bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Investigation of Threaded Cup Performance during Insertion in Total Hip Replacement
Authors: Knahr K. , Portmann D. , Schmuki D. , Pospischill M. , O'Keane M. , Howald R.
Published: January 2018

Cementless threaded cups are often used in Europe on the acetabular side of a total hip arthroplasty (THA), with some products achieving excellent clinical results. Titanium and titanium alloys are nowadays accepted as the materials of choice for these implants. In contrast, however, there is no consensus about the ideal thread design. This in vitro and human cadaver study aimed to compare the insertion torques of commercially available threaded cups during insertion. The aims were (1) to see whether the clinical experience of surgeons using these cups specifically related to insertion torque could be reproduced in the experiment and (2) to assess whether or not the cup size and thread design has a statistically significant influence on the insertion torque. Using a biaxial testing machine the cups were screwed into pre-machined polyurethane blocks and the insertion torque was recorded by an appropriate sensor. Clear differences were seen between the four different designs. A variance analysis using statistical software showed that both the cup size (p=0.003) and the thread design (p=0.0009) significantly affect the insertion torque. The human cadaver study allowing a right-left comparison of two different cups within the same specimen confirmed the insertion torque data of the experimental study. In addition, the trends observed during the course of the insertion agreed with the clinical experience of the orthopaedic surgeons consulted as part of this study.
The CLS Uncemented Expansion Cup: Six Cases of Component Failure
Authors: Heilpern G. , Parker B.
Published: January 2018

We report six cases of fracture of the metal backing of the CLS expansion cup. The aim of this paper is to draw attention to this mode of failure and recommend that in cases of unexplained hip pain in those with a CLS acetabular component X-rays in at least two planes are performed.
Ultrasound Evaluation of the Hips and Histological Correlations in Ellis Van Creveld Syndrome
Authors: Portinaro N.M.A. , Polo R.M. , Pelillo F. , Gargan M.F.
Published: January 2018

Ellis van Creveld Syndrome (EVCs) is a chondroectodermal dysplasia. Its clinical picture includes a meso-acromielic limb dwarfism with normal spine, involvement of the teeth, hair and nails, polydactyly of the hands and feet and heart malformations. Ultrasonography compared with histology were used in the present study to evaluate neonatal ultrasonographic hip development and acetabular hysto-morphology in EVCs. A flat and abnormal acetabulum with small beta angles and non measurable alfa angles were detected at repeated ultrasonographic evaluations at birth and at four months, with irregular echoes spiking from the inner part of the sockets; the acetabular cavities contained large early ossified proximal femoral epiphyses. Histology was obtained from phalangeal growth plates of a surgically removed extradigit, stained with alcian blue/PAS and E.E.. The growth plates showed a distorted anatomy with irregular column formation and abnormal distribution of the hypetrophic cells. Ultrasound morphology corresponded to the altered growth plates seen at histology. Early detection of an abnormally early developed proximal femoral ossification centre could be considered a diagnostic feature of the syndrome especially when present in the prenatal period.
Major Bleeding after Drainage Lancet Vascular Injury in Total Hip Arthroplasty
Authors: Buttaro M. , Dobladez M. Robledo , Piccaluga F.
Published: January 2018

We report a patient who presented with acute hypovolemic shock due to massive bleeding through the suction drainage lancet holes three days after a total hip arthroplasty. Emergency digital arteriography revealed active bleeding of a perforating muscular branch of the profunda femoris artery located at the level of the lancet holes. Selective embolization with a microcatheter controlled the haemorrhage and avoided further surgical exploration, which could have demonstrated no active bleeding from the hip or pelvis.
Transient Pulmonary Embolism during Impaction Bone Grafting of the Femur
Authors: Dabke H.V. , Blundell C.M. , Hodgson J.D. , Calder D.A.
Published: January 2018

We report a case of pulmonary embolism occurring transiently during impaction of morsellized bone graft in the femoral medullary canal as a part of revision hip arthroplasty. To our knowledge this complication has not yet been reported during impaction bone grafting. Increased awareness would lead to use of monitoring devices and early intervention during revision hip surgery.
Fatal Toxic Epidermal Necrolysis: A Complication of Vancomycin Treatment for an Infected Hip Arthroplasty
Authors: Mundy G.M. , Birtwistle S.J. , Chave T.A. , Hutchinson P.E.
Published: January 2018

