Key findings in hip surgery, including those related to fracture management and infection prevention, are presented in the new JBJS Guest Editorial What’s New in Hip Surgery. Here, we highlight the 5 most impactful studies, as selected by co-author Lisa C. Howard, MD, FRCSC, MHSc.
Hip Fracture Management
In a study of 11,018 total hip arthroplasties (THAs), THAs with cemented polished taper-slip stems had a 0.9% rate of postoperative periprosthetic femoral fracture, whereas those with cementless stems had a rate of 0.7% (p = 0.345). Male patients in the cemented group were 5 times more likely to undergo a reoperation for fracture than those in the cementless group1. “The concerns around postoperative periprosthetic femoral fractures with these stems are relatively new,” write Guest Editorial authors Dr. Howard and Dr. Sheridan, “and should be monitored closely in future studies.”
Periprosthetic Joint Infection (PJI)
To ascertain whether the timing of corticosteroid injections prior to arthroplasty influences infection risk, researchers performed a meta-analysis of 28 articles on THA and total knee arthroplasty (TKA), which included 61,049 patients undergoing THA. In the THA cohort, the corticosteroid group had a higher rate of PJI than the control group (p = 0.001). No such association was found for TKA. Further, a corticosteroid injection within 3 months prior to THA or TKA was associated with an increased risk of infection (p = 0.045). However, the study authors noted that higher-quality evidence is needed2.
Study results were reported for the WHiTE 8 randomized controlled trial (RCT), a multicenter superiority trial comparing high-dose, dual-antibiotic cement to standard-of-care, single-antibiotic-loaded cement with respect to the rate of deep surgical site infection at 90 days after hemiarthroplasty. A total of 4,936 patients (≥60 years old) with intracapsular hip fracture were included. The investigators concluded that high-dose cement did not reduce the rate of deep surgical site infection3.
A single-blinded RCT assessed intravenous versus intraosseous administration of vancomycin in THA. Twenty patients received either 15 mg/kg of vancomycin administered intravenously 1 hour prior to skin incision or 500 mg of vancomycin in 100 mL of normal saline solution injected into the greater trochanter at the time of skin incision. The intraosseous group demonstrated reduced serum vancomycin levels as well as higher levels of vancomycin in acetabular reamings, although no conclusions could be drawn regarding whether infection risk differed as a result4.
Implant Design and Related Outcomes
The effect of highly cross-linked polyethylene (HXLPE) liner thickness on implant survivorship was investigated in a retrospective study of 2,565 primary THAs with a mean follow-up of 13 years. HXLPE liner thickness ranged from 4.9 mm to 12.7 mm. Liner thickness was not associated with all-cause revision-free survival, nor was there a clinically meaningful difference in liner thickness between patients who underwent a reoperation or all-cause revision and those who did not. These findings suggest that using thin liners to enable the use of larger femoral heads is a safe practice5.
What’s New in Hip Surgery is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.
Recent OrthoBuzz posts include: What’s New in Osteoporosis, What’s New in Limb Lengthening and Deformity Correction, and What’s New in Musculoskeletal Infection.
References
- Lynch Wong M, Robinson M, Bryce L, Cassidy R, Lamb JN, Diamond O, Beverland D. Reoperation risk of periprosthetic fracture after primary total hip arthroplasty using a collared cementless or a taper-slip cemented stem. Bone Joint J. 2024 Feb 1;106-B(2):144-50.
- Albanese J, Feltri P, Boffa A, Werner BC, Traina F, Filardo G. Infection risk increases after total hip arthroplasty within 3 months following intra-articular corticosteroid injection. A meta-analysis on knee and hip arthroplasty. J Arthroplasty. 2023 Jun;38(6):1184-1193.e2.
- Agni NR, Costa ML, Achten J, Peckham N, Dutton SJ, Png ME, Reed MR; WHiTE 8 Investigators. High-dose dual-antibiotic loaded cement for hip hemiarthroplasty in the UK (WHiTE 8): a randomised controlled trial. Lancet. 2023 Jul 15;402(10397):196-202.
- Harper KD, Park KJ, Brozovich AA, Sullivan TC, Serpelloni S, Taraballi F, Incavo SJ, Clyburn TA. Otto Aufranc Award: Intraosseous vancomycin in total hip arthroplasty – superior tissue concentrations and improved efficiency. J Arthroplasty. 2023 Jul;38(7S):S11-5.
- Fransen BL, Howard LC, MacDonell T, Bengoa FJ, Sheridan GA, Garbuz DS, Neufeld ME. Highly crosslinked polyethylene liner thickness does not influence survival in primary total hip arthroplasty after mean follow-up of 13 years: a study of 2,565 hips with a single design liner. J Arthroplasty. 2023 Jul;38(7)(Suppl 2):S340-5.