Hines JT, et al. J Korean Med Sci. 2021 May;36(24):e177. https://doi.org/10.3346/jkms.2021.36.e177

Advances in technology have reduced the risk of fracture of ceramic total hip arthroplasty implants, but concerns remain about fracture of both components. We retrospectively reviewed 133 patients (157 hips) who had cementless alumina-on-alumina total hip arthroplasties with a sandwich-type acetabular component. Six patients (seven hips) died and five patients (six hips) were interviewed by telephone (95% followup). The 122 patients (144 hips) examined had a minimum followup of 36 months (average, 45 months; range, 36-68 months). All acetabular cups and femoral stems were radiographically stable at the last followup. Five hips in five patients (3.5%) were revised because of ceramic liner fractures. Ceramic liner fractures occurred at a mean of 35 months (range, 24-48 months) postoperatively. Acetabular cups in the fracture group (n = 5) were more anteverted than those in the nonfracture group (n = 139). In three patients the fracture apparently occurred during squatting, resulting in hyperflexion and wide hip abduction. Early ceramic liner fracture was associated with impingement associated with excessive anteversion of the acetabular cup in Korean patients who habitually squat.

Cui Q, et al. J Korean Med Sci. 2021 Feb;36(10):e65. https://doi.org/10.3346/jkms.2021.36.e65

Background: Many authors have reported good results with the use of vascularized fibular grafts to treat large osteonecrotic lesions of the femoral head. To our knowledge, there have been no prospective case-controlled studies comparing the effectiveness of vascularized fibular grafting with that of nonvascularized fibular grafting for the prevention of progression and collapse of the lesion. Methods: Nineteen patients (twenty-three hips) with a large osteonecrotic lesion of the femoral head (Stage IIC in ten hips, Stage IIIC in two, and Stage IVC in eleven, according to the classification system of Steinberg et al.) underwent vascularized fibular grafting. This group was retrospectively matched according to the etiology, stage, and size of the lesion to a group of nineteen patients (twenty-three hips) who underwent nonvascularized fibular grafting during the same time period. A prospective case-controlled study of the two groups, with a mean duration of follow-up of four years, was then performed. Results: The mean Harris hip score improved for 70% of the hips treated with a vascularized graft and 35% of the hips treated with a nonvascularized graft (p < 0.05). At the time of the final follow-up, nine of the ten hips with a Stage-IIC lesion treated with a vascularized fibular graft had not collapsed whereas seven of the thirteen hips with a larger lesion (Stage IIIC or IVC) had collapsed. Three hips (13%) were converted to a total hip replacement. The mean dome depression measured 2.8 mm. In the group treated with a nonvascularized graft, five of the ten Stage-IIC hips had not collapsed and eleven of the thirteen hips with a larger lesion had collapsed. Five (22%) of the hips were converted to a total hip replacement. The mean dome depression measured 4.3 mm. The rates of radiographic progression and collapse were significantly lower and the mean dome depression was significantly less in the group treated with a vascularized fibular graft (p < 0.05). Conclusions: Vascularized fibular grafting was associated with better clinical results and was more effective than nonvascularized fibular grafting for the prevention of collapse of the femoral head in a matched population with a Steinberg Stage-IIC or larger osteonecrotic lesion. The results of vascularized grafting were best when the procedure was used to treat precollapse lesions (Steinberg Stage IIC). Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Background: Unstable intertrochanteric fractures in elderly patients are associated with a high rate of complications. The purpose of this investigation was to compare the results of long-stem cementless calcar-replacement hemiarthroplasty with those of treatment with a proximal femoral nail for unstable intertrochanteric fractures in elderly patients. Methods: Fifty-eight elderly patients with an AO/OTA type 31-A2 intertrochanteric fracture of the femur were randomized into two treatment groups and were followed for a minimum of two years. The twenty-nine patients in Group I were treated with a long-stem cementless calcar-replacement prosthesis, and the twenty-nine patients in Group II were treated with a proximal femoral nail. The two treatment groups were comparable with regard to demographic and injury variables. Results: There were no significant differences between the groups in terms of functional outcomes, hospital stay, time to weight-bearing, or general complications. Patients treated with a proximal femoral nail had a shorter operative time, less blood loss, fewer units of blood transfused, a lower mortality rate, and lower hospital costs compared with those treated with the long-stem cementless calcar-replacement prosthesis. Conclusions: In elderly patients with an unstable intertrochanteric femoral fracture, a proximal femoral nail provides superior clinical outcomes but no advantage with regard to functional outcome when compared with a long-stem cementless calcar-replacement arthroplasty. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.