bluuebunny/crossref_metadata_2025 huggingface dataset:
Varus Proximal Femoral Osteotomy for hip Dysplasia in Adults
Authors: Ansari A. , Jones S. , Hashemi-Nejad A. , Catterall A.
Published: January 2018

A retrospective study was carried out to evaluate the role of varus proximal femoral osteotomy in relieving symptoms and improving function in adults affected by hip dysplasia. A group of 24 patients were identified that underwent 26 varus proximal femoral osteotomies between the period May 1979 and January 2001. All were investigated by dynamic hip arthrography to confirm restoration of congruency in the abducted position and the position of “best fit”. The mean age of the patients at the time of operation was 26 years (range 16 to 47) and the median duration of follow-up was 5.1 years (range 1.6 to 23.1 years). Clinical improvement was evaluated by determining the Harris Hip Score at the time of admission with a further assessment at the most recent follow-up. Additionally, radiological change was evaluated by measuring acetabular femoral head index, the centre-edge angle of Wiberg and the Tönnis grade of osteoarthritis. The results revealed an improvement in Harris hip score from a mean of 72.1 pre-operatively (range 58.8 to 88.53) to 96.83 at the most recent follow-up (range 85.1 to 100). The centre edge angle and acetabular head index also increased in all patients. The results were statistically significant (p value <0.05). The procedure was found to reduce discomfort and improve function in patients affected by hip dysplasia. No patients required further intervention to alter disease progression during the follow-up period. The best results were found when the operation was performed for long leg dysplasia. Only one patient required surgery for non-union at the osteotomy site. Varus proximal femoral osteotomy appears to be a good treatment option in young adults with hip dysplasia, even when early degenerative change is present.
Cup Inclination Angle of Greater than 50 Degrees Increases whole Blood Concentrations of Cobalt and Chromium ions after Metal-on-metal Hip Resurfacing
Authors: Hart A.J. , Buddhdev P. , Winship P. , Faria N. , Powell J.J. , Skinner J.A.
Published: January 2018

A cup inclination angle greater than 45 degrees is associated with increased wear rates of metal on polyethylene (MOP) hip replacements. The same maybe true for metal on metal (MOM) hips yet this has not been clearly shown. We measured the acetabular inclination angle from plain radiographs, and whole blood metal ion levels using Inductively Coupled Plasma Mass Spectrometry of 26 patients (mean Harris Hip Score 94 and mean time post op of 22 months) with Birmingham Hip Resurfacings.

We identified a threshold level of 50° cup inclination. Below this threshold, the mean whole blood cobalt and chromium were 1.6ppb and 1.88ppb respectively; above this threshold, the mean blood cobalt and chromium were 4.45ppb and 4.3ppb respectively. These differences were significant cobalt (p<0.01) and chromium (p=0.01). All patients above the threshold had metal levels greater than any of the patients below the threshold. For 14 patients, who returned one year later for a repeat blood metal level measurement, cobalt and chromium levels were very similar.

The effect of an acetabular inclination angle of greater than 50 degrees on wear rates of MOM hips, as measured through blood metal ion levels, appears to be similar to that seen with MOP hips. Additionally, our new analytical methods may allow blood metal levels to be used as a realistic biomarker of in vivo wear rate of MOM hips. The implication is that metal levels can be minimised with optimal orientation of the acetabular component.
Pseudoaneurysm of a Branch of the Profunda Femoris Artery following Distal Locking of an Intramedullary Hip Nail: An Unusual Anatomical Location
Authors: Rajaesparan K. , Amin A. , Arora S. , Walton N.P.
Published: January 2018

Vascular complications following internal fixation of trochanteric femoral fractures are extremely rare. Iatrogenic injury to the profunda femoris artery or one of its branches and resultant pseudoaneurysm formation has been documented, most commonly following sliding hip screw fixation and typically arises on the posteromedial aspect of the femur. We report an unusual variation, following proximal femoral nailing of an intertrochanteric femoral neck fracture, where the pseudoaneurysm presented four weeks following surgery on the posterolateral aspect of the femur. The mechanism of injury, clinical presentation and potential preventative measures are discussed.
The Polished Tri-Tapered Stem for Cement-In-Cement Revision Hip Arthroplasty, a Reliable and Reproducible Technique?
Authors: Young J. , Vallamshetla V.R.P. , Lawrence T.
Published: January 2018

The object of this study was to determine the short to medium term outcome of cementing a highly polished tapered implant into the old cement mantle once damaged cement is removed at the time of revision hip surgery. A consecutive series of 36 patients underwent c-stem cement-in-cement revision hip arthroplasty between June 2000 and April 2006. The primary outcome measure was the validated shortened Western Ontario and McMaster Universities (WOMAC) score, secondary outcomes were the Orthowave company patient satisfaction survey, radiological analysis, and general complications. The follow-up period was between 12 and 84 months (average 48.86 months). The mean post op WOMAC score at latest follow-up was 10.89 (0 to 29). Two patients died with their hip in situ. Two patients had radiological signs of prosthesis loosening on follow-up. Complications included: one sacral plexus palsy which had a partial recovery and one intra-operative periprosthetic fracture. One patient underwent cup revision for recurrent dislocation. Cement within cement revision hip arthroplasty using a highly polished tapered stem in the short to medium term provides satisfactory functional outcomes and is associated with a low complication rate and good survivorship.
Medium to Long Term Results of the Exeter Bipolar Hemiarthroplasty for Femoral Neck Fractures in Active, Independent Patients. 5–13 year follow-up
Authors: Miller D. , Choksey A. , Jones P. , Perkins R.
Published: January 2018

