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Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis

Sun C, Lee WG, Ma Q, Zhang X, Zhao Z, Cai X

J Orthop Surg Res, 2023 Aug 08;18(1):586.
PMID: 37553600 DOI: 10.1186/s13018-023-04023-w

BACKGROUND: The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty.
METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies.
RESULTS: There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups.
CONCLUSION: Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.

Matched MeSH terms: Hip Joint/surgery
Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties

Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, et al.

J Mater Chem B, 2023 Nov 15;11(44):10507-10537.
PMID: 37873807 DOI: 10.1039/d3tb01469j

The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.

Matched MeSH terms: Hip Joint/surgery
Fulltext Fluid flow characteristics within an oscillating lower spherical surface and a stationary concentric upper surface for application to the artificial hip joint

Tso CP, Hor CH, Chen GM, Kok CK

Heliyon, 2018 Dec;4(12):e01085.
PMID: 30627676 DOI: 10.1016/j.heliyon.2018.e01085

The synovial fluid motion in an artificial hip joint is important in understanding the thermo-fluids effects that can affect the reliability of the joint, although it is difficult to be studied theoretically, as the modelling involves the viscous fluid interacting with a moving surface. A new analytical solution has been derived for the maximum induced fluid motion within a spherical gap with an oscillating lower surface and a stationary upper surface, assuming one-dimensional incompressible laminar Newtonian flow with constant properties, and using the Navier-Stokes equation. The resulting time-dependent motion is analysed in terms of two dimensionless parameters R and β, which are functions of geometry, fluid properties and the oscillation rate. The model is then applied to the conditions of the synovial fluid enclosed in the artificial hip joint and it is found that the motion may be described by a simpler velocity variation, whereby laying the foundation to thermal studies in the joint.

Matched MeSH terms: Hip Joint
Reliability and sensitivity of radiographic measures of hip dysplasia in childhood Charcot-Marie-Tooth disease

Dwan LN, Gibbons P, Jamil K, Little D, Birke O, Menezes MP, et al.

Hip Int, 2023 Mar;33(2):323-331.
PMID: 34180253 DOI: 10.1177/11207000211027591

BACKGROUND: Hip dysplasia is a lack of femoral head coverage and disruption of hip and acetabular alignment and congruency, with severity ranging from mild subluxation in nascent at-risk hips to complete dislocation. Presentation of hip dysplasia in neuromuscular conditions can be sub-clinical or associated with a limp with or without hip pain, abductor and flexor weakness and reduced hip range of motion. Untreated hip dysplasia leads to early onset osteoarthritis requiring hip arthroplasty in early adulthood. Hip dysplasia occurs in 6-20% of children with Charcot-Marie-Tooth disease, however little is known about the reliability and sensitivity of detection on plain film pelvic radiographs.
METHODS: 14 common measures of hip dysplasia on anteroposterior pelvis radiographs were independently assessed by 2 orthopaedic specialists in 30 ambulant children with Charcot-Marie-Tooth disease. Hip health was also categorised based on clinical impression to assess the sensitivity of radiographic measures to identify hip dysplasia status.
RESULTS: 8 measures (acetabular index, head width, lateral centre-edge angle, lateral uncoverage, medial joint width, migration percentage, neck shaft angle, triradiate status) exhibited 'excellent' reliability between clinical evaluators. 5 of the 30 patients (17%) were identified as having nascent hip dysplasia. Reliable radiographic measures that significantly distinguished between nascent hip dysplasia and healthy hips were acetabular index, lateral centre edge angle, medial joint width and migration percentage.
CONCLUSIONS: We have identified a subset of reliable and sensitive radiographic hip measures in children with Charcot-Marie-Tooth disease to prioritise during hip screening to mitigate the deleterious effects of hip dysplasia, pain and disability in adulthood.

