Fall-related injuries (FRIs) are increasing among older adults, leading to complications, reduced quality of life, and deaths. Inflatable hip protectors(HPs) offer higher fracture prevention rates, but face acceptance challenges resulting in low adoption. Our study evaluates well-documented compliance parameters on our intelligent inflatable HP. Our human-centered designed inflatable garment prototype, Air-Sequr, may offer unique opportunities in hip fracture prevention.

Background: due to increase in total hip arthroplasties (THAs), the incidence of periprosthetic hip fractures (PPHFs) is forecast to raise considerably in the next decades, with Vancouver B1 fractures (VB1) accounting for one third of total cases. Femur fixation with cerclages (with or without screws) is considered the current treatment option for intraoperative VB1. Methods: the study retrospectively includes data from patients who developed VB1 PPHFs during THAs from December 3rd 2020 to November 30th 2022. The primary outcome of this study was to identify the reintervention-free survival rate. The secondary aim was to determine clinical and radiographic assessment at follow-up, based on Harris hip score (HHS) and limb length discrepancy (LLD). Results: 37 patients with mean age 60.03 ± 15.49 (22 to 77) years old were included. Overall, the Kaplan-Meier estimated a re-operation free survival rate of 99% (CI 95%) at 6 months. The mean limb length discrepancy (LLD) improved from -3.69±6.07 (range -27.9 to 2.08) mm to 0.10±0.67 (range -1.07 to 1.20) mm. The mean HHS improved from 42.72±14.37 (range 21.00-96.00) to 94.40±10.32 (range 56.00-100.00).

Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary due to developmental hip dysplasia (DDH). Gait analysis is considered a golden standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait, and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH (pr< 0.51, all p< 0.05). The preoperative gait alterations associated with OA or DDH were improved to similar levels in both groups after THA. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. These find-ings must be correlated with kinetic gait analysis data to fully evaluate gait and functionality dif-ferences among patient groups.

The ultrasound guided viscosupplementation of the hip joint with hyaluronic acid(HA)is considered a standard procedure among the conservative treatments for hip arthritis.The aim of the study was to evaluate the clinical benefit and the incidence of adverse events of the technique in a obseravtional study at one year follow up. We evaluated a consecutive series of 85 patients with a diagnosis of symptomatic arthritis that performed intra-articular ultrasound-guided hyaluronic acid injections. The scales used for evaluation were modified Harris Hip Score(mHHS),WOMAC (Western Ontario and McMaster University),Hip Outcome Score (HOOS) with subscale Sport (HOOSs), for pain the Visual Analogic Scale (VAS).The patients were classified according to Tonnis’ radiological classification of arthrosis (range 0-3):20 patients(grade 0),32(grade 1),18(grade 2),15(grade 3).At last follow up all the scales increased:mHHS from 59.35 to 82.1,HOOS from 69.45 to 78.53,HOS Sport from 47.4 to 58.11,VAS from 6.09 to 3.97,WOMAC from 33.2 to 31.5 (p<0.05 for all the parameters);13/85 requested arthroplasty. Based on our findings, indication for use of hyaluronic acid is limited to patients with mild to moderate arthritis.Patients in advanced arthritis refusing replacement surgery and asking for this treatment should be informed about the poor results of the technique even in the short term follow up.

Background: developmental dysplasia of the hip (DDH) is a condition characterized by abnormal hip development in infancy. Early diagnosis allows for effective treatment, while late presentation often necessitates complex surgical interventions. Current recommendations advise screening between the 6th and 8th week postnatal using ultrasound, typically employing the Graf method. However, there's no universal consensus on whether ultrasound screening significantly increases treatment compared to clinical examination-guided ultrasound. This study aims to explore the feasibility of prenatal ultrasound for early identification of DDH risk. Methods: This prospective observational study involved 100 pregnant women undergoing fetal hip ultrasound during the second and third trimesters. Using the modified Graf method, alpha and beta angles were calculated on the fetus. Postnatally, alpha and beta angles were compared with prenatal values. Results: Prenatal ultrasound at 24th week showed inconclusive results because of the difficulty in identification of Graf landmarks, while ultrasound at 34th week has proved to be a reliable and safe method for quantitative determination of alpha and beta angles. Significant correlations were found between prenatal and postnatal alpha and beta angles. Moreover, significant differences in prenatal alpha and beta values were observed in patients developing mature/immature hips postnatally. Conclusions: Prenatal diagnostics show promise for predicting infant hip development. Further research is warranted to validate correlation strength and clinical applicability.

The objective is to describe a new technique for subtrochanteric hip nonunions. Three patients with a nonunion of a previously nailed subtrochanteric hip fracture were selected. The nail was withdrawn, and a simple lateral approach was performed. A hip screw was introduced through the neck, and a dynamic plate (135-150º) was applied, to increase the femoral-neck angle (valgus) and reduce the head offset at the hip. The correction was achieved just by mobilizing the nonunion site. No osteotomy was done. Fixation promoted dynamic mechanical compression and fracture healing. The mean age of patients was 57 (34-85). 2 women, and one man. Duration of surgery was 102 min (63-123). Femoral neck angle before surgery was 125º (122-128), and after surgery 147º (142-150). Offset was 50 mm (42-59) before surgery and 20 mm (19-24) after surgery. Leg length was increased by 8,6 mm (6-12). Harris hip score was improved from 37,33 (30-42) to 93,33 (88-96). All patients healed and were asymptomatic after 12 months follow-up. In conclusion, valgus correction with a dynamic hip screw is a useful technique for a nonunion of a subtrochanteric hip fracture. This zone is well vascularized, so just dynamic mechanical compression at the fracture site is needed.

(1) Background: Pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors, or infections, so the differential diagnosis is crucial and biopsy is recommended. The purpose of this study was to compare complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our Institution with “pseudotumor” associated with hip prosthesis (8 male,13 female; mean age 69 years). One-stage revision was performed in 10 cases, two-stage in 10, excision only in one case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. Survival rate to all com-plications was 75%. Overall survival was 95% at five years. Mean HHS went from 35 pre-operative to 75 post-operative, highlighting improved functional results in all cases. We rec-orded no differences in complications and functional outcome between one and two-stage proce-dures. (4) Conclusions: In our experience, two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor size. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.

The syndrome of inappropriate antidiuresis (SIAD) is a rare and significant side effect of a variety of medications such as antidepressants, chemotherapeutic medications, and non-steroidal anti-inflammatory drugs. Regarding dipyrone, only a few cases have been mentioned in the world. The non-opioid analgesic metamizole (dipyrone) is used for the treatment of acute or chronic pain and fever and is one of the most frequently prescribed over-the-counter medications in Israel, Brazil, and Mexico. Dipyrone has low anti-inflammatory properties yet inhibits prostaglandins to some degree. In this case report, we present a case of a post-operative patient, who was on an analgesic cocktail containing dipyrone. The patient developed a new and sudden hyponatremia, namely, a drop of 12 meq/L of sodium in less than 24 hours. Dipyrone was found to be the culprit drug. Our case report demonstrates the importance of considering dipyrone in the diagnosis of medication-induced SIAD in patients taking analgesics.

