Top

Published in:

01-12-2020 | Hip-TEP | Review

Hospitalization length, surgical duration, and blood lost among the approaches for total hip arthroplasty: a Bayesian network meta-analysis

Authors: F. Migliorini, A. Trivellas, J. Eschweiler, Y. El Mansy, M. C. Mazzanti, M. Tingart, P. Aretini

Published in: MUSCULOSKELETAL SURGERY | Issue 3/2020

Abstract

Despite the numerous studies, there is no consensus concerning the best approach for total hip arthroplasty (THA), and debates are ongoing. The purpose of this study was to perform a Bayesian network meta-analysis (NMA) comparing several approaches for primary THA. The focus was on peri-operative outcomes: surgical duration, total estimated blood loss, and length of the hospitalization. This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health care interventions. In October 2019, the main databases were accessed. All the clinical trials comparing two or more different approaches for primary THA were assessed. For the methodology quality assessment, the PEDro score was performed. The Software STATA MP was used for the statistical analyses. The NMA was performed through the routine for Bayesian hierarchical random-effects analysis with the inverse variance statistic method for continuous variables. Data from 4843 procedures was analysed. Between patient’s demographic, good baseline comparability was found. The comparison total estimated blood loss detected statistically significant inconsistency (P = 0.01). The posterolateral approach reported the lowest value for the surgical duration. The test for overall inconsistency was statistically significant (P = 0.4). The posterolateral approach reported the shortest hospitalization length. The test for overall inconsistency was statistically significant (P = 0.9). The posterolateral approach reported shorter surgical duration and hospitalization length. Concerning the analysis of total estimated blood loss, no significant result was obtained. Data must be considered in the light of the limitations of the present study.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am 89(4):780–785. https://doi.org/10.2106/JBJS.F.00222CrossRef

Inacio MCS, Graves SE, Pratt NL, Roughead EE, Nemes S (2017) Increase in total joint arthroplasty projected from 2014 to 2046 in Australia: a conservative local model with international implications. Clin Orthop Relat Res 475(8):2130–2137. https://doi.org/10.1007/s11999-017-5377-7CrossRefPubMedPubMedCentral

Wu P, Liu Q, Fu M, Zhang Z, He S, Liao W, Kang Y (2018) Value of computed tomography-based three-dimensional pre-operative planning in cup placement in total hip arthroplasty with dysplastic acetabulum. J Invest Surg. https://doi.org/10.1080/08941939.2018.1444828CrossRefPubMed

Hung CC, Wang CY, Fu SH, Yang RS, Hsiao FY (2018) Effects of anti-osteoporosis medications on total hip arthroplasty risks in osteoporotic patients with hip osteoarthritis in Taiwan: a nationwide cohort study. Arch Osteoporos 13(1):107. https://doi.org/10.1007/s11657-018-0522-9CrossRefPubMed

Shigemura T, Yamamoto Y, Murata Y, Sato T, Tsuchiya R, Mizuki N, Toki Y, Wada Y (2018) Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: a systematic review and meta-analysis. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2018.06.019CrossRefPubMed

Migliorini F, Biagini M, Rath B, Meisen N, Tingart M, Eschweiler J (2018) Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials. Int Orthop. https://doi.org/10.1007/s00264-018-4124-3CrossRefPubMed

Moretti VM, Post ZD (2017) Surgical approaches for total hip arthroplasty. Indian J Orthop 51(4):368–376. https://doi.org/10.4103/ortho.IJOrtho_317_16CrossRefPubMedPubMedCentral

Connolly KP, Kamath AF (2016) Direct anterior total hip arthroplasty: comparative outcomes and contemporary results. World J Orthop 7(2):94–101. https://doi.org/10.5312/wjo.v7.i2.94CrossRefPubMedPubMedCentral

Miller LE, Gondusky JS, Kamath AF, Boettner F, Wright J, Bhattacharyya S (2018) Influence of surgical approach on complication risk in primary total hip arthroplasty. Acta Orthop 89(3):289–294. https://doi.org/10.1080/17453674.2018.1438694CrossRefPubMedPubMedCentral

10.