Matched MeSH terms: Hip Joint/surgery
Fulltext Influence of dimple depth on lubricant thickness in elastohydrodynamic lubrication for metallic hip implants using fluid structure interaction (FSI) approach

Mohd Syafiq Mohd Suri, Nor Liyana Safura Hashim, Ardiyansyah Syahrom, Mohd Juzaila Abd. Latif, Muhamad Noor Harun

Malaysian Journal of Medicine and Health Sciences, 2020;16(108):28-34.
MyJurnal

Introduction: The lubricant thickness in clearance between bearing surfaces for metallic hip implants are currently incapable of accommodating the motion experienced (high load and low entraining motion) in hip walking cycle. Thus, micro-dimpled surfaces were introduced onto surfaces of metallic acetabular cups to improve lubricant thick- ness. Micro-dimpled surface is a method of advanced surface improvement to increase the lubricant thickness in various tribological applications, such as hip implants. However, the application of micro-dimpled surfaces in hip implants has not yet been explored adequately. Therefore, this study aims to identify the influence of micro-dimpled depth on lubricant thickness elastohydrodynamically for metallic hip implants using Fluid-Structure Interaction (FSI) approach. Methods: Fluid-Structure Interaction (FSI) approach is an alternative method for analysing characteristics of lubrication in hip implant. Dimples of radius 0.25 mm and various depths of 5μm, 45μm and 100μm were applied on the cup surfaces. The vertical load in z-direction and rotation velocity around y-axes representing the average load and flexion-extension (FE) velocity of hip joint in normal walking were applied on Elastohydrodynamic lubri- cation (EHL) model. Results: The metallic hip implants with micro-dimpled surfaces provided enhanced lubricant thickness, namely by 6%, compared to non-dimpled surfaces. Furthermore, it was suggested that the shallow depth of micro-dimpled surfaces contributed to the enhancement of lubricant thickness. Conclusion: Micro-dimpled sur- faces application was effective to improve tribological performances, especially in increasing lubricant thickness for metallic hip implants.

Matched MeSH terms: Hip Joint
Fulltext Bilateral traumatic hip dislocation in a child: a case report

Khoo, S,M.

Malays Orthop J, 2007;1(2):17-20.
MyJurnal

Traumatic hip dislocation in children is uncommon; when this condition is diagnosed in paediatric patients, it is most frequently seen as a unilateral posterior dislocation and is rarely associated with fracture. We report here a case involving a young girl who dislocated both hips in two separate incidents.

Matched MeSH terms: Hip Joint
Fulltext Comment on: Developmental dysplasia of the hip: why are we still operating on them? A plea for institutional newborn clinical screening

Ibrahim S

Singapore Med J, 2019 06;60(6):322.
PMID: 31243463 DOI: 10.11622/smedj.2019060
Matched MeSH terms: Hip Joint
Early clinical and radiographic analysis of the Fitmore cup

Merican AM, Randle R

J Arthroplasty, 2006 Sep;21(6):846-51.
PMID: 16950037

The Fitmore titanium mesh cementless acetabular component in 115 hip arthroplasties was reviewed at an average of 33 months of follow-up. None were revised nor had infection. One hip dislocated 4 years postoperatively. Two femoral components were revised. The average Harris Hip Score at the last follow-up was 90 points. In the 96 sets of radiographs available, there was no loosening or new radiolucency. One hip had nonprogressive osteolysis adjacent to a screw. This press-fit cup has its polar region flattened and is rim loading. Noncontact (gaps) at the acetabular floor is expected and is not critical for fixation. In all but 6 hips, these gaps filled. In 5 hips, a minimal gap (

Matched MeSH terms: Hip Joint/radiography*; Hip Joint/surgery
Oversized acetabular socket causing groin pain after total hip arthroplasty

Abbas AA, Kim YJ, Song EK, Yoon TR

J Arthroplasty, 2009 Oct;24(7):1144.e5-8.
PMID: 18848418 DOI: 10.1016/j.arth.2008.09.008

The causes of groin pain after total hip arthroplasty are numerous, and the condition itself is disabling. Therefore, it is imperative that the cause of the pain is identified and managed appropriately. We report a case where the patient had groin pain after total hip arthroplasty as a result of an oversized cementless acetabular component, which caused a breach in the anterior wall of the acetabulum. The anterior wall of the acetabulum was reconstructed with femoral head allograft, and the patient has been symptom free since.

