Malalignment and distal contact of short tapered stems could be associated with postoperative thigh pain in primary total hip arthroplasty

Bibliometric perspectives on inflammatory and immunological research in pediatric asthma

OBJECTIVE

Pediatric bronchial asthma, a prevalent chronic inflammatory respiratory disease, significantly affects children globally. However, bibliometric analyses focused on its inflammatory and immunological aspects are limited. This study aims to provide an overview of the field, identify key focus areas, and predict emerging trends.

METHODS

We collected and analyzed relevant literature published from January 1, 2000, to May 31, 2024, from the Web of Science Core Collection. Collaborative network analysis was conducted using CiteSpace 5.8.R3, VOSviewer 1.6.20, and Bibliometrix.

RESULTS

A total of 911 papers were retrieved, showing growth in research output since 2006, with the United States leading in publications. The University of Western Australia ranks first in publication count, while the University of Wisconsin-Madison has the highest average citations per paper. Among 5,059 authors, 146 core authors contributed to 592 articles, accounting for 64.98% of total publications, with Anne M. Fitzpatrick as the leading author. The journal "Allergy, Asthma & Immunology Reviews" is the most influential, and "asthma" is the most cited keyword. Co-citation analysis reveals 20 keyword clusters, with hotspots including "efficacy" and "allergic rhinitis." The most cited paper is by D. P. Strachan in the "British Medical Journal."

CONCLUSION

This study reveals a significant increase in pediatric asthma research from 2000 to 2024, with the U.S. leading in scholarly contributions. Key findings highlight allergic airway inflammation and type 2 inflammation as primary mechanisms underlying the disease. Inhaled corticosteroids and biologics are identified as effective treatments. These insights emphasize the importance of global collaboration and ongoing research efforts to advance understanding of pathogenic mechanisms and clinical management in pediatric asthma patients.

Radiographic and Clinical Outcomes After Direct Anterior Versus Mini Posterior Total Hip Arthroplasty

Background

Total hip arthroplasty (THA) is a successful surgical treatment for end-stage hip arthritis. There is controversy over whether the surgical approach leads to any differences in implant sizing, implant positioning, and clinical outcomes. This study sought to compare radiographic and clinical outcomes when performing primary THA through the direct anterior approach (DAA) and posterior approach (PA).

Methods

In this retrospective cohort study of patients undergoing primary THA, 198 DAA patients were matched to 198 PA patients. Surgeries were performed by 3 fellowship-trained surgeons. Radiographic parameters analyzed were acetabular cup anteversion and abduction angles, femoral stem coronal alignment, femoral offset, and leg-length discrepancy. Postoperative complications, including periprosthetic joint infection, wound complications, periprosthetic fracture, and dislocation, were extracted from the medical record. Statistical analysis was performed to compare radiographic and clinical outcomes between groups.

Results

There were no statistically significant differences for any postoperative complications between the 2 groups. One dislocation occurred in the PA group, and no dislocations occurred in the DAA group. DAA had a longer operative time (117 vs 79 minutes, P < .01). PA had a higher increase in femoral offset compared to the contralateral limb (2.76 mm vs 1.01 mm, P < .01), higher cup anteversion (26.17° vs 23.44°, P < .001), and higher use of dual mobility components (6.06% vs 1.01%, P = .007).

Conclusions

Both DAA and PA lead to acceptable clinical and radiographic outcomes for primary THA, with significant differences noted for cup position, femoral offset, and use of dual mobility components. These differences likely represent surgeon factors to help mitigate the risk for dislocation.

Can Arthroplasty Stem Influence Outcome: A Randomized Controlled Trial of Stem Length in Cemented Total Hip Arthroplasty

BACKGROUND

The primary aim was to assess whether a short (125 millimeter (mm)) stem offered an equivalent hip-specific function compared to the standard (150 mm) stem when used for cemented total hip arthroplasty. Secondary aims were to evaluate health-related quality of life, patient satisfaction, stem height and alignment, as well as radiographic loosenings and complications between the two stems.