Introduction The Pericapsular Nerve Group (PENG) block is a novel technique that allows for analgesia of the anterior hip capsule via the articular branches of the accessory obturator nerve and femoral nerve, which have a significant role in the innervation of the hip capsule. PENG blockade is effective in both adult and pediatric patients. However, there are no studies in the available literature on patients under five years of age. Herein, we describe our experience with two pediatric patients with hip dysplasia. Purpose This study aimed to evaluate the analgesic effect of the pericapsular nerves group (PENG) in small children undergoing hip surgery. Patients and methods This study included two patients, aged 2 and 4 years old, who qualified for hip surgery. General or spinal anesthesia with the addition of a PENG block was performed. During the procedure, the basic hemodynamic parameters were monitored. After the surgery, the patients received 15mg/kg-1 iv paracetamol every 6 hours to prevent rebound pain. The pain was assessed using the FALCC score. The 15mg/kg-1 metamizole was administered if the FLACC score was 3. In the FLACC score 4, the application of 0,2mg/kg-1 Nalpain was ordered. Results The patient's hemodynamic parameters were stable and within normal range. FLACC scores from all patients ranged from 0 and 3 in the first 24 h period. One patient required metamizole 12 hours after surgery. No evidence of block complications was observed. Conclusions This case series showed that PENG block provided adequate postoperative analgesia and assured opioid-free pain management. However, we are convinced that future randomized, controlled trials are needed in this field.

Obtaining a proper position for THA’s components is a crucial aspect for the implant perfor-mance and consequently patient outcomes. Patient specific kinematic seems to be a key factor to reach the optimal implant positioning. The aim of this study was to assess the accuracy and safety of a computed dynamic analysis system which through patient specific guides tries to improve implant positioning and functional orientation according to patient’s spinopelvic mobility and anatomy.A total of 100 consecutive patients were prospectively enrolled. All patients received an OPS dynamic hip preoperative planning. A TC scan protocol follow up analysis has done at 6 month after surgery.The mean deviation from the planned acetabular inclination and anteversion was 4.3° e 3.8° respectively. The 98% of cases was within +/- 10° of Lewinnek safe zone both for inclination and anterversion. The height of osteotomy deviated on the average of 1.6mm. The 100% cases were included within 4mm of osteotomy. Patient specific and laser guided instru-mentation is safe and accurately reproduce the dynamic planning in terms of components orien-tation, osteotomy level, leg length and offset.

This paper provides a comprehensive overview of the potential applications of dual energy CT (DECT) in improving image quality and diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non contrast (VNC) images, in which the injected contrast medium is reduced from the articular cavity, in order to better analyze 2D and 3D images of the bone. Moreover , virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore , the role of iodine map to enhance the contrast between soft tissues, optimizing the visualization of contrast material, and to distinguish contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high spatial resolution dual energy CT reconstructed images.

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as “comfortable” were defined as the “comfort” group; others were placed in the “discomfort” group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the "comfort" and "discomfort" groups, respectively. Patients in the "discomfort" group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.

Background: The incidence of fracture and surgery of the hip and lower extremities is still high. Long postoperative bed rest has the potential to increase the incidence of various complications that may increase the morbidity and mortality rate of patients after hip and lower extremities surgery. Aim: This literature review aimed to identify the effects of early mobilization in hip and lower extremity postoperative. Method: Search for articles on several databases such as ProQuest, ScienceDirect, CINAHL, Medline, Wiley Online and Scopus, using the Boolean operator by combining several keywords according to the literature review topic, with inclusion criteria are published in the last 3 years (2019-2021), used a quantitative design, written in English and full text articles. A total of 435 articles were obtained, then screened and reviewed, so that there were 16 (sixteen) eligible articles.Result: There were 11 (eleven) effects of early mobilization, i.e. reducing length of stay, reducing the risk of deep vein thrombosis (DVT), reducing pulmonary infections (pneumonia), reducing urinary tract infections, reducing the risk of wound infection, improving extremity function and ability to walk, reducing postoperative pain, reducing the risk of pressure sores, reducing postoperative delirium, reducing readmission and lowering hospitalization costs. Conclusion: This literature review showed that early mobilization is safe and effective in postoperative patients to reduce the risk of complications and adverse events. Nurses and health workers who care for patients could implement early mobilization and motivate patients to be cooperative in undergoing early mobilization.

Both cementless and cemented stems have exhibited favorable long-term outcomes in total hip arthroplasty. Nonetheless, in elderly patients, cemented hips offer an advantage because of their reduced risk of periprosthetic fractures. The present study aimed to assess the initial outcomes of 28 patients who underwent unilateral cemented total hip arthroplasty utilizing the calcar-guided A2 stem (Artiqo GmbH, Lüdinghausen, Germany). Various types of antibiotic-loaded cement were employed. Demographic data, comorbidities, and standardized clinical assessment tools, including the Harris Hip Score, were utilized during the follow-up. Radiographic assessments included preoperative, postoperative, and follow-up imaging to evaluate subsidence, osteolysis, and bone resorption. The results indicated that among the 28 patients, 5 withdrew consent, and 2 patients passed away from unrelated causes. Additionally, one prosthesis was explanted because of undersizing of the cement stopper, resulting in an inadequate cement mantle. As a result, 20 patients underwent a 1-year follow-up, revealing noteworthy enhancements in clinical scores, with no instances of radiolucent lines or osteolysis. In summary, our short-term experience with this particular cemented short-stem design yielded promising results, exhibiting excellent functional outcomes and no aseptic loosening attributable to the stem. Further clinical studies and registry data are essential to corroborate these findings.

The purpose of this study was to compare the long-term clinical outcomes and quality of life measures for two fixation methods in the setting of displaced femoral neck fractures. The two groups included fixation with multiple cancellous screws (group 1) and telescopic femoral neck screws and small locking plate device (Targon FN) (group 2). Patients underwent reduction and internal fixation with either multiple cancellous screws or Targon FN device from March 2000 to January 2012. Failure endpoints included nonunion, osteonecrosis of the femoral head, and revision surgery. Patient reported outcome measures included chronic pain, ability to ambulate, and the use of ambulation assistive devices. Statistical analysis demonstrated a statistically significant lower rate of non-union and overall complication in the Targon FN group (p value < 0.001 and p value = 0.005 respectively). Logistic regression analysis showed that operative fixation with the Targon FN device decreased the odds ratio for overall complication by a factor of 0.34 (P = 0.02). There were no statistically significant differences between groups 1 and 2 in patient reported outcomes (chronic pain (p-0.21), ability to ambulate (p- 0.07), and the use of ambulation assistive device (p-0.07)). When compared to traditional cancellous screw fixation of femoral neck fractures, the Targon FN device has significantly lower complications rates and equivalent patient reported outcomes.

Hip joint surgeries, including total hip replacement or resurfacing, have increased tremendously in the last decades. Number of patients of all ages, replace their hip, due to severe injuries or trauma problems, so as to have a better life. According to these factors, new material and processes in implants manufacturing are imported to medicine, through research programs, every year. In the scope of one of these programs, that has to do with ceramic coatings on metallic resurfacing implants, a new 3axis Hip simulator was designed and manufactured in the Laboratory of Manufacturing Technology of the National Technical University of Athens. The scope of this paper is to present the main parts, materials and process used to manufacture the simulator as well as the way the simulator is working and how its movement in 3axis is accomplished. Furthermore, the evaluation of the machine and its use to examine resurfacing implants is presented.

Low back pain (LBP) is a health problem that affects 70-80% of the population in Western countries. Because of the biomechanical relationship between the lumbar region and the hip, it is thought that strengthening the muscles of this joint could improve the symptoms of people with LBP. The objective of the study is to evaluate the current evidence on the efficacy of hip strengthening exercises to reduce pain and disability in people with LBP. Clinical trials were collected from PubMed, PEDro, and Scopus databases published up to September 2022. Based on Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and using CASpe and PEDro tools for methodological quality assessment, we selected studies that included hip strengthening exercises as part of LBP treatment and measured pain and/or disability parameters. Among the 966 records identified in the search, a total of 7 studies met the established selection criteria. Overall, participants who performed hip strengthening exercises had significantly improved in pain and disability. The methodological quality of the included studies was assessed as “good”. In conclusion, the addition of hip muscle strengthening exercises iterating LBP effectively improving pain and disability.

