Sang-Min Kim

Hong SH, et al. J Korean Med Sci. 2027 Mar;42:e54. https://doi.org/10.3346/jkms.2027.42.e54

To report the long-term outcomes of conversion total hip arthroplasty (THA) for fused hips compared with primary THA for osteoarthritis. We reviewed patients who underwent conversion THA for fused hips using cementless modular stems between January 1995 and December 2006 at a single institution. From the cohort of 46 patients with fused hips, one-to-one propensity score matching based on age, sex, and body mass index identified 37 matched pairs with osteoarthritis. The mean age and follow-up were 49.5 (range: 19-71) and 18.2 (range: 10-28) years, respectively. Clinical outcomes were assessed using the HHS and UCLA activity score. Implant survivorship was estimated with revision for any reason as the endpoint. The mean HHS and UCLA activity score improved from 47.6 to 87.8 (P < 0.001) and 3.6 to 6.7 (P < 0.001), respectively. The final scores did not differ between the groups. A positive Trendelenburg sign was more frequent in the fused-hip group (29.7% vs. 8.1%, P = 0.018). In the fused-hip group, periprosthetic infection and periprosthetic fracture occurred in two hips each (5.4%). Sciatic nerve palsy occurred in one hip (2.7%) in the osteoarthritis group. The implant survivorship at 20 years was 79.0% in the fused-hip and 74.1% in the osteoarthritis group (log-rank, P = 0.548). After a mean follow-up of 18 years, conversion THA for fused hips using cementless modular stems demonstrated favourable long-term outcomes comparable to those of primary THA for osteoarthritis, supporting conversion THA as a reliable treatment option.

Ryu HG, et al. Yonsei Med J. 2025 Sep;66:e88. https://doi.org/10.3349/ymj.2025.0001

Background: Recent advancements in hip arthroplasty aim to enhance the stability, longevity, and functionality of femoral implants. However, the distal fitting of femoral stems, often caused by metaphyseal–diaphyseal mismatch, remains a significant issue, particularly in patients with Dorr type A femora. Such mismatches can result in suboptimal implant performance, leading to potential complications. This study focuses on evaluating the anatomical compatibility of five representative single-tapered wedge mid–short stems with the mediolateral (ML) anatomy of the proximal femur in an East Asian population, where these mismatches are often more pronounced. Methods: A total of 742 patients from two hospitals, all of whom underwent unilateral primary total hip arthroplasty, were included in the study. The contralateral proximal femur was confirmed to have normal anatomy in each patient. Hip anteroposterior radiographs were used for measurements, which were standardized in conjunction with CT images. Key anatomical parameters were measured, including proximal and distal medial–lateral canal dimensions, vertical offset, and medial offset. Five femoral stem designs—Tri-lock^®, Taperloc^®, Anthology^®, Accolade II^®, and Fit^®—were evaluated. R programming was employed for a detailed fit analysis to match stem sizes with patient anatomy, categorizing the fit as proximal, simultaneous proximal–distal, or distal engagement. Results: Among the femoral stems analyzed, the Fit^® stem demonstrated the closest alignment with the regression line for ML widths in the study population (slope = 0.69; population ML slope = 0.38). This was followed by Accolade II^®, which had a slope of 0.83. In terms of offset options, the Accolade II^® offered the largest offset coverage, making it particularly suitable for this population. The fit analysis revealed that the Fit^® stem had the highest suitable fit rate (90.56%), followed by Accolade II^® (73.04%). Taperloc^®, Anthology^®, and Tri-lock^® had similar fit rates of approximately 59%. Overall, optimal results were obtained for 92.05% of the population in the automated fitting trial, regardless of the product type. Conclusions: When designing modern cementless femoral stems intended for press-fit fixation, it is crucial to account for the anatomical variations specific to the target population. In this study, Fit^® and Accolade II^® femoral components demonstrated superior compatibility with the femoral anatomy of the East Asian population, particularly in those with a higher incidence of Dorr type A femora. These stems, characterized by slimmer distal dimensions and high-offset options, appear to minimize metaphyseal–diaphyseal mismatch and associated complications.

