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Purpose
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Intra-articular injection is a well-established and increasingly used treatment for the patient with mild-to-moderate hip osteoarthritis. The objectives of this literature review and meta-analysis are to evaluate the effect of prior intra-articular injections on the risk of periprosthetic joint infection (PJI) in patients undergoing total hip arthroplasty (THA) and to try to identify which is the minimum waiting time between hip injection and replacement in order to reduce the risk of infection.
Methods
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The database of PubMed, Embase, Google Scholar and Cochrane Library was systematically and independently searched, according to Preferred Reporting Items for Systematic Reviews and Meta–Analyses (PRISMA) guidelines. To assess the potential risk of bias and the applicability of the evidence found in the primary studies to the review, the Newcastle–Ottawa scale (NOS) was used. The statistical analysis was performed by using the software ’R’ version 4.2.2.
Results
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The pooling of data revealed an increased risk of PJI in the injection group that was statistically significative (P = 0.0427). In the attempt to identify a ’safe time interval’ between the injection and the elective surgery, we conducted a further subgroup analysis: in the subgroup 0–3 months, we noted an increased risk of PJI after injection.
Conclusions
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Intra-articular injection is a procedure that may increase the risk of developing periprosthetic infection. This risk is higher if the injection is performed less than 3 months before hip replacement.
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Modular neck (MN) implants can restore the anatomy, especially in deformed hips such as sequelae of development dysplasia.
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Early designs for MN implants had problems with neck fractures and adverse local tissue, so their use was restricted to limited indications.
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Results of the latest generation of MN prostheses seem to demonstrate that these problems have been at least mitigated.
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Given the results of the studies presented in this review, surgeons might consider MN total hip arthroplasty (THA) for a narrower patient selection when a complex reconstruction is required.
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Long MN THA should be avoided in case of body mass index > 30, and should be used with extreme caution in association with high offset femoral necks with long or extra-long heads. Cr-Co necks should be abandoned, in favour of a titanium alloy connection.
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Restoring the correct anatomic femoral offset remains a challenge in THA surgeries.
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MN implants have been introduced to try to solve this problem. The MN design allows surgeons to choose the appropriate degree and length of the neck for desired stability and range of motion.
Cite this article: EFORT Open Rev 2021;6:751-758. DOI: 10.1302/2058-5241.6.200064
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Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbopelvic complex (LPC).
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These movements are characterized by the spinopelvic parameters sacral slope, pelvic tilt, and pelvic incidence, which define a patient’s morphotype.
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LPC kinematics may be classified by various systems, the most comprehensive of which is the Bordeaux Classification.
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Hip–spine relationships in total hip arthroplasty (THA) may influence impingement, dislocation, and edge loading.
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Historical ‘safe zones’ may not apply to patients with impaired spinopelvic mobility; adjustment of cup inclination and version and stem version may be necessary to achieve functional orientation and avert complications.
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Stem design, bearing surface (including dual mobility), and head size are part of the armamentarium to treat abnormal hip–spine relationships.
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Special attention should be directed to patients with adult spine deformity or fused spine because they are at increased risk of complications after THA.