The success of total hip arthroplasty depends on the experience of the surgeon, and one of the ways the surgeon currently determines the final implant insertion depth is to listen to the change in audible pitch of the hammering sound. We investigated the use of acoustic vibration emissions as a novel method for insertion quality assessment. A non-invasive contact microphone-based measurement system for insertion depth estimation, fixation and fracture detection was developed using a simplified in vitro bone/implant (n=5). 2583 audio recordings were analysed in vitro to obtain energy spectral density functions. Out of the four main resonant peaks under in vitro conditions, broach insertion depth statistically correlates to increasing 3rd and 4th peak frequencies. Degree of fixation was also observed as higher goodness of fit (0.26-0.78 vs. 0.12-0.51 between two broach sizes, the latter undersized). Finally, however, the moment of fracture could not be predicted. A cadaver in situ pilot study suggests comparable resonant frequencies in the same order of magnitudes with the bone model. Further understanding of the signal patterns are needed for an early warning system diagnostic system for imminent fractures, bone damage, improving accuracy and quality of future procedures.

Purpose: In recent years, there has been an increasing interest in simultaneous hip and knee arthroplasty compared to staged procedures. The aim of this study was to clarify some controversies and show the safety for the patients by comparing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions, and early functional outcome after simultaneous and staged hip and knee arthroplasty. Methods: We conducted a retrospective trial that included all patients who were undergoing primary TKA, THA, and UKA by one single surgeon in a high-volume arthroplasty center between 2017 and 2020 as a simultaneous or staged procedure. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data was acquired through the electronic files at the OCM. For functional outcome, we compared the ability of the patients to walk independently on the ward and the ability to walk a set of stairs alone which was daily recorded by the attending physiotherapist. Results: In total 305 patients were assessed for eligibility and included in this clinical trial. 145 patients were allocated to the staged arthroplasty group. That group was subdivided in a hip and a knee group, whereas the knee group was split in TKA and unicompartmental knee arthroplasty (UKA). The second staged procedure was performed within 12 months of the first procedure.160 patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There is no significant difference in transfusion rate or complication rate. Secondarily: No correlation was found between the Hb-drop and the functional outcome as well as the length of stay (LOS). Walking the stairs showed a significant difference in the knee group. Conclusion: We observed no significant differences in transfusion rate, in-hospital complications, as well as readmission rate. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient and his outcome, in a high-volume center.

Pedigree data of 13 339 border collie dog was collected along with hip and elbow dysplasia records (1352 CHD and 524 CED), and an inbreeding-purging (IP) model was created to detect possible purging. Ancestral inbreeding coefficients were calculated by gene dropping simulation method (Ballou, 1997; Kalinowski, 2000) with GRain 2.0 (Baumung et al., 2015) software. GLMM models were created to the examined traits fitted with a log-link Poisson distribution, added to the estimated values of classical inbreeding coefficient (F_W), and the ancestral inbreeding (F_BAL, F_KAL, F_KAL_NEW) as covariates. The effective population size decreased in the examined period along with the increase of F_W however, slight differences were found as a consequence of breeding dog imports. CHD values were getting lower by the expansion of F_BAL as the alleles were inbred in the past. For CHD signs of purging were obtained. There was a positive trend regarding the breeding activity (both sire and dam of the future litters should be screened and certified free from CHD and CED), as years of selection increased the frequency of alleles with favorable hip and elbow conformation. Division of the ancestral inbreeding coefficient shows that alleles IBD for the first time (F_KAL_NEW) had a negative effect on both traits, while F_KAL shows favorable results for alleles IBD in the past generations. Some authors had proven this phenomenon in captive populations or experimental conditions however, no evidence of inbreeding purge has ever been described in dog populations. Despite the various breeding practices, it seems, that alleles of these polygenic disorders could be successfully purged out of the population with long term selection.

Objectives Independent validation of risk scores after hip fracture is uncommon, particularly for evaluation of outcomes other than death. We aimed to assess the Nottingham Hip Fracture Score (NHFS) for prediction of mortality, physical function, length of stay and postoperative complications. Design Analysis of routinely collected prospective data partly collected by follow-up interviews. Setting and Participants Consecutive hip fracture patients were identified from the Northumbria hip fracture database between 2014-2018. Patients were excluded if they were not surgically managed or if scores for predictive variables were missing. Methods C-statistics were calculated to test the discriminant ability of the NHFS, Abbreviated Mental Test Score (AMTS), and ASA grade for in-hospital, 30- and 120-day mortality, functional independence at discharge, 30-days and 120-days, length of stay, and postoperative complications. Results We analysed data from 3208 individuals, mean age 82.6 (SD 8.6). 2192 (70.9%) were female. 194 (6.3%) died during the first 30-days, 1686 (54.5%) were discharged to their own home, 211 (6.8%) had no mobility at 120-days, 141 (4.6%) experienced a postoperative complication. The median length of stay was 18 days (IQR 8-28). For mortality, c-statistics for the NHFS ranged from 0.68-0.69, similar to ASA and AMTS. For postoperative mobility, the c-statistics for the NHFS ranged from 0.74-0.83, similar to AMTS (0.61-0.82) and better than the ASA grade (0.68-0.71). Length of stay was significantly correlated with each score (p<0.001 by Jonckheere-Terpstra test); NHFS and AMTS showed inverted U-shaped relationships with length of stay. For postoperative complications, c-statistics for NHFS (0.54-0.59) were similar to ASA grade (0.53-0.61) and AMTS (0.50-0.58). Conclusions and Implications The NHFS performed consistently well in predicting functional outcomes, moderately in predicting mortality, but less well in predicting length of stay and complications. There remains room for improvement by adding further predictors such as measures of physical performance in future analyses.

Introduction: Childhood obesity is becoming an emerging public health issue as it is associated with increased morbidity and premature deaths. Determinants like the child’s household characteristics, maternal weight before the preconception stage, and maternal weight in childhood are studied. There is no study available to understand the association between overweight women of reproductive age and overweight children under five years of age. Studying these determinants to understand the problem can help in framing policies to intervene in the issue. Methods: The data for the study was collected from the National Family Health Survey 5 (NFHS5). It has been sub-grouped into urban and rural categories. The percentage of women with high-risk Waist-Hip-Ratio (WHR) and the percentage of overweight women were independent variables whereas the percentage of overweight under-five children was dependent. Simple linear regression, multiple linear regression, and Pearson correlation coefficient analysis were done for the collected data. Results: Study shows the percentage of overweight women has increased by 4.1%, and the percentage of overweight children has increased by 2% during the NFHS5 (2019-21) compared to NFHS4 (2015-16). Pearson correlation coefficient (R) is 0.5662 and Ꞵ-coefficient for multiple linear regression is 0.1397 for central obesity in women (%) and percentage of overweight children. Conclusion: Central obesity in women is more common than the overweight. Overweight in women as well as in children under five is increasing. Central obesity in women shows a moderate positive relation with overweight in children under five years.

Hip replacement has significantly improved the quality of life of patients with symptomatic hip osteoarthritis. Metal-on-metal (MoM) bearings have been used with conventional total hip re-placement (THR) for several decades with promising results from early applications. Wear and corrosion of these implants may lead to a release of metal products into surrounding tissue and body fluids. From the 1980s onwards, the search for increasingly better coupling materials with low levels of wear led to the rise of hard-on-hard couplings such as ceramic-on-ceramic (CoC). The latter is currently the coupling with the longest known duration and with a wear rate close to zero. MoM coupling has been for a long time the most significative alternative, but systemic and local complications linked to the release of chromium and cobalt ions, determine the withdrawn from the market. One other alternative proposed over the time has been Ceramic-on-Metal (CoM) bearing. Preliminary results have been described as favourable, but due to the failures of metal on metal it has been withdrawn from the market, without causing significant clinical complications. In this narrative review, we analysed risks and benefits associated with the implantation of hybrid hard-on-hard bearings, such as CoM.