We present the clinical and radiographic outcome of 49 Exeter bipolar hemiarthroplasties for femoral neck fractures in 49 patients with a median age of 71 years at the time of operation. Median length of follow-up was 7.1 years (5 to 13). There was one dislocation, and one peri-prosthetic fracture. There were no revisions for infection, acetabular erosion or stem loosening. Twenty-six patients had died by the time of final follow-up with an overall 5 year cumulative survival of 60.2%. Thirty day mortality was 36% in patients with an ASA score of 3. We present excellent clinical and radiological medium to long term results with no evidence of acetabular erosion. However, careful patient selection is necessary to avoid high early mortality rates.
Quality of Life in Different Age Groups after Metal-On-Metal Hip Resurfacing Arthroplasty
Authors: Papavasiliou A.V. , Villar R.N.
Published: January 2018

Hip resurfacing arthroplasty is known to improve quality of life (QoL) and allow increased activity levels in young patients. It is, however, traditionally offered to the younger age group of patients, largely those aged under 60 years. We studied 42 consecutive patients (42 hips) aged 60 years or over (mean age 64) and 41 consecutive patients (42 hips) under this age (mean age 49), all of whom had undergone a metal-on-metal hip resurfacing arthroplasty. A modified Harris hip score was translated to QoL scores using the Rosser Index Matrix immediately pre-operatively and at six weeks, six months, one year and four years after surgery. We found a significant improvement in QoL for both groups (p<0.0001) but no difference between the two groups. The maximum improvement was reached one year after surgery. Implant survival at four years was also similar (97.6% for group I and 100% for group II).

We thus conclude that in carefully selected active patients aged 60 years and over, hip resurfacing arthroplasty provides significant and equal QoL improvement as it does for those under this age with similar implant survival. For this reason, age alone should not influence a surgeon's decision to proceed with a hip resurfacing arthroplasty.
Acute Q-fever and History Taking – a Lesson Learned
Authors: Chee Y. , Clayton R.A.E. , Watson D. , Porter D.E.
Published: January 2018

A 50-year-old patient underwent a routine primary total hip replacement. Soon after surgery, he developed acute respiratory failure from post-operative sepsis. His condition deteriorated rapidly despite supportive management and he required admission into intensive care unit for assisted ventilation. It took almost one week before the underlying cause of the deterioration was determined to be unrelated to complications of surgery. A diagnosis of Q-fever was made following detailed attention to the clinical history. Appropriate treatment was started and the patient made a full recovery. The diagnosis was confirmed later following discharge from hospital.
Fatal Fat Embolism following Femoral Head Resection in Total Hip Arthroplasty
Authors: Walker N.M. , Bateson T. , Reavley P. , Prakash D.
Published: January 2018

We report a rare complication during primary total hip arthroplasty. A fatal fat pulmonary embolism immediately followed removal of the femoral head, prior to further preparation of the acetabulum or femoral shaft. Fat embolism syndrome is a well-known complication during total joint arthroplasty, usually attributed to preparation of the femoral shaft, particularly intramedullary reaming and insertion of the prosthesis. These risk factors have previously been identified in the literature. We believe that this case highlights the need for further research to establish the intramedullary pressures during the processes of dislocation and resection of the femoral neck and the attendant risk.
Complete Transiliac Pelvic Osteotomy for Patients with Developmental Dysplasia of the Hip without Internal Fixation
Authors: Orhun Haldun , Gurkan Volkan , Bayhan Ilhan , Dursun Muhsin , Kilickap Cuma , Berkel Tugrul
Published: January 2018

Several problems are encountered with pelvic osteotomy in hip dysplasia including in-sufficient coverage, avascular necrosis, graft instability and fixation of secondary bone grafts. We evaluated results of pelvic osteotomy in 4–8 year olds in our institution. 44 cases of developmental dysplasia of the hip between 1994 and 1999 were reviewed. 14 hips in 12 patients were treated with a step-cut osteotomy and the results are discussed. The mean age was 5.6 (range: 4–8) years, and mean follow up was 87.7 months (60–120). The patients were followed up according to the Severin clinical assessment criteria, and their radiological findings were evaluated and classified in accordance with the Tonnis criteria. Radiologically, a marked correction was obtained in center-edge angle, which was increased to 22.30 from the preoperative value of -11.20. No graft shift or loss was observed in any cases. There was also no loss in coverage achieved by surgical intervention. Coxofemoral positioning was found to be normal in eighty percent of cases. 8% of cases had avascular necrosis. Full range of hip motion was achieved in 84% of cases, and 84% of cases exhibited negative Trendelenburg's sign. The modified osteotomy we describe eliminated the need for fixation and secondary surgery. Graft stability and bone conservation were achieved.
Magnetic Resonance Imaging with Gadolinium Arthrography to Assess Acetabular Cartilage Delamination
Authors: Zaragoza Edward , Lattanzio Pierre-Jean , Beaule Paul E.
Published: January 2018