The incidence of MRSA or MRSE type infections involving hip prostheses is increasing. Treatment often involves removal of the prosthesis followed by a defined period of antibiotic treatment, prior to insertion of a second prosthesis. Vancomycin is often used in this setting. We report a fatal case of toxic epidermal necrolysis (TEN) in a patient receiving vancomycin following a first stage revision hip replacement. With the increasing use of vancomycin in revision arthroplasty cases, knowledge of this rare but commonly fatal side effect is important so that if it occurs, rapid and appropriate treatment may be commenced.
Total Hip Replacement: Results of a Postal Survey of Current Practice on the Cement Fixation of the Acetabular Cup in the UK
Authors: Mootanah R. , Ingle P. , Cheah K. , Dowell J. K. , Shelton J. C.
Published: January 2018

Previous finite element studies and laboratory investigations on reconstructed acetabulum joints show that long-term fixation of the acetabular cup in total hip replacements (THRs) is influenced by surgical fixation techniques. The aim of this study is to determine and understand the reasons of current practice in the cement fixation of the acetabular cup in THRs in the UK. Following a pilot study, a postal survey was carried out among 1350 orthopaedic consultants. Response rate was 40% and data obtained from the returned questionnaires provided information about the current practice of 431 consultants with an average of 16.5 years of experience and who perform an average of 55 cemented THR operations annually. The survey showed wide variations in the fixation methods of the acetabular component. 95% of the respondents use cement to fix the acetabular cup, 46% maintain the subchondral bone and 63% use a flanged acetabular cup. The numbers of anchorage holes drilled vary from zero to thirty-six and drill diameters vary from 2 to 15 mm. Anchorage hole depths vary from 3 to 20 mm. Given the variability of surgical fixation methods, further studies need to be carried out to determine how fixation techniques could be improved to increase the longevity of the acetabular component in THRs. Further investigations could lead to a better understanding of the factors that contribute to the stability of THRs.
Results of Hybrid Total Hip Replacement and Resurfacing - Is there a Difference?
Authors: Chirodian N. , Saw T. , Villar R.
Published: January 2018

Hip resurfacing has in recent years become increasingly popular as an arthroplasty technique, particularly amongst younger patients with more active lifestyles. The procedure has been heralded as a more conservative option, aimed at those wishing to continue strenuous work and recreational activities. Little evidence has appeared in the literature however, either with the results of resurfacing or comparing resurfacing to conventional total hip arthroplasty.

We compare the outcomes of a consecutive series of hybrid hip resurfacings against a similar series of conventional hybrid hip arthroplasties. In our series there was no difference in operation time, blood loss, or modified Harris Hip score at 12 months postoperatively. There was a small decrease in length of stay, which was not clinically significant. We conclude that whilst it has been previously shown that there is an overall preservation of bone stock following resurfacing arthroplasty, there is no evidence to back additional claimed benefits.
Hemiarthroplasty: To Cement or not to Cement? A Preliminary Report
Authors: Shewale S.B. , Pandit H.G. , Latham J.M.
Published: January 2018

Two hundred hemiarthroplasties were studied to compare uncemented Austin Moore and cemented Thompson's prostheses. The following variables were compared: pre-operative mobility, ASA grade, Abbreviated Mental test scores, surgeon grade, peri-operative mortality, infection rate, operation time, intra-operative fractures, dislocation rate, thigh pain and revision rate to total hip replacement. Both groups were comparable in all respects. The incidence of intra-operative fractures, infection, postoperative dislocation and conversion to Girdlestone arthroplasty was higher in the uncemented group. The mortality remained the same in both groups. The incidence of significant thigh pain was higher in the uncemented group (13%), of whom half (6%) had to undergo a conversion to a total hip replacement within the 24 months follow-up period. Our current study of changed practice concluded that cemented Thompson's prosthesis performs better than uncemented Austin Moore when the incidence of hip pain and subsequent conversion to a total hip replacement were considered.
Contamination of the Visors of Total Body Exhaust Suits in Total Hip Replacement Surgery
Authors: Allan D.B. , Wroblewski B.M.
Published: January 2018

We examined 40 visors, used with the Charnley helmets and the total body exhaust suits, for contamination with blood, fat, or washout fluids during primary and revision total hip arthroplasty. All visors showed droplet contamination. This was more extensive in revision surgery (55 droplets: mean) than in primary operations (20 droplets: mean). Surgeons undertaking total hip arthroplasty must have full-face cover.
Bilateral Simultaneous Iliac Dislocation of the Hip
Authors: Sen R.K. , Rajasekhar C. , Nagi O.N.
Published: January 2018