Total Hip Arthroplasty (THA) is a common surgical procedure used to treat hip osteoar-thritis and other joint conditions that cause pain and functional limitation. Traditionally, THA has been most performed in elderly patients, but in recent years there has been an in-crease in hip arthroplasties in young patients. Femoral prosthesis rupture is a rare but sig-nificant complication that can also occur in young patients undergoing total hip arthro-plasty (THA). Some of the factors that can contribute to femoral prosthesis ruptures include abnormal overload, defects in the design lack of geometric fit, type of materials used in the stem and femoral head connection. The aim of this study is to analyze the criticalities in the contact between the femoral head and the stem neck. In particular, the two types of con-tacts will be taken into consideration: proximal and distal and through the finite element method (FEA) the criticalities will be defined. The results show that in the proximal contact the voltages are higher than 500 Mpa. This is due to the fact that there are higher circum-ferential voltages. In addition, to prevent bacterial infiltration or debris from the outside, the distal connection is the recommended one.

Total hip arthroplasty (THA) is one of the most successful orthopedic procedures and is highly effective in improving function and quality of life. However, after discharge patients commonly experience edema, which can lead to health consequences and lower quality of life. For these rea-sons, the aim of this study is to evaluate the effectiveness of a specific intermittent leg pneumatic compression on lower limb edema and physical outcomes in patients after total hip arthroplasty, compared to standard conservative treatment. A total of 47 patients were enrolled and randomly allocated into two groups: the pneumatic compression group (PG=24) and the control group (CG=23). We evaluated thigh and calf circumferences, knee and ankle range of motion, pain and walking autonomy. Our results showed a greater reduction in thigh and calf circumference for PG (p<0.001), while other outcomes were similar for the two groups (p>0.05). The combination of standard therapy with pneumatic leg compression was more effective in reducing lower limb edema, thigh, and calf circumferences compared to the use of standard treatment. Our results suggest that pressotherapy treatment is a valuable and efficient option for managing lower limb edema and preventing VTE after THA.

Background: The growth of arthroplasty procedures requires innovative strategies to reduce inpatients Length of Stay (LOS). This study aims to develop a machine learning prediction model that may aid to predict LOS after hip or knee arthroplasties. Methods: A collection of all the clinical notes of patients undergoing elective primary or revision arthroplasty from 1 January 2019 to 31 December 2019 was performed. The hospitalization has been classified as “Short LOS” if it was less than or equal to 6 days and “Long LOS” if it was greater than 7 days. Clinical data coming from pre-operative laboratory analysis, vital parameters, demographic characteristics of patients were screened. Final data have been used to train a Logistic Regression model with the aim of predicting short or long LOS. Results: Final dataset was composed of 1517 patients (795 “LONG”, 722 “SHORT”, p = 0.3196) with a total of 1541 admissions (729 “LONG”, 812 “SHORT”, p &lt; 0.000). Complete model had a prediction efficacy of 78,99% (AUC 0.7899). Conclusions: Machine learning may facilitate day-by-day clinical practice predicting which patients are suitable for a shorter LOS, from those with a longer LOS in which a cautious approach could be recommended.

Background: The COVID-19 pandemic has presented numerous challenges to global healthcare system and emerging evidence suggests a potential link between COVID-19 treatment, specifically steroid therapy, and the development of avascular necrosis (AVN) of the hip. This review aims to provide a comprehensive overview of recent studies and case reports investigating the relationship between COVID-19, corticosteroid therapy, and the development of AVN. Understanding the nuances of AVN in the context of COVID-19 is crucial for healthcare professionals to navigate treatment decisions and mitigate potential complications. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used in the systematic review until September 1st, 2023. The full-texts of the remaining twenty-three (n=23) articles were independently reviewed by the authors of this review.  Conclusions: The association between steroid therapy for COVID-19 and the development of hip AVN is a noteworthy concern even though, no relationship is evident between the duration of treatment, cumulative dosage of medication, maximum daily dosage received, and the presence of AVN. Further research with larger cohorts and long-term follow-up is needed to better understand the causative relationship and optimal management strategies for hip AVN in the context of COVID-19 and steroid therapy

Robotic-assisted hip and knee arthroplasty represents significant advancements in orthopedic surgery. Artificial intelligence (AI) - driven chatbots, such ChatGP, plays a significant role in healthcare education. This study aims to evaluate the quality of responses provided by ChatGPT to the top 20 questions concerning robotic-assisted hip and knee arthroplasty.We have asked ChatGPT to select the top 20 questions on Google concerning robotic hip and knee arthroplasty and to provide a detailed answer to each of them. The accuracy of the information provided were examined by three orthopedic surgeons with scientific and clinical experience in hip and knee replacement surgery. The accuracy was assessed through a 5-point Likert scale (from 1 – completely incorrect to 5 – correct); the completeness through a 4-point Likert scale (from 0 – comprehensiveness not assessable for completely incorrect answers to 3 – exhaustive information) on two different occasions to ensure the consistency of the assessment. Our analysis reveals that ChatGPT provides a relatively high degree of accuracy, moreover the explanations can be considered satisfy, especially for factual questions. The findings suggest that ChatGPT can serve as a valuable initial resource for general information on robotic hip and knee arthroplasty but the integration with human expertise remains essential.

Introduction:The concept of same-day discharge has garnered increasing significance within orthopedic surgery, particularly in hip and knee procedures. Despite initial concerns surrounding the absence of prolonged hospital care, a burgeoning body of evidence highlights numerous advantages associated with same-day discharge, ranging from mitigating in-hospital infections to offering substantial financial and psychosocial benefits for both patients and healthcare providers. In this study, we aim to scrutinize the trends in same-day discharge specifically within the realm of total hip arthroplasties. Method:This retrospective analysis delves into the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database spanning from 2016 to 2021. Result:In this study, same-day hip patients skewed younger, comprising 48.3%females compared to 55.6% in hospitalized hip patients. Operatively, same-day hip surgeries boasted shorter durations, averaging 83.9 minutes, in contrast to the 92.3minutes for hospitalized hip procedures. Postoperatively, same-day hip patients exhibited significantly diminished rates of 30-day readmissions (1.7%vs. 3.5%), procedure-related readmissions (1.0%vs.2.1%), reoperations (1.1%vs.1.9%), and mortality (0.02% vs. 0.04%). In addition, we found that that unplanned readmissions in the same-day group are significantly predicted by being over 65 years old (OR: 2.0), having hypertension (OR: 1.6), chronic steroid usage (OR: 2.2), and severe COPD (OR: 2.0), while gender, emergent surgery indication, and smoking were not significant predictors. Moreover, the prevalence of the same-day discharge concept experienced a remarkable ascent from 2016 to 2021, with rates escalating from 1.5% to 25.6% of all total hip arthroplasties over a span of just six years. Conclusion:In conclusion, same-day discharge is a feasible and safe option for selected THA patients, improving healthcare efficiency and patient satisfaction.

Most common classifications for acetabular bone defects are based on radiographic two-dimension imaging, with low reliability and reproducibility. With the rise of modern processing techniques based on 3D modelling, methodologies for volumetric quantification of acetabular bone loss are available. Our study aims to describe a new methodology for quantitative assess-ment of acetabular defects, based on 3D modelling, focused on the surface analysis of the integrity of the main anatomical structures of the acetabulum represented by four corresponding sectors (posterior, superior, anterior, and medial). The defect entity is measured as the Area Increase Ra-tio (AIR) detected in all the sectors analyzed on three planes of view (frontal, sagittal and axial) compared to healthy hemipelvises. The analysis was performed on 3D-models from the CT-scan of six exemplary specimens with a unilateral pathological hemipelvis. AIR between the native and the pathological hemipelvis was calculated for each sector, for a total of 48 analysis (range, +0.93% - +171.35%). AIR of >50% were found in 22/48(45.8%) sectors and affected mostly the posterior, medial and superior sectors (20/22, 90.9%). Qualitative analysis showed consistency of the data with the morphological features of the defects. Further studies with larger samples are needed to validate the methodology and potentially develop a new classification scheme.

