Purpose: This study compared the clinical utility and safety of the muscle-sparing anterolateral supine (ALS) approach using a skin-crease bikini incision with the conventional direct lateral (DL) approach in terms of the short-term patient reported outcome measurement (PROM) and the postoperative complication rates. Materials and Methods: Between March 2023 and February 2024, patients who underwent primary total hip arthroplasty at a single institution were reviewed retrospectively. Ninety patients were identified in the ALS group, and 264 were identified in the DL group. After 1:1 matching for age, sex, and body mass index, 87 patients in each group were analyzed. The primary outcomes were the PROM, including the modified Harris Hip Score (mHHS), Oxford Hip Score (OHS), and Hip Disability and Osteoarthritis Outcome Score (HOOS), evaluated preoperatively and at six weeks, three months, six months, and one year postoperatively. The secondary outcomes included postoperative complications such as transient sensory changes, permanent nerve injury, dislocation, superficial and deep infections, intraoperative fracture, and iliopsoas tendinitis. Results: All three PROM (mHHS, OHS, and HOOS) showed statistically and clinically superior results in the ALS group compared to the DL group within the first six months postoperatively. No significant differences in the incidence of any recorded complications were observed between the two groups. Conclusion At three and six months postoperatively, the ALS approach with a bikini incision showed superior PROM compared to the DL, suggesting better early functional recovery and patient satisfaction. Although the PROM differences diminished at one year, the early postoperative advantage highlights the clinical benefits of the muscle-sparing ALS approach.

Background: Acetabular fractures are rare and challenging to treat, and the surgeon’s learning curve for managing these fractures is steep. The incidence of acetabular fractures is low, making it difficult to conduct single-surgeon, single-center studies.Therefore, multi-surgeon and multi-center studies may produce inconsistent outcomes compared to those of single-surgeon, singlecenter studies. According to the authors’ literature investigation, single-surgeon, single-center, large-scale studies on this topic are lacking. Thus, this study investigated the radiological and functional outcomes and prognostic factors in patients with displaced acetabular fractures treated by a single surgeon at a single center and followed up for at least 1 year. Methods: This retrospective study was conducted on 149 patients treated for acetabular fractures at Chungbuk national university hospital between January 2005 and December 2021. Demographic data, time to surgery, and complications were collected using medical records. The Judet and Letournel classification was confirmed using preoperative radiographs, and Matta’s quality of reduction was confirmed using immediate postoperative radiographs. At the latest outpatient follow-up, Matta’s radiological outcome grading and the modified Postel Merle d’Aubigné score were confirmed as radiological and functional outcomes, respectively. Results: The radiological outcome was excellent or good in 131 patients (87.9%) and fair or poor in 18 (12.1%) and influenced by age (p = 0.009), quality of reduction (p < 0.001), and the Judet and Letournel classification (p = 0.025). Functional outcome was excellent or good in 121 patients (81.2%) and fair or poor in 28 (18.8%); this was influenced by the quality of reduction (p < 0.001) and the Judet and Letournel classification (p = 0.030). Conclusions Our radiological and functional outcomes of acetabular fractures were comparable with those of other singlesurgeon, single-center studies regarding the follow-up period. Poor prognostic factors for radiological outcomes included age > 65 years, associated patterns, and poor quality of reduction. Associated patterns and poor quality of reduction were factors associated with poor functional outcomes.

Background: Acetabular fractures are rare and challenging to treat, and the surgeon’s learning curve for managing these fractures is steep. The incidence of acetabular fractures is low, making it difficult to conduct single-surgeon, single-center studies.Therefore, multi-surgeon and multi-center studies may produce inconsistent outcomes compared to those of single-surgeon, singlecenter studies. According to the authors’ literature investigation, single-surgeon, single-center, large-scale studies on this topic are lacking. Thus, this study investigated the radiological and functional outcomes and prognostic factors in patients with displaced acetabular fractures treated by a single surgeon at a single center and followed up for at least 1 year. Methods: This retrospective study was conducted on 149 patients treated for acetabular fractures at Chungbuk national university hospital between January 2005 and December 2021. Demographic data, time to surgery, and complications were collected using medical records. The Judet and Letournel classification was confirmed using preoperative radiographs, and Matta’s quality of reduction was confirmed using immediate postoperative radiographs. At the latest outpatient follow-up, Matta’s radiological outcome grading and the modified Postel Merle d’Aubigné score were confirmed as radiological and functional outcomes, respectively. Results: The radiological outcome was excellent or good in 131 patients (87.9%) and fair or poor in 18 (12.1%) and influenced by age (p = 0.009), quality of reduction (p < 0.001), and the Judet and Letournel classification (p = 0.025). Functional outcome was excellent or good in 121 patients (81.2%) and fair or poor in 28 (18.8%); this was influenced by the quality of reduction (p < 0.001) and the Judet and Letournel classification (p = 0.030). Conclusions Our radiological and functional outcomes of acetabular fractures were comparable with those of other singlesurgeon, single-center studies regarding the follow-up period. Poor prognostic factors for radiological outcomes included age > 65 years, associated patterns, and poor quality of reduction. Associated patterns and poor quality of reduction were factors associated with poor functional outcomes.