Traumatic anterior dislocation of the hip is an uncommon injury and bilateral anterior dislocation of the hip is still rare. A case is described of hitherto unreported simultaneous bilateral anterior iliac hip dislocation, complicated by fracture of the femoral head on one side. The extreme rarity of this fracture and the peculiar mechanism of injury (the treatment planning and the post reduction protocol) make this case worth reporting.
Rapidly Progressive Osteoarthrosis of the Hip
Authors: Thompson N.W. , Corr A.M. , Geddis C.J. , O'Brien S. , Beverland D.E.
Published: January 2018

A retrospective review of 991 primary total hip arthroplasties was performed to determine the incidence of rapidly progressive osteoarthrosis of the hip joint. Thirty-four patients (35 hips) were identified (3.5%). Females were predominantly affected (85%). A history of hypertension and regular non-steroidal anti-inflammatory drug use was significantly more common in those with rapid progression as compared to the normally progressive group. Transfusion requirements were also significantly greater for the rapidly progressive group. Patient age and operating time were both greater in those with rapid progression, but neither proved statistically significant. No significant difference was noted when comparing the affected side, body mass index or the pre-operative range of hip movements, ESR or Oxford Hip Score. From the radiographs, twenty cases were classified as type I (rapid), 11 type II (moderate) and 3 type III (delayed). Wear distribution was predominantly superolateral (85%) and anterosuperior (97%). All patients were treated by total hip arthroplasty. At latest follow-up (average, 18 months; range, 13–36 months) there was no significant difference in the Oxford Hip Score between the normally progressive and rapidly progressive groups. All radiographs were satisfactory. Total hip arthroplasty in these cases is technically challenging. When identified, such individuals should be given priority treatment due to the potentially rapid and extensive loss of bone stock that can occur.
Total hip arthroplasty with Boneloc cement: Unsatisfactory results in 163 hips after 9 to 11 years
Authors: Van Jonbergen J.P.W. , Anderson P.G. , Faber F.W.M.
Published: January 2018

Boneloc bone cement was introduced in the Netherlands in 1992. Inferior short-term results were reported which led to the withdrawal of Boneloc from clinical use in 1995. However, little is known about the long-term outcome of hip arthroplasties with Boneloc. Between April 1992 and August 1994, Boneloc was used in 163 Mallory-Head primary total hip arthroplasties in 163 patients. Follow-up analysis was performed in 2003. To date, 27 hips (17%) have been revised for aseptic loosening of the femoral component. Median time to revision was 5.5 years. Survival analysis based on revision for aseptic loosening showed 77% cumulative survival at 11 years. With revision for aseptic loosening and/or definite radiological loosening according to Harris as endpoint, cumulative survival was 59% at 11 years. In 27 of 43 patients with definite radiological loosening, a cement fracture was seen at a median of 2.9 years.

These results show failure of Boneloc cemented total hip arthroplasties occurring even during the later follow-up. Continuing periodic clinical and radiological examination is recommended.
Incidence of Early and Late Infection in Revision Hip Arthroplasty with Impacted Morsellised Bone Allograft Technique
Authors: El-Kawy S. , Hay D. , Acton D. , Drabu K.
Published: January 2018

We retrospectively reviewed 120 patients in order to establish the rate of early and late infection in patients who had undergone revision hip surgery using impacted morsellised bone allograft. Our study is based on clinical and radiological data for a period up to five years following surgery.

There was only one case of early superficial wound infection, which resolved following a course of antibiotics, and no cases of late infection in this series.

In our study the use of morsellised bone allograft does not appear to have any effect on the incidence of early or late hip joint infection provided contemporary measures are taken.
Success of Cannulated Screw Fixation of Subcapital Neck of Femur Fractures
Authors: Higgins G.A. , Sadiq S. , Waseem M. , Hirs P. , Paul A.S.
Published: January 2018

In this study we retrospectively reviewed 251 patients who had internal fixation for neck of femur fracture using cannulated screws. Twenty were lost to follow-up or died soon after surgery. The fracture was displaced in 114 (49.9%) and undisplaced in 117 (50.6%) patients. There were 65 males and 171 females with an average age of 75.7 years. Average follow-up was 12 months. Of the 117 patients with undisplaced fractures 75 (64.1%) healed uneventfully. Further surgery was performed in 21 (17.9%) patients. In the 114 patients with displaced fractures, satisfactory reduction was achieved in 74 patients and of these 54 had good screw placement. Fifty-one (44.7%) patients healed uneventfully. Twenty-two (20%) of the 114 displaced fracture patients required further surgery. Forty (35%) had an unsatisfactory reduction and, of these, 26 (65%) had poor screw placement. Re-operation rates were 17.9% and 20% respectively. The rate of AVN was similar in both fracture types (10.3%-11%), but the rate of non-union was four times higher (2.6%-11.5%) in displaced subcapital fractures. The most important factors within the control of the surgeon that influence the rate of healing are adequate reduction and correct placement of the screws. In this series the reduction was unsatisfactory in 40 (35%) cases of the displaced NOF fractures, and the screws were incorrectly positioned in 46 (40.4%) of the 114 displaced fractures compared with 11 (9.4%) of the 117 undisplaced fractures. This highlights the importance of adequate reduction to enable correct screw placement in displaced fractures.
Age Affects the Perception of Limb Length Discrepancy in Patients with and without a Total Hip Arthroplasty
Authors: Della Valle A. Gonzélez , Zoppi A. , Peterson M.G.E. , Salvati E.A.
Published: January 2018

