Utilizing an antibiotic-eluting articulated cemented spacer in the two-stage management of infected total hip arthroplasty: a technical note.

Two-stage revision is generally preferred to eradicate chronic periprosthetic infections after total hip arthroplasty (THA) because of its good infection control and promising results. During two-stage revision, a temporary antibiotic-impregnated cement spacer was initially used for the local delivery of antibiotics, thereby reducing the risk of infection recurrence. Many researchers have reported various techniques for fabricating cemented spacers; however, there is no established standard technique. We share our cost-effective and easily reproducible technique for creating an articulated cemented spacer for managing infected THA.

The efficacy of Denosumab in the treatment of femoral head osteonecrosis: a retrospective comparative study.

The present study aimed to compare clinical and radiological differences of ONFH patients who were treated with denosumab, and a control group. A total of 178 patients (272 hips) with symptomatic, nontraumatic ONFH were divided into a denosumab group (98 patients, 146 hips) and a control group (80 patients, 126 hips). Patients in the denosumab group received a 60 mg subcutaneous dose of denosumab every 6 months. For the clinical assessments, Harris hip scores (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated. Plain radiographs and MRI were performed before and a minimum of 1 year after administration of denosumab, which were evaluated for radiological results including femoral head collapse (≥ 2 mm) and volume change of necrotic lesion. Femoral head collapse occurred in 36 hips (24.7%) in the denosumab group, and 48 hips (38.1%) in the control group, which was statistically significant (P = 0.012). Twenty-three hips (15.8%) in the denosumab group and 29 hips (23%) in the control group required THA, which showed no significant difference (P = 0.086). At the final follow-up, 71.9% of hips in the denosumab group had a good or excellent HHS compared with 48.9% in the control group, showing a significant difference (P = 0.012). The denosumab group showed a significantly higher rate of necrotic lesion volume reductions compared with the control group (P < 0.001). Denosumab can significantly reduce the volume of necrotic lesions and prevent femoral head collapse in patients with ARCO stage I or II ONFH.

Fixation of femoral neck fracture with femoral neck system: a retrospective cohort study of 43 patients.

BACKGROUNDS: This study aimed to analyze the clinical outcomes of femoral neck fractures (FNF) in patients treated with a femoral neck system (FNS, DePuy Synthes), which is a recently introduced device. METHODS: This retrospective cohort study of 43 patients who underwent osteosynthesis using FNS for FNF between July 2019 and June 2021 with a minimum follow-up of 6 months. The researchers examined the patients' demographic factors and radiologically evaluated the fracture type and fixation status, bone union, and postoperative complications. RESULTS: Of 43 patients, 25 were female, and the patients' mean age and body mass index were 62.1 years and 22.5 kg/m2, respectively. According to the Association of Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, the most common fracture types were 31B1.1 and B1.2 (13 cases each), followed by B2.3, B2.1, and B2.2 (seven, five, and four cases, respectively). Radiological bone union was confirmed in 39 patients (90.7%), and the mean time to union was 3.6 months. Two cases of nonunion, one case of lag screw cut-out, and one case of osteonecrosis were confirmed; all four cases later underwent arthroplasty. The mean time to reoperation was 4.5 months. Meanwhile, five patients underwent implant removal after the bone union, and distal locking screw stripping was noted in three patients. All three patients required metal plate cutting to remove the implants. CONCLUSIONS: Osteosynthesis of FNF using the newly introduced FNS showed favorable clinical outcomes and no specific hardware-related complications were reported during the follow-up. However, attention must be paid to the issue regarding distal locking screw failure during hardware removal.

Differences in periprosthetic bone mineral density tendencies with Types 1 and 3C stems in bipolar hemiarthroplasty following hip fracture.

