Purpose: Nondisplaced femoral neck fractures have traditionally been treated with in situ fixation. However, poor surgical and clinical outcomes have been reported for fractures with valgus deformity >15°, and the reduction of valgus impaction has recently been emphasized. In addition, early degenerative osteoarthritis can be caused by cam-type femoroacetabular impingement after healing of femoral neck fractures. This study was designed with the objective of confirming the difference in progression of radiographic osteoarthritis according to the severity of the valgus deformity.
Materials and Methods: Patients who underwent internal fixation using multiple cannulateld screws for management of nondisplaced femoral neck fractures were divided into two groups: high valgus group (postoperative valgus angle ≥15°) and low valgus group (postoperative valgus angle <15°). Evaluation of demographic data and changes in the joint space width from the immediate postoperative period to the latest follow-up was performed.
Results: A significant decrease in joint space width in both hip joints was observed in the high valgus group when compared with the low valgus group, including cases with an initial valgus angle less than 15°and those corrected to less than 15°of valgus by reduction. No complications requiring surgical treatment were observed in either group; however, two cases of avascular necrosis, one in each group, which developed in the low valgus group after reduction of the fracture, were followed for observation.
Conclusion: Performing in situ fixation in cases involving a valgus deformity ≥15°in non-displaced femoral neck fractures may cause accelerated narrowing of the hip joint space.

Purpose: To figure out how complete control of family visits to prevent infection of coronavirus disease 2019 (COVID-19) affected the activity recovery of hip fracture patients admitted to nursing hospitals.
Materials and Methods: Eighty-one patients with hip surgery in the two years prior to COVID-19 pandemic were classified as Group A, and 103 patients in the next two years were designated as Group B. The subjects’ walking ability was evaluated by using the modified Koval index (MKI). In order to analyze the impact of the family visit control to the subjects, each group was classified into two different groups: (1) inpatients group who admitted to nursing hospitals and (2) home-treated patients. Additionally, statistical elements were processed in consideration of other factors that may affect the results of the experiment.
Results: The MKI evaluated at 6 months postoperative was 3.31±1.79 in Group A and 2.77±1.91 in Group B, and it was meaningfully low after the pandemic (P=0.04). There was significantly low among both of Group A 2.74±1.76 and Group B 1.93±1.81 after the pandemic (P=0.03) among those treated at the nursing hospital. The rate of deterioration of the MKI was 35 (43.2%) in Group A and 57 (55.3%) in Group B, which increased by 12.1% after the pandemic.
Conclusion: The pandemic had a negative effect on the recovery of postoperative activities of elderly hip fracture patients who admitted to nursing hospitals when family access was completely restricted to prevent infection.

Purpose: The aim of this study was to compare short-term results from use of the direct anterior approach (DAA) and the conventional posterolateral approach (PLA) in performance of bipolar hemiarthroplasty for treatment of femoral intertrochanteric fractures in elderly patients.
Materials and Methods: A retrospective review of 100 patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty was conducted. The PLA was used in 50 cases from 2016 to 2019; since that time we have used the DAA in 50 cases from 2019 to 2021. Measurements of mean operative time, blood loss, hospitalization period, and ambulation status, greater trochanter (GT) migration and stem subsidence were performed. And the incidence of complications was examined.
Results: Operative time was 73.60±14.56 minutes in the PLA group and 79.80±8.89 minutes in the DAA group (P<0.05). However, after experiencing 20 cases using DAA, there was no statistically difference in operative time between two groups (P=0.331). Blood loss was 380.76±180.67 mL in the PLA group and 318.14±138.51 mL in the DAA group (P<0.05). The hospitalization was 23.76±11.89 days in the PLA group and 21.45 ±4.18 days in the DAA group (P=0.207). In both groups, there were no progressive GT migration, intraoperative fractures or dislocations, although there was one case of infection in the PLA group.
Conclusion: Although use of the DAA in performance of bipolar hemiarthroplasty required slightly more time in the beginning compared with the PLA, the DAA may well be an alternative, safe surgical technique as a muscle preserving procedure in elderly patients with intertrochanteric fractures.

Purpose: The objective of this study was to analyze the results from a cohort of patients who underwent a revision total hip arthroplasty (THA) using a dual mobility cup (DMC) implant.
Materials and Methods: A retrospective review of revised THAs was conducted using the database from a single tertiary referral hospital. A total of 91 revision THAs from 91 patients were included in the study. There were 46 male hips and 45 female hips. The mean age was 56.3±14.6 years, and the mean follow-up period was 6.4±5.9 years. In performance of revision THAs, the DMC implants were used in 18 hips (19.8%), and the conventional implants were used in 73 hips (80.2%).
Results: During the follow-up period, three dislocations were identified, and the overall dislocation rate was 3.3%. Early dislocation (at one month postoperatively) occurred in one patient, while late dislocation (at a mean of 7.5 years) occurred in two patients. There was no occurrence of dislocation in the DMC group (0%), and three dislocations were detected in the conventional group (4.1%). However, no significant difference in the rate of dislocation was observed between the two groups (P=0.891).
Conclusion: Although the rate of dislocation was higher in the conventional group, there were no statistically significant differences between the two groups due to the small number of patients. Nevertheless, we believe that the dual mobility design is advantageous in terms of reducing dislocation rate and can be recommended as an option for a revision THA.