The amount of lengthening or shortening that can be detected by patients before and after total hip arthroplasty has not been yet quantified. We studied the ability to detect limb length inequality in 194 patients with and without a total hip arthroplasty, match-paired for age and sex. None of the participants had clinical signs of lumbosacral pathology, spinal deformity, or fixed pelvic obliquity; and all had equal functional and actual limb length. The participants walked with shoes, with and without the addition of fixed insoles, to simulate 2.5, 5, 10 and 15 millimeters of shortening and lengthening of the tested limb. Lengthening and shortening were similarly detected. Younger individuals detected the differences better than older ones (p=0.001), and there was a significant correlation between the decade of life and the ability to detect a limb length discrepancy (r=–0.22; p=0.002). This study demonstrates that perception of limb length is affected by the age, with older individuals having less awareness of changes in limb length than younger ones.
Palacos and Peanut Allergy
Authors: Ganapathi M. , Jones M.W. , Pumphrey R.S.H.
Published: January 2018

Palacos cement contains peanut oil. The manufacturer's instruction states that its use is contraindicated in patients allergic to peanuts. Awareness of this fact by orthopaedic surgeons was evaluated by postal questionnaire, which showed that 73% of those responding were not aware. However, on the basis of the available evidence in the literature, the clinical relevance of the manufacturer's advice appears dubious.
Haematogenous Spread of Pulmonary Tuberculosis to a Hemiarthroplasty of the Hip
Authors: Deo H. , Clare A. , Khan F.
Published: January 2018

Tuberculosis (TB) in a joint arthroplasty is unusual, and is usually due to reactivation from a previously infected joint or rarely from endogenous spread. We present a patient with septic loosening of a cemented Thompson's hemiarthroplasty due to Mycobacterium tuberculosis infection seven years post-operatively. At the time of surgery he had no symptoms or signs of TB. There have been no such reported cases in the English medical literature.
Clinical Outcome Study and Radiological Findings of Zweymuller Metal on Metal Total Hip Arthroplasty. A Follow-up of 6 to 15 Years
Authors: Paleochorlidis Ilias S. , Badras Leonidas S. , Skretas Efstathios F. , Georgaklis Vasilios A. , Karachalios Theofilos S. , Malizos Konstantinos N.
Published: January 2018

We report the clinical and radiological outcome of 99 Zweymuller metal on metal total hip arthroplasties in 84 patients followed up prospectively for a mean period of 9.5 (range, 6–15) years. There were 29 (34.5%) male and 55 (65.5%) female patients with a mean age of 62.85 years (range, 50–70 years) at the time of surgery. All patients had osteoarthritis. One acetabular component and one stem were revised due to aseptic loosening. One femoral stem was revised due to a periprosthetic fracture. HHS score improved from a preoperative mean of 62.56 points (SD 8.87) to a final postoperative follow-up mean of 93.48 (SD 7.7). Cumulative success rate for both implants at 13 years, with aseptic loosening as the end point, was 97.05%, while for both implants at 13 years, with revision for any reason as the end point, it was 91.17%. Satisfactory results were observed with the use of this prosthesis.
Triple Pelvic Osteotomy for the Treatment of Residual Hip Dysplasia. Analysis of Complications
Authors: Vukašinović Zoran , Pelillo Francesco , Spasovski Duško , Šešlija Igor , Živković Zorica , Matanović Dragana
Published: January 2018

