UNASSIGNED: The effect of transcutaneous electrical nerve stimulation (TENS) on pain and impression of change was assessed during a 2.5-hour intervention on the first postoperative days following hip surgery in a randomized, single-blinded, placebo-controlled trial involving 30 patients.
UNASSIGNED: Mixed-frequency TENS (2 Hz/80 Hz) was administered using specially designed pants integrating modular textile electrodes to facilitate stimulation both at rest and during activity. The treatment outcome was assessed by self-reported pain Numerical Rating Scale (NRS) and Patient Global Impression of Change (PGIC) scores at four time points. The ability to perform a 3-meter walk test and the use of analgesics were also evaluated. Group comparison and repeated-measure analysis were carried out using nonparametric statistics.
UNASSIGNED: The active TENS group exhibited significantly higher PGIC scores after 30 minutes, which persisted throughout the intervention (all p ≤ 0.001). A reduction in NRS appeared after one hour of active TENS, persisting throughout the intervention (all p ≤ 0.05). The median group differences in pain ratings were greater than the minimum clinically important difference, and the analysis of pain trajectories confirmed clinical significance at the individual level. Moreover, patients in the active TENS group were more likely able to perform a 3-meter walk test by the end of the intervention (p = 0.04). Analysis of the opioid-sparing effect of TENS was inconclusive (p = 0.066). No postoperative surgical complications or TENS-related side effects were observed during the study.
UNASSIGNED: Mixed-frequency TENS integrated in pants could potentially be an interesting addition to the arsenal of treatments for multimodal analgesia following hip surgery. This trial is registered with NCT05678101.

Injuries in pediatric and adolescent athletes continue to rise in the United States, with increases in year-round sports participation, earlier sport specialization, and inadequate access to neuromuscular training programs. In this setting, the use of magnetic resonance imaging (MRI) provides a critical diagnostic tool. This review article describes the utility of MRI in diagnosing common pediatric and adolescent sports injuries and presents imaging findings associated with these pathologies.

UNASSIGNED: Septic arthritis of the hip in children and adolescents is a common condition requiring timely diagnosis and intervention. Surgical irrigation and debridement is typically performed through the anterior approach because of concerns about injury to the medial femoral circumflex artery leading to avascular necrosis. While there are multiple studies investigating the sequelae of anterior and medial approaches for reduction of developmental dislocation of the hip, none have compared these approaches for the pediatric septic hip. We hypothesize that there will be no significant difference in the rate of avascular necrosis when comparing the medial and anterior approaches to the septic hip in pediatric patients.
UNASSIGNED: A retrospective review was performed of pediatric septic hips treated with irrigation and debridement through either a medial or anterior approach at a single institution over an 18-year period of time. The primary outcome measure was the development of avascular necrosis.
UNASSIGNED: Thirteen of 164 patients (7.9%) developed avascular necrosis. Avascular necrosis was noted in 9 of 101 patients who had anterior approach and 4 of 63 patients who underwent medial approach (p = 0.76). The average age for patients developing avascular necrosis was 10.0 years old versus 6.8 years old in patients who did not develop avascular necrosis (p = 0.01). The average follow-up was 3.3 years in patients with avascular necrosis versus 1.5 years for patients who did not develop avascular necrosis (p = 0.01).
UNASSIGNED: Medial approach to the pediatric septic hip does not increase the rate of avascular necrosis compared to the anterior approach.
UNASSIGNED: Retrospective comparison study, Level III.

UNASSIGNED: Revision hip and knee total joint arthroplasty (TJA) carries a high burden of postoperative complications, including surgical site infections (SSI), venous thromboembolism (VTE), reoperation, and readmission, which negatively affect postoperative outcomes and patient satisfaction. Socioeconomic area-level composite indices such as the area deprivation index (ADI) are increasingly important measures of social determinants of health (SDoH). This study aims to determine the potential association between ADI and SSI, VTE, reoperation, and readmission occurrence 90 days following revision TJA.
UNASSIGNED: 1047 consecutive revision TJA patients were retrospectively reviewed. Complications, including SSI, VTE, reoperation, and readmission, were combined into one dependent variable. ADI rankings were extracted using residential zip codes and categorized into quartiles. Univariate and multivariate logistic regressions were performed to analyze the association of ADI as an independent factor for complication following revision TJA.
UNASSIGNED: Depression (p = 0.034) and high ASA score (p < 0.001) were associated with higher odds of a combined complication postoperatively on univariate logistic regression. ADI was not associated with the occurrence of any of the complications recorded following surgery (p = 0.092). ASA remained an independent risk factor for developing postoperative complications on multivariate analysis.
UNASSIGNED: An ASA score of 3 or higher was significantly associated with higher odds of developing postoperative complications. Our findings suggest that ADI alone may not be a sufficient tool for predicting postoperative outcomes following revision TJA, and other area-level indices should be further investigated as potential markers of social determinants of health.

