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Total Hip Arthroplasty for Osteonecrosis in Patients Under 50 years old is Associated with an Increased risk of post-surgical Complications

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Original Article | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 99-104 | Pradip Ramamurti, Corinne Vennitti, Shivam Gandhi, Quanjun Cui, Tracy Borsinger

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.790

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 22 Aug 2025, Review Date: 17 Sep 2025, Accepted Date: 28 Oct 2025 & Published Date: 10 Dec 2025

Author: Pradip Ramamurti [1], Corinne Vennitti [1], Shivam Gandhi [1], Quanjun Cui [1], Tracy Borsinger [1]

[1] University of Virginia, Department of Orthopaedic Surgery, 2280 Ivy Road, Charlottesville, VA 22903.

Address of Correspondence

Dr. Corinne Vennitti
University of Virginia, Department of Orthopaedic Surgery, 2280 Ivy Road, Charlottesville, VA 22903.
E-mail: CV3AJ@uvahealth.org

Abstract

Introduction: Osteonecrosis (ON) of the femoral head is responsible for roughly 2 to 10% of total hip arthroplasty (THA) indications. The purpose of this study is to compare complication rates for patients under 50 years old undergoing THA for ON versus osteoarthritis (OA).
Methods: Patients between the ages of 18- and 50-years old undergoing THA for ipsilateral osteonecrosis were identified in the PearlDiver database. A control cohort of patients between the same age thresholds were identified who underwent THA for osteoarthritis. Any patient with a history of proximal femur fracture or prior operative fixation of a proximal femur fracture was excluded. Patients were included if they had a 5-year postoperative database followed up after THA. The 90-day rates of post-operative medical and 5-year surgical complications were recorded. Multivariate analysis was conducted to account for confounding variables and covariates. Subgroup analyses were also performed stratified by age (<30, 30–40, and 40–50 years) to assess revision outcomes.
Results: A final cohort of 6,955 patients met inclusion criteria, 1,769 (25.4%) underwent THA for osteonecrosis while 5,186 (74.6%) underwent THA for OA. Patients undergoing THA for ON had a higher incidence of 5-year post-surgical instability (3.1% vs. 2.2%, OR 1.51, P=0.025) when compared to THA for OA. Similarly, those undergoing THA for OA had a higher incidence of 5-year revision (4.4% vs. 3.0%, OR 1.45, P=0.018) and 90-day readmission (8.0% vs. 4.4%, OR 1.41, P=0.006), and emergency department visits (18.4% vs. 11.1%, OR 1.33, P=0.001) when compared to those undergoing THA for OA.
Conclusion: Patients younger than 50 years old undergoing THA for ON experience increased post-surgical complications such as revision, dislocation, hospital readmission and emergency department visits compared to patients under 50 years old undergoing THA for OA. These findings provide insight for preoperative considerations for arthroplasty surgeons in this patient population.
Keywords: Hip osteoarthritis, Hip osteonecrosis, Total hip arthroplasty, Avascular necrosis, Implant survival, Clinical outcomes, Revision total hip arthroplasty

References

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[3] Tripathy, Sujit Kumar et al. “Management of femoral head osteonecrosis: Current concepts.” Indian journal of orthopaedics vol. 49,1 (2015): 28-45. doi:10.4103/0019-5413.143911
[4] Hines, Jeremy T et al. “Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment.” Journal of Korean medical science vol. 36,24 e177. 21 Jun. 2021, doi:10.3346/jkms.2021.36.e177
[5] Mont, Michael A. MD1; Cherian, Jeffrey J. DO1; Sierra, Rafael J. MD2; Jones, Lynne C. PhD3; Lieberman, Jay R. MD4. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A Ten-Year Update. The Journal of Bone and Joint Surgery 97(19):p 1604-1627, October 7, 2015. | DOI: 10.2106/JBJS.O.00071
[6] Birla, Vikas et al. “Risk factors and pathogenesis of steroid-induced osteonecrosis of femoral head – A scoping review.” Journal of clinical orthopaedics and trauma vol. 23 101643. 13 Oct. 2021, doi:10.1016/j.jcot.2021.101643
[7] Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol. 2007 Jul;63(1):16-28. doi: 10.1016/j.ejrad.2007.03.019. Epub 2007 Jun 6. PMID: 17555906.
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How to Cite this Article: Ramamurti P, Vennitti C, Gandhi S, Cui Q, Borsinger T. Total Hip Arthroplasty for Osteonecrosis in Patients Under 50 years old is Associated with an Increased risk of post-surgical Complications. Journal of Clinical Orthopaedics. July-December 2025;10(2):99-104.

