail Website
Guest Editor
1. Orthopedics-Traumatology and Prosthetic Surgery and Hip and Knee Revision, Rizzoli Orthopedic Institute, Bologna, Italy
2. Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
Interests: hip; knee; orthopedics

Special Issue Information

Dear Colleagues,

We are proud to announce a call for papers on the current techniques in hip surgery. This issue is devoted to all orthopedic surgeons treating hip disorders at any age. Great emphasis will be given to newer techniques of total hip arthroplasty surgery in terms of biomaterials, long-term results, complications, surgical approaches, and newer technologies. Moreover, our aim is to promote the role of non-arthroplasty/preservative surgery in  pediatric, young adult, and active patients and outline how these techniques can improve the quality of life of our patients. Journal of Clinical Medicine Two out of three case reports and surgical techniques on isolated cases are beyond the scope of this supplement. Selected manuscripts on orthopedic oncology will be considered and included.

Prof. Dr. Cesare Faldini
Prof. Dr. Alberto Di Martino
Prof. Dr. Francesco Traina
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hip
  • total hip arthroplasty
  • preservative surgery
  • surgical approach
  • deformity
  • infections
  • trauma
  • degenerative hip
  • arthroscopy

Published Papers (6 papers)

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Research

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13 pages, 794 KiB  
Article
Anterior Minimally Invasive Approach (AMIS) for Total Hip Arthroplasty: Analysis of the First 1000 Consecutive Patients Operated at a High Volume Center
by Cesare Faldini, Valentino Rossomando, Matteo Brunello, Claudio D’Agostino, Federico Ruta, Federico Pilla, Francesco Traina and Alberto Di Martino
J. Clin. Med. 2024, 13(9), 2617; https://doi.org/10.3390/jcm13092617 - 29 Apr 2024
Viewed by 208
Abstract
(1) Background: Direct anterior approach (DAA) has recently acquired popularity through improvements such as the anterior minimally invasive surgical technique (AMIS). This retrospective study examines the first 1000 consecutive THAs performed utilizing the AMIS approach in a high-volume center between 2012 and 2017. [...] Read more.
(1) Background: Direct anterior approach (DAA) has recently acquired popularity through improvements such as the anterior minimally invasive surgical technique (AMIS). This retrospective study examines the first 1000 consecutive THAs performed utilizing the AMIS approach in a high-volume center between 2012 and 2017. (2) Methods: 1000 consecutive THAs performed at a single institution utilizing the AMIS approach were retrospectively analyzed with a minimum five-year follow-up. Full evaluation of demographic information, clinical parameters, intraoperative complications, and radiological examinations are reported. (3) Results: Overall complication rate was 9.4% (94/1000), including 8 dislocations, 57 femoral-cutaneous nerve injuries, 12 intraoperative femoral fractures, 9 infections and 8 leg length discrepancy. Implant survival rates were 98.5% at 1 year, 97.5% at 3 years, 97% at 5 years, and 95.3% at 7 years. Causes of failure included periprosthetic fractures (0.8%), implant dislocations (0.6%), septic loosening (0.5%), aseptic mobilizations (0.2%), and symptomatic limb length discrepancies (0.2%). (4) Conclusions: Controversies persist around the direct anterior approach (DAA) for THA, primarily regarding the increased complications rate during the learning curve. However, this study advocates for widespread adoption of the DAA approach. The results demonstrate acceptable complication rates and remarkable functional outcomes, affirming its viability in the broader orthopedic patient population. Full article
(This article belongs to the Special Issue Current Trends in Hip Surgery)
11 pages, 1120 KiB  
Article
Ultrasound-Guided Hip Injections with High Density Hyaluronic Acid: Outcome at One Year Follow Up
by Antonino Giulio Battaglia, Rocco D’Apolito, Fabio Labionda, Joil Ramazzotti and Luigi Zagra
J. Clin. Med. 2024, 13(9), 2515; https://doi.org/10.3390/jcm13092515 - 25 Apr 2024
Viewed by 292
Abstract