The purpose of this study was to compare the periprosthetic bone mineral density (BMD) changes in the patients who underwent bipolar hemiarthroplasty (BPHA) for geriatric femoral neck fracture between two major different types of cementless femoral stems. A total of 93 patients (96 hips) who underwent BPHA for femoral neck fracture were categorized into two groups: Type 1 (42 patients, 44 hips), and Type 3C stem (51 patients, 52 hips). We investigated the annual follow-up trends of periprosthetic BMD at each Gruen zone during minimum postoperative 5-years; moreover, we compared the trends of periprosthetic BMD between both groups. The mean follow-up period was 7.1 years. In both groups, the overall BMD at the last follow-up had decreased compared with the baseline. In those with the Type 1 stem, BMD in the lateral femoral meta-diaphysis significantly decreased at 1-year follow-up after surgery. In those with Type 3C stem, BMD in the lateral femoral metaphysis postoperatively decreased after 3-years, whereas the BMD in the mediolateral femoral diaphysis drastically decreased postoperative 1-year period and plateaued thereafter. Different tendencies according to stem design were observed obviously in the postoperative BMD change of the proximal femur in patients who underwent BPHA for geriatric femoral neck fracture.

Forte ceramic-on-delta ceramic cementless total hip arthroplasty: an 8- to 15-year follow-up study.

INTRODUCTION: Forte ceramic head on delta ceramic liner articulation showed satisfactory midterm results without ceramic-related complication. We aimed to investigate the clinical and radiological outcomes of cementless total hip arthroplasty (THA) with forte ceramic head on delta ceramic liner articulation. MATERIALS AND METHODS: Overall, 107 patients (57 men, 50 women; 138 hips) who underwent cementless THA with forte ceramic head on delta ceramic liner articulation were enrolled. The mean follow-up duration was 11.6 years. For the clinical assessments, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), presence of thigh pain, and presence of squeaking were evaluated. Radiographs were assessed to search for osteolysis, stem subsidence, loosening of implants. Kaplan-Meier survival curves were evaluated. RESULTS: The mean HHS and WOMAC improved from 57.1 and 28.1 preoperatively to 81.4 and 13.1 at the final follow-up, respectively. Nine revisions (6.5%) were performed; 5 hips for stem loosening, 1 hip for ceramic liner fracture, 2 hips for periprosthetic fracture, and 1 hip for progressive osteolysis around cup and stem. Thirty-two patients (37 hips) complained squeaking, in which 4 cases (2.9%) were identified as ceramic-related noises. After a mean follow-up period of 11.6 years, 91% (95% CI 87.8-94.2) were free from revision of both femoral and acetabular components due to any reason. CONCLUSIONS: Cementless THA with forte ceramic-on-delta ceramic articulation showed acceptable clinical and radiological results. Serial surveillance of these patients should be performed due to the possibility of cerami- related complications such as squeaking, osteolysis, and ceramic liner fracture.

Incomplete Intertrochanteric Fracture: A Pattern Analysis Using Multiplanar Reformation Computed Tomography.

Background: Incomplete fractures are assumed to occur in the intertrochanteric area as fractures at other sites, but reports of incomplete intertrochanteric fractures (IIFs) are rare. In 1999, Schultz et al. defined isolated greater trochanter fractures (GTFs) as IIFs when intertrochanteric extension is observed on magnetic resonance (MR) images. On multiplanar reformation computed tomography (MPR CT) images acquired for further study of apparently isolated GTFs, we noted incomplete cortical breakage in the intertrochanteric area. We then found that the fracture line was incomplete on plain radiographs in some intertrochanteric fractures. We evaluated IIFs and apparently isolated GTFs using MPR CT and analyzed the fracture patterns of IIFs that were confirmed using MPR CT. Methods: Between February 2006 and June 2019, 36 cases of IIF were detected using MPR CT in 36 patients. They were 17 women and 19 men with a mean age of 74.7 years (range, 26-94 years). Plain radiographs and MPR CT images were evaluated by two experienced orthopedic surgeons. In addition, MR imaging was performed in 5 cases. Results: Plain radiographs showed no evidence of fracture in 2 cases, isolated GTF in 7 cases, and IIF in 27 cases. In all cases, incomplete cortical breakage in the intertrochanteric area was confirmed on MPR CT images. Cortical breakage was located in the anterior portion of the intertrochanteric area, whereas the posterior portion remained intact in all cases. The detection rate of cortical breakage was higher on coronal or sagittal images than that on axial images. On MR images of 5 cases, intertrochanteric extensions were found in the medullary space. All extensions originated in the greater trochanter area and extended anteriorly in the axial plane and inferomedially in the coronal plane. On the T1-weighted mid-coronal image, the extension reached or passed the midline in 3 cases, and cortical breakage was detected in only 2 cases. Conclusions: In all cases of IIF, cortical breakage was detected in the anterior portion of the proximal femur, leaving the posterior cortex intact. This finding is notably different from that of intertrochanteric extension (from posterior to anterior) detected on MR images of isolated GTFs.

