Plasma interleukin 33 a cytokine associated with inflammatory and autoimmune disease has been described to be significantly raised in osteonecrosis of the femoral head. The concentration of plasma interleukin - 33 levels was not estimated in Sickle cell disease patients hence we investigated the levels of plasma interleukin – 33 in sickle cell disease adult patients with or without ONFH .
Methods: This study was done as a cross sectional analytical study following the STROBE panel. Plasma Interleukin 33 levels was estimated by ELISA in 68 sickle cell patients confirmed by electrophoresis (HPLC) and 15 adults as controls. ONFH was noted in 44 Sickle cell disease patients based on MRI findings. The data was analyzed by quantitative variables were reported as mean +_ standard deviation (SD). Non-paired t-tests was used to compare the IL-33 Levels in both groups. All tests were to be two-tailed at the 5% level of significance.
Results: There was no significant difference in the plasma interleukin levels among sickle cell patients with and without ONFH. On comparing with the controls, plasma interleukin levels were found to be significantly on a lower side [3.11 vs. 6.18, p = 0.013].
Conclusions: Plasma Interleukin 33 levels have been found to be significantly lower than the normal population in sickle cell patients irrespective to the state of ONFH present or not. They cannot act as a marker of ONFH as were being considered in idiopathic ONFH or ONFH caused by other causes like trauma, chronic steroids or alcohol usage etc.

Introduction:Avascular necrosis(AVN) of femoral head typically presents in young population. Core decompression(CD) in pre-collapse stage provides pain relief and preservation of femoral head. The results of CO vary considerably despite early diagnosis. Clinicians concur that primary treatment should focus on preservation of the natural surface of the joint. we aimed to investigate predictive risk factors of failure in CD. Method: We retrospectively reviewed 135 patients(208hips;72 men[128 hips],58 female[80 hips]) who underwent CD(mean age:34.7 years[range:21-71]) from April-2010 to December-2017. All patients were followed with a mean of 57 months. In present study, all hips were in pre-collapse stage (FicatI, II).Result: from 208 hips were performed with CD, there were 42% failed and 58% success rate. The Kerboul, Ficat, Arco classification, multifocal AVN , Alcohol, smoking, opium and corticosteroid were significantly associated with failed Decompression In uniltivariate logistic regression analysis. The factors mentioned above were significantly higher in patients whose CD surgery was unsuccessful, but to predict the success rate of treatment need to multivariate logistic regression analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classification, Alcohol and multifocal AVN of femoral head were significantly correlated with CD failure. The most common predictive factors in CD failure were the Ficat-II, Kerboul-stage-3, multifocal AVN of and Alcohol usage.Conclusion:we had overall 58% success rate in CD of femoral head. Imaging studies are most valuable predictors for success of CD. We are in an align with previous studies in showing corticosteroid use is not a predictor of CD failure of femoral head AVN.

Introduction-The adverse effects of Covid-19 is still under observation, which has affected not only the respiratory system. but also bone and soft tissues, Systemic inflammation plays a major role in the physiology of bone and joint in COVID-19 patients. Cytokines that are induced by COVID-19 include CXCL10, IL-17, and TNF-alpha are also responsible for reducing the proliferation and differentiation of osteoblasts. Exorbitant usage of Corticosteroids for management of COVID-19 has shown a major effect on the bone which can cause AVN Methodology-we retrospectively collected the data of 18 patients with developed AVN Hip along with covid -19 status and who received oral prednisolone, IV dexamethasone steroid. Patients were analyzed based on clinical and radiological aspects . Results- Out of all based on MRI findings, only three cases developed AVN hip with a mean daily dose of 15mg/kg for 3 weeks. Case 1(80 kg) received 1275 mg prednisolone, case 2 (65kg) 900 mg and case 3 ( 72kg) 1000mg equivalent prednisolone. The meantime of diagnosing AVN was 78 days. Conclusions-Literature suggests 2 months of exposure to > 60 mg prednisone was associated with a 1.2 fold increased risk for the development of osteonecrosis. Current guidelines suggest not more than 6 mg per day dose of dexamethasone( 40mg prednisolone) for getting mortality benefit from covid 19. So in our observation indiscriminate and lack of guidelines regarding the use of steroids in covid -19 patients led to a high dose of steroid administration, which along with covid-19 led to AVN in these patients.

