Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modified Stoppa Approach in Treating Pelvic and Acetabular Fractures

Objective Pelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures. Methods The clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared. Results The patients were followed up for 6–7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05). Conclusions The pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.

Mobility-related outcomes for periacetabular osteotomy in persons with acetabular dysplasia: setting the stage for measurement of real-world outcomes

ABSTRACT Periacetabular osteotomy (PAO) is a surgery for persons with symptomatic acetabular dysplasia (AD) that increases acetabular coverage of the femoral head for reducing hip pain and improving function. Patient-reported outcomes (PROs) are significantly improved following PAO, yet little is known regarding mobility-related outcomes. This narrative review provides a synthesis of evidence regarding PROs and mobility-related outcomes in persons with AD following PAO. We further identified important future research directions, chiefly the need for measurement of real-world outcomes. We searched PubMed using comprehensive predefined search terms. We included studies that (i) enrolled persons with AD undergoing PAO, (ii) included PROs and/or mobility-related outcomes and (iii) were written in English. We synthesized and summarized study characteristics and findings. Twenty-three studies were included in this review. Commonly evaluated PROs included pain (n = 14), hip function (n = 19) and quality of life (n = 9). Mobility-related outcomes included self-reported physical activity (PA; n = 11), walking speed and cadence (n = 4), device-measured PA (n = 2), and sit-to-stand, four-square-step and timed stair ascent tests (n = 1). Persons with AD had significant improvements in PROs following PAO, yet mobility-related outcomes (e.g. walking speed and device-measured PA levels) did not change over 1 year following PAO. Few studies have evaluated mobility-related outcomes following PAO, and these studies were of a low methodological quality. Future research might include experience sampling data collection approaches and body-worn devices as free-living, technology-driven methodologies to evaluate mobility and other outcomes in persons with AD undergoing PAO.

Socioeconomic status and use of analgesic drugs before and after primary hip arthroplasty: a population-based cohort study of 103,209 patients during 1996–2018

Background and purpose — Total hip arthroplasty (THA) is an effective and common procedure. However, persistent pain and analgesic requirement up to 2 years after THA surgery are common. We examined the trends in the utilization of analgesics before and after THA, overall, and in relation to socioeconomic status (SES) in a populationbased cohort. Patients and methods — We used the Danish Hip Arthroplasty Register to identify 103,209 patients who underwent THA between 1996 and 2018. Data on prescriptions and SES markers was obtained from Danish medical databases. Prevalence rates of redeemed prescriptions for analgesics with 95% confidence intervals were calculated for 4 quarters before and 4 quarters after THA for the entire THA population, and by 3 SES markers (education, cohabiting status, and wealth). Results — Overall, the prevalence of analgesic use prior to surgery was 42% at 9–12 months and 59% at 0–3 months before the THA. The prevalence of analgesics reached its highest at 64% 0–3 months after THA but declined to 27% at 9–12 months after THA. Low education, living alone, and having low wealth (low SES) were associated with higher prevalence of analgesics use both before and after THA. Interpretation — 59% of patients used analgesics 0–3 months before surgery, which could indicate that THA might not be considered the last option for treatment and that surgery criteria might depend more on factors such as patient preferences or hip function. Moreover, health professionals should prioritize the use of a detailed plan when phasing out analgesics after THA to counteract unnecessary use, especially when treating patients with low SES.

Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults

Background To compare the clinical efficacy of a femoral neck system (FNS) and cannulated screws (CS) in the treatment of femoral neck fracture in young adults. Methods Data from 69 young adults, who were admitted for femoral neck fracture between March 2018 and June 2020, were retrospectively analyzed. Patients were divided into two groups according to surgical method: FNS and CS. The number of intraoperative fluoroscopies, operative duration, length of hospital stay, fracture healing time, Harris score of hip function, excellent and good rate of hip function, and postoperative complications (infection, cut out the internal fixation, nail withdrawal, and femoral neck shortening) were compared between the two groups. Hip joint function was evaluated using the Harris Hip Scoring system. Results All 69 patients had satisfactory reduction and were followed up for 12–24 months, with a mean follow-up of 16.91 ± 3.01 months. Mean time to fracture healing was13.82 ± 1.59 and 14.03 ± 1.78 weeks in the FNS and CS groups, respectively. There was a statistical difference in the number of intraoperative fluoroscopies between the 2 groups (P = 0.000). There were no significant differences, in operation duration, hospital length of stay, fracture healing time, complications, Harris Hip Score for hip function and excellent and good rate between the two groups (P > 0.05). The incidence of complications was 6.1%(2/33) in the FNS group lower than 25%(9/36) in the CS group, a difference that was statistically significant (P = 0.032). At the last follow-up, the Harris Hip Score of the hip joint in the FNS group was 90.42 ± 4.82and 88.44 ± 5.91 in the CS group. Conclusions Both treatment methods resulted in higher rates of fracture healing and excellent hip function. Compared with CS, the FNS reduced the number of intraoperative fluoroscopies, radiation exposure to medical staff and patients, and short-term complications including femoral neck shortening and bone nonunion.