Wang Z, Hou JZ, Wu CH, Zhou YJ, Gu XM, Wang HH, Feng W, Cheng YX, Sheng X, Bao HW (2018) A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. J Orthop Surg Res 13(1):229. https://doi.org/10.1186/s13018-018-0929-4CrossRefPubMedPubMedCentral

11.

Huang SG, Chen B, Lv D, Zhang Y, Nie FF, Li W, Lv Y, Zhao HL, Liu HM (2017) Evaluation of shoulder function in clavicular fracture patients after six surgical procedures based on a network meta-analysis. Disabil Rehabil 39(2):105–112. https://doi.org/10.3109/09638288.2016.1140827CrossRefPubMed

12.

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP, Mulrow C, Catala-Lopez F, Gotzsche PC, Dickersin K, Boutron I, Altman DG, Moher D (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784. https://doi.org/10.7326/M14-2385CrossRefPubMed

13.

Howick JCI, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) The 2011 Oxford CEBM levels of evidence. Oxford Centre for Evidence-Based Medicine. https://www.cebm.net/index.aspx?o=5653. Accessed Oct 2019

14.

de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55(2):129–133CrossRefPubMed

15.

Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G (2013) Graphical tools for network meta-analysis in STATA. PLoS One 8(10):e76654. https://doi.org/10.1371/journal.pone.0076654CrossRefPubMedPubMedCentral

16.

Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12(3):123–129. https://doi.org/10.1007/s10195-011-0144-0CrossRefPubMedPubMedCentral

17.

Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplast 28(9):1634–1638. https://doi.org/10.1016/j.arth.2013.01.034CrossRef

18.

Bergin PF, Doppelt JD, Kephart CJ, Benke MT, Graeter JH, Holmes AS, Haleem-Smith H, Tuan RS, Unger AS (2011) Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Jt Surg Am 93(15):1392–1398. https://doi.org/10.2106/JBJS.J.00557CrossRef

19.

Biau DJ, Porcher R, Roren A, Babinet A, Rosencher N, Chevret S, Poiraudeau S, Anract P (2015) Neither pre-operative education or a minimally invasive procedure have any influence on the recovery time after total hip replacement. Int Orthop 39(8):1475–1481. https://doi.org/10.1007/s00264-015-2802-yCrossRefPubMed

20.

Dienstknecht T, Luring C, Tingart M, Grifka J, Sendtner E (2014) Total hip arthroplasty through the mini-incision (micro-hip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg Hong Kong 22(2):168–172. https://doi.org/10.1177/230949901402200210CrossRefPubMed

21.

Fink B, Mittelstaedt A (2012) Minimally invasive posterior approach for total hip arthroplasty. Orthopade 41(5):382–389. https://doi.org/10.1007/s00132-011-1893-4CrossRefPubMed

22.

Fransen B, Hoozemans M, Vos S (2016) Direct anterior approach versus posterolateral approach in total hip arthroplasty: one surgeon, two approaches. Acta Orthop Belg 82(2):240–248PubMed

23.

Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Noth U (2012) Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 36(3):491–498. https://doi.org/10.1007/s00264-011-1280-0CrossRefPubMed

24.

Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC (2011) Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial. Clin Orthop Relat Res 469(1):200–208. https://doi.org/10.1007/s11999-010-1331-7CrossRefPubMed

25.

Gore DR, Murray MP, Sepic SB, Gardner GM (1982) Anterolateral compared to posterior approach in total hip arthroplasty: differences in component positioning, hip strength, and hip motion. Clin Orthop Relat Res 165:180–187

26.

Ji HM, Kim KC, Lee YK, Ha YC, Koo KH (2012) Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplast 27(3):378–385. https://doi.org/10.1016/j.arth.2011.06.007CrossRef

27.

Joseph NM, Roberts J, Mulligan MT (2017) Financial impact of total hip arthroplasty: a comparison of anterior versus posterior surgical approaches. Arthroplast Today 3(1):39–43. https://doi.org/10.1016/j.artd.2016.01.002CrossRefPubMed

28.

Laffosse JM, Accadbled F, Molinier F, Chiron P, Hocine B, Puget J (2008) Anterolateral mini-invasive versus posterior mini-invasive approach for primary total hip replacement. Comparison of exposure and implant positioning. Arch Orthop Trauma Surg 128(4):363–369. https://doi.org/10.1007/s00402-007-0385-9CrossRefPubMed

29.