The Relationship between Femoral Stem Tilt and Stem Length in Total Hip Arthroplasty: A Retrospective Case-Control Study.

Background: The current trend of using short femoral stems in total hip arthroplasty (THA) is associated with angular deviation of the femoral stem towards the native femoral axis. The purpose of this study was to compare the difference in stem tilt angle between two different stems with a similar design except for the stem length. Methods: This is a retrospective review of 66 patients who underwent primary THA between April 2012 and May 2016, using a trans-gluteal direct lateral approach by a single surgeon. We evaluated the femoral stem tilt angle in both the coronal and sagittal planes and performed multivariate logistic regression analysis to evaluate possible risk factors. We also simulated the range of motion (ROM) of the hip joint using three-dimensional computer-aided design software (SolidWorks, 2016) to examine the clinical significance of femoral stem tilt. Results: The mean coronal tilt angle was 1.8° ± 1.0° in the conventional stem group and 1.6° ± 1.1° in the short stem group, showing no statistically significant difference between the groups (p = 0.570). However, the mean sagittal tilt angle was 4.0° ± 2.0° in the conventional stem group and 7.8° ± 2.0° in the short stem group (p < 0.001). The stem type and stem length had a linear correlation with the sagittal tilt angle (p < 0.001) in multivariate regression analysis. A simulated hip ROM demonstrated a 3.8° decrease in extension in proportion to a 3.8° increase in the mean sagittal stem tilt angle of the short femoral stem. Conclusions: Anterior femoral stem tilting in the sagittal plane was prominent when the shorter stem was used, and anterior tilting was responsible for decreased ROM in hip extension.

Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study.

BACKGROUNDS: The basic method of surgical treatment for extracapsular hip fractures (ECFs), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for these fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out. METHODS: We retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group. RESULTS: We used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients' high body mass index (BMI) (p = 0.019), BCFs (p = 0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p = 0.032 and p = 0.043, respectively), and anti-rotation screw pull-outs (p = 0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p = 0.020). In the multivariate analysis of group 1, the patients' BMIs (p = 0.024) and BCFs (p = 0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out. CONCLUSIONS: The cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.

Postoperative contact dermatitis caused by skin adhesives used in orthopedic surgery: Incidence, characteristics, and difference from surgical site infection.

ABSTRACT: Skin adhesives are used to close clean surgical wounds. We aimed to investigate the incidence of skin adhesive-related contact dermatitis and the characteristics that differentiate it from a surgical site infection.We retrospectively analyzed patients whose surgical wound was closed using a liquid skin adhesive (Dermabond Prineo skin closure system, Ethicon, NJ) by a single surgeon between March 2018 and June 2020. Medical records were reviewed to evaluate complications indicating contact dermatitis, including wound infections and hematomas.We included 143 patients (men, 59; women, 84; mean age, 60.8 years). No patient had an early surgical site infection or wound dehiscence, but 4 (2.8%) developed postoperative contact dermatitis (week 7, 1; week 4, 2; day 9, 1). Manifestations included eczema and pruritus, without local heat or wound discharge. All cases resolved without complications, including infection.Contact dermatitis occurred in 2.8% of patients who received liquid skin adhesive, and the symptoms differed from those of surgical site infection. Patients should be informed about the risk of contact dermatitis before applying a liquid skin adhesive.

Clinical outcomes of using contralateral-side laterally bent intramedullary nails in atypical femur fractures with femoral bowing.