Matched MeSH terms: Hip Joint/radiography; Hip Joint/surgery
Fulltext Outcome of Surgical Treatment for Displaced Acetabular Fractures

Anizar-Faizi A, Hisam A, Sudhagar KP, Moganadass M, Suresh C

Malays Orthop J, 2014 Nov;8(3):1-6.
PMID: 26401227 MyJurnal DOI: 10.5704/MOJ.1411.001

The aim of this study was to assess the outcome of surgical treatment in displaced acetabular fractures in our local facilities. Previous studies reveal good outcome via open reduction method with achievement of congruent joint. We note that studies in this respect have not been conducted in our region. We retrospectively analyzed thirty patients with acetabular fractures who underwent open reduction and internal fixation. The data collection was performed over a 4-year period, from 2008 to 2011. The results showed 20 out of 30 patients (66.7%) had excellent/good results (Harris Hip Score equal or more than 80). Post operative complications were deep infection (6.7%), iatrogenic sciatic nerve injury (10.0%), avascular necrosis (16.7%), heterotopic ossificans (3.3%), degenerative changes in hip joint (43.3%) and loss of reduction (3.3%). In conclusion, surgical treatment of displaced acetabular fractures produces good functional outcome despite the complications.

Matched MeSH terms: Hip Joint
Fulltext Minimally Invasive Total Hip Arthroplasty in a Patient with Hereditary Multiple Exostoses: A Case Report

Santoso A, Utomo P, Im CJ, Park KS, Yoon TR

Malays Orthop J, 2018 Nov;12(3):53-56.
PMID: 30555649 DOI: 10.5704/MOJ.1811.010

Hip geometry abnormalities found in patients with hereditary multiple exostoses (HME) could promote premature hip joint degeneration which needs treatment. We report the case of a 45-year old male with right hip arthrosis who underwent two-incision minimally invasive (MIS-2) total hip arthroplasty (THA), with satisfactory outcome. This technique could be an alternative approach for performing THA in patients with hereditary multiple exostoses.

Matched MeSH terms: Hip Joint
Fulltext Septic hip dislocation with a preserved femoral head: successful outcome following open reduction

Kamal J, Abdul Halim AR, Sharaf I

Medicine & Health, 2017;12(2):335-340.
MyJurnal

Septic arthritis of the hip in children represents a serious disorder with unfavourable long-term sequelae. In neonates, a poor hip outcome is expected especially if the treatment was delayed. Late sequelae can lead to structural joint damage and instability, causing deformity and dislocations which ultimately may result in limb length discrepancy, early degenerative changes and limited range of motion. Surgery at the appropriate time can improve the hip condition and functional outcome. Previous classifications of post septic hip sequelae are useful guides for treatment, but did not discuss one particular group of patient. This group-septic hip dislocation with a preserved femoral head, has recently been described as a distinct entity. This report highlights an 11-year follow-up of a 2-year-old child who had a successful outcome following open reduction and varus derotation
osteotomy for a septic hip dislocation with a preserved femoral head.
Keywords: septic arthritis, hip dislocation, child, infection

Matched MeSH terms: Hip Joint
Fulltext Antibiotic-laden Arthroplasty with a Novel Design of Cement Mould and Metallic Endoskeleton for Treatment of Hip Infection, an Inexpensive Alternative: A Preliminary Report of Two Cases

William C, Simmrat S, Suhaeb AM

Malays Orthop J, 2017 Jul;11(2):78-81.
PMID: 29021886 MyJurnal DOI: 10.5704/MOJ.1707.015

