Calcar-guided short-stem total hip arthroplasty: Will it be the future standard? Review and perspectives

Short stems in total hip arthroplasty(THA)are becoming increasingly popular.In Germany,already 10.4%of all primary THAs are performed using a cementless short stem.The concept of modern,calcar-guided,short stems aims for an individualized reconstruction of the hip anatomy by following the calcar of the femoral neck,a bone-and soft-tissue-sparing implantation technique,and physiological loading.The stem design uses either metaphyseal fixation alone or additional diaphyseal anchoring,depending on the stem alignment and indication.These individualized anchorage types increase the potential indications for the safe use of a short stem.The design features may account for potential advantages of current short stem implants compared with earlier shortstem designs,particularly in cases of reduced bone quality or osteonecrosis of the femoral head and femoral neck fractures.The implantation technique,however,requires distinct knowledge regarding the characteristics of varus and valgus positioning,with the potential for clinical consequences.A learning curve for surgeons new to this technique must be taken into account.Cortical contact with the distal lateral cortex appears to be crucial to provide sufficient primary stability,and the use of intraoperative imaging to identify“undersizing”is highly recommended.Current results of several national registries indicate that calcarguided short stems are among the most successful implants in terms of mid-term survivorship.However,long-term data remain scarce.This review introduces the characteristics of calcar-guided short-stem THA and summarizes the current evidence.

Clinical observation of acupuncture combined with sitting-position knee-adjustment manipulations for patellofemoral arthritis

Objective To observe the efficacy of acupuncture combined with sitting-position knee-adjustment manipulations in treating patellofemoral osteoarthritis.Methods Ninety-two patients with patellofemoral osteoarthritis were randomized into an observation group and a medication group,with 46 cases in each group.The observation group received acupuncture and sitting-position knee-adjustment manipulations,and the medication group received oral celecoxib capsules.After 8-week treatment,changes in the short-form McGill pain questionnaire(SF-MPQ)and Lysholm knee scoring scale(LKSS)scores were observed,and the clinical efficacy was compared.Results The total effective rate was 87.0%in the observation group and 63.0%in the control group;the between-group difference was statistically significant.Before treatment,there were no significant differences in the SF-MPQ score or LKSS score(P>0.05).After 8-week treatment,the SF-MPQ[including pain rating index(PRI),visual analog scale(VAS),and present pain intensity(PPI)]and LKSS scores showed notable changes in both groups(P<0.05);the SF-MPQ and LKSS scores in the observation group were significantly different from those in the control group(P<0.05).Conclusion Combining acupuncture and sitting-position knee-adjustment manipulations can reduce pain and ameliorate joint function in patients with patellofemoral osteoarthritis,producing more significant efficacy than oral celecoxib capsules.