Background: Acetabular fractures are rare and challenging to treat, and the surgeon’s learning curve for managing these fractures is steep. The incidence of acetabular fractures is low, making it difficult to conduct single-surgeon, single-center studies.Therefore, multi-surgeon and multi-center studies may produce inconsistent outcomes compared to those of single-surgeon, singlecenter studies. According to the authors’ literature investigation, single-surgeon, single-center, large-scale studies on this topic are lacking. Thus, this study investigated the radiological and functional outcomes and prognostic factors in patients with displaced acetabular fractures treated by a single surgeon at a single center and followed up for at least 1 year. Methods: This retrospective study was conducted on 149 patients treated for acetabular fractures at Chungbuk national university hospital between January 2005 and December 2021. Demographic data, time to surgery, and complications were collected using medical records. The Judet and Letournel classification was confirmed using preoperative radiographs, and Matta’s quality of reduction was confirmed using immediate postoperative radiographs. At the latest outpatient follow-up, Matta’s radiological outcome grading and the modified Postel Merle d’Aubigné score were confirmed as radiological and functional outcomes, respectively. Results: The radiological outcome was excellent or good in 131 patients (87.9%) and fair or poor in 18 (12.1%) and influenced by age (p = 0.009), quality of reduction (p < 0.001), and the Judet and Letournel classification (p = 0.025). Functional outcome was excellent or good in 121 patients (81.2%) and fair or poor in 28 (18.8%); this was influenced by the quality of reduction (p < 0.001) and the Judet and Letournel classification (p = 0.030). Conclusions Our radiological and functional outcomes of acetabular fractures were comparable with those of other singlesurgeon, single-center studies regarding the follow-up period. Poor prognostic factors for radiological outcomes included age > 65 years, associated patterns, and poor quality of reduction. Associated patterns and poor quality of reduction were factors associated with poor functional outcomes.

Background: Acetabular fractures are rare and challenging to treat, and the surgeon’s learning curve for managing these fractures is steep. The incidence of acetabular fractures is low, making it difficult to conduct single-surgeon, single-center studies.Therefore, multi-surgeon and multi-center studies may produce inconsistent outcomes compared to those of single-surgeon, singlecenter studies. According to the authors’ literature investigation, single-surgeon, single-center, large-scale studies on this topic are lacking. Thus, this study investigated the radiological and functional outcomes and prognostic factors in patients with displaced acetabular fractures treated by a single surgeon at a single center and followed up for at least 1 year. Methods: This retrospective study was conducted on 149 patients treated for acetabular fractures at Chungbuk national university hospital between January 2005 and December 2021. Demographic data, time to surgery, and complications were collected using medical records. The Judet and Letournel classification was confirmed using preoperative radiographs, and Matta’s quality of reduction was confirmed using immediate postoperative radiographs. At the latest outpatient follow-up, Matta’s radiological outcome grading and the modified Postel Merle d’Aubigné score were confirmed as radiological and functional outcomes, respectively. Results: The radiological outcome was excellent or good in 131 patients (87.9%) and fair or poor in 18 (12.1%) and influenced by age (p = 0.009), quality of reduction (p < 0.001), and the Judet and Letournel classification (p = 0.025). Functional outcome was excellent or good in 121 patients (81.2%) and fair or poor in 28 (18.8%); this was influenced by the quality of reduction (p < 0.001) and the Judet and Letournel classification (p = 0.030). Conclusions Our radiological and functional outcomes of acetabular fractures were comparable with those of other singlesurgeon, single-center studies regarding the follow-up period. Poor prognostic factors for radiological outcomes included age > 65 years, associated patterns, and poor quality of reduction. Associated patterns and poor quality of reduction were factors associated with poor functional outcomes.