Ilchmann T, Gersbach S, Zwicky L, Clauss M (2013) Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study. Orthop Rev Pavia 5(4):e31. https://doi.org/10.4081/or.2013.e31CrossRefPubMedPubMedCentral

30.

Martin R, Clayson PE, Troussel S, Fraser BP, Docquier PL (2011) Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year. J Arthroplast 26(8):1362–1372. https://doi.org/10.1016/j.arth.2010.11.016CrossRef

31.

Martin CT, Pugely AJ, Gao Y, Clark CR (2013) A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplast 28(5):849–854. https://doi.org/10.1016/j.arth.2012.10.029CrossRef

32.

Muller M, Tohtz S, Springer I, Dewey M, Perka C (2011) Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Arch Orthop Trauma Surg 131(2):179–189. https://doi.org/10.1007/s00402-010-1117-0CrossRefPubMed

33.

Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplast 24(5):698–704. https://doi.org/10.1016/j.arth.2008.04.012CrossRef

34.

Petis SM, Howard JL, Lanting BA, Marsh JD, Vasarhelyi EM (2016) In-hospital cost analysis of total hip arthroplasty: does surgical approach matter? J Arthroplast 31(1):53–58. https://doi.org/10.1016/j.arth.2015.08.034CrossRef

35.

Poehling-Monaghan KL, Krych AJ, Levy BA, Trousdale RT, Sierra RJ (2017) Female sex is a risk factor for failure of hip arthroscopy performed for acetabular retroversion. Orthop J Sports Med 5(11):2325967117737479. https://doi.org/10.1177/2325967117737479CrossRefPubMedPubMedCentral

36.

Pogliacomi F, De Filippo M, Paraskevopoulos A, Alesci M, Marenghi P, Ceccarelli F (2012) Mini-incision direct lateral approach versus anterior mini-invasive approach in total hip replacement: results 1 year after surgery. Acta Biomed 83(2):114–121PubMed

37.

Radoicic D, Zec V, Elassuity WI, Azab MA (2018) Patient’s perspective on direct anterior versus posterior approach total hip arthroplasty. Int Orthop 42(12):2771–2775. https://doi.org/10.1007/s00264-018-4002-zCrossRefPubMed

38.

Rathod PA, Bhalla S, Deshmukh AJ, Rodriguez JA (2014) Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach? Clin Orthop Relat Res 472(6):1877–1885. https://doi.org/10.1007/s11999-014-3512-2CrossRefPubMedPubMedCentral

39.

Rittmeister M, Peters A (2006) Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach. Orthopade 35(7):716, 718–722. https://doi.org/10.1007/s00132-006-0963-5CrossRef

40.

Rodriguez JA, Deshmukh AJ, Rathod PA, Greiz ML, Deshmane PP, Hepinstall MS, Ranawat AS (2014) Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 472(2):455–463. https://doi.org/10.1007/s11999-013-3231-0CrossRefPubMed

41.

Rosenlund S, Broeng L, Holsgaard-Larsen A, Jensen C, Overgaard S (2017) Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach. Acta Orthop 88(3):239–247. https://doi.org/10.1080/17453674.2017.1291100CrossRefPubMedPubMedCentral

42.

Rykov K, Reininga IHF, Sietsma MS, Knobben BAS, Ten Have B (2017) Posterolateral vs direct anterior approach in total hip arthroplasty (POLADA trial): a randomized controlled trial to assess differences in serum markers. J Arthroplast 32(12):3652–3658 e3651. https://doi.org/10.1016/j.arth.2017.07.008CrossRef

43.

Schleicher I, Haas H, Adams TS, Szalay G, Klein H, Kordelle J (2011) Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach. Acta Orthop Belg 77(4):480–487PubMed

44.

Sendtner E, Borowiak K, Schuster T, Woerner M, Grifka J, Renkawitz T (2011) Tackling the learning curve: comparison between the anterior, minimally invasive (micro-hip(R)) and the lateral, transgluteal (Bauer) approach for primary total hip replacement. Arch Orthop Trauma Surg 131(5):597–602. https://doi.org/10.1007/s00402-010-1174-4CrossRefPubMed

45.