Background: The ultrasound-guided viscosupplementation of the hip joint with hyaluronic acid (HA) is considered a standard procedure among the conservative treatments for hip arthritis. The aim of this study was to evaluate the clinical benefit and the incidence of adverse events of [...] Read more.
Background: The ultrasound-guided viscosupplementation of the hip joint with hyaluronic acid (HA) is considered a standard procedure among the conservative treatments for hip arthritis. The aim of this study was to evaluate the clinical benefit and the incidence of adverse events of the technique in an observational study at one year follow up. Methods: We evaluated a consecutive series of 85 patients with a diagnosis of symptomatic arthritis who underwent intra-articular ultrasound-guided hyaluronic acid injections. The scales used for evaluation were modified Harris Hip Score (mHHS), WOMAC (Western Ontario and McMaster University), and Hip Outcome Score (HOS) with subscale Sport (HOSs), for pain the Visual Analogic Scale (VAS). The patients were classified according to Tonnis’ radiological classification of arthritis (range 0–3): 20 patients (grade 0), 32 (grade 1), 18 (grade 2), 15 (grade 3). Results: At last follow up, all the scales increased: mHHS from 59.35 to 82.1, HOS from 69.45 to 78.53, HOss from 47.4 to 58.11, VAS from 6.09 to 3.97, WOMAC from 33.2 to 31.5 (p < 0.05 for all the parameters); the results were elaborated with GraphPad Prism v5.0 (Prism Software La Jolla, CA, USA) using Wilcoxon’s test. A total of 13 patients out of 85 needed arthroplasty, all classified as Tonnis grade 3. No serious adverse events were noted due to the procedure. Conclusions: Based on our findings, indication for the use of hyaluronic acid is limited to patients with mild to moderate arthritis. Patients in advanced arthritis refusing replacement surgery and asking for this treatment should be informed about the poor results of the technique even in the short term. Full article
(This article belongs to the Special Issue Current Trends in Hip Surgery)
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17 pages, 1611 KiB  
Article
When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature
by Mariachiara Cerchiaro, Giulia Trovarelli, Andrea Angelini, Elisa Pala, Antonio Berizzi, Carlo Biz and Pietro Ruggieri
J. Clin. Med. 2024, 13(3), 815; https://doi.org/10.3390/jcm13030815 - 31 Jan 2024
Viewed by 731
Abstract
(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this [...] Read more.
(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with “pseudotumors” associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision. Full article
(This article belongs to the Special Issue Current Trends in Hip Surgery)
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10 pages, 936 KiB  
Article
Does Body Mass Index (BMI) Affect the Reconstruction of Biomechanical Parameters in Patients Undergoing Total Hip Replacement (THR) through the Direct Anterior Approach (DAA)?
by Manuel Weißenberger, Tizian Heinz, Dominik Rak, Ioannis Stratos, Philip Mark Anderson, Martin Lüdemann, Konstantin Horas, Axel Jakuscheit and Maximilian Rudert
J. Clin. Med. 2024, 13(2), 467; https://doi.org/10.3390/jcm13020467 - 15 Jan 2024
Viewed by 733
Abstract
Objective: Direct anterior approach total hip replacement (DAA-THR) is gaining increased interest due to its tissue-sparing nature and rapid recovery. Obesity has been shown to be a significant parameter influencing cup positioning in DAA-THR. It was the intention of this retrospective study to [...] Read more.
Objective: Direct anterior approach total hip replacement (DAA-THR) is gaining increased interest due to its tissue-sparing nature and rapid recovery. Obesity has been shown to be a significant parameter influencing cup positioning in DAA-THR. It was the intention of this retrospective study to examine how obesity would influence the restoration of native hip biomechanical parameters during DAA-THR. Materials and Methods: A total of 74 patients from a high-volume university orthopedic center after unilateral DAA-THA were included. Patients were retrospectively allocated to a study group (BMI > 30 kg/m2) and a control group (BMI < 30 kg/m2). Furthermore, propensity-score matching for baseline parameters was performed, leaving 30 patients in each