UNASSIGNED: Gout is the most prevalent form of inflammatory arthritis in the world. Total hip arthroplasty (THA) has emerged as a widely sought-after and highly effective surgical procedure for advanced hip diseases. However, there is a lack of research on the impact of gout on primary THA outcomes in large cohorts. This study aimed to address this gap by primarily investigating complications following THA in patients with or without gout.
UNASSIGNED: Patients with records of gout in the 2 years leading up to their primary THA and who also have at least 2 years of follow-up were identified using a national insurance database and compared to a 5:1 matched control. A total of 32,466 patients with gout and 161,514 patients without gout undergoing THA were identified. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. In addition, 90-day emergency department (ED) visits and inpatient readmission were also documented.
UNASSIGNED: Patients with gout demonstrated higher rates of medical complications including deep vein thrombosis, transfusion, acute kidney injury, and urinary tract infection than non-gout patients (p < 0.001). Gout patients also showed higher rates of pulmonary embolism (p = 0.017). Increased incidences of surgical complications were identified in gout patients, specifically wound complications and periprosthetic joint infection (p < 0.001). There was an increased risk of revision for gout patients up to 90 days (p = 0.003), 1 year (p = 0.027), and 2 years (p = 0.039). There was also an increased risk of dislocation for gout patients up to 90 days (p = 0.022) and 1 year (p = 0.047), but not at 2 years. No significant difference was observed in aseptic loosening or periprosthetic fracture. Additionally, gout patients also demonstrated a higher likelihood of 90-day ED visits and readmission (p < 0.001).
UNASSIGNED: Primary THA in gout patients is associated with increased risks of multiple medical and surgical complications. Our findings provide insights into the planning and expectation of THA for patients with gout. These insights have the potential to benefit the decision-making process for gout patients considering THA.

OBJECTIVE: The objective of this study was to analyze the safety and efficacy of using a robotic hip exoskeleton designed by Samsung Electronics Co., Ltd., Korea, called the Gait Enhancing and Motivating System-Hip (GEMS-H), in assistance mode only with the poststroke population in an outpatient-rehabilitation setting.
METHODS: Forty-one participants with an average age of 60 and average stroke latency of 6.5 years completed this prospective, single arm, interventional, longitudinal study during the COVID-19 pandemic. Significant modifications to the traditional outpatient clinical environment were made to adhere to organizational physical distancing policies as well as guidelines from the Centers for Disease Control. All participants received gait training with the GEMS-H in assistance mode for 18 training sessions over the course of 6-8 weeks. Performance-based and self-reported clinical outcomes were assessed at four time points: baseline, midpoint (after 9 training sessions), post (after 18 training sessions), and 1-month follow up. Daily step count was also collected throughout the duration of the study using an ankle-worn actigraphy device. Additionally, corticomotor excitability was measured at baseline and post for 4 bilateral lower limb muscles using transcranial magnetic stimulation.
RESULTS: By the end of the training program, the primary outcome, walking speed, improved by 0.13 m/s (p < 0.001). Secondary outcomes of walking endurance, balance, and functional gait also improved as measured by the 6-Minute Walk Test (47 m, p < 0.001), Berg Balance Scale (2.93 points, p < 0.001), and Functional Gait Assessment (1.80 points, p < 0.001). Daily step count significantly improved with and average increase of 1,750 steps per day (p < 0.001). There was a 35% increase in detectable lower limb motor evoked potentials and a significant decrease in the active motor threshold in the medial gastrocnemius (-5.7, p < 0.05) after training with the device.
CONCLUSIONS: Gait training with the GEMS-H exoskeleton showed significant improvements in walking speed, walking endurance, and balance in persons with chronic stroke. Day-to-day activity also improved as evidenced by increased daily step count. Additionally, corticomotor excitability changes suggest that training with this device may help correct interhemispheric imbalance typically seen after stroke.
BACKGROUND: This study is registered with ClinicalTrials.gov (NCT04285060).

Background Dislocation is one of the most prominent and challenging complications following the revision of total hip arthroplasty (THA). Dual-mobility cups are an option to address this problem. There is, however, little data on the outcomes of modern modular dual-mobility (MDM) cups in the revision of THA. In this study, the clinical and radiological outcomes following the revision of THA with an MDM cup using the direct anterior approach (DAA) were evaluated. Methodology We retrospectively reviewed patients who underwent a revision of THA between March 2017 and July 2019. The inclusion criteria were a revision of THA using an MDM cup through the DAA. A uniform acetabular implant was used in each revision. Outcome measures were assessed radiographically and clinically. The clinical outcome measures consisted of dislocation, infection, and re-revision. Functional assessment was performed using the Harris Hip Score preoperatively and at the last clinical examination in our department. Results This study retrospectively identified a cohort of 26 patients who underwent a revision of THA. Two patients were excluded due to incomplete follow-up because they died. Finally, 24 patients were included. A total of 17 isolated acetabular revisions and seven complete revisions were performed with a mean follow-up of 39 months (range = 29-59). No dislocations or deep infections were observed in our population to date. Except for one case of early aseptic loosening of the acetabular component, we observed no other signs of loosening, osteolysis, migration, or intraprosthetic dislocation. Conclusions THA revision through the DAA using an MDM cup is a safe and effective procedure. We observed no dislocation in a high-risk population undergoing THA revision surgery during a minimal follow-up of two years.