METHODS

A prospective twin-center double-blind randomized control trial was conducted. During a 15-month period, 220 patients undergoing total hip arthroplasty were randomized to either a standard (n = 110) or a short (n = 110) stem. There were no significant (P ≥ .065) differences in preoperative variables between the groups. Functional outcomes and radiographic assessment were undertaken at a mean of 1 and 2 years.

RESULTS

There were no differences (P = .428) in hip-specific function according to the mean Oxford hip scores at 1 year (primary endpoint) or at 2 years (P = .622) between the groups. The short stem group had greater varus angulation (0.9 degrees, P = .003) when compared to the standard group and were more likely (odds ratio 2.42, P = .002) to have varus stem alignment beyond one standard deviation from the mean. There were no significant (P ≥ .083) differences in the forgotten joint scores, EuroQol-5-Dimension, EuroQol-visual analogue scale, short form 12, patient satisfaction, complications, stem height, or radiolucent zones at 1 or 2 years between the groups.

CONCLUSION

The cemented short stem used in this study had equivalent hip-specific function, health-related quality of life, and patient satisfaction when compared to the standard stem at mean 2 years post operation. However, the short stem was associated with a greater rate of varus malalignment, which may influence future implant survival.

Intermediate to Long-Term Outcomes of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem

BACKGROUND

Short cementless stems in total hip arthroplasty have gained increasing popularity, yet on-going studies of many of these implants are lacking. The aim of this study was to evaluate the minimum 5 year clinical and radiological results of a short, highly porous single tapered-wedge cementless femoral implant.

METHODS

A retrospective study of 281 hips in 256 patients who had a minimum 5-year follow-up and underwent primary total hip arthroplasty (THA) between 2010 and 2016 were evaluated. Clinical and radiological results, complications, and the presence of postoperative thigh pain were evaluated.

RESULTS

The mean follow-up was 8 years (range, 5 to 12 years). Clinically, patients had significant improvement in the average patient related outcome scores (PROMS) postoperatively (Harris Hip Score: pre 47 vs post 95, University of California Los Angeles (UCLA) activity scale: pre 4 vs post 6, Western Ontario and McMaster Universities Arthritis Index (WOMAC): pre 51 vs post 3, SF-12 Physical Component Summary (PCS): pre 32 vs post 52, SF-12 Mental Component Summary (MCS): pre 49 vs post 55 (P<0.001)). Radiographic signs of ingrowth were present in all hips. There were three patients (1.1%) who developed transient thigh pain postoperatively, all of which resolved with non-operative management.

CONCLUSION

This study provides the longest follow-up of this short, highly porous single tapered-wedge cementless femoral stem in the literature. This short single wedge stem with its highly porous coating demonstrated reproducible bone ingrowth in all patients, and significant functional improvement with a very low rate of transient thigh pain.

Intermediate-Term Survivorship of Total Hip Arthroplasty With a Proximally Coated Tapered-Wedge Femoral Stem: A Retrospective, Multi-Center Registry Review

BACKGROUND

Short tapered-wedge stems have been used frequently over the past decade, but long-term follow-up data are not readily available in the literature.

METHODS

A retrospective outcomes review was conducted to assess survivorship and clinical outcomes for the TRI-LOCK® Bone Preservation Stem (TRI-LOCK BPS; DePuy Synthes, Warsaw, IN, USA), a proximally coated, tapered-wedge femoral stem.

RESULTS

In a cohort of 2,040 hips, Kaplan-Meier survivorship estimates (95% CI {confidence interval}; N with further follow-up, where N is the number of hips remaining at each post-operative interval), with survivorship defined as no revision of any component for any reason were 96.6% (92.8%,98.4%; 45) at eight years under the clinical assumption and 98.6% (97.9%,99.1%; 90) at 14 years under the registry assumption. With survivorship defined as stem revision for any reason, estimates were 97.7% (93.7%,99.2%; 45) at eight years under the clinical assumption and 99.2% (98.6%,99.5%; 90) under the registry assumption. Mean Harris Hip Scores and WOMAC scores were 90.08 and 21.98, respectively, at 10 years postoperatively.