Background: Periprosthetic joint infection (PJI) following total hip and knee arthroplasty remains an extremely challenging and relatively high complication. This study aims to develop, validate and evaluate the use of machine learning (ML) algorithm to predict PJI in patients undergoing revision arthroplasties. Methods: A comprehensive review of patients undergoing hip or knee revision arthroplasty from 1 January 2015 to 31 March 2021 was conducted. Clinical data coming from preoperative patients history, laboratory analysis and demographic characteristics of patients were screened. Final data have been used to train a Logistic Regression model with the aim of predicting PJI preoperatively. Results: 1360 patients were enrolled, 1141 in the aseptic cohort and 219 in the infected cohort were included. ML demonstrated good discriminatory performance in predicting PJI in the selected patients (area under the curve 0.770 ± 0.006 in the training set and 0.720 ± 0.057 in the test set), and identified 3 significant predictors of PJI. Conclusion: ML algorithm trained using preoperative clinical data accurately predicted PJI. The incorporation of ML models into preoperative assessment of patients undergoing prosthetic revision procedures are useful in providing specific risk assessment to aid individualised counselling, shared decision making and presurgical optimization.

Background: Although triptorelin acetate (TA) is generally considered a safe medication, severe adverse drug reactions (ADRs) to triptorelin have occurred. In this study, we present the largest retrospective analysis of ADRs related to TA during the treatment of pediatric central precocious puberty. Methods: We describe a total of 38 suspected cases of TA-induced ADRs reported to the pharma-covigilance center of Shenzhen Children’s Hospital from September 2015 to December 2022. Causality assessment was carried out using the validated Kramer’s algorithm. The severity of ADRs was evaluated using the Modified Hartwig and Siegel Scale. Results: The most common ADRs attributed to TA were damage to the cutaneous tissues (29.3%) and reactions affecting the systemic and digestive systems (20.7%). The majority (61.1%) of ADRs occurred within 2 hours of administration. Among the 12 patients with severe ADRs, the three most frequent symptoms were anaphylactic reactions, hip synovitis, and arthralgia. Additional-ly, six patients experienced ADRs due to a change in the manufacturing process. Conclusion: The majority of ADRs observed in pediatric cases were type I anaphylactic reactions, which are rare but life-threatening. It is advisable to perform skin prick tests and intradermal tests when switching pharmaceutical manufacturers.

Gaucher Disease's (GD) pathophysiology generates anesthetic concerns in Total Hip joint Arthroplasty (THA), and due to its rareness, data on perioperative risks is scarce. This 22-year study at a large reference center addresses anesthetic management and perioperative outcomes in GD. This retrospective-cohort study assessed anesthetic success and safety in 30 THA patients, comparing them with a control-matched group. Data on clinical characteristics, perioperative events, and outcomes were collected. The primary outcome was difficult anesthesia-initiation incidence. Secondary outcomes were difficult intraoperative course and hemodynamic management, and the development of postoperative-complications. The age, sex, weight, body mass index, primary-to-revision hip arthroplasty ratio were similar in both groups. The mean age was 48±13 years. Ten arthroplasties were revision while twenty were primary. There was no significant difference at all-type anesthesia first initiation attempt success. No particular preference by staff anesthetists for general anesthesia or neuraxial procedures was observed. The GD group showed significantly higher mean intraoperative packed red blood cell units administered (0.73 vs 0.18);(p= 0.038)), higher intraoperative and postoperative platelet transfusion incidence (5/30 [16.7%] vs. 0/56 [0.00%];p=0.004) and (3/30 [10%] vs 0/56 [0%];p=0.040) and longer mean recovery-room length-of-stay (426±412 vs 175±140;p=0.004). Postoperative complications were not significantly different.

Arthroplasty is commonly performed to treat advanced osteoarthritis or other degenerative joint conditions, but it can also be considered for young patients with severe joint damage that significantly limits their functionality and quality of life. Young patients are still at risk of aseptic mobilization and bone resorption due to the phenomenon of stress-shielding that causes an uneven distribution of tensions along the femoral contact surface prosthesis. This phenomenon can be limited by appropriately choosing the material of the prosthesis or by varying its stiffness, making sure that its mechanical behavior simulates that of the femur as much as possible. The aim of this study is to evaluate the mechanical behavior of a prosthesis optimized both in shape and material and in comparing the results with a standard titanium prosthesis. Methods: Through three-dimensional modeling and the use of software finite element method (FEM) such as ANSYS we simulate the mechanical behavior of traditional prosthesis and prosthesis optimized topologically respecting the ASTM F2996-13 standard Results: With topological optimization there is a stress reduction from 987 Mpa to 810 Mpa with a mass reduction of 30%. With the use of carbon fiber, it is possible to further reduce stress to 509 Mpa. Conclusions: The reduction of stress on the femoral stem allows an optimal distribution of the load on the cortical bone thus decreasing the problem of stress-shielding.

Music has been proposed for a long time as a treatment for mental disorders. However, some special types of music or stimulating sounds might induce negative emotions. Herein, 8-week-old male mice were exposed to two specific genres of music, hip-hop (HH) and heavy metal (HM), and construction noise (CN), and a series of behavioral experiments were performed to evaluate the impact of these music or sounds on the emotion of mice. The experiment lasted 1 week in which 8-week-old male mice were used as animal models. We found that long term exposure HM, HH, and CN induced depressive symptoms with a decrease in dopamine receptor 1 and BDNF in the mixture of hippocampus and frontal cortex of mice. Our results have highly addressed that certain special types of sound or music might induce negative emotions and loss of dopaminergic neurons in mice, and it is necessary to intervene in adolescences who are exposed to these music or sounds for a long time.

The EXO+ hip protector was developed to minimize the risk of hip fractures in seniors following falls. This study evaluated its usability in a Singapore nursing home from the perspective of staff, focusing on Learnability, Efficiency, and Satisfaction. A mixed-method design was employed, with nursing home residents wearing the EXO+ daily for 8 weeks. Quantitative data on wear time was collected alongside qualitative insights from four repeated focus group discussions with care staff. In total, 15 residents (including 8 residents with cognitive impairments) and 9 staff participated. The analysis revealed six themes and fourteen subthemes related to EXO+’s usability. Residents wore the device for an average of 1.54 hours per day, with those having cognitive impairments showing increased wear times, especially in the mornings and on weekdays. Findings indicated that the EXO+ was learnable and satisfactory for nursing home use, provided there are adequate supporting features. The efficiency of the EXO+ was not fully measured since no falls were reported during the study period. The study offers valuable insights for potential design modifications and workflow adaptations to enhance the implementation of hip protectors in healthcare settings, highlighting facilitators and barriers to support device uptake.

Background: GaitSmart (GS) is a sensor-based digital medical device that can be used with the integrated app vGym to provide a personalised rehabilitation programme for older people undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study aimed to determine whether the GS intervention used in the rehabilitation of older people undergoing THA or TKA is potentially cost-effective compared to the current standard of care (SoC). Methods: Decision-analytic modelling was conducted to estimate cost-effectiveness over a seventeen- week time horizon, from an NHS perspective. UK clinical and cost data from the GaitSmart randomised clinical trial was used to obtain input parameters, and sensitivity analysis was performed to address uncertainty. Results: Over a seventeen-week time horizon, GS incurred cost savings of £450.56 and a 0.02 gain in quality-adjusted life years (QALYs) compared to the SoC. These results indicate that GS is the dominant intervention because the device demonstrated greater effectiveness and lower costs. Probabilistic sensitivity analyses confirm the robustness of our results. Conclusion: GS appears to offer short-term efficiency benefits and demonstrates cost-effectiveness for the improvement of gait in people undergoing THA or TKA, compared to the SoC. These findings provided new evidence to inform policymakers.