Introduction: Periacetabular osteotomy (PAO) is an established treatment for developmental hip dysplasia (DDH) and can also be utilised in the management of femoroacetabular impingement (FAI) with acetabular retroversion. This study used a national registry to assess the outcomes of PAO for DDH and FAI. Methods: PAOs recorded in the UK Non-Arthroplasty Hip Registry between 2012 and 2022 were identified along with recorded patient and surgical characteristics. Cases were grouped according to the primary pathology (DDH or FAI). Patient reported outcome measures (PROMs) captured included the International Hip Outcome Tool (iHOT)-12 (primary outcome) and the EuroQol-5 Dimensions (EQ-5D) index preoperatively and at 6 months, 1, 2, and 5 years post-operatively. Results: 1,006 PAOs were identified; 995 for DDH (91%), 91 for FAI (9%). Most patients (91%) were female. The DDH group were significantly older (mean 31.9 years) than the FAI group (25.4 years) but had similar body mass index (mean 25.8kg/m2). Overall, significant (all p<0.0001) iHOT-12 and EQ-5D improvement (delta) vs baseline pre-operative scores were achieved at 6 months (mean iHOT-12 improvement +27.0 (95%CI 24.9 to 29.2, n=487 [50.6%])) and maintained out to 5 years (+29.4 (19.4 to 39.3, n=29 [7.6%]), at which point 70% and 56% of patients continued to demonstrate a score improvement greater than or equal to the minimum clinically important difference (≥13 points) and substantial clinical benefit (≥28 points) for iHOT-12 respectively. Conclusion: This study demonstrates excellent functional outcomes following PAO undertaken for DDH and FAI in the short to medium term in a large national registry.

Introduction:The safety of continuing total joint arthroplasty(TJA), as an elective procedure, during the pandemic is controversial. The present study aimed to investigate the incidence of symptomatic coronavirus disease 2019(COVID-19) and its related risk factors in unvaccinated patients after TJA within 1 month after discharge in 2 large cities of our country. methods:The present prospective study included all the patients admitted to 3 hospitals, located in Tehran and Isfahan, 2 highly populated cities of Iran, from April-2020, to April-2021, for elective TJA. Urgent TJA (traumatic fractures) were excluded. The primary outcome was symptomatic COVID-19 within 1 month after discharge that was diagnosed using the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) reverse transcription polymerase chain reaction test. Afterward, the incidence of COVID-19 in the study population was compared with that in the general population to estimate the safety of elective TJA during the pandemic. Results: From the 1007 patients undergoing TJA, 755 patients met the inclusion criteria. None of the patients was vaccinated against COVID-19. Among them, 18 patients(2.4%) developed symptomatic COVID-19 within month after discharge. In the same time interval, the incidence of COVID-19 was 2.2% in the general population of these 2 cities, which was similar to the incidence reported in the study population. Of the patients who were positive for COVID-19,4 patients were hospitalized,and 3 of them were admitted to an intensive care unit; however, no mortality was reported.Conclusion:The TJA will be a safe elective procedure for the patients during the pandemic if the preventive protocols are followed strictly.

The slipped capital femoral epiphysis is a rare disease in adolescents but can cause several problems according to the displacement and type of treatment. DUNN technic is the best Treatment in large displacement SFE allowing an anatomic reduction. We conducted a retrospective study between January 2009 and March 2022 at the Pediatric Orthopedic and Trauma department of a university hospital. The aim of this work is to assess the DUNN technic in the treatment of stage III SFE cases and to establish prognostic criteria. Our study involved 12 hips in 12 children with a mean age of 14 years with a male predominance (83%). It was a stable form in 7 cases (58%) and unstable in 5 (42%). The radiological assessment included anteroposterior radiography of the pelvis and frog-leg lateral radiography. The slip was on step III (Southwick angle > 60 °) in all cases. All children have received medical treatment with analgesics and nonsteroidal Anti-inflammatorys since hospitalization. Bed rest was performed in all cases before and after surgery. All hips were operated by modified Dunn technic. Our results were evaluated after a mean follow-up of 21,5 months. The clinical and radiological outcome was considered excellent in 2 hips, good in 5, intermediate in 3 cases, and poor in 2 hips. Complications were chondrolysis in 03 cases and osteonecrosis of the femoral head in 02 cases. According to our results, the anterior approach without trochanterotomy seems to be reproducible, with good long-term results.