Infection of the hip after implant fixation is an uncommon yet devastating complication that results in poor long-term outcome. The gold standard treatment for chronic infection after hip arthroplasty is a two-stage protocol: eradication of infection, follow by re-implantation arthroplasty. The use of interim antibiotic-laden cement spacer has become a popular procedure to maintain hip joint function and provide antibiotic elution simultaneously before re-implantation. However, antibiotic cement spacer is mechanically weak and breaks if overloaded. Therefore, we designed a cement mould with metallic endoskeleton with the aim of creating a stronger, inexpensive, antibiotic-impregnated spacer resembling a unipolar arthroplasty. We report two cases of severe hip joint infection after implant fixation (bipolar hemiarthroplasty, screw fixation neck of femur). Both patients had undergone first stage surgery of debridement and articulating antibiotic cement insertion using our design. Although the second stage surgery was planned for these patients, both patients delayed the operation in view of good functional status after a year walking with the antibiotic cement spacer. These cases showed that the mechanical property of the new antibiotic cement spacer was promising but further mechanical studies upon this new endoskeleton design are required.

Matched MeSH terms: Hip Joint
Fulltext Slipped upper femoral epiphysis: a case of missed diagnosis

Maj MK, Ar AH, Das S

Chang Gung Med J, 2011;34(6 Suppl):13-6.
PMID: 22490452

A slipped upper femoral epiphysis (SUFE) is a known hip disorder in adolescents in which the proximal femoral epiphysis slips and displaces relative to the metaphysis. We report an obese 12-year-old boy who presented with acute pain in the left hip after a fall. He was otherwise healthy with no prior joint pain. Pelvic radiography was misread twice before a second fall led to a severe SUFE.

Matched MeSH terms: Hip Joint/radiography*
Fulltext A child with septic arthritis of hip: a rarely encountered cause

Abdul Halim AR, Norhamdan Y, Ramliza R

Med J Malaysia, 2011 Jun;66(2):154-5.
PMID: 22106702 MyJurnal

We report a rare case of septic arthritis in a healthy child caused by Salmonella enteritidis. No predisposing factor was detected. Salmonella enteritidis was isolated from the infected joint tissue obtained following surgical drainage. Based on the culture and sensitivity report, he was treated with a 6-week course of antibiotic. He improved dramatically without any detrimental sequelae at end of one year.

Matched MeSH terms: Hip Joint*
First series of Exeter small stem primary total hip arthroplasty minimum 5 years of follow-up

Tai CC, Nam HY, Abbas AA, Merican AM, Choon SK

J Arthroplasty, 2009 Dec;24(8):1200-4.
PMID: 19682839 DOI: 10.1016/j.arth.2009.07.001

We carried out a prospective study of 47 Exeter (Stryker Inc, Warsaw, Ind) small stem total hip arthroplasty in 42 patients with an average age of 58 years and a mean follow-up of 8.5 years. The Oxford hip score improved from a preoperative mean of 47 to 17 at last follow-up. More than 87% patients had excellent or good Harris hip scores, and 90% were able to walk with little or no pain. Stem subsidence within the cement mantle was observed in 26% of cases, and none showed evidence of aseptic loosening or implant failure. Two stems were removed due to infection. The survival rate of this implant was 95.7% at 10 years. This first series of Exeter small stem showed excellent medium-term results, comparable to its larger counterparts.

Matched MeSH terms: Hip Joint/surgery*
Fulltext Necrotizing fasciitis

Zubaidah AW, Lim VKE

Med J Malaysia, 1996 Mar;51(1):134-6.
PMID: 10967993

A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.

Matched MeSH terms: Hip Joint/surgery
Fulltext Primary stability recognition of the newly designed cementless femoral stem using digital signal processing

Baharuddin MY, Salleh ShH, Hamedi M, Zulkifly AH, Lee MH, Mohd Noor A, et al.