INTRODUCTION: This study aimed to evaluate the clinical outcomes of using contralateral-side laterally bent intramedullary nails (IMNs) in bowed atypical femur fractures (AFFs). MATERIALS AND METHODS: We retrospectively reviewed bowed AFFs treated with contralateral-side laterally bent IMNs. In total, 20 patients with 25 cases of AFFs were included. Surgical outcomes including bone union time, complications, femoral bowing, and leg length discrepancy (LLD) were evaluated. We evaluated the surgical safety of performing contralateral-side intramedullary nailing with its intraoperative and postoperative complications and compared the LLD. RESULTS: The average age was 76.8 years (range 67-86 years), and all of patients were female. There were 10 cases of complete AFFs and 15 cases of incomplete AFFs. Fourteen patients (70%) had a history of bisphosphonate (BP) use with an average of 74.5 months of its use. In the complete AFF cases, reduction of the fractures was tried to restore the patients' normal anatomical geometry. The average lateral gap was 0.6 mm (0-1 mm), and the average medial gap was 1.6 mm (1-3 mm). All cases achieved bone union without secondary intervention. There were no intraoperative fractures or postoperative complications. The average bone union time was 22.0 weeks and 9.2 weeks in complete and incomplete AFFs, respectively. The average preoperative femoral bowing seen in the coronal and sagittal planes was 10.1° and 16.1°, respectively, while the average postoperative bowing was 6.6° and 11.3°, respectively. The average change of angle was 3.5° in the coronal plane and 4.8° in the sagittal plane. The mean change of LLD was 5.7 mm. CONCLUSION: The use of contralateral-side laterally bent IMNs in treating bowed femurs showed excellent clinical outcomes without complications. In severely bowed femurs, this technique can be safe and useful.

Arthroscopy versus nonoperative treatment of symptomatic femoroacetabular impingement syndrome: A systematic review and meta-analysis.

BACKGROUND: Presently, hip arthroscopy is a widely adopted surgical intervention for the treatment of femoroacetabular impingement (FAI). However, there is insufficient evidence regarding which between arthroscopy and nonoperative treatment is more optimal for symptomatic FAI. METHODS: MEDLINE, Embase, Web of Science, and the Cochrane Library were systematically searched for studies that compared arthroscopy and nonoperative interventions for FAI treatment from inception to August 4, 2020. We included studies that directly compared surgical and nonsurgical treatment for symptomatic FAI and excluded those that did not use arthroscopic treatment as a surgical technique and studies performed on patients with concomitant diagnoses instead of pure FAI. We compared the following clinical outcome scores at 6 and 12 months of follow-up: International Hip Outcome Tool 33 (iHOT-33), hip outcome score (HOS), EuroQol-visual analog scale (EQ-VAS), modified Harris hip score (mHHS), and nonarthritic hip score (NAHS). RESULTS: Five studies totaling 838 patients were included in the qualitative and quantitative synthesis; 382 patients underwent hip arthroscopy, and 456 patients were treated by nonoperative interventions. At 6 months of follow-up, there were no statistically significant differences in iHOT-33 ratings (mean difference [MD] = 7.92, P = .15), HOS (MD of HOS-ADL = 5.15, P = .26 and MD of HOS-Sports = 2.65, P = .79, respectively), and EQ-VAS (MD = 1.22, P = .76) between the 2 treatment strategies. At 12 months of follow-up, the arthroscopy group had a greater mean improvement in iHOT-33 score than the conservative treatment group (MD = 8.42, P = .002), but there was no difference between the groups in terms of mHHS rating (MD = -0.24, P = .83) and NAHS (MD = -2.08, P = .09). CONCLUSION: Despite arthroscopy being associated with significantly superior iHOT-33 scores after 12 months of follow-up, we were unable to discern the difference between the treatment strategies using other scoring methods, such as HOS, EQ-VAS, mHHS, and NAHS. Further studies will be needed to conclusively determine if 1 strategy is superior to the other for treating FAI.

Total Hip Arthroplasty for Secondary Coxarthrosis in Patients with Hereditary Multiple Exostoses: Minimum 5-Year Follow-up Results and Surgical Considerations.

