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Carsten Perka Center for Musculoskeletal Surgery, Charité Medical University Center, Berlin, Germany

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Maziar Mohaddes Hässleholms Hospital, Region Skåne, Hässleholm, Sweden
Orthopedics, Faculty of Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Axel Ekkernkamp BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany

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Niklas Keller Harding Center for Risk Literacy, University of Potsdam, Faculty of Health Sciences, Potsdam, Germany

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Dirk Stengel BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany

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Purpose

  • To assess utility, benefits, and risks of 4th-generation alumina–zirconia ceramic pairings in elective total hip arthroplasty (THA).

Methods

  • A comprehensive mixed-methods best-evidence synthesis using data from systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohort studies, as well as joint replacement registries, was conducted to estimate overall revision and survival rates, periprosthetic infection, bearing fractures, and noise phenomena with 4th-generation alumina–zirconia ceramic versus other tribological couplings in elective THA. The systematic review part across multiple databases was registered with PROSPERO (CRD42023418076), and individual study data were extracted for statistical re-analysis.

Results

  • Twenty overlapping systematic reviews, 7, 17, and 8 references from RCTs, cohort studies, and joint replacement registries form the basis of this work. According to current best evidence, it is (i) 15–33 times more likely that 4th-generation alumina–zirconia pairings avoid a revision for infection than causing a revision for audible noise, (ii) 38–85 times more likely that 4th-generation alumina–zirconia pairings avoid a revision for infection than causing a revision for ceramic head fractures, and (iii) three to six times more likely that 4th-generation alumina–zirconia pairings avoid a revision for infection than cause a revision for ceramic liner fractures.

Conclusion

  • Fourth-generation alumina–zirconia pairings in THA show a favorable benefit–risk ratio, with rare compound-specific adverse events and complications significantly outbalanced by long-term advantages, such as a markedly lower incidence of revision for infection.

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Thorsten Gehrke Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany

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Mustafa Citak Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany

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Mustafa Akkaya Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany

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  • Acetabular revision arthroplasty, a demanding field of reconstructive hip surgery, calls for innovative strategies to deal with challenging bone defects and implant failure seen in revision cases.

  • Conventional implant solutions might fall short of adequately addressing severe bone loss and ensuring stable fixation, highlighting the necessity of customized strategies.

  • Personalized megaimplants, distinguished by their tailor-made design and large-scale construction, present a viable option to overcome these challenges.

  • The present article provides an elaborate analysis of custom-made megaimplants in acetabular revision arthroplasty, shedding light on the underlying principles, design complexities, manufacturing methods, applications in the clinical setting, and outcome assessment.

  • The aim of this review is to present a comprehensive insight into personalized megaimplants and their contribution to the advancement of orthopedic surgery.

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Tarik Ait-Si-Selmi Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, 55 Avenue Jean Mermoz, Lyon, France
Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France

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Jean-Pierre Vidalain Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France

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Sonia Ramos-Pascual ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Thomas Kuratle ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Mo Saffarini ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Edouard Dejour ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Michel P Bonnin Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, 55 Avenue Jean Mermoz, Lyon, France
Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France

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Purpose

  • to systematically review comparative studies reporting revision rates, clinical outcomes, or radiographic outcomes of total hip arthroplasty (THA) using collared versus collarless conventional-length uncemented hydroxyapatite (HA)-coated stems.

Methods

  • In adherence with PRISMA guidelines, a literature search was performed on Medline, Embase, and Scopus. Comparative clinical studies were eligible if they reported outcomes of collared versus collarless uncemented HA-coated stems for primary THA. Two reviewers screened titles, abstracts, and full-texts to determine eligibility; then performed data extraction; and assessed the quality of studies according to Joanna Briggs Institute (JBI) checklist.