Recent reports have demonstrated magnetic resonance imaging (MRI) as a promising technique in detecting articular cartilage lesions of the hip joint. The purpose of our study was to evaluate the diagnostic performance of MRI with gadolinium arthrography in detecting acetabular cartilage delamination in patients with pre-arthritic hip pain. 46 patients (48 hips) underwent surgical dislocation of the hip. Mean age was 38.8 (range 17–56). There were 26 males and 20 females. All patients had Magnetic Resonance Imaging with gadolinium arthrography (MRA) before undergoing open hip surgery where the acetabular cartilage was inspected. Acetabular cartilage delamination on MRA was seen on sagittal images as a linear intra-articular filling defect of low signal intensity >1mm in thickness on T1 weighted images and surrounded by contrast. On MRA all hips had a labral tear confirmed at surgery. At surgery 30 hips had evidence of acetabular cartilage delamination, 4 hips had ulceration and 14 had no articular cartilage damage. The majority of labral tears and cartilage damage were located in the antero-superior quadrant. The sensitivity and specificity of MRA detection of cartilage delamination confirmed at surgery were 97% and 84%, respectively. The positive and negative predictive values of the MRA finding were 90% and 94%, respectively. The presence of the acetabular cartilage delamination represents an early stage of articular cartilage degeneration. When evaluating a young adult with hip pain, labral tears in association with cartilage delamination should be considered. MRA represents an effective diagnostic tool.
Total Hip Arthroplasty for Displaced Fracture of the Femoral Neck using Size 32 mm Femoral Head and Soft Tissue Repair after a Posterior Approach
Authors: Konan Sujith , Rhee Shin-Jae , Haddad Fares S.
Published: January 2018

The optimal operative treatment of displaced sub capital femoral fractures in the elderly is controversial. Recently, randomised controlled trials have suggested a better outcome with the use of total hip arthroplasty (THA) to treat displaced intra capsular fractures of the femur for elderly patients in good health. However, overall there is limited evidence to support the choice between different types of arthroplasty. Dislocation remains a concern with THA, especially when a posterior approach is used. We analysed the outcome of twenty primary cementless THA using a posterior approach with soft tissue repair and a size 32 mm head in active elderly patients presenting with displaced intra capsular femoral neck fractures. We also compared the results with the outcome in a cohort of matched patients who underwent primary THA for osteoarthritis. Satisfactory results were noted in terms of pain control, return to pre-morbid activity and radiological evidence of bone implant osseointegration. The functional outcome in the fracture group was similar to the osteoarthritis group. In conclusion, with optimal patient selection THA seems to provide a good functional outcome and pain control in the management of displaced intracapsular femoral neck fractures. Use of 32 mm head and posterior capsule repair may reduce the high risk of dislocation noted with the posterior approach.
Medium-term Analysis of Modern Ceramic-On-Ceramic Bearing in THA
Authors: Aldrian Silke , Nau Thomas , Gillesberger Felix , Petras Nina , Ehall Reinhard
Published: January 2018

A variety of different bearing surfaces have been used to avoid osteolysis following hip replacement. We report a retrospective review of medium-term results of a modern ceramic-ceramic bearing (Biolox®, CeramTec, Plochingen, Germany) and uncemented components (Alpha Cera Fit® Alphanorm®, Lassnitzhöhe, Austria) in 107 hip arthroplasties. The clinical outcome based on serial radiographs and scoring was assessed with a minimum follow-up of 7 years (mean, 7, 6 years; range, 7, 1–8, 3 years). The average age of the patients at surgery was 64, 6 + 11, 7 years (range: 21–88 years). The mean Harris hip score was 90, 4 (range, 84, 7–99, 2). Three patients with an extra long femoral neck experienced fracture of the ceramic femoral head, resulting in cessation of use of this combination. Radiological evaluation did not reveal any signs of lysis or loosening. Massive heterotopic ossification was seen in three patients. Medium-term follow-up showed excellent clinical and radiological results. Continued follow-up will be required to determine if this ceramic-on-ceramic bearing is associated with extended survivorship.
The Complication Rate and Medium-Term Functional Outcome after Total Hip Replacement in Smokers
Authors: Khan L. A. Kashif , Cowie Jonathan G. , Ballantyne James A. , Brenkel Ivan J.
Published: January 2018

We aimed to study the effect of smoking on the complication rate and medium-term functional outcome after total hip replacement. 1767 patients undergoing a cemented THR in one hospital were followed up prospectively at 6, 18, 36, and 60 months. Harris Hip Scores, SF-36 scores and complications were recorded. There was no statistically significant difference in early complications and length of hospital stay between smokers and those patients who had never smoked. Smokers were less likely to require a blood transfusion and showed a statistically lower Harris Hip Score at six months but there was no difference seen at the subsequent time-points to five years after surgery. Smoking did not influence the complication rate or medium-term functional outcome at five years after total hip replacement.
Healing of the Ruptured Ligamentum Teres after Hip Dislocation - An Arthroscopic Finding
Authors: Schaumkel Janus V. , Villar Richard N.
Published: January 2018

Following recent advances in arthroscopy of the hip, interest has increased in injuries to the ligamentum teres and treatment strategies for them. Following a traumatic dislocation of the hip joint it is thought that the ligamentum teres is likely to be ruptured and it is thought that healing cannot occur because of the continued movement of the joint. We report on two patients with a past history of an established traumatic dislocation of the hip joint who were seen at subsequent hip arthroscopy to have a soft-tissue connection between the femoral head and the cotyloid fossa of the acetabulum. This suggests that the ligamentum teres has the potential to heal.
Partial Resurfacing with Varus Osteotomy for an Osteochondral Defect of the Femoral Head
Authors: Van Stralen Renee A. , Haverkamp Daniel , Van Bergen Christiaan J. A. , Eijer Henk
Published: January 2018