Purpose: This study examined the methods for treatment of femoral neck fracture (FNF) preferred by members of the Korean Hip Society (KHS) and identified factors that influence decisions regarding the surgical intervention of choice.
Materials and Methods: A total of 97 members of the KHS responded to the 16-question survey which included questions about the mean number of surgeries performed each month for treatment of femoral neck fractures, the cut-off age for deciding between internal fixation and arthroplasty, the implant used most often, usage of cement, and factors influencing each decision.
Results: The mean cut-off age used when deciding between internal fixation and arthroplasty was 64 years old. Hemiarthroplasty (HA) (70%) was the most preferred option for treatment of displaced FNFs in cases where arthroplasty was indicated (total hip arthroplasty [THA] 19% and dual mobility THA 11%). The main reasons for selection of arthroplasty over reduction with internal fixation were age and pre-fracture ambulatory status. Pre-trauma ambulatory status and/or sports activity were the main factors in selection of HA over THA. Cement was used by 33% of responders. Poor bone quality and a broad femoral canal were factors that influenced the usage of cement.
Conclusion: Management of FNFs in the elderly is a major health problem worldwide; thus, remaining alert to current trends in treatment is essential for surgeons. The mean cut-off age used in deciding between internal fixation and arthroplasty was 64 years old. HA is the preferred method for treatment of displaced FNFs for members of the KHS.

The aim of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) for comparison of the effectiveness of pericapsular nerve group (PENG) block with that of other analgesic techniques for reduction of postoperative pain and consumption of opioids after total hip arthroplasty (THA). A search of records in the PubMed, Embase, and Cochrane Library, and ClinicalTrials.gov databases was conducted in order to identify studies comparing the effect of the PENG block with that of other analgesics on reduction of postoperative pain and consumption of opioids after THA. Determination of eligibility was based on the PICOS (participants, intervention, comparator, outcomes, and study design) criteria as follows: (1) Participants: patients who underwent THA. (2) Intervention: patients who received a PENG block for management of postoperative pain. (3) Comparator: patients who received other analgesics. (4) Outcomes: numerical rating scale (NRS) score and opioid consumption during different periods. (5) Study design: clinical RCTs. Five RCTs were finally included in the current meta-analysis. Significantly lower postoperative opioid consumption at 24 hours after THA was observed in the group of patients who received the PENG block compared with the control group (standard mean difference=– 0.36, 95% confidence interval –0.64 to –0.08). However, no significant reduction in NRS score at 12, 24, and 48 hours after surgery and opioid consumption at 48 hours after THA was observed. The PENG block showed better results for opioid consumption at 24 hours after THA compared with other analgesics.

Stenotrophomonas maltophilia, a well-established opportunistic bacterium, primarily impacts healthcare settings. Infection of the musculoskeletal system with this bacterium is rare. We report on the first known case of hip periprosthetic joint infection (PJI) caused by S. maltophilia. The potential for development of a PJI caused by this pathogen should be considered by orthopaedic surgeons, particularly in patients with multiple severe comorbidities.

Purpose: Management of pediatric subtrochanteric femur fractures (SFFs) is difficult. The aim of this study was to evaluate the outcomes of adolescent SFFs treated with adult proximal humeral locking plates (PHLPs).
Materials and Methods: A retrospective analysis of 18 adolescents (11 male, 7 female) with a diagnosis of SFF who underwent internal fixation with a PHLP was conducted. Data regarding injury mechanism, fracture pattern, and time to union were recorded for all patients. In addition, a clinical and functional evaluation of patients was performed using the Harris hip score (HHS), Iowa hip score (IHS), modified Merle d’Aubigne-Postel score (MMAPS), Flynn criteria, and hip range of motion (ROM).
Results: The mean age of the patients was 12.72±2.05 years (range, 10-16 years). Radiological observation was performed for evaluation of five different injury mechanisms and different fracture patterns in patients. The mean postoperative HHS was 92.27±5.61, the mean IHS was 90.88±6.46, and the mean MMAPS was 17.22±0.94. According to the Flynn criteria, excellent results were achieved in 14 cases and satisfactory results were obtained in four cases. Measurements of the patients’ mean hip ROM values were as follows: 17.77±3.52°in extension, 115.27±6.74°in flexion, 43.05±3.48°in abduction, 27.50±4.28°in adduction, 42.22±4.60°in internal rotation, and 42.22±3.91°in external rotation.
Conclusion: Surgery performed on adolescent patients using an adult PHLP showed good, safe results. Therefore, it should be considered as an alternative option.

The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide.

Septic arthritis (SA) is a joint inflammation that develops secondary to infectious causes. SA in children is associated with a high rate of morbidity and mortality; therefore, it is regarded as an orthopedic emergency. Because SA of the hip joint usually mimics other musculoskeletal diseases, diagnosis remains challenging. Although this lesion usually shows a good outcome, treatment at an inappropriate time, neglect, or inadequate treatment could lead to poor outcomes. We report on the case of a healthy adolescent who complained of episodes of fever and chills, weight loss, pain in his left hip, and limping. After performing necessary workups, two differential diagnoses of tumor and SA were made. The results of Gram stain and culture of the synovial fluid after surgical excision showed Klebsiella pneumoniae and Enterobacter cloacae complex. To the best of our knowledge, this is the first report of SA due to co-infection with K. pneumoniae and E. cloacae in a healthy patient.