Spaans AJ, van den Hout JA, Bolder SB (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83(4):342–346. https://doi.org/10.3109/17453674.2012.711701CrossRefPubMedPubMedCentral

46.

Takada R, Jinno T, Miyatake K, Hirao M, Kimura A, Koga D, Yagishita K, Okawa A (2018) Direct anterior versus anterolateral approach in one-stage supine total hip arthroplasty. Focused on nerve injury: a prospective, randomized, controlled trial. J Orthop Sci 23(5):783–787. https://doi.org/10.1016/j.jos.2018.05.005CrossRefPubMed

47.

Vicente JR, Croci AT, Camargo OP (2008) Blood loss in the minimally invasive posterior approach to total hip arthroplasty: a comparative study. Clin Sao Paulo 63(3):351–356CrossRef

48.

Yang CF, Zhu QS, Han YS, Zhu JY, Wang HQ, Cong R, Zhang DW (2009) Anterolateral minimally-invasive total hip arthroplasty: a clinical comparative study of 110 cases. Zhonghua Yi Xue Za Zhi 89(1):2–6PubMed

49.

Zawadsky MW, Paulus MC, Murray PJ, Johansen MA (2014) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplast 29(6):1256–1260. https://doi.org/10.1016/j.arth.2013.11.013CrossRef

50.

Zhang XL, Wang Q, Jiang Y, Zeng BF (2006) Minimally invasive total hip arthroplasty with anterior incision. Zhonghua Wai Ke Za Zhi 44(8):512–515PubMed

51.

Zhao H-Y, Kang P-D, Xia Y-Y, Shi X-J, Nie Y, Pei F-X (2017) Comparison of early functional recovery following total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial. Arthroplasty 32(11):3421–3428. https://doi.org/10.1016/j.arth.2017.05.056CrossRef

52.

Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, Cremers S, Abraham IL (2003) Orthopedic surgery transfusion hemoglobin european overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43(4):459–469CrossRefPubMed

53.

Spiess BD (2004) Transfusion of blood products affects outcome in cardiac surgery. Semin Cardiothorac Vasc Anesth 8(4):267–281. https://doi.org/10.1177/108925320400800402CrossRefPubMed

54.

Rawn J (2008) The silent risks of blood transfusion. Curr Opin Anaesthesiol 21(5):664–668. https://doi.org/10.1097/ACO.0b013e32830f1fd1CrossRefPubMed

55.

Surgenor SD, Kramer RS, Olmstead EM, Ross CS, Sellke FW, Likosky DS, Marrin CA, Helm RE Jr, Leavitt BJ, Morton JR, Charlesworth DC, Clough RA, Hernandez F, Frumiento C, Benak A, DioData C, O’Connor GT, Northern New England Cardiovascular Disease Study G (2009) The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg 108(6):1741–1746. https://doi.org/10.1213/ane.0b013e3181a2a696CrossRefPubMed

56.

Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, Starr NJ, Blackstone EH (2006) Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 34(6):1608–1616. https://doi.org/10.1097/01.CCM.0000217920.48559.D8CrossRefPubMed

57.

Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR (2007) Estimating the cost of blood: past, present, and future directions. Best Pract Res Clin Anaesthesiol 21(2):271–289CrossRefPubMed

58.

Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Shores P, Mullen K, Bini SA, Clarke HD, Schemitsch E, Johnson RL, Memtsoudis SG, Sayeed SA, Sah AP, Della Valle C (2018) The efficacy of tranexamic acid in total hip arthroplasty: a network meta-analysis. J Arthroplast 33(10):3083–3089.e4. https://doi.org/10.1016/j.arth.2018.06.023CrossRef

59.

Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD (2013) Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop 37(11):2109–2118. https://doi.org/10.1007/s00264-013-2053-8CrossRefPubMedPubMedCentral

60.

