Two-Dimensional Versus Three-Dimensional Preoperative Planning in Total Hip Arthroplasty.

BACKGROUND: Preoperative planning in total hip arthroplasty (THA) involves utilizing radiographs or advanced imaging modalities, including computerized tomography scans, for precise prediction of implant sizing and positioning. This study aimed to compare 3-dimensional (3D) versus 2-dimensional (2D) preoperative planning in primary THA with respect to key surgical metrics, including restoration of the horizontal and vertical center of rotation (COR), combined offset, and leg length. METHODS: This study included 60 patients undergoing primary THA for symptomatic hip osteoarthritis (OA), randomly allocated to either robotic arm-assisted or conventional THA. Digital 2D templating and 3D planning using the robotic software were performed for all patients. All measurements to evaluate the accuracy of templating methods were conducted on the preoperative computerized tomography scanogram, using the contralateral hip as a reference. Sensitivity analyses explored differences between 2D and 3D planning in patients who had superolateral or medial OA patterns. RESULTS: Compared to 2D templating, 3D templating was associated with less medialization of the horizontal COR (-1.2 versus -0.2 mm, P = .002) and more accurate restoration of the vertical COR (1.63 versus 0.3 mm, P < .001) with respect to the contralateral side. Furthermore, 3D templating was superior for planned restoration of leg length (+0.23 versus -0.74 mm, P = .019). Sensitivity analyses demonstrated that in patients who had medial OA, 3D planning resulted in less medialization of horizontal COR and less offset reduction. Conversely, in patients who had superolateral OA, there was less lateralization of horizontal COR and less offset increase using 3D planning. Additionally, 3D planning showed superior reproducibility for stem, acetabular cup sizes, and neck angle, while 2D planning often led to smaller stem and cup sizes. CONCLUSIONS: Our findings indicated higher accuracy in the planned restoration of native joint mechanics using 3D planning. Additionally, this study highlights distinct variances between the 2 planning methods across different OA pattern subtypes, offering valuable insights for clinicians employing 2D planning.

Return to sports following lower limb musculoskeletal tumor surgery-A systematic review.

BACKGROUND: Survivors of primary malignant musculoskeletal tumors often face long-term disability. Clinicians at present are unable to provide evidence-based advice about returning to sports, which is important for active patients. PURPOSES: Identify patients returning to sports. Describe the sporting activities in which patients participate. Identify the outcome measures used to assess return to sport. Identify barriers preventing return to sports. STUDY DESIGN: Systematic review. METHODS: A comprehensive search strategy was used to identify relevant studies combining the following concepts: (1) Bone/Soft tissue tumor, (2) Lower limb, (3) Surgical interventions, and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors (MTB, FS, and CG). RESULTS: Twenty-two studies were selected, published between 1985 and 2020, including 1005 patients. Fifteen of the 22 studies had valid data on return to sports, with 705 participants, of which 412 (58.4%) returned to some form of sport such as swimming and cycling, at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing surgery and amputation; none of these were able to identify a difference in sports participation or ability. CONCLUSION: There is insufficient published research to provide guidance for patients with respect to return to sports following musculoskeletal tumors. Future prospective studies are needed to collect better pre- and post-treatment data at multiple time intervals. Validated clinical and patient sports participation outcomes such as type of sports, level, frequency, and validated sports-specific outcome scores should be recorded. In particular, more comparison between limb sparing surgery and amputation would be welcome.

The management of type B1 periprosthetic femoral fractures: when to fix and when to revise.

The incidence of periprosthetic fractures around total hip arthroplasty is increasing as patient longevity rises and the number of patients with hip implants continues to grow. Type B1 periprosthetic femoral fractures are associated with a well-fixed stem and have traditionally been treated with internal fixation. However, there are a subset of these fractures which fare badly when internal fixation is undertaken, and revision of the femoral component to a long-stemmed implant may be more appropriate. We look at the traditional methods of fixation, and the evidence and indications for revision of these fractures.