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Background. Osteoarthritis (OA) is the most common disease of the hip in adults, and its etiology is divided into two groups: primary and secondary. Although acetabular dysplasia is the most frequent reason for total hip arthroplasty (THA) in Japan, primary OA has increased recently. Although there are two types of femoral head migration in primary OA: superior and medial, there are some patients with prominent femoral head lateralization. This study aimed at evaluating the relationship between femoral head lateralization and bone morphology of the acetabulum and proximal femur using radiographic factors in primary OA of the hip. Methods. A retrospective study was conducted between 2008 and 2017 to assess 1308 hips with OA who underwent primary THAs at our institute. The diagnostic criteria for primary OA were Crowe type 1, Sharp's angle <45°, and center-edge (CE) angle >25°. We classified patients with primary OA into two groups based on femoral head lateralization: group L with lateralization or group N without. Radiographic factors included Sharp's angle, CE angle, acetabular inclination, acetabular depth ratio (ADR), acetabular head index (AHI), and femoral neck-shaft angle (FNA), all examined on an anteroposterior pelvic radiograph. Femoral neck anteversion was calculated using computerized axial tomography. Results. Primary OA was diagnosed in 210/1308 hips (16.1%) (group L: 112 hips (8.6%); group N: 98 (7.5%)). Patient demographics were not significantly different. Radiographic factors with observed significant differences between group L and group N were the average CE angle (33.0° vs. 35.1°, respectively, p = 0.009), ADR (251.6 vs. 273.4, p < 0.001), AHI (77.2 vs. 80.4, p < 0.001), and FNA (136.9° vs. 134.8°, p = 0.012). Conclusions. This investigation suggests that primary OA with femoral head lateralization demonstrated specific identifiable radiographic characteristics in the acetabulum and proximal femur that might contribute to hip joint instability such as the dysplastic hip. [ABSTRACT FROM AUTHOR]

Objectives: This study documents the time elapsed from the diagnosis of osteonecrosis of the femoral head (ONFH) to surgery, exploring the factors that influence ONFH severity., Design: Retrospective observational study of a nationwide database., Setting: The Kaplan-Meier method with log-rank tests was applied to examine the period from definitive diagnosis of ONFH to surgery using any surgery as the end point. For bilateral cases, the date of the first surgery was the endpoint., Participants: This study included 2074 ONFH cases registered in 34 university hospitals and highly specialised hospitals of the multicentre sentinel monitoring system of the Japanese Investigation Committee between 1997 and 2018., Main Outcome Measure: The primary outcome was the time from diagnosis to surgery. The secondary outcome was the proportion of subjects remaining without surgery at 3, 6 and 9 months, and at 1, 2 and 5 years after diagnosis., Results: The median time to surgery was 9 months (IQR 4-22 months) after diagnosis of ONFH. The time to surgery was significantly shorter in the alcohol alone group and the combined corticosteroid and alcohol group than in the corticosteroid alone group (p=0.018 and p<0.001, respectively), in early stage ONFH with no or mild joint destruction (stages II and III, p<0.001), and with joint preserving surgery (p<0.001). The proportion without surgery was 75.8% at 3 months, 59.6% at 6 months, 48.2% at 9 months, 40.5% at 1 year, 22.2% at 2 years and 8.3% at 5 years., Conclusion: ONFH has been considered to be an intractable disease that often requires surgical treatment, but the fact that surgery was performed in more than half of the patients within 9 months from diagnosis suggests severe disease with a significant clinical impact., Trial Registration Number: Chiba University ID1049., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)