Zan PWW, Fan L, Wu Z, Yu X, Xu T, Li G (2016) Closed-suction drainage versus no drainage in total hip arthroplasty, a meta-analysis of randomized controlled trials. Int J Clin Exp Med 9(2):725–735

61.

de Steiger RN, Lorimer M, Solomon M (2015) What is the learning curve for the anterior approach for total hip arthroplasty? Clin Orthop Relat Res 473(12):3860–3866. https://doi.org/10.1007/s11999-015-4565-6CrossRefPubMedPubMedCentral

62.

D’Arrigo C, Speranza A, Monaco E, Carcangiu A, Ferretti A (2009) Learning curve in tissue sparing total hip replacement: comparison between different approaches. J Orthop Traumatol 10(1):47–54. https://doi.org/10.1007/s10195-008-0043-1CrossRefPubMedPubMedCentral

63.

Christensen CP, Karthikeyan T, Jacobs CA (2014) Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplast 29(9):1839–1841. https://doi.org/10.1016/j.arth.2014.04.036CrossRef

64.

Muller DA, Zingg PO, Dora C (2014) Anterior minimally invasive approach for total hip replacement: five-year survivorship and learning curve. Hip Int 24(3):277–283. https://doi.org/10.5301/hipint.5000108CrossRefPubMed

65.

Epstein AM, Read JL, Hoefer M (1987) The relation of body weight to length of stay and charges for hospital services for patients undergoing elective surgery: a study of two procedures. Am J Public Health 77(8):993–997CrossRefPubMedPubMedCentral

66.

Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, Beverland D (2005) A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Jt Surg Am 87(4):701–710. https://doi.org/10.2106/jbjs.d.02645CrossRef

67.

van Aalst MJ, Oosterhof J, Nijhuis-van der Sanden MW, Schreurs BW (2014) Can the length of hospital stay after total hip arthroplasty be predicted by preoperative physical function characteristics? Am J Phys Med Rehabil 93(6):486–492. https://doi.org/10.1097/PHM.0000000000000054CrossRefPubMed

68.

Epps CD (2004) Length stay, discharge disposition, and hospital charge predictors. AORN J 79(5):975–976, 979–981, 984–997CrossRef

69.

Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL (2000) Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplast 15(4):448–452. https://doi.org/10.1054/arth.2000.4346CrossRef

70.

Bauer R, Kerschbaumer F, Poisel S, Oberthaler W (1979) The transgluteal approach to the hip joint. Arch Orthop Trauma Surg 95(1–2):47–49. https://doi.org/10.1007/bf00379169CrossRefPubMed

71.

Pai VS (2002) A modified direct lateral approach in total hip arthroplasty. J Orthop Surg Hong Kong 10(1):35–39. https://doi.org/10.1177/230949900201000107CrossRefPubMed

72.

Berstock JR, Blom AW, Whitehouse MR (2017) A comparison of the omega and posterior approaches on patient reported function and radiological outcomes following total hip replacement. J Orthop 14(3):390–393. https://doi.org/10.1016/j.jor.2017.06.010CrossRefPubMedPubMedCentral

Title: Hospitalization length, surgical duration, and blood lost among the approaches for total hip arthroplasty: a Bayesian network meta-analysis
Authors: F. Migliorini
A. Trivellas
J. Eschweiler
Y. El Mansy
M. C. Mazzanti
M. Tingart
P. Aretini
Publication date: 01-12-2020
Publisher: Springer Milan
Keywords: Hip-TEP
Hip-TEP
Published in: MUSCULOSKELETAL SURGERY / Issue 3/2020
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI: https://doi.org/10.1007/s12306-020-00657-9

At a glance: The STEP trials

Springer Medicine

Hospitalization length, surgical duration, and blood lost among the approaches for total hip arthroplasty: a Bayesian network meta-analysis

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2020

Assessment of the young adult hip joint using plain radiographs

PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity—results from a randomised trial

Long-term results of Zweymüller SLL femoral stem in revision hip arthroplasty for stage II and IIIA femoral bone defect: a 9–15-year follow-up study

Management of high-grade hallux rigidus: a narrative review of the literature

Reorganization of the Rizzoli Orthopaedic Institute during the COVID-19 outbreak

Simultaneous removal of a locking plate and implantation of a reversed shoulder prosthesis in elderly patients suffering from fracture sequelae of the proximal humerus