UNASSIGNED: Local infiltration analgesia (LIA) has been advocated for the pain management after total hip arthroplasty (THA). The analgesic benefits of an added pericapsular nerve group (PENG) block remain questionable.
UNASSIGNED: This randomized, single-blind trial enrolled patients undergoing elective THA under general anaesthesia and standardized postoperative analgesia. Patients were allocated to receive either a PENG block (20 mL of ropivacaine 0.475 %) combined with intraoperative LIA (PENG + LIA group, n = 32), or intraoperative LIA alone (LIA group, n = 32). The primary outcome was oral morphine equivalent (OME) consumption at day 1. Secondary outcomes were: pain scores at post anaesthesia care unit (PACU) discharge and on day 2, times for the Timed to Up and Go (TUG) test and measurement of adductor strength on day 1, and patients\' satisfaction using the EVAN-G questionnaire.
UNASSIGNED: Compared with LIA alone, PENG + LIA resulted in similar OME consumption on day 1 (78 [51-91.5] mg vs 58 [30-80] mg respectively, median difference (95%CI) of -17 (-34 to 1) mg, p = 0.09). Pain scores and morphine consumption were not different between groups at any time point. TUG and thigh adduction tests were similar between LIA and PENG + LIA groups (respectively 35 [25-48.5] vs 31.5 [19.5-46.5] sec, p = 0.39; and 105 [85-150] vs 100 [80-125] mmHg, p = 0.61). No difference in the patients\' satisfaction was found.
UNASSIGNED: The addition of a PENG block to large-volume LIA did not significantly improve the analgesia for elective THA in the setting of an adequate basic postoperative analgesia regimen. The results of the lower limb functional tests confirmed the PENG block to be motor-sparing.

Cycling stands as one of the most widely embraced leisure activities and serves purposes such as exercise, rehabilitation, and commuting. This study aimed to assess the feasibility of assisting three unimpaired participants (age: 34.0 ± 7.9 years, height: 1.86 ± 0.02 m, weight: 75.7 ± 12.7 kg) using the GuroX hip exoskeleton, originally designed for walking assistance, during cycling against a resistance of 1 W/kg. The performance evaluation employed a sweep protocol that manipulated the timing of the exoskeleton\'s peak extension and flexion torque in addition to human-in-the-loop optimization to enhance these timings based on metabolic cost. Our findings indicate that with a peak assistance torque of approximately 10.3 Nm for extension and flexion, the GuroX substantially reduced the net metabolic cost of cycling by 31.4 ± 8.1% and 26.4 ± 14.1% compared to transparent and without exoskeleton conditions, respectively. This demonstrates the significant potential of a hip exoskeleton developed for walking assistance to profoundly benefit cycling. Additionally, customizing the assistance strategy proves beneficial in maximizing assistance. While we attribute the average motor power to be a major contributor to the reduced cycling effort, participant feedback suggests that user comfort and synchronization between the user and exoskeleton may have played integral roles. Further research should validate our initial findings by employing a larger participant pool in real-world conditions. Incorporating a more diverse set of parameters for the human-in-the-loop optimization could enhance individualized assistance strategies.

UNASSIGNED: Granuloma formation following total hip arthroplasty (THA) can occur regardless of the bearing surface. In very rare cases, extensive granulomas mimicking tumors may develop which are known as pseudotumors. The aim of this study is to report on these rare yet complex situations to stimulate reflection in diagnostic and therapeutic approaches.
UNASSIGNED: A retrospective case series study of 5 patients (2 females, 3 males) of aggressive granulomatous lesions on primary prostheses and 4 revision prostheses for aseptic loosening, implanted at a mean age of 74.8 years (range 64-83). A clinical, functional, radiographic, and anatomopathological analysis were conducted.
UNASSIGNED: Four patients underwent revision surgery, while one died before intervention. Functional impairment was significant with a mean pre-reintervention Postel-Merle d\'Aubigné (PMA) score of 8.2 (range 4-11). Femoral involvement was constant, associated with acetabular involvement in only one case. bony involvement was major, with a minimum of 5 Gruen zones affected, showing complete cortical lysis. Histopathological analysis consistently revealed multinucleated giant cells and macrophages, predominantly with metallic wear particles. In 2 cases, vascular involvement was suspected without a clearly delineated tumor. Two cases required femoral resection prostheses, one necessitated inter-ilio-abdominal amputation due to extensive soft tissue involvement, one underwent implant removal which failed to prevent progression, and one patient died before reoperation.
UNASSIGNED: The volume of lesions in these 5 cases appears markedly larger than reported cases.Extensive pseudo-tumoral granulomatous lesions following THA are rare but carry poor functional prognosis. Evaluation to rule out infection and neoplastic pathology is imperative. Surgical management often resembling tumor treatment should be considered. Early diagnosis is crucial to allow intervention before reaching the stage of massive prosthetic replacement.
UNASSIGNED: IV retrospective study.