Does a computed tomography-based navigation system reduce the risk of dislocation after total hip arthroplasty in patients with osteonecrosis of the femoral head? A propensity score analysis

Impact of CT-based navigation, large femoral head, and dual-mobility liner on achieving the required range of motion in total hip arthroplasty

Aims

This study aimed to investigate whether the use of CT-based navigation enhances: 1) the accuracy of cup placement; and 2) the achievement rate of required range of motion (ROM). Additionally, we investigated the impact of using a large femoral head and dual-mobility liner on the achievement rates.

Methods

This retrospective study analyzed 60 manual and 51 CT-based navigated primary total hip arthroplasties performed at a single facility. Postoperative CT scans and CT-based simulation software were employed to measure the cup orientation and to simulate the ROM. We compared the absolute errors for radiological inclination (RI) and radiological anteversion (RA) between the two groups. We also examined whether the simulated ROM met the required ROM criteria, defined as flexion > 110°, internal rotation > 30°, extension > 30°, and external rotation > 30°. Furthermore, we performed simulations with 36 mm femoral head and dual-mobility liner.

Results

The absolute errors of RI and RA from the preoperative plan were significantly smaller in the CT-based navigation group (3.7° (SD 3.5°) vs 5.1° (SD 3.5°); p = 0.022, and 3.9° (SD 3.5°) vs 6.8° (SD 5.0°); p = 0.001, respectively). The proportion of cases achieving the required ROM in all directions was significantly higher in the CT-based navigation group (42% vs 63%; p = 0.036). The achievement rates of the required ROM were significantly higher with the use of a 36 mm ball or dual-mobility liner compared to the use of a 32 mm ball (65% vs 51%; p = 0.040 and 77% vs 51%; p ≤ 0.001, respectively).

Conclusion

CT-based navigation enhanced required ROM achievement rates by > 20%, regardless of the ball diameter. The improved accuracy of cup placement through CT-based navigation likely contributed to the enhancement. Furthermore, the use of large femoral heads and dual-mobility liners also improved the required ROM achievement rates. In cases with a high risk of dislocation, use of these devices is preferred.

Does Osteonecrosis of the Femoral Head Increase Early Complication Rates After Total Hip Arthroplasty? A Japanese Nationwide Medical Claims Database Study

BACKGROUND

Osteonecrosis of the femoral head (ONFH) and osteoarthritis (OA) are two common diagnoses for patients undergoing total hip arthroplasty (THA). The early surgical complications in THA for ONFH compared to OA are inconsistently reported. Therefore, this study aimed to evaluate whether THA for ONFH was associated with early postoperative complications in comparison to THA for OA using a large database of Japanese patients.

METHODS

In this cohort study, using a Japanese national medical claims database on ONFH and OA patients undergoing THA from December 2011 to March 2023, we assessed the surgical-related complications, medical complications, and mortality during hospitalization after propensity score matching by age, sex, body mass index, and comorbidities. A total of 24,326 pairs of THAs for ONFH and OA were included.

RESULTS

In the THA for ONFH group, the odds ratios for various complications were as follows: dislocation (1.3, 95% CI [confidence interval]: 1.1 to 1.6, P < 0.01), infection (1.0, 95% CI: 0.8 to 1.2, P = 0.94), periprosthetic fracture (1.0, 95% CI: 0.8 to 1.4, P = 0.86), nerve palsy during hospitalization (0.4, 95% CI: 0.2 to 0.9, P = 0.034), pneumonia (1.7, 95% CI: 1.1 to 2.5, P < 0.01), deep vein thrombosis (0.9, 95% CI: 0.8 to 1.0, P = 0.018), pulmonary embolism (1.5, 95% CI: 0.9 to 2.5, P = 0.14), cardiac events (0.7, 95% CI: 0.3 to 2.1, P = 0.55), cerebrovascular events (0.7, 95% CI: 0.5 to 1.0, P = 0.084), acute renal failure (1.4, 95% CI: 0.4 to 4.4, P = 0.56), and mortality during hospitalization (1.8, 95% CI: 1.3 to 2.4, P < 0.01).

CONCLUSIONS

These findings contribute to identifying postoperative risks for ONFH patients and suggest that more attention should be paid to preoperative planning and postoperative care for ONFH patients.

A 5-Year Longitudinal Assessment of Quality of Life in Patients Who Have Osteonecrosis of the Femoral Head Undergoing Total Hip Arthroplasty: A Multicenter Study

BACKGROUND

The effects of surgical treatment on the quality of life (QOL) of patients who have osteonecrosis of the femoral head (ONFH) have been rarely reported. This multicenter study aimed to elucidate the longitudinal QOL in patients who have ONFH undergoing total hip arthroplasty.