Osteochondral defects of the femoral head represent a major challenge and various modern treatment options exist. We report a 16-year-old male with a large (3 × 3cm) osteochondral defect of the femoral head that was treated with a partial resurfacing prosthesis combined with a high varus osteotomy, performed by surgical dislocation of the hip. Two years after surgery the patient was progressing well without complications.
Periprosthetic Femoral Fractures around Hip Arthroplasty: Current Concepts in their Management
Authors: Tsiridis Eleftherios , Pavlou George , Venkatesh Ram , Bobak Peter , Gie Graham
Published: January 2018

Peri-prosthetic fractures (PFF) are complex management problems in orthopaedic surgery. Their treatment has evolved with advances in principles of internal fixation and revision hip surgery. Current classification systems look at anatomical location, prosthesis stability and Bone quality. Recent evidence highlights the importance of fracture stability in treatment planning, the weaknesses of single plating, the increasing role of long stem revision and also the importance of Bone allografts. We present the principles of management of both intra and post-operative PFFs, including surgical techniques and published outcomes.
A New Classification System for the Adult Dysplastic Hip Requiring Total Hip Arthroplasty: A Reliability Study
Authors: Gaston Mark S. , Gaston Paul , Donaldson Peter , Howie Colin R.
Published: January 2018

Current classification systems used for developmental dysplasia of the hip (DDH) in adult patients about to undergo total hip arthroplasty use a combined assessment of the acetabulum and femur which ignores femoral geometry and problems related to reconstruction of leg length. Currently accepted systems are those of Crowe and Hartofilakidis; it is our opinion that they do not predict surgical difficulties encountered at total hip arthroplasty. We describe a new classification system for adult DDH that divides the acetabulum and femur into separate components. The acetabular classification comprises: AI: Dysplastic acetabulum; AII: The acetabulum associated with a low femoral dislocation; AIII: The post-surgical acetabulum, with (AIIIa) or without retained metalwork (AIIIb). The femoral classification consists of: FI: Dysplastic femur but contained within true or low acetabulum; FII: The high femur; FIII: Post-surgical femur, again with or without metalwork (FIIIa and FIIIb). 50 pre-operative radiographs of hips with DDH about to undergo total hip replacement were assessed by orthopaedic consultants, registrars and medical students. They were classified using the new system, Crowe and Hartofilakidis systems. Interobserver and intraobserever reliability was assessed using Fleiss' kappa coefficient with combined (acetabulum and femur) kappa scores for the new system of 0.69 for interobserver and 0.67 for intraobserver reliability. This equated to ‘substantial agreement’ according to Landis and Koch and the new system showed at least comparable levels of reliability to the Hartofilakidis and Crowe systems. We have demonstrated reproducibility of our new classification system for DDH in the adult population and believe it could provide useful information when planning arthroplasty and be used to predict technical difficulties and outcome.
Use of Irradiated Bone Graft for Impaction Grafting in Acetabular Revision Surgery: A Review of Fifty Consecutive Cases
Authors: Mehendale Sanchit , Learmonth Ian D. , Smith Evert J. , Nedungayil Suneel , Maheshwari Rohit , Hassaballa Mo A.
Published: January 2018

Impaction bone grafting is a useful technique in the armament of a revision hip surgeon. Traditionally fresh frozen allograft has been used for this technique. However there are concerns about the transmission of viral proteins and prions through this form of allograft. As a result irradiated bone graft has been favoured in some centres. There is no long term series describing the results of impaction bone grafting using irradiated bone. This paper reviews a consecutive series of 50 cases of acetabular revision surgery performed between 1995 and 2001 and followed up over a mean period of 45 months. The preoperative bone defect was graded by the Paprosky classification. There were 2 cases of type 1a, 9 type 2a, 15 type 2b, 7 type 2c, 10 type 3a and 7 type 3b. All cases were followed up clinically and radiologically. Case notes were reviewed for primary prosthesis, operative details and reason for revision. The radiographs were evaluated for signs of bone incorporation, remodelling, loosening and migration of the acetabular component. There were 5 cases of aseptic loosening at the end of the follow up period. One patient had recurrent dislocation and was revised. 20 cases (40%) showed changes suggestive of bone incorporation, while only 3 cases (6%) showed remodelling. Clinically a good or excellent outcome with absence of pain was achieved in 35 patients (70%).

The results suggested that acetabular impaction bone grafting using irradiated bone graft is comparable to fresh frozen allograft. The low percentage of remodelling remains a concern and warrants further studies.
Long Term Results of Cementless Total Hip Replacement for Reversal of hip Ankylosis
Authors: Rajaratnam Samuel S. , Sexton Shaun A. , Waters Tim S. , Walter William L. , Zicat Bernard A. , Walter William K.
Published: January 2018

Fifteen patients (16 hips) with an ankylosed hip joint for a mean of 36 years (3.5 to 65), had their hips converted to a cementless Total Hip Replacement (THR). They were followed-up for a median of 10.75 years (5.0 to 19) with none lost to follow-up. All patients showed improved mobility and function post-operatively. The Harris Hip Score improved from 70 (SEM 3.4) to 83 post-operatively (SEM 4.4), which was statistically significant (p < 0.05). There was one acetabular cup revision at 5 years post implantation for aseptic loosening. All other femoral and acetabular components remained clinically and radiographically well fixed. We conclude that a previously ankylosed hip can be effectively converted to a cementless total hip replacement with good long term results.
Early Failure of the Dual Coat Cormet 2000 Metal on Metal Acetabular Component
Authors: Dixon Sean M. , Jeavons Lisa , Reddy Ravi P. , Williams Dan , Fern E. Darren , Norton Mark R.
Published: January 2018