group. Biomechanical parameters of the hip (i.e., femoral offset (FO), abductor lever arm (ABL), acetabular offset (AO), center of rotation (COR), stem alignment (SA), body weight lever arm (BWL), cup inclination (CI), and leg length discrepancy (LLD) were evaluated on standardized plain radiographs, and parameters were compared to the native contralateral hip. Results: Mean BMI in the study group was 35.07 ± 5.13 kg/m2 and 25.43 ± 2.64 kg/m2 in the control group. There was a significant decrease of the ABL only in the study cohort (p = 0.01). CI and SA did not differ between both cohorts. FO was slightly increased compared to the native hip in both groups. There was a marginally higher but non-significant proportion of improper FO restoration in the study group (19 vs. 16 patients, p = 0.60). Conclusions: Obesity, as quantified by BMI, only has a limited impact on the adequate reconstruction of native biomechanical parameters of the hip during DAA-THR. ABL was the only parameter to be significantly decreased in the overweight patients after DAA-THR. Therefore, special care should be taken on proper acetabular reaming and consequent seating of the cup in the obese patient to avoid excessive lateral positioning. Full article
(This article belongs to the Special Issue Current Trends in Hip Surgery)
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11 pages, 1512 KiB  
Article
Survival and Results after Resection and Reconstruction with Megaprosthesis at the Hip in Octogenarians
by Guido Scoccianti, Matteo Innocenti, Roberto Scanferla, Federico Scolari, Francesco Muratori, Andrea Ungar, Carlo Rostagno and Domenico Andrea Campanacci
J. Clin. Med. 2023, 12(24), 7740; https://doi.org/10.3390/jcm12247740 - 17 Dec 2023
Viewed by 652
Abstract
Few data are available about results after procedures of resection and megaprosthesis at the hip in very elderly patients. The aim of our study was to ascertain survival and complications in patients aged 80 or older undergoing these major orthopedic procedures. A consecutive [...] Read more.
Few data are available about results after procedures of resection and megaprosthesis at the hip in very elderly patients. The aim of our study was to ascertain survival and complications in patients aged 80 or older undergoing these major orthopedic procedures. A consecutive series of 27 procedures in 26 patients aged 80–93 years was evaluated. In total, 15 procedures were performed due to oncological diseases, 6 were performed following joint arthroplasty failures or periprosthetic fractures, and 6 were performed after trauma or trauma sequelae. Survival of the patients ranged from 0 to 122 months. Overall survival was 56% at 3 years, 24% at 5 years, and 16% at 8 years. An early postoperative death during the first 3 months occurred in five patients (18.5%). The only preoperative parameter negatively affecting survival was preoperative hemoglobin lower than 11 g/dL. Local complications were similar to reported rates in all-age patients’ series. In our experience, resection and megaprosthetic reconstruction can also be a valid choice in very elderly patients, with 56% of patients living more than two years from surgery and 24% more than five. Nevertheless, early postoperative deaths are frequent. A multidisciplinary evaluation of frailty of the patient must be accomplished, and patients and relatives must be informed about the risks of the procedure. Full article
(This article belongs to the Special Issue Current Trends in Hip Surgery)
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Review

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11 pages, 1368 KiB  
Review
Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review
by Francesco Castagnini, Francesco Pardo, Stefano Lucchini, Marco Rotini, Bruno Cavalieri, Mattia Dalla Rosa, Stefano Vitacca, Alberto Di Martino, Cesare Faldini and Francesco Traina
J. Clin. Med. 2024, 13(2), 604; https://doi.org/10.3390/jcm13020604 - 21 Jan 2024
Viewed by 716
Abstract
Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were [...] Read more.
Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications. Full article
(This article belongs to the Special Issue Current Trends in Hip Surgery)
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