Abstract: In complex revision total hip arthroplasties, careful preoperative planning is crucial for the proper reconstruction of hip biomechanics. With conventional 2D radiographic images and computed tomography (CT) the 3D extension of the defect and the remaining bone stock may not be evaluated properly. 3D printed models can aid the surgeon in planning complex acetabular re-construction. The purpose of this study is to compare the accuracy of bony defect assessment in severe acetabular defects surgery with 3D printing planning as compared to conventional 2D ra-diographic planning and CT. Twenty-five patients with severe acetabular defects (Paprosky IIC and III) undergoing revision surgery were enrolled. Each patient had a 3D printed model of their femur and pelvis created based on CT scans. Clinical and radiographic assessments were conducted before and after surgery, with four key bone landmarks measured and compared between X-ray, CT, 3D models, and surgical reports. The findings revealed discrepancies in defect assessment between different imaging methods. X-rays and CT scans sometimes incorrectly identified affected areas, while the 3D models showed more accurate results. This study suggests that 3D printed models can significantly improve the preoperative evaluation of complex hip arthroplasty revisions, enabling surgeons to better select optimal surgical strategies.

The paper analyses the national DK-model Hydrological Information and Prediction (HIP) system and HIP portal viewed as a ‘Digital Twin’ and how the introduction of real-time dynamic updating of the DK-model HIP simulations can give room for plug-in sub-models with real-time boundary conditions made available from a HIP portal. The possible feedback to a national real-time risk knowledge base during extreme events (flooding and drought) is also discussed. Under climate change conditions, Denmark is likely to experience more rain in winter, more evapotranspiration in summer, intensified cloudbursts, drought, and sea level rise. These challenges have been addressed as part of the Joint Governmental Digitalization Strategy 2016-2020 for better use and sharing of public data about the terrain, water, and climate to support climate adaptation, water management, and disaster risk reduction. This initiative included the development of a new web-based data portal (HIP portal) developed by the Danish Agency for Data Supply and Infrastructure (SDFI). GEUS delivered 5 terra-byte of hydrological model data to the portal with robust calibration methods and hybrid Machine Learning (ML) being key parts of the deliverables. The paper discusses the challenges and potentials of further developing the HIP Digital Twin with ‘plug-in Digital Twins’ for local river basins including feedback to the national level.

Total Hip Arthroplasty is one of the most successful surgery. However, due to the worldwide growing population life expectancy and the related incidence of age-dependent bone diseases, a growing number of cases of intra-operative fractures lead to revision surgery with high rates of morbidity and mortality. Surgeons choose the type of the implant, either cemented or cementless prosthesis, on the basis of the age, the quality of the bone and the general medical conditions of the patients. Generally, no quantitative measures are available to assess the intra-operative fracture risk. Consequently, the decision-making process is mainly based on medical operators’ expertise and qualitative information obtained by imaging. Motivated by this scenario, we here propose a mechanical-supported strategy to assist surgeons in their decisions, by giving intelligible maps of the risk fracture which take into account the interplay between actual strength distribution inside the bone tissue and its response to the forces exerted by the implant. To this end, we produce charts and patient-specific synthetic “traffic-light” indicators of fracture risk, by making use of ad hoc analytical solutions to predict the stress levels in the bone by means of CT-based mechanical and geometrical parameters of the patient. We felt that, if implemented in a friendly software or proposed as an app, the strategy could constitute a practical tool to help the medical decision-making process, in particular with respect to the choice of adopting cemented or cementless implant

Owing to the risk of atypical femoral fractures, total hip arthroplasty presents unique challenges for patients with ipsilateral osteoarthritis and localized periosteal thickening in the femoral subtrochanteric region. Stem length selection is critical for minimizing stress concentration in the thickened cortex to avoid such fractures. Herein, we report the case of a 78-year-old woman with ipsilateral hip osteoarthritis and localized subtrochanteric periosteal thickening. Preoperative planning included finite element analysis to assess stress distribution across various stem lengths. Simulation aimed to determine the optimal stem length to span the cortical thickening and reduce the risk of postoperative complications. The results of finite element analysis indicated that a stem length of &gt;150 mm was required to effectively reduce the stress at the site of cortical thickening. A 175-mm stem was selected for total hip arthroplasty, which provided a favorable stress distribution and avoided the risk of stress concentration. Therefore, in cases of ipsilateral osteoarthritis with localized subtrochanteric periosteal thickening, finite element analysis can be valuable for preoperative planning to determine the optimal stem length, thereby reducing the risk of atypical femoral fractures. Further studies with multiple cases are recommended to validate these findings and improve surgical outcomes.

Background: Despite the tremendous effort in hamstring injury prevention, injury rates in soccer remain elevated. Hypothesis: Hamstring and hip/pelvic isometric strength imbalances may increase the likelihood of hamstring strain injury (HSI) occurrence amongst soccer players.Study design: Case-control study.Methods: In 120 male soccer players (mean age: 20.0 +/- 6.96 years) pre-season maximum isometric strength of the hip adductors, abductors, flexors, and knee flexors were measured, and strength ratios were calculated. Previous injury and anthropometric data were registered. Injury data were collected following the FIFA/UEFA consensus. A multivariate and Machine learning-based Logistic Regression model was employed to estimate the likelihood of players sustaining a hamstring injury.Results: 21 players sustained 32 hamstring injuries. Players with higher abduction strength in the dominant leg had an 18.5% lower risk of sustaining a hamstring injury (OR = 0.818, CI 95% = [(0.695-0.964]). No other significant contributor variables were found to be significant predictors of hamstring injury in the player group (p> 0.05).Conclusion: Isometric strength of the abductor muscles in the dominant limb had a significant association with hamstring injury.Clinical relevance: Our findings indicate the utilization of hip strength measurements as an integral component of the pre-season screening assessment, thereby affirming prior research on the correlation between lumbo-pelvic stability and incidence of hamstring injuries. Consequently, clinicians should contemplate incorporating hip strengthening exercises into regular training sessions, rehabilitation programs, and injury prevention protocols especially indicated when lower hip strength levels are observed.

Despite ongoing efforts, the relationship between groin strength and injury remains unclear. The challenge of accurately predicting injuries presents an opportunity for researchers to develop pre-vention strategies to reduce the occurrence of such injuries. Consequently, this issue requires further investigation to obtain insights into effective mitigation strategies. In 120 male soccer players the maximum isometric strength of the hip muscle groups was measured, and the strength ratios were calculated. Previous injury and anthropometric data were registered. Injury data were collected following the FIFA/UEFA consensus. The K- Nearest Neighbour (k-NN), was used to predict the incidence of injury, while the significant predictive variables of the k-NN algorithm were fitted into a multivariate logistic regression model (LR) to analyze the likelihood of players sustaining a groin injury. The LR model determined two variables as significant predictors of groin injury. Players were less likely to sustain a groin injury by 76% for each decrease of the Adductors/Abductors isometric strength ratio in the non-dominant limb (OR = 0.238, CI 95%= [(0.098-0.572]). Players with a history of previous injury had a 67% greater risk of sustaining an injury (OR = 0.333, CI 95%= [(0.1068-1.038]). Isometric hip adductor and abductor strength im-balances of the non-dominant lower limb and a history of previous injury were risk factors for groin injury in soccer players.