METHODS

Self-assessment QOL questionnaires, including the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), Oxford Hip Score (OHS), and 12-Item Short-Form Health Survey Version 2 (SF-12v2), were administered to 124 patients at 6 months, 1 year, 2 years, and 5 years postoperatively. These scores were compared according to age, sex, and associated factors from preoperative status to 2 years postoperatively (study 1) and from 2 to 5 years postoperatively (study 2).

RESULTS

Postoperative JHEQ satisfaction, pain, movement, mental, OHS, and SF-12v2 physical component summary (PCS) scores significantly improved 6 months postoperatively. The satisfaction level and OHS in men and patients aged < 60 years continuously improved significantly until 2 years postoperatively. Postoperative JHEQ movement scores gradually improved in patients aged ≥ 60 years. The SF-12v2 role component summary scores improved significantly 2 years postoperatively. Compared to the scores at postoperative 2 years, JHEQ satisfaction level in the patients aged ≥ 60 years and patients who had corticosteroid-associated ONFH, JHEQ pain and mental scores in women and corticosteroid-associated patients, and JHEQ movement and OHS in women improved significantly at 5 years postoperatively. Women showed better pain visual analog scale for up to 5 years postoperatively. The PCS at postoperative 2 years was significantly better in alcohol-associated patients than in patients who have corticosteroid-associated ONFH; however, there were no significant differences at 5 years postoperatively. The PCS was significantly better in patients aged < 60 years and in women at 5 years postoperatively.

CONCLUSIONS

Longitudinal change in QOL scores of patients who have ONFH who underwent total hip arthroplasty indicated different improvement patterns according to age, sex, and associated factors.

Impact of Flatback Deformity and Stiff Spinopelvic Mobility on 3-Dimensional Pelvic and Hip Kinematics After Total Hip Arthroplasty

Background

Spinopelvic abnormalities have been reported to be a risk factor for dislocation after total hip arthroplasty (THA). This study aimed to compare the kinematics of the pelvis and hip joints in patients with and without spinopelvic abnormalities after THA and to elucidate dynamic forward-leaning movement during chair-rising, which are not detectable through static radiographs.

Methods

This case series included 108 hips that underwent dynamic anteroposterior radiographic imaging of the sit-to-stand motion after THA. The average age at surgery was 68 ± 10 years, with 95 hips (88%) in women (average body mass index, 23.5 ± 3.2 kg/m2). Kinematic analysis was performed to measure the anterior pelvic plane angle (APPa) and hip flexion/extension angles from seated to standing positions using model-image registration techniques. Pelvic incidence (PI) and lumbar lordosis (LL) were measured to calculate PI-LL.

Results

Flatback deformity was present in 45 hips (42%) and stiff spinopelvic mobility (SPM) in 35 hips (32%), with both deformities present in 21 hips (19%). The pelvis was consistently significantly posteriorly tilted in the flatback deformity group throughout the movement compared with the normal group, with the greatest difference observed in the standing position. The hip flexion angles in the flatback deformity group showed significant extension in the standing position (7° greater than that in the normal group). For stiff SPM, a significant posterior tilt in the standing position was observed. Accordingly, the range between the maximum hip flexion and extension was 13° greater. There was no significant difference between the maximal flexion and extension centers.

Conclusions

Patients with flatback deformities consistently exhibited posterior APPa, especially when standing. In stiff SPM, a large range of hip flexion and extension while chair-rising increased the risk of impingement, indicating the necessity for a wider range of motion without changing the target orientation. These findings highlight the importance of considering spinopelvic alignment when planning cup positioning in THA to minimize the risk of dislocation.

Level of Evidence

Level III. See Instructions for Authors for a complete description of levels of evidence.

Geographic distribution of the incidence of osteonecrosis of the femoral head in Japan and its relation to smoking prevalence

OBJECTIVES

Alcohol intake and smoking are modifiable lifestyle-related risk factors for osteonecrosis of the femoral head (ONFH). We investigated geographic differences in ONFH incidence in Japan and the correlation with alcohol intake and smoking to develop prevention strategies for ONFH in Japan.

METHODS

This ecological study was conducted in Japan primarily using the following data sources: nationwide epidemiological survey and national survey. We estimated the annual ONFH incidence and the prevalence of alcohol drinking and smoking in each prefecture. Prefectural incidence and prevalence were calculated by sex and age-standardization.

RESULTS

The mean annual ONFH incidence per 100,000 population was 3.08 in men and 1.63 in women, respectively. There was no significant correlation between ONFH incidence and the prevalence of any levels of alcohol intake, while smoking ≥20 cigarettes/day showed a significant and moderate correlation in men (r = 0.47, p = .01). This correlation remained significant after adjustment for the prevalence of any levels of alcohol intake (standardized partial regression coefficient = 0.47-0.49, p = .009-.01).

CONCLUSION

ONFH incidence is geographically variable in Japan, and this may be partly explained by the distribution of smoking prevalence. Smoking cessation may contribute to an effective decline in the overall ONFH incidence in Japan.