PFNA-II Internal Fixation Helps Hip Joint Recovery and Improves Quality of Life of Patients with Lateral-Wall Dangerous Type of Intertrochanteric Fracture

Objective. To analyze the effect of PFNA-II internal fixation on hip joint recovery and quality of life (QOL) in patients with lateral-wall dangerous type of intertrochanteric fracture. Methods. One hundred and twelve patients with lateral-wall dangerous type of intertrochanteric fracture who underwent surgical treatment in our hospital from May 2017 to May 2019 were selected as the participants of the study. Based on the treatment method, all the enrolled patients were divided into two groups: proximal femoral nail antirotation (PFNA group; n = 59 ) who received closed reduction and minimally invasive PFNA internal fixation and dynamic hip screw group (DHS; n = 53 ) who received internal fixation. The clinical indicators, curative effect, hip function score, pain degree, postoperative QOL score, and complications were compared between the two groups. Results. The operation time, intraoperative blood loss, postoperative drainage volume, and the incidence of postoperative complications in PFNA group were statistically lower than those in DHS group ( P < 0.05 ). The curative effect in PFNA group was notably better than that in DHS group. There were no significant differences in scores of hip function, visual analogue scale (VAS), and QOL between the two groups before operation ( P > 0.05 ). However, the hip function score and QOL score increased in both groups after surgery, and the increase was more significant in the PFNA group, while the VAS score decreased in both groups, and the decrease in PFNA group was more significant ( P < 0.05 ). Conclusion. PFNA internal fixation for the treatment of lateral-wall dangerous type of intertrochanteric fracture has the advantages of short operation time, less intraoperative blood loss, effective improvement of hip joint function, and fewer postoperative complications, which is worthy of clinical application.

Oblique-ilioischial Plate Technique: A Novel Method for Acetabular Fractures Involving Low Level Posterior Column

Background: Complex acetabular fractures involving the anterior and posterior columns are an intractable clinical challenge. The study investigated the safety and efficacy of oblique-ilioischial plate technique for acetabular fractures involving low level posterior column. Methods: A retrospective analysis of 18 patients operated with the oblique-ilioischial plate technique by the modified Stoppa approach (or combined with iliac fossa approach) between August 2016 and July 2021 for low level posterior column acetabular fractures was conducted. The anterior column was fixed with a reconstructed plate from the iliac wing along the iliopectineal line to the pubis. The low level posterior column was fixed with the novel oblique-ilioischial plate running from the ilium to the ischial ramus. Operative time, intraoperative blood loss, reduction quality, and postoperative hip function were recorded.Results: Out of the 18 patients, 10 were male and 8 were female (mean age: 48.6±10.2 years, range: 45–62 years; mean interval from injury to operation: 7.2±1.4 days, range: 5–19 days; mean operative time: 2.1±0.3 h, range: 1. 0–3.2 hours; mean intraoperative blood loss: 300±58.4 mL, range: 200–500 mL). Postoperative reduction (Matta’s criteria) was deemed as excellent (n = 9), good (n = 4), and fair (n = 5). At the final follow-up, the hip function (modified Merle d’Aubigne-Postel scale) was deemed as excellent (n = 11), good (n = 3), and fair (n = 4). The mean union time was 4.5±1.8 months (range: 3–6 months). No implant failure, infection, heterotopic ossification, or neurovascular injury were reported. Conclusion: The oblique-ilioischial plate technique via anterior approach for acetabular fractures involving low level posterior column offers reliable fixation, limited invasion, little intraoperative bleeding, and fewer complications. However, larger multicenter control studies are warranted.