The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti-alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTR) compared to CoCr-alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti-alloy debris was observed. A 52-year-old active male underwent THA after posttraumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and restricted range of motion. X-rays revealed protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al and V. CT and MRI confirmed Ti-alloy cup failure and severe ALTR. During revision surgery, the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through the central hole it created over time. Histological analysis of tissue samples showed wear-induced synovitis with areas of multinucleated foreign-body giant cells and accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of substantial release of Ti-alloy debris from orthopaedic implants.

Although Cable driven rehabilitation devices (CDRD) have advantages over traditional link-driven devices, including lightweight, ease of reconfiguration, remote actuation, etc, the majority of existing lower-limb CDRD is limited to rehabilitation in the sagittal plane. In this work, we extend our previous sagittal plane model (2DOF) to accommodate hip motion in the frontal plane (abduction/adduction) toward studying the feasibility of tracking bi-planar motion (combined frontal and sagittal plane motion) via intra-planar cable routing. Two optimization problems have been formulated to estimate an optimal location of the hip cuffs, first to estimate the optimal cuff location at each time step to identify a single ‘averaged’ optimal cuff location and second to calculate a single optimal cuff location for the entire gait cycle. The optimization solutions identified for the 3DOF model revealed that optimization of the location of cuffs on the anterior and posterior side of the hip joint for 4 cable configuration is not sufficient to generate the desired bi-planar motion. For simultaneous tracking of the bi-planar motion, 2 additional cables have been added at hip joints and are routed in an intra-planar manner. The simulation result with the 3DOF model confirmed successful bi-planar trajectory tracking. The various number of cables and cable routings for tracking bi-planar motion will be studied in future work.

Antibiotic-loaded bone cement has been traditionally advocated as a key step for the success of one-stage hip revision surgery, while cementless techniques have been re-cently proposed with and without the use of local antibacterials as an equally suc-cessful alternative. Aim of this review is to investigate the effective role of local anti-microbial protection for one-stage cemented and cementless hip revision surgery. Twelve studies reporting the results of cemented single-stage procedure at a minimum two years follow-up were reviewed. When pooling together the data, no infection re-currence was observed on average in 83.3% of the patients (range 75.0% to 100%). Only two papers, both from the same French group, included patients treated without the use of antibiotic-loaded bone cement, with an average infection control of 95.9% in a total of 195 patients. This figure appears better that the 80.7% infection control ob-tained by pooling together all the remaining studies. Concerning cementless one-stage revision, a total of 17 studies, reporting on 521 patients, showed an average 90.0% (range 56.8% to 100%) no infection recurrence, at a minimum two years follow-up. Eight papers reported the outcomes of cementless implants without any local antibac-terial protection and nine more described four different techniques for local antimi-crobial implant protection. No comparative study investigated cementless revision with or without local antibacterial protection. Pooled data showed an average infection control of 86.7%, without the application of local antibacterials, compared to 90.1% to 100% with local antimicrobial protection, depending on the technology used. Howev-er, due to the relatively low number of patients treated with each local antimicrobial protection, no statistical difference could be found, either considering local antibacte-rial strategies alone or pooled together. No side effect had been reported by any local antibacterial technique. This review points out that local antibacterial protection for one-stage hip revision surgery, although safe and largely performed in the clinical set-ting, appears still to rely mainly on experts’ opinion and on observational series with no prospective or comparative trial, hence no definitive conclusion can be drawn con-cerning its effective role in one-stage hip revision surgery.

Objective The aim of this study was to examine the impact of a modern lifestyle on college female students' health, specifically focusing on their hip and knee joint mobility. The objective of this study was to assess the influence of hydraulic resistance training with the self-myofascial release technique on improving joint mobility in female college students. The training also aimed to compare the effectiveness of hydraulic resistance exercise with and without the self-myofascial release technique on hip and knee joint mobility.Methods The study used a randomized controlled trial design to recruit 30 female college students aged 18-25 through campus advertisements and announcements. Medical conditions or injuries that might have affected participation was screened. Participants were indiscriminately allocated to Group A (Hydraulic Resistance Training with Self-Myofascial Technique) or Group B (Hydraulic Resistance Training without Self-Myofascial Technique). The baseline assessments included joint range of motion (ROM) measurements using a goniometer. Certified trainers supervised the training sessions, and the data were analyzed using SD and mean using SPSS. ResultsThis study aimed to evaluate the impact of hydraulic resistance training with self-myofascial release on hip and knee joint mobility in female college students. The results showed that both groups showed improved hip and knee flexion with and without the self-myofascial release technique. However, the Group A using the self-myofascial release technique (Group A) showed a more significant enhancement, as indicated by the smaller p value compared to Group B. It has been suggested that the self-myofascial release technique may improve hip and knee joint mobility. ConclusionThis study concluded that Hydraulic Resistance Training with Self-Myofascial Release (HSMR) could improve hip and knee joint mobility among female college students. These findings suggest that integrating the self-myofascial release technique into training regimens can improve joint mobility. However, further research with larger sample sizes and extended intervention periods was needed to understand the long-term effects and sustainability of these improvements.

We investigated the micro-threaded stem taper surface and the impact on premature failures, aseptic loosening, and infection. We have focused on the fretting, and crevice corrosion of micro-threaded tapers, as well as the characterization of microstructure and surface properties of two new and three retrieved Zweymüller stem tapers of cementless hip endoprostheses selected from a set of 45 stems. The retrievals examined were those in which the sole source of modularity with a metallic component was the head-stem taper interface between the Ti alloy taper stem and the ceramic head. To determine the surface chemistry and microstructures of both new and retrieved hip endoprostheses stem taper titanium alloy, scanning electron microscopy (SEM) was employed for morphological and microstructural analyses. At the same time, energy dispersive spectroscopy (EDS) was utilized for characterizing chemical element distribution, and electron backscattered diffraction (EBSD) was used for phase analysis. The micro-threated stem taper’s roughness for different manufacturers was investigated using an optical profilometer. Standard roughness pa-rameters Ra (average surface roughness) and Rz (mean peak to valley height of the roughness pro-file) were used in this investigation.Additionally, profile depth and peak spacing for different samples were investigated. The surface roughness results indicate no significant difference in roughness associated with varying survivorship times, ranging from 3 to 239 months, and across different manufacturers. Electrochemical studies revealed no fretting corrosion in retrieved stem tapers (ceramic head) that prematurely failed due to aseptic loosening after 239 months, infection after 3 months, and low-grade infection after a 32-month lifetime. Therefore, three retrieved ta-pers and two new ones for comparison underwent potentiodynamic measurements in Hank’s so-lution to ascertain the corrosion rate of new and retrieved stem taper surfaces. The results show a low corrosion rate for both new and retrieved samples that failed prematurely due to aseptic loosening. However, the corrosion rate of infected and low-grade infected tapers was higher. In conclusion, our study aligns with existing literature, suggesting that the use of ceramic heads de-creases the problem of taper corrosion and subsequently reduces premature failures in total hip arthroplasty.