Results

  • The search returned 972 records, 486 were duplicates, and 479 were excluded after title/abstract/full-text screening. Three further studies were included from the references of eligible studies and from discussions with subject matter experts, resulting in 11 included studies. The JBI checklist indicated six studies scored ≥7 points and four studies ≥4 points. Pooled data revealed collared stems had significantly lower revision rates (OR = 0.45; 95% CI = 0.31–0.64) and subsidence (MD = −1 mm; 95% CI = −1.6–-0.3), but no significant difference in intraoperative complication rates (OR = 0.94; 95% CI = 0.67–1.32) in the short term to mid-term. Unpooled data indicated that collared stems provide equivalent survival, equivalent or better outcomes, and equivalent or lower complication rates.

Conclusion

  • In comparative studies, collared stems have lower revision rates than collarless stems, as well as equivalent or better clinical and radiographic outcomes. Differences could be due to a protective effect that the collar offers against subsidence, particularly in undersized or misaligned stems. Further studies are warranted to confirm long-term results and better understand differences between registry data and clinical studies.

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Mattia Loppini Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy

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Francesco Manlio Gambaro Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy

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Marco di Maio Università degli Studi di Trieste, Piazzale Europa 1, Trieste, Italy

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Guido Grappiolo IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy

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  • The number of primary total hip arthroplasties (THAs) and revisions is expected to steadily grow in the future. The femoral revision surgery can be technically demanding whether severe bone defects need to be addressed.

  • The femoral revision aims to obtain a proper primary stability of the stem with a more proximal fixation as possible. Several authors previously proposed classification systems to describe the morphology of the bony femoral defect and to drive accordingly the surgeon in the revision procedure.

  • The previous classifications mainly considered cortical and medullary bone at the level of the defect of poor quality by definition. Therefore, the surgical strategies aimed to achieve a distal fixation bypassing the defect or to fill the defect with bone impaction grafting or structured bone grafts up to the replacement of the proximal femur with megaprosthesis.

  • The consensus on a comprehensive and reliable classification system and management algorithm is still lacking. A new classification system should be developed taking into account the bone quality. The rationale of a new classification is that ‘functional’ residual bone stock could be present at the level of the defect. Therefore, it can be used to achieve a primary (mechanical) and secondary (biological) stability of the implants with a femoral fixation more proximal as possible.

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Yun Yang Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, PR China

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Yin-xiao Peng Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, PR China

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Bin Yu Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, PR China

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Aim

  • The aim of this study was to provide a comprehensive overview of floating hip injury and attempt to provide a management algorithm.

Methods

  • PubMed was searched using the terms ‘Floating hip’ or ‘acetabular fracture’ and ‘Ipsilateral femoral fracture’ or ‘pelvic fracture’ and ‘Ipsilateral femoral fracture’. One author performed a preliminary review of the abstracts and references of the retrieved articles.

Results

  • The mean injury severe score reported was higher than 20. Chest and abdominal injuries, as well as fractures at other sites, were the most common associated injuries. Despite the high disability rate, surgery remained the preferred option for managing these injuries. The surgical timing varied from a few hours to several days and was subjected to the principles of damage control orthopedics. Although, in most cases, fixation of femoral fractures took precedence over pelvic or acetabular fractures, there was still a need to consider the impact of damage control orthopedics, associated injuries, and surgeon's considerations and preferences. Posttraumatic arthritis, neurological deficits, heterotopic ossification, femoral head necrosis, femoral nonunion, and limb inequality were common complications of the floating hip injury.

Conclusions

  • The severity of such injuries often exceeds that of an isolated injury and often requires specialized multidisciplinary treatment. In the management of these complex cases, the complexity and severity of the injury should be fully assessed, and an appropriate surgical plan should be developed to perform definitive surgery as early as possible, with attention to prevention of complications during the perioperative period.