There is still controversy regarding clinical outcomes following primary hip arthroplasty after solid organ transplantation (SOT). The aim of this study was to determine whether clinical outcomes after hip arthroplasty differ between previous SOT recipients and control subjects with no history of undergoing SOT. We conducted a systematic search of MEDLINE, Embase, and the Cochrane Library for studies comparing the clinical outcomes after hip arthroplasty following SOT published up to January 5, 2022. A comparison of medical and surgeryrelated complications, as well as the readmission rate and 90-day mortality rate between previous SOT recipients and control subjects was performed. Subgroup analyses of the SOT types, liver transplantation (LT) and kidney transplantation (KT), were also performed. Ten studies that included 3,631,861 cases of primary hip arthroplasty were included; among these, 14,996 patients had previously undergone SOT and 3,616,865 patients had not.Significantly higher incidences of cardiac complications, pneumonia, and acute kidney injury were observed in the SOT group compared with the control group. Regarding surgical complications, a higher transfusion rate was observed in the SOT group. The readmission rate and 90-day mortality rate were also significantly higher in the SOT group. A significantly higher incidence of deep vein thrombosis was observed in the KT subgroup compared with the control group. A higher risk of medical and surgical complications, as well as higher readmission and mortality rates after hip arthroplasty was observed for previous SOT recipients compared to patients with no history of SOT.

PURPOSE: There are concerns that administration of bisphosphonate (BP) can substantially suppress bone turnover, potentially interfering with fracture healing. We investigated the effects of preoperative BP administration before internal fixation of intertrochanteric femoral fractures using fracture healing and clinical outcomes. MATERIALS AND METHODS: We retrospectively analyzed data from 130 patients who underwent internal fixation for osteoporotic intertrochanteric femoral fractures between March 2012 and July 2016. Patients previously treated with BPs for at least 3 months (BP group; n=29) were compared with the remaining patients (BP-naïve group; n=101). Radiographs were used to assess and compare fracture healing 3 months and 1 year postsurgery. The primary clinical outcome measure assessed was change in Koval score. RESULTS: Fracture union at 3 months after surgery was verified in 72.4% of patients (21/29) in the BP group and 90.1% of patients (91/101) in the BP-naïve group (P=0.027). Fracture union at 1 year postsurgery (BP group, 93.1% [27/29] vs. BP-naïve group, 97.0% [98/101], P=0.310) and change in Koval score (1.1 vs. 1.0, P=0.694) were not significantly different between the groups. Multivariable logistic regression analysis revealed that a history of BP administration was associated with an increased risk of delayed union at 3 months postsurgery (P=0.014). CONCLUSION: Preoperative administration of BP was associated with a decreased fracture healing rate 3 months after internal fixation, compared with BP-naïve patients. Therefore, patients previously treated with a BP should be carefully allowed to wean off walking aids and transition to full weight-bearing in the early postoperative period.
Bone Remodeling ; Diphosphonates ; Femoral Fractures ; Fracture Healing ; Hip Fractures ; Humans ; Logistic Models ; Osteoporosis ; Outcome Assessment (Health Care) ; Postoperative Period ; Retrospective Studies ; Walking ; Weight-Bearing

PURPOSE: The purpose of this study was to introduce our method of stabilizing unstable intertrochanteric fractures by using the dynamic hip screw (DHS) with a beta-tricalcium phosphate (β-TCP) graft and to compare the outcomes of this procedure with those of the conventional DHS without β-TCP. MATERIALS AND METHODS: Patients who underwent surgery by using DHS between March 2002 and January 2016 were retrospectively reviewed for analysis of the outcomes. The inclusion criteria were: 1) age of 60 years and older; 2) low-energy fracture resulting from a fall from no greater than the standing height; 3) multifragmentary pertrochanteric fracture (AO classification 31-A2.2, 2.3); and 4) follow-up of over 3 months. We compared 29 patients (29 hips) who underwent surgery, using DHS without β-TCP, with 29 age-sex matched patients (29 hips) who underwent surgery using DHS with grafted β-TCP granules to empty the trochanter area after reaming. We investigated the fracture union rate, union time, and length of lag screw sliding. RESULTS: Bone union was achieved in all cases. The mean union time was 7.0 weeks in the β-TCP group and 8 .8 weeks in the non-β-TCP group. The length of lag screw sliding was 3.6 mm in the β-TCP group and 5 .5 mm in the non-β-TCP group. There were no implant failure cases in both groups. CONCLUSION: The β-TCP graft for reinforcement DHS acquired satisfactory clinical outcomes for treating unstable intertrochanteric fractures.
Classification ; Femur ; Follow-Up Studies ; Hip Fractures ; Hip* ; Humans ; Methods ; Retrospective Studies ; Transplants*