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Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 4-7 | Océane Mauffrey, Kevin Yu, Malvika Choudhari, Ashley Lynn Habig, Alec Pugh, Vinay Narotam

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.702

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 11 Jan 2025, Review Date: 08 Mar 2025, Accepted Date: 10 Apr 2025 & Published Date: 30 Jun 2025

Author: Océane Mauffrey [1], Kevin Yu [2], Malvika Choudhari [1], Ashley Lynn Habig [3], Alec Pugh [1], Vinay Narotam [4]

[1] The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
[2] The University of North Carolina, Gillings School of Public Health 135 Dauer Drive, Chapel Hill, NC, 27599, United States of America
[3] The University of North Carolina, Undergraduate, Chapel Hill, NC, 27599, United State of America
[4] The University of North Carolina, Department of Orthopaedics, 130 Mason Farm Road, Chapel Hill, NC 27514, United States of America Address of Correspondence

Address of Correspondence

Dr. Océane Mauffrey,
The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
E-mail: Oceane_mauffrey@med.unc.edu

Abstract

Background: Clubfoot is a congenital deformity characterized by cavus deformity of the midfoot, adductus of the forefoot and equinus and varus of the hindfoot. The Ponseti method, a series of casting and bracing protocols has become the standard of care as a highly effective non-surgical intervention. Poor adherence with stringent brace wearing protocols has been identified as one of the leading causes of deformity recurrence with the Ponseti method. The present study seeks to uncover the socioeconomic variables which may contribute to brace adherence.
Methods: This survey study included 219 patients, 56 responded (25.5% RR). The survey assessed zip code, annual income, number of caregivers and siblings, brace adherence, and recurrence. Adherence was measured categorically (Likert) and continuously (0-100%); recurrence was measured categorically (yes/no). A t-test was used to evaluate the relationship between adherence and deformity recurrence. All other variables were analyzed using chi squared and Fischer’s exact.
Results: 23 patients reported an annual income of $100,000 or greater (n=23), and most had received at least a college education (n=37), many had graduate’s degrees (n=20), most reported two caregivers (n=44), and 1 sibling (n=21). 36 patients reported brace wearing All of the time, and 21 patients reported their child needing to repeat serial casting or additional surgery, indicating recurrence. No significant relationship was found between brace adherence and deformity recurrence (p>0.05). No significant relationship was found between annual income, number of caregivers, highest level of education, number of siblings against brace adherence (p>0.05).
Conclusion: These findings contrast with the well-documented risk of recurrence with decreased brace adherence; perhaps due to parental overreporting of brace wearing. The expected relationship between social variables and brace adherence was also not supported potentially because of a skew in our population towards patients with higher education and income.
Keywords: Clubfoot, Social Determinants of Health, Clinical Outcomes, Brace Compliance