Management of unstable slipped capital femoral epiphysis (SCFE) is controversial with variable rates of avascular necrosis (AVN). Treatment options include in-situ stabilization, gentle/positional reduction and screw fixation, and anatomic reduction by modified Dunn’s procedure. We present a technique of controlled re-positioning (CRP) in unstable SCFE wherein the epiphysis is repositioned to the pre-acute slip stage, and primary osteoplasty (PO) is done to avoid FAI. 38 unstable slips were treated in our institution. Of these, 14 underwent successful CRP, screw fixation and PO. All except for one patient were followed up for a minimum of one-year. Head-Neck angle and anterior Physeal separation were measured at presentation, and alpha-angle, Head-Neck offset ratio, and AVN were assessed during follow-up. Average age of the patients was 14 years (9 to 18). Average intraoperative FIR before osteoplasty was 18.5° (-40° to -5°) which improved to +22.1° (+15° to +30°). Average follow-up was 16.6 months (3 to 43). Mean pre-operative Head-Neck angle were 48.7° (34.1° to 70.7°) which improved to 18.4° (1.8° to 35.7°) post-operatively with a decrease of 30.3° (6.9° to 45.3°). At final follow-up, average alpha-angle was 46.4° (30.9° to 64.6°) and average head-neck offset ratio was 0.22 (0.09 to 0.96). One patient developed sectoral AVN (7.1%). Controlled re-positioning, screw fixation and PO is a feasible treatment option in a subgroup of patients with unstable SCFEs. Limitation with this technique is that the final decision is made intra-operatively and the need for an alternative procedure if repositioning fails needs to be counselled pre-operatively.

Purpose: We present the results the medium term outcomes of external fixation technologies application as a containment treatment and corrective treatment.
Materials and methods: We analyzed the results of treatment of 85 patients aged 6 to 13 years with Perthes’s disease.
Patients are divided into 3 groups. I group includes 46 patients with II stage according to Joseph. II group includes 24 patients with III a stage. Distribution of joints according to Catterall, class III – 38, class IV - 32; according to Herring, group В/С -37, group С - 33. III group includes 15 patients with III b and IV stages.
In all cases the applied hip decompression by external fixator. The method was applied in an isolated form in 20 cases. In 34 observations made additionally varus osteotomy, in 27 cases - the pelvic osteotomy. We performed head-reduction osteotomy in 9 patients and modeling head resection in 6 patients in the third group.
Results: Distribution anatomical outcomes according to Stulberg: in group I: class I - 14, class II - 24, class III – 6, class IV – 2; in II group: class II - 8, class III – 14, class IV – 2; in group III: class II - 6, class III – 9
Conclusions: Middle - term follow-ups showed that the adequate joint unloading, local blood supply stimulation, differentiated use of reconstructive procedures provided the conditions for restoration of the epiphysis structure and epiphysis shape improvement.