Summary With the analysis of nationwide health claim data, treatment with the composite agent of SERMs and vitamin D reduces the risk of osteoporotic fracture and hip fracture better compared to SERMs treatment in women with osteoporosis aged ≥ 50 years. Purpose This study compared the potential of the composite agent of selective estrogen receptor modulators (SERMs) and vitamin D (SERM + VitD) with that of SERMs-only for fracture prevention and mortality reduction in women aged ≥ 50 years. Methods The incidence of osteoporotic fracture (fractures of the vertebrae, hip, wrist, or humerus) and all-cause death after treatment with SERM + VitD and SERMs were characterized using the Korean National Health Insurance Service database 2017–2019. The participants were divided into two groups (SERM + VitD vs SERMs). After exclusion and propensity score matching, 2,885 patients from each group were included in the analysis. Fracture incidence was compared between groups. Kaplan–Meier curves were used to compare mortality. Cox proportional hazards regression analysis was used to compare the risks of fracture occurrence and mortality between the groups. Results The incidence rate (138.6/10,000 vs. 192.4/10,000 person-years), and risk of osteoporotic fractures (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61–0.97; p = 0.024) were lower in the SERM + VitD group than in the SERMs group. Analysis for specific fractures showed a lower hazard of hip fracture in the SERM + VitD group (HR, 0.25; 95% CI, 0.09–0.71; p = 0.009). No difference was observed between the groups regarding mortality. Conclusion The risk of osteoporotic fractures, especially hip fractures, was lower in the SERM + VitD group than in the SERMs group. Therefore, the composite agent of SERMs and vitamin D can be considered as a viable option for postmenopausal women with a relatively low fracture risk.

In present study, icariin (ICA)/tannic acid (TA)-nanodiamonds (NDs) were prepared as follows. ICA was anchored to ND surfaces with absorbed TA (ICA/TA-NDs) and we evaluated their in vitro anti-inflammatory effects on lipopolysaccharide (LPS)-activated macrophages and in vivo cartilage protective effects on a rat model of monosodium iodoacetate (MIA)-induced osteoarthritis (OA). The ICA/TA-NDs showed prolonged release of ICA from the NDs for up to 28 days in a sustained manner. ICA/TA-NDs inhibited the mRNA levels of pro-inflammatory elements, including matrix metalloproteinases-3 (MMP-3), cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and increased the mRNA levels of anti-inflammatory factors (i.e., IL-4 and IL-10) in LPS-activated RAW 264.7 macrophages. Animal studies exhibited that intra-articular injection of ICA/TA-NDs notably suppressed levels of IL-6, MMP-3, and TNF-α and induced level of IL-10 in serum of MIA-induced OA rat models in a dose-dependent manner. Furthermore, these noticeable anti-inflammatory effects of ICA/TA-NDs remarkably contributed to the protection of the progression of MIA-induced OA and cartilage degradation, as exhibited by micro-computed tomography (micro-CT), gross findings, and histological investigations. Accordingly, in vitro and in vivo findings suggest that the prolonged ICA delivery of ICA/TA-NDs possesses an excellent latent to improve inflammation as well as defend against cartilage disorder in OA.

Ryu HG, et al. Hip Pelvis. 2023 Sep;35(3):193-199. https://doi.org/10.5371/hp.2023.35.3.193

Inflammatory environments provide vital biochemical stimuli (i.e., oxidative stress, pH, and enzymes) for triggered drug delivery in a controlled manner. Inflammation alters the local pH within the affected tissues. As a result, pH-sensitive nanomaterials can be used to effectively target drugs to the site of inflammation. Herein, we designed pH-sensitive nanoparticles in which resveratrol (an anti-inflammatory and antioxidant compound (RES)) and urocanic acid (UA) were complexed with a pH-sensitive moiety using an emulsion method. These RES-UA NPs were characterized by transmission electron microscopy, dynamic light scattering, zeta potential, and FT-IR spectroscopy. The anti-inflammatory and antioxidant activities of the RES-UA NPs were assessed in RAW 264.7 macrophages. The NPs were circular in shape and ranged in size from 106 to 180 nm. The RES-UA NPs suppressed the mRNA expression of the pro-inflammatory molecules inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages in a concentration-dependent manner. Incubation of LPS-stimulated macrophages with RES-UA NPs reduced the generation of reactive oxygen species (ROS) in a concentration-dependent manner. These results suggest that pH-responsive RES-UA NPs can be used to decrease ROS generation and inflammation.