References

1. Shabtai L. Worldwide spread of the Ponseti method for clubfoot. World J Orthop. 2014;5(5):585. doi:10.5312/wjo.v5.i5.585
2. Rieger MA, Dobbs MB. Clubfoot. Clin Podiatr Med Surg. 2022;39(1):1-14. doi:10.1016/j.cpm.2021.08.006
3. Cady R, Hennessey TA, Schwend RM. Diagnosis and Treatment of Idiopathic Congenital Clubfoot. Pediatrics. 2022;149(2):e2021055555. doi:10.1542/peds.2021-055555
4. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet: J Bone Jt Surg-Am Vol. 2004;86(1):22-27. doi:10.2106/00004623-200401000-00005
5. Švehlík M, Floh U, Steinwender G, Sperl M, Novak M, Kraus T. Ponseti method is superior to surgical treatment in clubfoot – Long-term, randomized, prospective trial. Gait Posture. 2017;58:346-351. doi:10.1016/j.gaitpost.2017.08.010
6. Wang YY, Su YC, Tu YK, et al. Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials. J Bone Jt Surg. 2024;106(4):356-367. doi:10.2106/JBJS.22.01210
7. Recordon JAF, Halanski MA, Boocock MG, McNair PJ, Stott NS, Crawford HA. A Prospective, Median 15-Year Comparison of Ponseti Casting and Surgical Treatment of Clubfoot. J Bone Jt Surg. 2021;103(21):1986-1995. doi:10.2106/JBJS.20.02014
8. Ganesan B, Luximon A, Al-Jumaily A, Balasankar SK, Naik GR. Ponseti method in the management of clubfoot under 2 years of age: A systematic review. Nazarian A, ed. PLOS ONE. 2017;12(6):e0178299. doi:10.1371/journal.pone.0178299
9. Abdelgawad AA, Lehman WB, Van Bosse HJP, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B. 2007;16(2):98-105. doi:10.1097/BPB.0b013e32801048bb
10. Ramírez N, Flynn JM, Fernández S, Seda W, Macchiavelli RE. Orthosis Noncompliance After the Ponseti Method for the Treatment of Idiopathic Clubfeet: A Relevant Problem That Needs Reevaluation. J Pediatr Orthop. 2011;31(6):710-715. doi:10.1097/BPO.0b013e318221eaa1
11. Jawadi AH, Al-Abbasi EM, Tamim HA. Factors predicting brace noncompliance among idiopathic clubfoot patients treated with the Ponseti method. J Taibah Univ Med Sci. 2015;10(4):444-448. doi:10.1016/j.jtumed.2015.06.003
12. Department of Orthopaedics and Traumatology, Harran University, School of Medicine, Sanliurfa, Turkey, Bozkurt C, Sipahioglu S, Department of Orthopaedics and Traumatology, Harran University, School of Medicine, Sanliurfa, Turkey. Effects of younger siblings on the brace compliance and recurrence in children with clubfoot during Ponseti treatment. Acta Orthop Traumatol Turc. 2021;55(2):102-106. doi:10.5152/j.aott.2021.20040
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16. Hu W, Ke B, Niansu X, et al. Factors associated with the relapse in Ponseti treated congenital clubfoot. BMC Musculoskelet Disord. 2022;23(1):88. doi:10.1186/s12891-022-05039-9
17. Van Schelven H, Moerman S, Van Der Steen M, Besselaar AT, Greve C. Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis. Acta Orthop. Published online October 5, 2021:1-9. doi:10.1080/17453674.2021.1982576
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How to Cite this article: Mauffrey O, Yu K, Choudhari M, Habig AL, Pugh A, Narotam V. Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoo. Journal of Clinical Orthopaedics January-June 2025;10(1):4-7.

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A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 38-44 | B S Océane Mauffrey, B A Kevin Yu, B S Malvika Choudhari, Ashley Lynn Habig, Vinay Narotam

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.712

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 14 Feb 2025, Review Date: 15 Mar 2025, Accepted Date: 28 Apr 2025 & Published Date: 30 Jun 2025

Author: B S Océane Mauffrey [1], B A Kevin Yu [2], B S Malvika Choudhari [1], Ashley Lynn Habig [3], Vinay Narotam [4]

[1] Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
[2] Department of Orthopaedics, University of North Carolina, Gillings School of Public Health, Chapel Hill, North Carolina, United States of America,
[3] Department of Orthopaedics, University of North Carolina, Undergraduate, Chapel Hill, North Carolina, United States of America,
[4] Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States of America

Address of Correspondence

Dr Océane Mauffrey,
Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
E-mail: oceane_mauffrey@med.unc.edu

Abstract

Objective: The Ponseti method is a widely adopted nonsurgical approach for correcting clubfoot deformities, but its success relies heavily on consistent brace usage during the maintenance phase. The present study seeks to analyze whether socioeconomic factors affect brace adherence in clubfoot patients.
Study Design: The present study was reviewed and approved by the Institutional Review Board. The charts of 83 patients treated for clubfoot by two providers at a single institution between 2013 and 2022 were reviewed to investigate the impact of various socioeconomic variables on brace adherence and its association with treatment outcomes. Brace adherence was determined based on provider documentation noting self-reported parental accounts of adherence. Annual family income was derived from North Carolina census data based on zip code. Chi-squared tests and two sample t-tests analyses were performed, controlling for clinical factors such as treatment strategy, comorbidities, laterality, and prenatal diagnosis.
Results: Patients from families with higher annual income based on zip codes demonstrated higher brace adherence rates. Patients from racial minority backgrounds exhibited reduced adherence with brace usage, likely in the context of greater obstacles to care. No significant correlations were found between brace adherence and distance to the hospital, gender, or language.
Conclusion: The findings highlight the multifaceted nature of brace adherence in clubfoot patients undergoing Ponseti treatment, suggesting the importance of addressing specific patient demographics, socioeconomic contexts, and caregiver support structures to optimize treatment outcomes. Further research involving a larger and more diverse cohort is necessary to validate these findings.
Keywords: Clubfoot, Social determinants of health, Clinical outcomes, Brace compliance.