We report a 10% failure rate for aseptic loosening and overall revision rate of 15% at 5 years mean follow up in 190 patients using the Cormet 2000 Dual coat acetabular component. Between 2001 and 2004, the original Dual coat component was used in our region by 4 experienced arthroplasty surgeons. 142 were used with resurfacing heads. The average age was 54 and 99 were male. Revision for aseptic loosening was required in 20 cups (10%) at a mean interval of 23 months including five within 2 months. Persistent groin pain was seen in a further three patients who have declined further surgery. Failure of the backing of this implant to integrate reliably with bone has led to an unacceptably high early loosening rate of the original design which was phased out in 2003.
Hip Arthroplasty in a Patient with Congenital Pubic Diastasis and Bladder Exstrophy
Authors: Camera Andrea , Grappiolo Guido , Santoro Giuseppe
Published: January 2018

We report a total hip arthroplasty performed for arthritis and osteonecrosis in a patient with congenital pubic diastasis and bladder exstrophy. A satisfactory outcome was achieved after appropriate consideration of the technical and biomechanical issues involved.
Conservative Stems in Total Hip Replacement
Authors: Learmonth Ian D.
Published: January 2018

Arthritis of the hip primarily involves the joint surfaces. Intuitively the principal objective in the surgical management of arthritis is to replace the damaged articular surfaces. However, early attempts at conservative replacement failed both because of inadequate fixation and failure of the articulation. Conservative hip implants take less bone at the time of surgery and preserve bone in the longer term with more physiological loading. In addition, the implants are usually easier to insert with soft tissue sparing surgery. While these implants potentially offer an additional option in the surgical management of younger patients with arthritis, this advantage is negated if there is an unacceptably high incidence of premature failure. This paper explores the evolution and results of conservative total hip prostheses that culminated in the contemporary designs.
Impacted Bone Allografts and a Cemented Stem after Failure of an Uncemented Stem: Preliminary Results
Authors: Buttaro Martin A. , Marcos Lucas , Farfalli German , Comba Fernando , Piccaluga Francisco
Published: January 2018

We reviewed the results of impaction bone grafting technique and a cemented stem in 27 consecutive patients with a failed uncemented femoral component. At an average follow-up of 55 months (25 to 94) none of the femoral components were removed or revised because of aseptic loosening or deep infection. In one hip a non progressive radiolucent line was observed in Gruen zone 5 with no clinical evidence of failure. The average postoperative Merle d'Aubigné and Postel Hip Score was 5.8 points for pain, 5.5 points for mobility and 5.4 points for gait. Revision of a failed uncemented stem with impaction grafting technique provided pain relief and improved function. The rate of success and restoration of bone stock were encouraging at mid-term follow-up.
Early Results of a New Highly Porous Modular Acetabular Cup in Revision Arthroplasty
Authors: Ramappa Manjunath , Bajwa Ali , Kulkarni Ashwin , Mcmurtry Ian , Port Andrew
Published: January 2018

Background

The ‘Tritanium’® (Stryker, New Jersey, USA) highly porous acetabular cup is a new implant used in revision hip arthroplasty.

Aim

To determine the early results of this device.

Methods

A prospective study of 43 acetabular component revisions performed using the implant between March 2007 and February 2008 was undertaken. All procedures were performed at a single centre with standard approach and follow up.

Results

The mean age of patients at surgery was 66 years. Mean follow up was 18.2 months. AAOS classification revealed 17% type 1, 49% type 2, 24% Type 3 and 5% Type 4 defects at surgery. 5% had no bone defect. Bone graft was used to in 73% of patients. Mean Harris Hip Score improved from 68 pre-operatively to 86 at the last follow-up. Cup integration was seen in 95% of patients by 6 weeks. One patient with pelvic discontinuity had symptomatic aseptic loosening which was revised.

Conclusion

The ‘Tritanium'acetabular cup has been successful in achieving rapid osseointegration with few complications. The management of pelvic discontinuity continues to be a challenge.
Patient-Reported Outcome following Metal-On-Metal Resurfacing of the Hip and Total Hip Replacement
Authors: Hall David P. , Srikantharajah Del , Anakwe Raimond E. , Gaston Paul , Howie Colin R.
Published: January 2018

Patient-reported outcome and satisfaction scores have become increasingly important in evaluating successful surgery. This case-matched control study compared patient-reported outcome and satisfaction data following hip resurfacing and total hip arthroplasty. Thirty-three consecutive patients selected for hip resurfacing were compared with 99 patients undergoing cemented total hip replacement (THR), matched for age, sex and pathology. Participants completed a Short-Form 12 Health Survey (SF-12) and Oxford Hip Score questionnaire preoperatively and 6 months post operatively with an additional patient satisfaction questionnaire. There was no difference in length of hospital stay. While both groups reported improved outcome scores, multivariate regression analysis did not demonstrate any significant benefit for one group over the other. Both groups reported high levels of satisfaction, which tended to be better in patients undergoing hip resurfacing.
Radiographic Assessment of Biomechanical Parameters following hip Resurfacing and Cemented Total Hip Arthroplasty
Authors: Robb Curtis , Harris Richard , O'dwyer Kevin , Aslam Nadim
Published: January 2018

Resurfacing hip arthroplasty and total hip replacement both aim to restore anatomical parameters. Leg length and offset discrepancy can result in altered joint reaction forces, and are associated with increased wear, dislocation, and decreased patient satisfaction. This study assesses the accuracy of leg length and offset restoration after either a Birmingham Hip Resurfacing (BHR) or a cemented total hip replacement (THR).