Biomed Res Int, 2014;2014:478248.
PMID: 24800230 DOI: 10.1155/2014/478248

Stress shielding and micromotion are two major issues which determine the success of newly designed cementless femoral stems. The correlation of experimental validation with finite element analysis (FEA) is commonly used to evaluate the stress distribution and fixation stability of the stem within the femoral canal. This paper focused on the applications of feature extraction and pattern recognition using support vector machine (SVM) to determine the primary stability of the implant. We measured strain with triaxial rosette at the metaphyseal region and micromotion with linear variable direct transducer proximally and distally using composite femora. The root mean squares technique is used to feed the classifier which provides maximum likelihood estimation of amplitude, and radial basis function is used as the kernel parameter which mapped the datasets into separable hyperplanes. The results showed 100% pattern recognition accuracy using SVM for both strain and micromotion. This indicates that DSP could be applied in determining the femoral stem primary stability with high pattern recognition accuracy in biomechanical testing.

Matched MeSH terms: Hip Joint/physiopathology*; Hip Joint/surgery
Fulltext Heterotopic ossification in stroke is not that rare: lesson from rehabilitation standpoint

Fatimah Ahmedy, Nurul Diyanah Zenian, Wan Juhaini Paizi, Teh Yong Guang, Khin Nyein Yin, D. Maryama Ag Daud, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):71-71.
MyJurnal

Introduction:Stroke is a major public health concern and treating its complications is important for functional recov-ery. Heterotopic ossification (HO), a condition where bone is developed in non-skeletal tissue, is not an uncommon stroke-related complication with reported occurrence up to 12%. It typically presents with joint range of motion (ROM) limitation, pain and swelling. Detecting HO is important to prevent forceful joint manipulation during reha-bilitation that can cause pain and fracture. Two cases of diagnosing HO during the course of stroke rehabilitation are presented. Case description: First case was a subacute stroke in 25 year-old male with right-sided hemiparesis and right hip joint ROM limitation. He did not consent to have passive ROM exercise and refused to be seated due to severe right hip pain. Second case was a 41 year-old male with chronic right-sided hemiparetic stroke exhibiting ipsilateral lower limb neurological recovery but inability to perform bed mobility and walking despite regaining motor function. The right hip joint ROM was limited in the absence of pain. Radiographs demonstrated presence of HO in the affected hip of both patients. Gentle hip ROM exercise was prescribed and noted improvement in ROM with subsequent ability for sitting (first case) and short-distance ambulation (second case). Conclusion: HO should be considered as a differential diagnosis in stroke patients having limited ROM, hence the importance of thorough physical examination. Presence of HO would guide rehabilitation process by encouraging gentle ROM exercise in the attempt to reduce public health burden from halted functional recovery in stroke.

Matched MeSH terms: Hip Joint
The impact of surface and geometry on coefficient of friction of artificial hip joints

Choudhury D, Vrbka M, Mamat AB, Stavness I, Roy CK, Mootanah R, et al.

J Mech Behav Biomed Mater, 2017 08;72:192-199.
PMID: 28500998 DOI: 10.1016/j.jmbbm.2017.05.011

Coefficient of friction (COF) tests were conducted on 28-mm and 36-mm-diameter hip joint prostheses for four different material combinations, with or without the presence of Ultra High Molecular Weight Polyethylene (UHMWPE) particles using a novel pendulum hip simulator. The effects of three micro dimpled arrays on femoral head against a polyethylene and a metallic cup were also investigated. Clearance played a vital role in the COF of ceramic on polyethylene and ceramic on ceramic artificial hip joints. Micro dimpled metallic femoral heads yielded higher COF against a polyethylene cup; however, with metal on metal prostheses the dimpled arrays significantly reduced the COF. In situ images revealed evidence that the dimple arrays enhanced film formation, which was the main mechanism that contributed to reduced friction.

Matched MeSH terms: Hip Joint

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