BACKGROUND: Hereditary multiple exostoses (HME) is an autosomal dominant disorder. The lesion in the proximal femoral metaphysis can bring about hip dysplasia and subsequent degenerative arthritis. Due to its rare prevalence, there have been a few case reports of total hip arthroplasty (THA) for osteoarthritis secondary to HME. The aim of this study was to report mid- to long-term outcomes of THA in HME patients and discuss special considerations that should be taken into account during surgery. METHODS: We retrospectively evaluated the clinical and radiological results of THA for osteoarthritis secondary to HME in 11 hips of 9 patients after a minimum follow-up of 5 years (mean, 9.9 years). There were 3 men (3 hips) and 6 women (8 hips), with a mean age of 53.6 years (range, 46.8-58 years) at the index surgery in this study. Harris hip score (HHS) was used for clinical outcome assessment, and radiologically, implant stability, radiolucent lines, liner wear, and any sign of osteolysis or implant loosening were evaluated. Postoperative complications including infection, deep vein thrombosis, and dislocations were also investigated. RESULTS: Cemented stems and cementless cups with the conventional polyethylene liner were used in bilateral hips of a single patient. In the other cases, cementless implants were used with ceramic-on-ceramic bearings. The mean HHS improved from 34.8 preoperatively to 92.5 postoperatively. Polyethylene liner wear and osteolysis were observed in 1 patient with cemented stems. Radiolucent lines were observed in 2 different cases. However, the femoral stems remained stable. There were no surgery-related complications except heterotopic ossification during follow-up. CONCLUSIONS: Despite the several surgical considerations, the mid- to long-term clinical and radiological outcomes of THA in HME patients were satisfactory. The abnormal, wide mediolateral diameter of the proximal metaphysis should be considered in selecting and inserting the stem with adequate anteversion. Leg length discrepancy was also common, so teleradiographs should be obtained before surgery. Intraoperative leg length evaluation might be difficult due to the morphologic changes in the proximal femur after mass excision and individual bone length differences.

A novel arthroscopic classification of labral tear in hip dysplasia.

BACKGROUND: Acetabular labral tears cause of pain in patients with symptomatic hip dysplasia. To date, no structured grading system has been developed to evaluate labral tears in these patients. The present study describes a new system of grading labral tears in patients with acetabular dysplasia. METHODS: The data of 66 patients who underwent hip arthroscopy for symptomatic hip dysplasia from March 2014 to February 2018 were reviewed. Labral tears were classified into four groups, based on the occurrence of chondrolabral junction (CLJ) disruption, capsulolabral recess (CLR) disruption, and labral displacement. Labral tears without instability were classified as grade 1 or 2. Partial delamination or blistering of the labrum with minimal fraying at the CLJ was classified as grade 1, whereas labral tears with CLJ disruption were classified as grade 2. Unstable labral tears with CLR disruption followed by CLJ disruption, but without labral displacement, were classified as grade 3, whereas unstable labral tears with CLR and CLJ disruption, but with labral displacement, were classified as grade 4. The radiological and clinical characteristics of patients in each grade were determined including by simple radiographs and MRI/MR arthrography, as were concomitant findings, including rupture of the ligamentum teres, articular cartilage damage, and presence of a paralabral cyst. The surgical options selected for each grade and clinical outcomes, including modified Harris hip scores (mHHS) and Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores, were evaluated. Spearman's correlation analyses were performed to assess whether labral tear grade correlated with baseline characteristics, the incidence of concomitant injuries, and the severity of osteoarthritis (OA). The Wilcoxon test for paired data was performed to compare treatment results with pain scores. RESULTS: The study cohort included six men and 53 women of mean ± SD age 39.9 ± 13.0 years (range, 15-66 years). Of the 66 hips, seven (10.6%), 10 (15.2%), 30 (45.5%), and 19 (28.8%) were classified as grades 1-4, respectively. Symptom duration (P = 0.017), preoperative Tönnis OA grade (P < 0.001), cartilage damage (P < 0.001), and the presence of a paralabral cyst (P = 0.001) correlated significantly with baseline tear grade. In all groups, mHHS and WOMAC scores improved after surgical treatment. CONCLUSIONS: Arthroscopic findings of labral tears in patients with hip dysplasia differed from the conventional classification. The classification system proposed in this study will likely be useful for determining the degree of labral tear in patients with hip dysplasia and for predicting treatment outcomes.

Venous thromboembolism after delayed surgery for a hip fracture: A retrospective cohort study.