Standardised antero-posterior radiography was performed on two groups of 30 patients with unilateral primary osteoarthritis undergoing either a cemented total hip or resurfacing. The normal contra-lateral hip was used as the control. Leg length and offset were measured pre-operatively with no significant difference between the two groups.

Cup offset, femoral offset, total offset and leg length of the prosthesis and normal side were measured by two observers and mean measurements were analysed by a paired t test.

Leg lengths in each group did not differ significantly from the normal side, THR 0.53 mm (95% CI -2.4 to 3.4 mm) but BHR implantation did result in mean leg shortening of -1.9 mm (95% CI -4.5 mm to 0.6 mm). Cup offset differed significantly from normal anatomy in both groups, as did femoral and total offset for the total hip replacement group. However, femoral offset was restored in the Birmingham resurfacing group. When the THR group was compared against the BHR group we found no difference between restoration of leg lengths (p = 0.21) and cup offset (p = 0.30) but femoral (p = 0.0063) and total offset (p = 0.03) were restored more accurately with a BHR.
Osteolysis of the Greater Trochanter following Reattachment of hip Abductors using Polyester Suture in Total Hip Arthroplasty
Authors: Kundra Rakesh K. , Karim Sabeeha N , Lawrence Trevor
Published: January 2018

We report a specific pattern of osteolysis around bone tunnels on the lateral cortex of the greater trochanter following abductor reattachment using a polyester suture.

Radiographs of 395 patients who underwent cemented THA during a four year period between 1999 and 2003 were reviewed. 27 patients had abductor reattachment using number 5 Ethibond™ suture through bone tunnels. These patients displayed a predominantly osteolytic pattern of bone reaction around the greater trochanter bone tunnels. All patients were subsequently reviewed in clinic at 4–7 years following surgery. Three patterns of response were observed around the bone tunnels.

Recognition of this unique osteolysis pattern may be important in the investigation of complications following cemented THA.
Late Instability of Bilateral Metal on Metal Hip Resurfacings Due to Progressive Local Tissue Effects
Authors: Killampalli Vijay V. , Reading Alexander D.
Published: January 2018

Reports have emerged of local debris consisting of metal particles, with the development of pseudotumours, pelvic masses, lymphocytic perivascular infiltration of tissue around the implant and a neo-capsule tissue reaction in metal on metal (MoM) hip arthroplasty. Steeply-inclined acetabular components a large abduction angle of more than 55 degrees along with a combination of small size component are likely to give rise to higher levels of metal ions. This report describes a case of localised tissue destruction of abductor muscle probably due to the metal debris causing late onset subluxation/dislocation of a hip resurfacing. Late instability of hip resurfacing should raise concerns relating to possible local tissue reaction and muscle damage, and early revision may be recommended.
Long-Stem versus Short-Stem Preformed Antibiotic-Loaded Cement Spacers for Two-Stage Revision of Infected Total Hip Arthroplasty
Authors: Romanò Carlo L. , Romanò Delia , Logoluso Nicola , Meani Enzo
Published: January 2018

Two-stage revision is the most widely accepted and performed intervention for chronically infected hip prostheses. In recent years short and long stem antibiotic-loaded preformed spacers have become available on the market. The aim of this prospective, comparative study was to assess the safety and efficacy of long stem versus short stem preformed spacers.

From year 2000 to 2007 102 consecutive patients underwent two-stage revision of septic hip replacement with a preformed antibiotic-loaded cement spacer and a cementless modular hip revision prosthesis. Patients were divided in two groups: Group L (long stem spacer) (N=60) and Group S (short stem) (N=42) and compared.

No systemic toxicity due to local antibiotic release and no spacer breakage were observed in either group. At spacer removal, no statistically significant difference was observed in infection recurrence. After revision, at a mean 4 years follow-up, 2 patients in Group L and 2 in Group S showed infection recurrence. The Harris Hip Score improved in both groups, compared to post spacer implant values: 79.6 ± 15.4 versus 38.4 ± 14.5 in Group L (p < 0.0001) and 82.3 ± 14.4 versus 44.8 ± 16.6 in Group S (p < 0.0001); the difference between groups was not statistically significant.

Short and long stem spacers provide comparable low infection recurrence rate and clinical outcome, with negligible risk of breakage and toxicity.
Retrograde Genocephalic Removal of Fractured or Immovable Femoral Stems in Revision Hip Surgery
Authors: Szendröi Miklós , Tóth Kálmán , Kiss János , Antal Imre , Skaliczki Gábor
Published: January 2018