Predisposing factors of CAM-type femoroacetabular impingement (FAI) include acetabular protrusion and acetabular retroversion, however, nothing is known about the development in dysplastic hips.
Purpose of this study was to determine the correlation between CAM-type FAI and developmental dysplastic hips diagnosed on x-ray and rotational computed tomography.
In this retrospective study, 52 symptomatic hips were included at a mean age of 28.8±7.6years. Inclusion criteria consisted of consecutive patients who suffered from symptomatic dysplastic or borderline dysplastic hips who underwent a clinical examination, conventional radiographs and rotational computed tomography. Demographics, standard measurements and the rotational alignments were recorded and analysed between the CAM and nonCAM group.
Results:
19 presented with CAM impingement whereas in 33 patients no signs of CAM impingement were noticed. For demographics, no significant differences between the two groups were identified. On conventional radiography, the acetabular hip index as well as CE angle for the development of CAM impingement were significantly different compared to the nonCAM group with a CE angle of 21.0±5.4° vs. 23.7±5.8° (p=0.050) and an acetabular hip index of 25.6±5.7 vs. 21.9±7.3 (p=0.031), respectively. Furthermore, a crossing over sign was observed to be more common in the nonCAM group which is contradictory to the current literature. For rotational alignment no significant differences between CAM and nonCAM were observed.
In dysplastic hips the CAM FAI correlates to a lower CE-angle and a higher acetabular hip index. In contrast to the current literature no significant correlations to the torsional alignment nor to crossing over signs were observed.

Background: This study used a national registry to assess the outcomes of hip arthroscopy (HA) for the treatment femoroacetabular impingement (FAI). Methods: All HAs recorded in the UK Non-Arthroplasty Hip Registry (NAHR) between January 2012 and April 2022 were identified along with recorded patient and surgical characteristics. Cases were grouped according to the index procedure performed for FAI (cam, pincer, or mixed). Patient outcomes captured included the International Hip Outcome Tool (iHOT)-12 and the EuroQol-5 Dimensions (EQ-5D) index preoperatively and at 6 months, 1 and 2 years post-operatively. Results: 6,410 HAs were identified; 3,917 cam (61.1%), 549 pincer (8.6%), 1,944 mixed (30.3%). Mean age (35.9 years) was similar between groups. There was a greater proportion of females in the pincer group (76%) compared to cam (53%) and mixed (50%). A higher proportion of patients had a recorded cartilage injury in association with a cam lesion compared to pincer. Overall, significant iHOT-12 and EQ-5D improvement (delta) vs baseline pre-operative scores were achieved for all FAI subtypes at 6 months (overall mean iHOT-12 improvement +26.0 (95%CI 25.0 to 27.1, n=2,515 [40.3%]) and maintained out to 12 months (+26.1 (24.9 to 27.2, n=2,247 [37.5%]) at which point 66% and 47% of patients continued to demonstrate a score improvement greater than or equal to the minimum clinically important difference (≥13 points) and substantial clinical benefit (≥28 points) for iHOT-12 respectively. Conclusion: This study demonstrates excellent early functional outcomes following HA undertaken for FAI in a large national registry.

Introduction: Young adult hip pathology commonly affects patients of reproductive age. The extent to which peri-acetabular osteotomy influences sexual function is not well described. This study aims to describe trends in self-reported reported sexual function before and after PAO.

Methods: Adult (≥18 years) patients who underwent PAO for any indication between 1/01/2012 and 31/10/2020 were extracted from the UK Non-Arthroplasty Hip Registry. PROMS scores (iHOT-12 questionnaires) were collected pre-operatively and at 6 and 12 months. The iHOT-12 then asks asking patients to quantify ‘how much trouble they experience with sexual activity because of their hip?’ with responses converted to a continuous scale (0-100) to measure function.

Results: Of 854 procedures (89% female, mean age 31 years (SD 9)), 90% (680 of 759 respondents) indicated pre-operatively that questions about sexual activity were relevant to them (male 90%, female 90%). Overall, mean pre-operative sexual function increased from 38.6 (95%CI 36.4 to 40.9, n=607) to 60.9 (57.8 to 64.0, n=338) at 6 months, and 67.1 (64.0 to 70.3, n=342) at 12 months post-operatively.

At 12 months, both sexes saw significant improvement in their pre-operative sexual function scores (p<0.0001). Males started from significantly higher baseline sexual function (61.6 vs 36.3) and achieved higher scores by 12 months (77.5 vs 66.1) compared to female patients. There was no significant difference in pre- or post-operative scores when comparing younger (<40 years) and older (>40 years).