Total hip arthroplasty is a complex procedure. The achievements of implantology enabled the development of a faithful representation of hip joint physiology as well as the production of materials that can successfully replace damaged natural tissues. A very important issue is the correct selection of the geometry of the endoprosthesis adequate to the load of the joint. Materials used for endoprosthesis are a metal head and a polymer cup (e.g. PE-UHMW). The main interactions in the endoprosthesis are friction and surface pressure, which must be limited, exceeding them causes the destruction of the biomechanical system - plastic deformation of the polymer and the formation of too large and unacceptable radial clearances. Based on the author's developed calculation method of hip joint endoprosthesis contact parameters, the impact on maximum contact pressure and the angle of contact of the joint load was estimated depending on the diameter of the endoprosthesis and radial clearance. The correctness of changing the values of maximum contact pressure from the mentioned parameters was determined. Correspondingly: an increase in joint load causes a linear increase in the maximum contact pressure; increasing the diameter of the endoprosthesis head - their non-linear decrease, and increasing radial clearance - their increase

The ACEtabular rim eXtension (ACE-X) implant is a custom-made 3-dimensional-printed titanium device designed for the treatment of canine hip dysplasia. Thirty-four dogs (61 hips) underwent ACE-X implantation, and assessments were conducted using computed tomography, force plate analysis, Ortolani’s test, and Helsinki Chronic Pain Index (HCPI) questionnaires at five intervals: pre-operative day, surgery day, 1.5-month, 3-month, and 12-month follow-up. Statistically significant increases in femoral head coverage with negative Ortolani subluxation test were observed immediately after surgery and persisted throughout the study. Osteoarthritis (OA) scores remained stable, but osteophyte size significantly increased between the surgery day and the 12-month follow-up, especially in hips with a baseline OA score of 2 compared to those with a score of 1. Force plate data showed no significant changes during the study. The HCPI demonstrated a significant decrease in pain score from pre-operative value to 6-week follow-up and gradually decreased over time. Major complications were identified in 6 hips (9.8%) of 4 dogs. In conclusion, the ACE-X implant effectively increased femoral head coverage, eliminated subluxation, and provided long-term pain relief with minimal complications, benefiting over 90% of the study population. The study supports the ACE-X implant as a secure and valuable treatment for canine hip dysplasia.

With the ever-growing emphasis on global decarbonization and rapid increases in the power density of electronics equipment in recent years, new methods and lightweight materials have been developed to manage heat load as well as interfacial stresses associated with Coefficient of Thermal Expansion (CTE) mismatch between components. The Al-Si system provides an attractive combination of CTE performance and high thermal conductivity whilst being a very lightweight option. Such materials are of interest to industries where thermal management is a key design criterion, such as aerospace, automotive, consumer electronics, defense, EV and space. This paper will describe the development and manufacture of a family of high-performance hypereutectic Al-Si alloys (AyontEX™) by a powder metallurgy method. These alloys are of particular interest for structural heat sink applications that require high reliability under thermal cycling (CTE of 17μm/(m·°C)) as well as reflective optics and instrument assemblies that require good thermal and mechanical stability (CTE of 13μm/(m·°C)). Critical performance relationships are presented, coupled with the microstructure, physical and mechanical properties of these Al-Si alloys.

Background Telomere shortening is related to aging and unfavourable health outcomes. Obesity and metabolic diseases are important factors for accelerating aging. This study aimed to find out the association between obesity, metabolic disease, and telomere length in metabolically healthy adults. Methods 237 adults were enrolled with written consents at a health promotion centre of a tertiary hospital from February 2014 to March 2015. After excluding 99 subjects who met the exclusion criterion, a total of 130 metabolically healthy subjects were selected for final analysis. The subjects were divided into quartile groups according to the telomere lengths of their oral mucosal cells. Results The subjects consisted of 66 (50.8%) males with a mean age of 58.59 years. The body mass index (BMI, kg/m2) increased significantly along with the quartile groups (Q1, 23.00; Q2, 23.96; Q3, 23.70; Q4, 25.20; P-for trend=0.008). Waist circumference (WC, P-for trend=0.022), waist-to-hip ratio (WHR, P-for trend=0.005), and waist-to-height ratio (WHtR, P=0.001) also increased along with the quartile groups. Obesity prevalence (BMI ≥25 kg/m2), abdominal obesity (WC ≥90 cm for men, ≥85 cm for women), WHR 〉1.0 for men or 〉0.85 for women, and WHtR ≥0.5 increased significantly as the telomere length increased (P-for trend <0.05). After adjusting for covariates, the ORs for each obesity markers increased as the telomere length increased (P-for trend <0.05); and the ORs of WHtR were especially meaningful (Q1, 1.00; Q2, 2.53; Q3, 2.97; Q4, 7.81; P-for trend = 0.001). There were no significant trends for metabolic syndrome and its components along with the prevalence of fatty liver disease. Conclusion Obesity markers and telomere length had significant positive correlation despite the established theory. The obesity paradox may exist in metabolically healthy adults with regard to telomere length, However, further studies with larger sample sizes for the association between obesity and telomere length are needed.

Background: biophysical stimulation therapy, and in particular Pulsed Electromagnetic Fields (PEMFs) and capacitively coupled electric fields (CCEFs) has significantly increased in the last twenty years. For this, it is necessary to have clear information regarding the efficacy, the therapeutic indication and the expected objectives. Methods: we conducted a narrative review taking into consideration different types of studies with different areas of application. The objective was to take into consideration and analyze the different fields of use and the relevant information present in the literature. Results: There is unanimous opinion regarding the usefulness of applying biophysical therapy on the bone compartment both in terms of the tissue healing process and the symptoms associated with this situation. Differently, but no less importantly, in the joint compartment positive opinions were observed mainly on the inflammatory and catabolic process, however, at present,we did not report evidence regarding cartilaginous tissue regeneration. Conclusion: the effectiveness of PEMFs and CCEFs on the bone healing process in the Orthopedic and Traumatology fields is consolidated evidence in the literature. We have also found positive results on symptoms and patient compliance with rehabilitation therapies. Therefore, notable application can be envisaged in the fields of Prosthetic Surgery and Sports Medicine.

Jumping side volley has created breathtaking moments and cherished memories for us. Regrettably, a scientific study on the skill has not been found in literature. Relying on talent of athletes to improvise on the fly can hardly be considered a viable learning strategy. This study targets to fill the gap by quantifying factors contributing to develop its coaching method. Using 3D motion capture (12-cameras, 200Hz) and full-body biomechanical modeling, our study aimed to identify elements that govern entrainment of the skill by examining jumping, kicking and falling phases of its execution. Given the rarity of players who have acquired this skill, we found five subjects for the study. Twenty-three trials were captured and quantified. The results unveil the following key elements: 1) the control of trunk rotation during the jumping, 2) the angle between thighs upon take-off, 3) the whip-like control of the kicking leg during airborne, 4) timing between ball motion and limbs’ coordination, and 5) damping mechanism during falling. An accurate kick can only be achieved through repetitive training. This underlines the need for athletes to master a safe landing technique that minimizes risk of injury during practice. Therefore, training should begin with learning a safe falling technique.

Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. They are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI or ultrasonography should be conducted to clarify the etiology, rule out other diseases and confirm the diagnosis. Moreover, clinicians should gain familiarity with this disease and their diagnostic confidence should increase, leading to early diagnosis of nerve damage and prevention of muscle atrophy. The reviewed and updated epidemiology, anatomy, pathophysiology, etiology, clinical presentation and EDX technique and interpretation of the entrapment neuropathies of the lower limb are further described in this article.

Additive manufacturing (AM) or 3D printing is a promising industrial technology that enables rapid prototyping of complex configurations. Powder Bed Fusion (PBF) is one of the most popular AM techniques for metallic materials. Until today, only a few metals and alloys are available for AM, e.g. titanium alloys, the most common of which is Ti-6Al-4V. After optimization of the PBF parameters, with or without post processing such as heat treatment or hot isostatic pressing, the printed titanium alloy can easily reach tensile strengths of over 1100 MPa due to the quickly cooling of AM process. However, attributed to the unique features of metallurgical defects and microstructure introduced by this AM process, their fatigue strength has been low, often only not less than 30% of the tensile strength, especially in very-high-cycle regime, i.e. failure life beyond 107 cycles. Here, we have reviewed the current state of research on the very-high-cycle fatigue (VHCF) of additively manufactured (AMed) titanium alloys, refined the basic quantities of AMed microstructure and metallurgical defects, summarized the main factors limiting their VHCF strengths, and suggested possible ways to improve VHCF performance.