Revision arthroplasty for femoral stem breakage can be challenging. We report a new method for the removal of the distal stem segment performed in 6 cases between 2004 and 2008. After extracting the proximal part of the femoral component, the femoral canal was opened at the knee joint and a modified intramedullary nail was used to dislodge the distal stem under fluoroscopic control. In five cases the surgery was uneventful. In one case femoral perforation occurred due to the contour of the cement mantle at the tip of the stem. In the postoperative period all patients progessed well. Removal of a broken stem using our method has limited indications, and it is not recommended in septic cases or when the cement mantle at the tip of the stem has an oblique contour. It also requires opening of the knee joint, but the technique is simple, saves surgical time and in selected cases it does not weaken the femur.
A Comparison of the Validity and Reliability of Established Bone Stock Loss Classification Systems and the Proposal of a Novel Classification System
Authors: Parry Michael C. , Whitehouse Michael R. , Mehendale Sanchit A. , Smith Lindsay K. , Webb Jason C. , Spencer Robert F. , Blom Ashley W.
Published: January 2018

The classification and management of aseptic loosening of total hip arthroplasty remains a distinct challenge to the modern orthopaedic surgeon. The aim of this study was to assess the inter-observer and intra-observer reliability of commonly used classification systems for the assessment of bone stock loss in revision hip surgery. Radiographs of 23 femoral and 32 acetabular components in 30 patients were assessed using the Paprosky, AAOS and Endo-Klinik classification systems. A novel classification system was introduced and also used to assess the radiographs. Assessment was undertaken by 3 surgeons on 2 separate occasions and the inter- and intra- observer reliability calculated. The novel classification system showed a good to very good intra-observer reliability for both femoral and acetabular components (0.77–1.0; p<0.001), performing better than the other systems assessed. The novel femoral system demonstrated moderate to good inter-observer agreement (0.46–0.73), performing as well as the Paprosky (0.63–0.80) and AAOS (0.63–0.68) femoral systems. The novel acetabular system demonstrated fair to moderate inter-observer reliability (0.35–0.51) performing better than the AAOS acetabular classification (0.07–0.10) and as well as the Paprosky acetabular classification system (0.59–0.60). We propose this novel system as an alternative method for assessing bone stock loss in revision hip surgery.
Seven to Twelve Year Results with Versys ET Cementless Stem. A Retrospective Study of 225 Cases
Authors: D'Angelo Fabio , Murena Luigi , Vulcano Ettore , Zatti Giovanni , Cherubino Paolo
Published: January 2018

A retrospective review was conducted to evaluate the mid-term results (8.5 years follow-up) of the Versys ET stem (Zimmer, Warsaw, Indiana, USA). From 1995 to 2000, 225 total hip arthroplasties (THA) were performed using this device. All patients were evaluated clinically by the Harris Hip Score, and radiographically. The Hip Score increased from 54 preoperatively to 97 points postoperatively. The stem displayed a varus alignment between 5° and 10° in 17 cases without any clinical consequences (HHS 96.8). We recorded one case of septic loosening and one case of aseptic loosening. The stability of the stem was radiographically evaluated according to Engh's criteria, confirming bone ongrowth in all other cases.
Treatment for Acetabular Dysplasia using the Uncemented RM Acetabular Component – a 20 Year Follow-Up
Authors: Ihle Martin , Mai Sabine , Siebert Werner E.
Published: January 2018

Our study reports a sub-group of patients with developmental dysplasia from a previously published larger series, with particular emphasis on the use of the uncemented RM acetabular component. We evaluated the long term results of 93 consecutive uncemented THAs in 80 patients using the titanium-coated RM acetabular component and the CLS femoral component in a prospective study. Eighteen hips in 16 patients had osteoarthritis secondary to developmental dysplasia of the hip. The mean follow-up was 19.6 years (18.2 to 20.9). Fourteen patients with 15 hips were clinically and radiographically examined and evaluated. Two patients with 3 hips died. No patient was lost to follow-up. No implant had to be revised, and no cases showed evidence of radiographic loosening. Nine acetabular components were not completely covered by host bone but this did not affect the outcome. At the latest follow-up the mean Harris Hip Score was 92 (81 to 100). The mean annual wear rate was 0.12 mm.

The RM acetabular component performed well over 20 years in this selected group of patients. Complete acetabular containment was not needed, thus allowing reliable reconstruction of the anatomical centre of rotation.
Can Introduction of an Uncemented, Hydroxyapatite Coated Hemiarthroplasty for Displaced Femoral Neck Fractures be Recommended?
Authors: Hansen SøRen Kring , Brix Michael , Birkelund Lasse , Troelsen Anders
Published: January 2018

The role of uncemented fully hydroxyapatite coated hemiarthroplasties for the treatment of displaced femoral neck fractures remains unclear. We investigated if complications, reoperations and mortality differed from that of cemented hemiarthroplasties. The study groups consisted of 78 cemented and 97 uncemented, hydroxyapatite coated hemiarthroplasties with minimum 1 year follow-up. The dislocation rate was 3% in both groups (p=0.84). Proximal femoral fracturing occurred in 1% in the cemented group and in 4% in the uncemented group (p=0.26). Reoperations were performed following 4% of procedures in the cemented group and following 2% of procedures in the uncemented group (p=0.48). Mortality rates did not differ statistically significant between groups. Outcomes were comparable. Introduction of an uncemented hydroxyapatite coated hemiarthroplasty for treatment of displaced femoral neck fractures can be recommended.
Arthroscopic Repair of Acetabular Chondral Delamination with Fibrin Adhesive
Authors: Tzaveas Alexandros P. , Villar Richard N.
Published: January 2018