AIM: The purpose of this study was to investigate the demographic characteristics and prevalence of postoperative venous thromboembolism (VTE) in delayed hip fracture patients referred to our hospital (a tertiary referral center), and further verify the effect of intensive prophylaxis protocol in preventing the occurrence of VTE. METHODS: We retrospectively evaluated 264 hip fracture patients whose surgery was delayed by >24 h. The patients were divided into two groups, according to the VTE prophylaxis protocol (conventional vs intensive). We evaluated the time from injury to surgery, and analyzed the prevalence of postoperative symptomatic VTE between the groups. The patient outcome measures, including in-hospital mortality and 30-day-mortality after hip surgery, were also evaluated. RESULTS: The mean time from injury to operation was 127.4 h (95% confidence interval 92.2-162.7 h). The incidence of postoperative symptomatic VTE was 5.9% in the conventional prophylaxis group and 0.8% in the intensive prophylaxis group. The intensive prophylaxis group had a significantly lower incidence of postoperative VTE (P = 0.036). Eight patients with deep vein thrombosis on preoperative screening who underwent inferior vena cava filter insertion did not develop postoperative symptomatic VTE. Logistic regression analysis results also showed that the protocol statistically reduced the development of VTE (odds ratio 0.14, 95% CI 0.02-1.21, P = 0.042). CONCLUSIONS: Delayed hip fracture surgery resulted in a higher incidence of VTE in patients who received conventional prophylaxis; however, our intensive prophylaxis protocol successfully prevented postoperative symptomatic VTE, including pulmonary embolism. Geriatr Gerontol Int 2020; 20: 1151-1156.

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study.

BACKGROUNDS: One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head. METHODS: A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient's contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio). RESULTS: Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3, 75.0, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85-1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28-0.38). In contrast, the ratio was 1.30 (95% CI: 1.03-1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio (P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups (P <  0.001). CONCLUSIONS: SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.

Hip Arthroscopy for Femoroacetabular Impingement and Concomitant Labral Tears: A Minimum 2-Year Follow-Up Study.

PURPOSE: The present study investigated the minimum 2-year outcomes of hip arthroscopy for femoroacetabular impingement (FAI) and concomitant labral tears in Asian patients. METHODS: Patients who underwent hip arthroscopy for both FAI and concomitant labral tears between January 2012 and December 2017 were included. Patients with hip osteoarthritis of Tönnis grade ≥2, previous hip surgery, or followed for less than 2 years were excluded. Clinical assessments were performed using the modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and the rates of achieving threshold values of the minimal clinically important difference and patient acceptable symptomatic state at the latest follow-up. Plain radiographs were acquired pre- and postoperatively for radiologic assessments. RESULTS: A total of 73 patients (90 hips, 58 male, 15 female; mean age 34.4 years) who underwent hip arthroscopy for FAI and concomitant labral tears were enrolled. Forty-three hips (47.8%) had cam-type, 7 (7.8%) had pincer-type, and 40 (44.4%) had mixed-type FAI. The mean follow-up duration was 5.2 years. In cam- and mixed-type FAI hips, the mean α angle significantly decreased from 66.7 ± 8.28° preoperatively to 44.9 ± 3.78° postoperatively (95% confidence interval [CI] 19.6°-22.8°; P < .001). The mean modified Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index increased from 74.8 ± 13.2 and 75 ± 12.7 preoperatively to 93 ± 8.1 (95% CI 15.4-20.9; P = .001) and 89.4 ± 8.4 postoperatively (95% CI 11.8-17; P = .001), respectively. Seventy-four hips (82.2%) crossed the minimal clinically important difference, and 85 hips (94.4%) had achieved the patient acceptable symptomatic state. There were 2 cases of pudendal nerve palsy and 1 case of sciatic nerve palsy. No additional surgeries were required. CONCLUSIONS: Hip arthroscopy can be an effective treatment for FAI and concomitant labral tears in Asian patients as demonstrated in this study, with improved PRO scores and reoperation rates. Longer-term studies with larger cohorts are necessary. LEVEL OF EVIDENCE: Level IV, case series.

Temporary Bridge Occipitocervical Fixation for Comminuted Atlantoaxial Fracture.

