Yoon-Vin Kim, MD, Joo-Hyoun Song, MD, PhD, Young-Wook Lim, MD, PhD, Woo-Lam Jo, MD, PhD, Seung-Hun Ha, MD, Kee-Haeng Lee, MD, PhD. Hip Pelvis 2024;36:47-54. https://doi.org/10.5371/hp.2024.36.1.47

The purpose of this study is to compare the cut-out rate and sliding distance associated with limb length inequality between operations using a standard non-sliding lag screw versus those using a non-sliding lag screw with U-blade (RC) in the Gamma3 nail. This is a retrospective review of two case series involving different lag screws for the Gamma3 nail. Propensity score matching analysis was used to adjust the confounding factors. A comparative analysis of 304 patients who treated with Gamma3 nail with either a standard non-sliding lag screw or a U-Blade (RC) lag screw was performed. Between 2014 and 2018, 152 patients were treated with U-blade (RC) lag screws, and these patients were matched with those treated with standard lag screws. There was no significant difference in cut-out rate between groups. However, additional use of anti-rotation U-blade (RC) could significantly decrease lag screw sliding, with the group treated with U-Blade (RC) lag screws exhibiting shorter sliding, especially in AO/OTA31 A2 and A3 fractures. Also, in A2 and A3 fractures, the mean lag screw sliding distance was greater than that seen in A1 fractures in both groups. These findings can help trauma surgeons choose the proper implant to reduce leg length inequality.

Background: The aim of this study was to investigate whether the use of three-dimensional (3-D) computed tomography (CT)-based head-lesser trochanter distance (HLD) could reduce leg length discrepancy (LLD) more than the use of a two-dimensional (2-D) plain film method in primary bipolar hemiarthroplasty. Methods: Propensity score matching (PSM) analysis was used to adjust the confounding factors. A retrospective comparative analysis of 128 patients was performed. In the control group, the leg length was equalized using the 2-D, plain film-based HLD. In the study group, primary bipolar hemiarthroplasty was performed using the 3-D CT-based HLD method. Postoperative LLDs were compared between the two groups using the method of Ranawat. In addition, the Harris hip score (HHS) was evaluated and compared at one year after surgery. Results: A significant difference was observed in mean postoperative LLD between the 2-D HLD group and the 3-D CT HLD group: 1.6 ± 1.2 mm (range, 0.1–6.0 mm) and 1.1 ± 1.2 mm (range, 0.1–5.1 mm), respectively (p < 0.05). Additionally, a higher percentage of patients in the 3-D CT HLD group had an LLD of less than 2 mm. The mean HHS at one year after surgery showed no significant difference between the two groups. Conclusions: To minimize the occurrence of LLD, HLD measurement from a CT scanner may be more accurate than an X-ray. The 2-D and 3-D HLD differences in the 3-D CT HLD group were statistically significant. Using a 3-D, CT-based HLD method might decrease the possibility of an LLD over 2 mm.

BackgroundTotal shoulder arthroplasty (TSA) can fail for several reasons, such as component loosening, periprosthetic fracture, instability, infection, soft tissue failure, or joint overstuffing. Severe metallosis without loose glenoid components after TSA may result in the need for revision to reverse TSA. Case presentationFour years before the current presentation, an 86-year-old woman suffered from right shoulder pain and swelling. The initial diagnosis was osteoarthritis of the shoulder joint, for which she underwent TSA. Four years later, she complained of shoulder joint pain, swelling, and limited range of motion. On sonography, subscapularis and supraspinatus tendon tears were identified. Plain radiographs and computed tomography (CT) scans showed metallosis around the shoulder joint. Due to the rocking horse mechanism, wear of the upper portion of the glenoid component and bearing caused a foreign-body reaction and severe metallosis around the joint. Due to a massive rotator cuff tear combined with glenoid component wear, the patient eventually underwent reverse TSA (RTSA) and was satisfied with the final results. ConclusionsSevere metallosis due to glenoid component wear combined with a massive rotator cuff tear in TSA may cause the need for revision to RTSA.

Ji Hoon Bahk, MD, PhD, Joo-Hyoun Song, MD, PhD, Young Wook Lim, MD, PhD, Cheolsoon Park, MD, Kee-Haeng Lee, MD, PhD. Hip Pelvis 2025;37:112-9. https://doi.org/10.5371/hp.2025.37.2.112

Background The aim of this study was to investigate whether the use of three-dimentional (3-D) computed tomography (CT) based head-lesser trochanter distance (HLD) could reduce leg length discrepancy (LLD) more than the use of a two-dimentional (2-D) plain film method in primary bipolar hemiarthroplasty. Methods Propensity score matching (PSM) analysis was used to adjust confounding factors. A retrospective comparative analysis of 128 patients was performed. In the control group, the leg length was equalized using the 2-D plain film based HLD. In the study group, primary bipolar hemiarthroplasty was performed using the 3-D CT based HLD method. Postoperative LLDs were compared between the two groups using the method of Ranawat. In addition, Harris Hip Score (HHS) was evaluated and compared at one year after surgery. Results Significant difference was observed in mean postoperative LLD between the 2-D HLD group and the 3-D CT HLD group: 1.6 ± 1.2 mm (range, 0.1-6.0 mm) and 1.1 ± 1.2 mm (range, 0.1–5.1 mm), respectively (p < 0.05). Also, a higher percentage of patients in the 3-D CT HLD group had an LLD less than 2 mm. Mean HHS at one year after surgery showed no significant difference between the two groups. Conclusions To minimize the occurrence of LLD, HLD measurement from a CT scanner may be more accurate than an X-ray. 2-D and 3-D HLD difference in the 3-D CT HLD group was statistically significant. Using 3-D CT based HLD method might decrease the possibility of an LLD over 2 mm.