Acetabular chondral delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but disrupted from the subchondral bone. Excision of chondral flaps is the usual procedure for this type of lesion. However, we report 19 consecutive patients in whom the delaminated chondral flap was re-attached to the underlying subchondral bone with fibrin adhesive. We used the modified Harris hip score for assessment of pain and function. Improvement in pain and function was found to be statistically significant six months and one year after surgery. No local or general complications were noted. Three patients underwent further surgery for unrelated reasons. In each, the area of fibrin repair appeared intact and secure. Our results suggest that fibrin is a safe agent to use for acetabular chondral delamination.
False Aneurysm of the External Iliac Artery Caused by Aseptic Loosening and Migration of a Cemented Cup
Authors: Nehme Alexandre H. , Matta Jihad F. , Moufarrej Nadim M. , Jabbour Fouad C. , Moucharafieh Ramzi C. , Feghaly Michel A.
Published: January 2018

A 79 year old woman with bilateral hip replacements presented with severe left thigh swelling, and life threatening hypovolemic shock. After adequate resuscitation, an angio CT scan of her pelvis showed a false aneurysm of the external iliac artery in proximity to a loose pegged cemented cup. A pelvic X-ray 6 years prior to presentation had revealed a medialized high riding pegged cemented cup with a loose cemented stem. Vascular reconstruction followed by revision of the left THA was necessary.
Acetabular Reconstruction Using Fresh Frozen Bone Allograft
Authors: Dua Aman , Kiran Krishna , Malhotra Rajesh , Bhan Surya
Published: January 2018

The success of total hip arthroplasty has led to a move toward operating on a wider and younger population. All implants have a finite useful life, and bone loss is associated with all major causes of failure. The use bone allograft, either morselized or structural has the aim of reconstituting the bone stock. We retrospectively reviewed the clinical and radiological results of 72 acetabular reconstructions both primary and revision, done at our institute between May 1999 and October 2004 with a minimum follow-up of one year. The Harris Hip Score (HHS) was calculated and follow-up radiographs were evaluated for graft incorporation; evidence of loosening and migration. Preoperatively 28 acetabular defects were type III (AAOS), 18 were type II, 16 were type I and 10 were type IV. 60 reconstructions were done using cementless acetabular prostheses, and the remaining twelve had cemented implants. Patients were followed up for an average of 30.69 months (range 12 - 64 months). The mean preoperative HHS was 36.13 points which improved to a mean of 81.6 points (range 61 to 91) at final follow-up. None of the patients required reoperation. Dislocation was the commonest complication (8 hips). Short and medium term results were encouraging with the use of this technique.
Is Kalamchi and MacEwen Group I avascular necrosis of the femoral head harmless in developmental dysplasia of the hip?
Authors: Ağuş Haluk , Ömeroğlu Hakan , Biçimoğlu Ali , Tümer Yücel
Published: January 2018

The aim of this clinical study was to evaluate the influence of Kalamchi and MacEwen group I avascular necrosis of the femoral head (AVN) on the radiographic and clinical outcomes in developmental dysplasia of the hip (DDH). Preoperative and follow-up (at 2–3, 4–6, 7–9 and 10–15 years of age) Sharp's acetabular angles (AA) and the final Wiberg's center-edge angles (CEA) and proximal femoral center-trochanter distances (CTD) of 13 hips with group I AVN (AVN group) were compared with measurements of 22 hips without AVN (control group). All hips were initially treated by the same soft tissue surgical procedure (posteromedial limited surgery) under the age of 18 months and were completely followed up to at least 10 years of age. Radiographic diagnosis of group I AVN was made between 6 and 12 months postoperatively. The period for complete radiographic recovery of group I ischemic changes was between 2 to 4.5 years. Preoperative mean AA values of both groups were similar. However, the mean AA was found to be worse in the AVN group than in the control group during follow-up. Control group hips had a better mean CEA and higher number of hips having normal CTD than the AVN group, at latest follow-up. In conclusion, when compared with uncomplicated hips, group I ischemic changes retard acetabular development and have quantitative unfavorable effects on lateral femoral head coverage and proximal femoral anatomy in DDH. In addition, the healing process in group I AVN patients is extended.
Long Term Preservation of Femoral Bone following Hemiresurfacing
Authors: Amstutz Harlan C. , Esposito Christina , Campbell Pat
Published: January 2018

Long term femoral fixation, bone remodeling and neck preservation are demonstrated histologically in three hips treated with hemiresurfacing. They were performed in young patients for Ficat stage III or early IV osteonecrosis as a “time buying procedure”. The cases were revised after 13, 16 and 22 years because of cartilage wear which was anticipated. One head was resurfaced using titanium and two with custom alumina ceramic components. Fixation was achieved using early bone cleansing and cementing techniques. Retrieval analysis found remarkable preservation of bone stock and viability without neck narrowing.
Surgical debridement with muscle flap transposition and systemic teicoplanin therapy for infected hip arthroplasty
Authors: d'Ettorre Gabriella , Marchetti Francesco , Ceccarelli Giancarlo , Gizzi Francesca , Tierno Francesca , Falcone Marco , Venditti Mario , Carlesimo Bruno , Vullo Vincenzo
Published: January 2018

The use of muscle flaps is now accepted as a method for coverage of infected wounds. To obtain complete eradication of infection following hip arthroplasty surgery is combined with antibiotic treatment. Aggressive debridment to remove devitalized tissue followed by vastus lateralis muscle flap transposition may improve the likelihood of success in certain challenging cases. We report two cases of prosthetic joint infection treated by aggressive debridment and vastus lateralis transposition with associated appropriate antibiotic therapy. Complete recovery of functional status was observed.