Cementless total hip arthroplasty for three different degrees of hip involved secondary to ankylosing spondylitis: an analysis of 195 hips

Background Hip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement. Methods The 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared. Results The follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P < 0.001), while group A and B can realize better HHS than group C (P < 0.001). The three groups had similar SF-12 postoperatively. For group A, LOS and cost for unilateral procedure were the least than that for group B and C (P = 0.003 and P = 0.001). Similar radiological assessments were achieved for three groups. 1 hip in group A encountered delay union of wound. 1 hip in group C encountered delay union of wound and dislocation and another patient encountered femoral fracture intraoperatively. 12 hips (12.8%) in group A, 6 hips (12.2%) in group B, and 6 hips (11.5%) in group C encountered asymptomatic heterotopic ossification (P = 0.977). Conclusion For AS patients with hip involvement, THA can improve hip ROM and function. THA for the non-ankylosed hip can realize the better hip function and postoperative ROM than ankylosed hip.

Complications after Dynamic Hip Screw Osteosynthesis of Proximal Femoral Fractures at Army Instructional Hospital-Libreville

The DHS system is an effective means of open reduction and internal fixation of proximal femur fractures. Postoperative complications are little described and deserve to be studied for better preventive and curative treatment. We report the observations of five (5) patients who presented postoperative complications specific to the DHS system at army instructional Hospital-Libreville. These described complications are related to deterioration of internal fixation leading to callus, nonunion, or infection. Those found are the cut out phenomenon, avascular necrosis of the femoral head, and the fracture of the DHS system. All these complications required surgical revision without functional repercussions at the last follow-up. Complications of internal fixation by the DHS system can be avoided by rigorous asepsis, adequate indications for surgery, and rigorous surgical techniques. Good management can restore hip function.

New Strategies for Early Diagnosis and Treatment of Osteoid Osteoma of the Lesser Trochanter of Femur

Aims: Herein, we examined the efficacy of open resection in proximal femoral osteoid osteoma (OO) treatment. Besides, we analysed the causes of misdiagnosis of proximal femoral OO to provide a reference for its diagnosis and treatment.Methods: This was a retrospective study involving 29 patients with proximal femoral OO admitted into our hospital from January 2010 to January 2018. The baseline characteristics of the participants included; 21 males and 9 females, aged between 13 to 25 (mean 16.2) years old, and the course of the disease was 1 to 14 (mean 6.1) months. We used previous medical experience records of the patients to analyze for the causes of misdiagnosis. Moreover, we compared the difference between preoperative and postoperative treatment practices in alleviating pain in OO patients and restoring hip function. Follow-ups were conducted regularly, and patients advised to avoid strenuous exercises for 3 months.Results: We followed up 29 patients (21 intercortical, 2 sub-periosteal, and 6 medullary) for an average of 42.5 months. We found that 13 patients (44.8%) had been misdiagnosed of synovitis, Perthes disease, osteomyelitis, intra-articular infection, and joint tuberculosis, whose average time from symptoms to diagnosis were 9.8 months. Postoperative pain score and joint function score improved significantly compared with preoperative, and complications were rare.Conclusion: Open surgical resection constitutes an effective treatment for proximal femoral OO by accurately and completely removing the nidus. Lack of understanding, wrong choice of examination, and the complexity and diversity of clinical manifestations constitute the main reasons for the misdiagnosis of proximal femoral OO.

Weight Loss in Patients Waiting for Total Hip Arthroplasty: Fiber-Enriched High Carbohydrate Diet Improves Hip Function and Decreases Pain before Surgery

The impact of obesity on clinical outcomes following joint replacement procedures is resounding. Therefore, multiple strategies to achieve a substantial weight loss before surgery are needed in obese patients. The aim of the study was to test the effect of a fiber-enriched high carbohydrate (FEHC) diet on the reduction in body weight and pain in elderly obese patients undergoing total hip arthroplasty (THA). Sixty-one candidates for THA were included in our study. Prior to the procedure, the participants have been randomly assigned to a 3-month diet intervention (FEHC diet or free diet). Anthropometric measures and food questionnaires were collected at the enrollment and after 3 months. The Oxford Hip Score (OHS), the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario McMaster Universities OA Index (WOMAC) were administered at baseline and before surgery. A statistically significant variation of weight was found in the FEHC diet group (−3.7 kg, −4.4–−2.5) compared to the control group (−0.2 kg; −1.4–1.7; p < 0.0001), as well as significant improvements in the OHS (p < 0.0001), the HOOS (p < 0.0001) and the WOMAC (p < 0.0001) questionnaires. According to the results of the study, the FEHC diet in obese patients undergoing THA might help weight loss and improve related anthropometric parameters as well as hip function and pain.