CONCLUSION

Our evaluation demonstrates excellent construct and stem survivorship and clinical outcomes at intermediate-term postoperative follow-up.

Survival and radioclinical evaluation of the Optimys™ short stem at more than 6years' mean follow-up: A retrospective study of 108 cases

INTRODUCTION

The short stems developed in recent years offer an interesting alternative to standard long stems. The Optimys™ short stem has been widely studied, but not according to the National Institute for Health and Care Excellence (NICE) criteria. We therefore conducted a retrospective study of Optimys™ at a minimum 5years' follow-up, to assess: (1) survival on NICE criteria, (2) complications, (3) functional results, and (4) subsidence, restoration of offset and bone remodeling.

HYPOTHESIS

Optimys™ shows survival comparable to that of other non-cemented standard and short stems, with a<0.5% per year revision rate or<2.5% at 5years on NICE criteria.

MATERIAL AND METHODS

A single-center retrospective study included 108 Optimys™ stems at a mean 76.5months' follow-up (range: 60-112months). Clinical [Harris, Oxford-12 and forgotten hip (French version: SHO-12) scores] and radiologic data were collected pre- and postoperatively. Analysis focused on implant survival, complications, functional results and radiological results (restoration of offset, bone remodeling, subsidence and osseointegration) and risk factors for stem migration.

RESULTS

At a mean 76.5months' follow-up (range: 60-112months), Optimys™ survival was 97.7% (95% CI: 0.945-1). Oxford and Harris scores improved significantly: respectively, 16.1 vs. 44.7 [Δ=28.598; 95% CI: 27.410-29.785 (p<0.001)] and 45.3 vs. 95 [Δ=49.662; 95% CI: 47.442-51.882 (p<0.001)]. Mean forgotten hip score (SHO-12) at last follow-up was 82.7±19.6 (range: 35.4-100.0). There was 1 case of aseptic revision at 11months for femoral osseointegration defect. Mean subsidence was 1.64mm (range: 0-20.63mm); no predisposing factors could be identified. Femoral offset increased by a mean 2.41±4.53mm (range: -10.10 to 14.70mm).

CONCLUSION

The present study reports good survival for the Optimys™ stem, which meets NICE criteria. Radiologic and clinical results were encouraging, with a low rate of subsidence, comparable to other series, but with increased femoral offset.

LEVEL OF EVIDENCE

IV; retrospective cohort study.

Mid-term outcomes after total hip arthroplasty in 106 Crowe II/III hips: different hip center positions

BACKGROUND

Under the obvious acetabular superolateral bone defect of Crowe II/III hips, this study aimed to investigate the difference in surgical technique of different hip center positions from the surgical data and clinical outcomes.

METHODS

From July 2007 to December 2016, 87 patients (106 Crowe II/III hips) consecutively received total hip arthroplasty (THA). The minimum follow-up time was 5 years. The mean limb length discrepancy was 1.97 ± 1.81 cm. Twenty-four hips had surgical histories. The patients were divided into three groups according to the acetabular prosthesis positions, depending on the Crowe classification, respectively, group 1 (Crowe I), group 2 (Crowe II) and group 3 (Crowe III). The surgical data and clinical results were used to evaluate the outcome of different surgical techniques of different hip center positions, including surgical time, blood loss, blood transfusion, number of osteotomy hips, osteotomy length, the distribution of prothesis, postoperative inpatient days, Harris hip scores, Visual Analogue Scale (VAS), Back Pain Function Scale (BPFS) and complications.