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Guido Grappiolo IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via

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Edoardo Guazzoni IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Department of Orthopaedics and Traumatology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy

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Francesco Manlio Gambaro Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

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Mattia Loppini IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

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Hanna Wellauer Department of Orthopaedics, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland

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Roman Heuberger RMS Foundation, Bettlach, Switzerland

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Emanuel Gautier Department of Orthopaedics, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland

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Moritz Tannast Department of Orthopaedics, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland

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Hubert Steinke Institute for the History of Medicine, University of Bern, Bern, Switzerland

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Peter Wahl Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland

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Pablo Castillón Department of Trauma and Orthopaedic Surgery, Hospital, Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain

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Josep Maria Muñoz Vives Department of Trauma and Orthopaedic Surgery, Hospital Althaia Manresa. Manresa, Barcelona, Spain
Department of Trauma and Orthopaedic Surgery, Hospital Nostra Senyora de Meritxell, Andorra

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Héctor José Aguado Department of Trauma and Orthopaedic Surgery, Hospital Clínico Universitario de Valladolid. Valladolid, Spain
Universidad de Valladolid, Valladolid, Spain

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Arantxa Capel Agundez Department of Trauma and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain

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Alina Ortega-Briones Department of Trauma and Orthopaedic Surgery, Hospital Clínico Universitario de Valladolid. Valladolid, Spain

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Jorge Hassan Núñez Department of Trauma and Orthopaedic Surgery, Hospital, Universitari Mútua Terrassa, Terrassa, Barcelona, Spain
Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain

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the PISCO Investigators †
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the PISCO Investigators

  • A peri-implant femoral fracture (PIFF) is defined as a femoral fracture in the presence of a pre-existing non-prosthetic implant. Classification systems, treatment guidelines and fixation strategies exist for peri-prosthetic fractures, but there is no standard of care regarding PIFFs.

  • The aim of the Peri-Implant Spanish Consensus (aka PISCO) investigators is to reach an agreement regarding current practices for management of PIFFs and to propose four main principles to assess surgical treatment and prevention of these fractures.

  • This consensus review was conducted according to the Delphi method. Twenty-two expert orthopaedic trauma surgeons performed the consensus and the definitive statements were approved unanimously.

  • Biological fixation principles must be utilized in the surgical treatment of peri-implant femur fractures, which include closed or minimally invasive reduction techniques. The osteosynthesis must protect the entire bone.

  • Gaps between two implants should be avoided. If implant overlap is not possible to achieve, then spanning inter-implant fixation systems must be used, especially in osteoporotic bone.

  • Previous implants should be retained during surgical treatment of peri-implant femur fractures. Only those implants that would interfere with current fixation goals should be removed.

  • If the previous implant is in the femoral neck region, then femoral neck protection must be maintained when treating the peri-implant fracture, even if the neck fracture has already healed.

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Joseph J Ruzbarsky Steadman Philippon Research Institute, Vail, Colorado, USA
Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, USA

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Rui W Soares Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA

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Spencer M Comfort Steadman Philippon Research Institute, Vail, Colorado, USA

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Justin W Arner Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

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Marc J Philippon Steadman Philippon Research Institute, Vail, Colorado, USA
Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, USA

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  • With the growing number of primary arthroscopies performed, patients requiring revision hip arthroscopies for various issues is high including postoperative adhesion formation, a source of pain, mechanical symptoms, range of motion limitation, stiffness, and microinstability.

  • Adhesions are a consequence of biological pathways that have been stimulated by injury or surgical interventions leading to an increased healing response.

  • Preventative efforts have included surgical adjuncts during/after primary hip arthroscopy, biologic augmentation, and postoperative rehabilitation.

  • Treatment options for adhesion formation includes surgical lysis of adhesions with or without placement of biologic membranes aimed at inhibiting adhesion reformation as well as systemic medications to further reduce the risk.

  • Postoperative rehabilitation exercises have also been demonstrated to prevent adhesions as a result of hip arthroscopy. Ongoing clinical trials are further investigating pathways and prevention of adhesion formation.

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