References

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  3. Hordyjewska-Kowalczyk E, Nowosad K, Jamsheer A, Tylzanowski P. Genotype-phenotype correlation in clubfoot (talipes equinovarus). J Med Genet 2022;59:209-19.
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  5. Esparza M, Tran E, Richards BS, Jo CH, Shivers C, Karacz C, et al. The ponseti method for the treatment of clubfeet associated with amniotic band syndrome: A single institution 20-year experience. J Pediatr Orthop 2021;41:301-5.
  6. Stoll C, Alembick Y, Dott B, Roth MP. Associated anomalies in cases with congenital clubfoot. Am J Med Genet A 2020;182:2027-36.
  7. Rastogi A, Agarwal A. Long-term outcomes of the Ponseti method for treatment of clubfoot: A systematic review. Int Orthop 2021;45:2599-608.
  8. Al-Mohrej OA, Alshaalan FN, Alhussainan TS. Is the modified ponseti method effective in treating atypical and complex clubfoot? A systematic review. Int Orthop 2021;45:2589-97.
  9. Zionts LE, Dietz FR. Bracing following correction of idiopathic clubfoot using the ponseti method. J Am Acad Orthop Surg 2010;18:486-93.
  10. Johnson RR, Friedman JM, Becker AM, Spiegel DA. The ponseti method for clubfoot treatment in low and middle-income countries: A systematic review of barriers and solutions to service delivery. J Pediatr Orthop 2017;37:e134-9.
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  16. Bina S, Pacey V, Barnes EH, Burns J, Gray K. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev 2020;2020:CD008602.
  17. Recordon JA, Halanski MA, Boocock MG, McNair PJ, Stott NS, Crawford HA. A prospective, median 15-year comparison of ponseti casting and surgical treatment of clubfoot. J Bone Jt Surg Am 2021;103:1986-95.
  18. Švehlík M, Floh U, Steinwender G, Sperl M, Novak M, Kraus T. Ponseti method is superior to surgical treatment in clubfoot – long-term, randomized, prospective trial. Gait Posture 2017;58:346-51.
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  21. Hegazy M, El Barbary H, Hammoud M, Arafa A, Mohamed MT, Barakat AS, et al. The foot external rotation above-knee (FERAK) brace versus the Denis Browne brace for management of idiopathic clubfoot following ponseti casting: A randomized controlled trial. Int Orthop 2022;46:313-9.
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How to Cite this article: Mauffrey BSO, Yu BAK, Choudhari BSM, Habig AL, Narotam V. A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method. Journal of Clinical Orthopaedics January-June 2025;10(1):38-44.

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Evolution of Femoral Neck Implants: In Search of the Perfect Implant

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 01-05 | Sachin Kale, Arvind Vatkar, Sanjay Dhar, Pramod Bhor, Ashish Phadnis, Rohan Jayaram

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.640

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 11 Jul 2024, Review Date: 08 Aug 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024

Author: Sachin Kale [1], Arvind Vatkar [2, 3], Sanjay Dhar [1], Pramod Bhor [2], Ashish Phadnis [4], Rohan Jayaram [1]

[1] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India,
[3] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India
[4] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India

Address of Correspondence

Dr. Sachin Kale
Professor and Head of Unit, Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India.
Email: sachinkale@gmail.com

Abstract

Femoral neck fractures have significant orthopedic difficulty, particularly in younger patients with high-energy trauma. The femoral neck system improves rotational stability, allows for controlled dynamic compression, and is less invasive than cannulated cancellous screws. However, steep learning curves, more significant starting expenditures, and more long-term data still need to be addressed. Emerging technologies, such as robotic-assisted surgeries and personalized implants created with artificial intelligence and 3D printing, can transform fracture therapy by boosting accuracy, lowering complications, and improving patient-specific care. Future advances will improve results and patient happiness.
Keywords: Femoral neck fractures, femoral neck system, cannulated screws, rotational stability, angular stability, minimally invasive surgery, fracture fixation, osteoporotic fractures, clinical outcomes, implant innovations.

How to Cite this article: Kale S, Vatkar A, Dhar S, Bhor P, Phadnis A, Jayaram R. Evolution of Femoral Neck Implants: In Search of the Perfect Implant. Journal of Clinical Orthopaedics July-December 2024;9(2):01-05.

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