RESULTS

The mean follow-up time was 8.93 ± 2.55 years. Nineteen hips performed intraoperative osteotomy. From group 1 to group 3, the mean osteotomy length were 0.53 ± 1.11 cm, 0.05 ± 0.22 cm, and 0.00 ± 0.00 cm, respectively (p = 0.083); the surgical time were 142.57 ± 57.94 min, 118.4 ± 41.22 min, and 120.00 ± 84.85 min, respectively (p = 0.324); the blood loss were 498.21 ± 368.53 mL, 333.33 ± 167.62 mL, and 350.00 ± 212.13 mL, respectively (p = 0.255); the blood transfusion were 288.48 ± 381.68 mL, 128.00 ± 235.17 mL, and 385.00 ± 219.20 mL, respectively (p = 0.199); the postoperative inpatient days were 7.95 ± 4.42 d, 7.47 ± 4.29 d, and 6.50 ± 0.71 d, respectively (p = 0.831). Among the groups, the distribution of acetabular prosthesis, acetabular liner, acetabular prosthesis sizes, femoral head sizes and femoral prothesis distal sizes were not significantly different (p > 0.05). Only the distribution of femoral prosthesis was significantly different (p = 0.046); the Harris, VAS, BPFS, and the distribution of complications were not significantly different (p > 0.05).

CONCLUSIONS

We provided a framework to guide decision-making in Crowe II/III hips for surgeons: the surgical technique of different hip center positions was stable and had good outcomes, but the acetabular prothesis position and femoral prothesis should be determined according to the intraoperative situation.

LEVEL OF EVIDENCE

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

Medium-term outcomes of short stems in total hip arthroplasty

Background

Prosthetic surgery has shown good short-term results with the use of short stems, results comparable with the experience of conventional stems. The aim of this study was to investigate and describe the characteristics and clinical course of patients operated on with the short stem GTS in the medium term.

Methods

Between November 2010 and September 2014, 152 primary hip prostheses were operated on in 142 patients with a mean follow-up of 95.49 months (range 75–120). We analyzed the intraoperative and postoperative complications and the reviews performed during the follow-up.

Results

One intraoperative complications occurred; case in which a femoral calcar fracture occurred and a screw was required during the operation. The clinical evaluation at the end of the follow-up, according to the Merle D’Aubigne Scale, showed the mean value was 17.3684 (SD 0,79472), with a survival at the end of the follow-up of 99.3% of the placed GTS stems.

Conclusions

GTS short stems have shown good results after more than 6 years of follow-up, with comparable results to conventional uncemented stems. Short-stem hip arthroplasty is an advanced way to preserve bone stock while protecting soft tissue

Study on Pain Catastrophizing From 2010 to 2020: A Bibliometric Analysis via CiteSpace

Purpose: This study aimed to evaluate the global scientific output of research on pain catastrophizing and explore the hotspots and frontiers from 2010 to 2020 using bibliometric methods.

Methods: Publications regarding pain catastrophizing published from 2010 to 2020 were extracted from the Web of Science Core Collection. CiteSpace was used to analyze the number of publications, countries, institutions, journals, authors, cited references, and keywords using standard bibliometric indicators.

Results: A total of 1,576 publications on pain catastrophizing were retrieved from 2010 to December 31, 2020. The number and rate of the annual publications gradually increased totally. Pain (130) was the most productive journal. Meanwhile, Pain ranked first in the frequency (1,432) and centrality (0.31) of the cited journals. The most productive country and institution in this frequency field were the United States (642) and the University of Washington (73), respectively. Jensen MP (34) was the most prolific author, and Sullivan MJL (1,196) ranked first among the cited authors. In the ranking of frequency in the cited references, the first article was a critical review about pain catastrophizing published by Quartana (100). The keyword “Low back pain” had the highest frequency (556). “Total hip” was identified as a frontier research item for 2016–2020.

Conclusion: The findings of this bibliometric study provide the current status and trends in the clinical research of pain catastrophizing and may help researchers to identify hot topics and explore new research directions in this field.