Conclusion: Most patients can expect to experience improvement in their sexual function following PAO, regardless of sex or age group.

Introduction: This study aims to describe the characteristics and outcomes of patients who reported their pre-operative quality of life (QoL) was ‘worse than death’ (‘WTD’) prior to hip arthroscopy (HA) or peri-acetabular osteotomy (PAO).

Methods: Adult patients who underwent HA or PAO between 1st January 2012 and 31st October 2020 were extracted from the UK Non-Arthroplasty Hip Registry. International Hip Outcome Tool 12 (iHOT-12) and EuroQol-5 Dimensions (EQ-5D) index questionnaires were collected pre-operatively and at 6 and 12 months. WTD was defined as an EQ-5D score of less than zero. Chi-squared and t-tests were used to compare categorical and continuous variables respectively.

Results: 8493 procedures (6355 HA, 746 PAO) were identified in whom 7101 (84%) returned pre-operative EQ-5D questionnaires. 283 HA and 52 PAOs declared their pre-operative QoL to be ‘WTD’.

For HA, iHOT-12 scores in WTD patients were significantly poorer pre- [10.8 (95% CI 9.6 to 12.0) vs 33.3 (32.8 to 33.8)] and 12 months post-operatively [34.9 (29.0 to 40.8) vs 59.3 (58.2 to 60.4)] compared to controls. Whilst the majority of patients saw improvement in their scores (p <0.0001), a significantly smaller proportion achieved the minimum clinically important difference for iHOT-12 by 12 months. (51% in the WTD group vs 65% in the control group). Similar trends were observed for PAO.

Conclusions: Patients with WTD quality of life may benefit less from hip preservation surgery and should be counselled accordingly regarding expectations. Although the scores improve, only 51% achieve scores beyond MCID.

Introduction: The design of uncemented femoral stems for use in total hip arthroplasty has evolved. Several uncemented short stems have been developed with different bone fixations, shapes, or stem lengths. The literature analyzing the biomechanical performance of short to standard stem lengths is limited. The aim was to compare the stress repartition on a standard uncemented stem and a shortened uncemented femoral stem with the same design features. Material and methods: This finite element analysis assessed the stress repartition on two femoral components with the same design (uncemented, collared, proximal trapezoidal cross-section, and a tapered quadrangular distal stem) but with two different lengths. The shortened stem was shorter by 40 mm compared to the standard stem. The stress repartition was analysed according to the Von Mises criterion. Results: The stress repartition was similar for the standard and shorter stem without significant difference (p = 0.94). The mean Von Mises stress was 58.1 MPa [0.2; 154.1] for the standard stem and 57.2 MPa [0.03; 160.2] for the short stem. The distal part of the standard stem, which was removed in the short stem, had mean stress of 3.7 MPa [0.2; 7.0]. Conclusion: The finite element analysis found similar stress repartitions between a standard uncemented collared stem and a short, collared stem with the same design. A clinical study assessing the clinical outcomes and the bone remodelling with a collared short stem would be interesting to confirm these first promising results.

Introduction: Total hip arthroplasty (THA) is one of the most successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA) has a large number of advantages, however, there are several concerns regarding the higher rate of complications in this procedure. The aim of the current study was to evaluate the complications and outcomes of cementless one-stage BTHA in osteoarthritic patients.
Methods: A total of 147 patients were investigated in the current prospective study. The patients aged 54.67±7.08 years. The surgeries were performed through Harding approach. The patients were evaluated clinically and radiologically in serial visits. Modified Harris hip score (MHHS) was completed pre- and post-operatively.
Results: The mean hospital stay was 3.8±0.6 days. Hemoglobin level decreased significantly after the operation (P=0.038). There was two deep venous thrombosis, one superficial infection and one temporal proneal nerve palsy but no pulmonary embolism, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 41.64±5.42 which significantly improved to 89.26±4.68 in the last visit (P<0.001).
Conclusion: The excellent functional improvement and low rate of complications demonstrated that one-stage cementless BTHA through Harding approach was a suitable treatment option in patients with bilateral hip osteoarthritis.