OBJECTIVE: We sought to evaluate the feasibility of temporary bridge occipitocervical fixation temporary bridge occipitocervical fixation (T-BOCF) for comminuted atlantoaxial fractures. METHODS: A 57-year-old man presented with multiple trauma including a comminuted, undisplaced atlantoaxial fracture; subdural hemorrhage; skull base fracture; scalp laceration; right second finger tendon injury; and right distal femur open fracture. T-BOCF was performed to preserve neck motion while providing rigid stability to atlantoaxial fracture. Occipital plate and bilateral lateral mass screws were inserted at C3, C4, and C5, avoiding the fracture site; this was followed by rod connection without fusion. The screw-rod construct was removed after confirmation of bone union in the fracture site 12 months after the initial operation. RESULTS: Computed tomography performed at 12 months after the operation demonstrated solid bone union. Dynamic radiographs taken 12 months after implant removal demonstrated a flexion-extension range of motion of 16 degrees at C0‒C2 and 19.8 degrees at C2‒C7. The total flexion-extension range of motion was 35.8 degrees. CONCLUSIONS: T-BOCF is a viable option for treatment of comminuted, undisplaced atlantoaxial fractures. The technique is easier than direct C1‒C2 fusion and can avoid complications associated with occipitocervical fusion or C1‒C2 screw fixation. The blood supply to the fracture site is preserved by avoiding subperiosteal stripping, and semispinalis cervicis insertion at the C2 spinous process is also circumvented. Furthermore, neck motion is preserved after implant removal.

The Effect of Povidone-Iodine Lavage in Preventing Infection After Total Hip and Knee Arthroplasties: Systematic Review and Meta-Analysis.

BACKGROUND: Dilute povidone-iodine (PI) lavage, a simple disinfection method, could reduce postoperative infection risk. However, there is no clinical consensus regarding its efficacy in total joint arthroplasties (TJAs). This systematic review and meta-analysis evaluated PI lavage's efficacy in preventing infection after TJA. METHODS: MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published before November 22, 2019, that compared postoperative infection rates in patients who underwent TJA with or without PI lavage before wound closure. Subgroup analyses were designed to identify the differences in infection site (overall or deep), type of surgery (total hip arthroplasty or total knee arthroplasty), time until diagnosis of infection (3 or 12 months postoperatively), and primary/aseptic revision arthroplasties. RESULTS: We included 7 studies with 31,213 TJA cases, comprising 8861 patients who received PI lavage and 22,352 who did not. Pooled odds ratio for overall infection rate for the PI and non-PI lavage groups was 0.67 (95% confidence interval, 0.38-1.19, P = .17) and for the deep infection rate was 0.90 (95% confidence interval, 0.27-2.98, P = .86). Subgroup analyses revealed no differences in postoperative infection rates between the PI and non-PI lavage groups in terms of total hip arthroplasty and total knee arthroplasty, diagnosis of infection at 3 and 12 months postoperatively, or primary and aseptic revision arthroplasties. CONCLUSION: We detected no differences in the overall postoperative infection rates between the PI and non-PI lavage groups before wound closure in TJA including all studies in the subgroup analyses.

Multiple drilling and multiple matchstick-like bone allografts for large osteonecrotic lesions in the femoral head: an average 3-year follow-up study.

INTRODUCTION: We aimed to present the clinical outcomes of multiple drilling and multiple matchstick-like bone allograft for large osteonecrotic lesions of the femoral head as a joint-preserving surgery. MATERIALS AND METHODS: Between March 2014 and March 2018, 57 patients (77 hips) who underwent multiple drilling and multiple matchstick-like bone allograft for large lesions (≥ 30%) in osteonecrosis of the femoral head (ONFH) were included. Harris hip scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained preoperatively and at the latest follow-up. Plain radiographs were obtained every 3 months. Femoral head collapse ≥ 2 mm was defined as a radiological failure, and conversion to total hip arthroplasty (THA) was regarded as a clinical failure. RESULTS: After exclusion of 5 patients (5 hips) who lost to follow-up, 52 patients (34 men, 18 women; 72 hips) were finally enrolled. The mean follow-up period was 3.4 (range 2-4.5) years. Nineteen hips (28.4%) required conversion to THA at a mean of 21.6 (range 6-42) months postoperatively. In the remaining 53 hips (71.6%) with clinical success, the mean HHS and WOMAC improved from 63 and 31.3 preoperatively to 80.6 and 16.3 at the final follow-up, respectively (p < 0.001). Radiological failure occurred in four hips (6%). The overall failure rate was 31.9% (23/72 hips), and the mean survival duration until failure was 21.2 months (6-42 months). The lesion size, lesion location, and the use of corticosteroids as the cause of ONFH were associated with clinical failure. CONCLUSION: Multiple drilling and multiple matchstick-like bone allograft may be a useful treatment option for alleviating the symptoms in ONFH patients with large lesions who want to preserve their hips.