The aim of the paper was to present the results achieved with triple pelvic osteotomy in the treatment of residual hip dysplasia, with special interest in identifying recurrences and complications and how to avoid them. 60 patients (76 hips) with developmental dysplasia of the hip (DDH), treated by the triple pelvic osteotomy according to Tönnis and modified by Vladimirov, were included in the study. Hips were evaluated radiologically with the center-edge (CE) angle, break of the Shenton-Menard arch and index of acetabular depth by Heyman-Herndon, and functionally using the Harris Hip Score (HHS). The postoperative results showed an average increase of the CE angle by a mean of 23.5±9.28 degrees, with a highly significant difference between the preoperative and final postoperative findings (t-test, t=-20.85, p<0.01). The mean HHS significantly improved (p<0.01). Total complication rate was 13, 1%, divided in: 1,3% (one case) of triple nonunion of iliac, pubic and ischial bones, 7,9% (six cases) of double nonunion of pubic and ischial bones, 2,6% (two cases) of peroneal palsy and 1,3% (one case) of infection. In this study the triple pelvic osteotomy showed to be reliable for acetabular dysplasia in adolescent and young adult, alone or in association with proximal femoral osteotomy and/or great trochanter distal advancement.
Large Ball Metal on Metal Hips Obscure Cup Angle Measurement on Plain Radiographs
Authors: Hart Alister J. , Dandachli Wael , Schlueter-Brust Klaus , Henckel Johann , Cobb Justin
Published: January 2018

CT when compared to plain radiograph is known to be a more valid measure of acetabular component orientation. The validity of plain radiographs may be further compromised by large diameter metal femoral heads because of obscuration of the acetabular rim. We quantified this effect by measuring acetabular cup angles (inclination and version) of 49 metal on metal (MOM) hip resurfacings using plain radiographs and 3D CT based measurement. Bland-Altman plots revealed poor agreement between plain radiographic and CT based measurement with 2 standard deviation limits of agreements of: +7 to –15 degrees for cup inclination angle; and +16 to –31 degrees for cup version angle. The large differences between plain radiographic and CT measurement of cup positions are probably due to the large diameter metal femoral head that can obscure the cup margin. We have used a metal artefact reduction CT protocol with a 3D imaging software package to overcome this problem and measure cup position relative to the Anterior Pelvic Plane.
Changes in Whole Blood Metal Ion Levels following Resurfacing: Serial Measurements in a Multi-Centre Study
Authors: Isaac Graham H. , Siebel Thomas , Oakeshott Roger D. , McLennan-Smith Robert , Cobb Andrew G. , Schmalzried Thomas P. , Vail Thomas P.
Published: January 2018

Seventy-seven patients implanted with unilateral resurfacing prosthesis were recruited from four centres. Serial whole blood samples were collected and ion levels were analysed. In most cases, the ion levels stabilized by 3 months. The 24 month median ion levels were 1.49ug/l for chromium and cobalt. In approximately 50% of patients the increase in chromium and cobalt level was less than 1ug/l. There were 6 patients with abnormally high metal ion levels. Of these 4 were significant outliers, had high ion levels that became apparent between 12 and 24 months after implantation, and had a high cup abduction angle. Not all patients with high cup abduction angles demonstrated high levels. There were differences in ion levels between the four centres that correlated with variation in acetabular component placement. Variability in ion levels was seen with the same prosthesis, underscoring the importance of surgical technique, longitudinal analysis, and multi-centre trials.
Results of Total Hip Arthroplasties in the Young Patient; Further Evidence for a Barrier Against Articular wear Debris by Hydroxyapatite Coatings
Authors: Emans Pieter J. , Ten Broeke Rene H.M. , Van Mulken Jeroen M.J. , Kuijer Roel , Van Rhijn Lodewijk W. , Geesink Rudolph G.T.
Published: January 2018

We examined the hypothesis that the circumferential osseous apposition around HA-coated implants forms a protective barrier against articular wear debris. Sixty-five hydroxyapatite-coated total hip arthroplasties in 57 patients (age <50years) with polyethylene-metal articulation were evaluated regarding PE-wear, osteolysis, and clinical outcome at a minimum of 10 years follow-up.

There was no correlation between PE-wear and osteolysis of the femoral zones or cup zones I and III. A strong Pearson correlation was found between polyethylene wear and osteolysis around cup zone II, where the cup only consisted of polyethylene (p<0,01). The aseptic failure rate was 1.5% for the femoral component and 4.5% for the cup after 10 years of follow–up. The average Harris Hip Score was 90 and the average Engh score for fixation was 23 after 10 years. Around HA-coated parts of the prosthesis bone formation remained stable, regardless of the degree of polyethylene wear. The average linear polyethylene wear was 0,16 mm/year.

The circumferential osseous apposition of the HA-coated implants possibly formed a protective barrier against articular wear debris. The use of cups with a backside gap resulted in PE-wear associated osteolysis in cup zone II and may be considered to be best avoided.
Midterm Results of Cementless Total Hip Replacement in Rapidly Destructive Arthropathy and a Review of the Literature
Authors: Peters Karin S. , Doets H. Cornelis
Published: January 2018

Background and Purpose

Rapidly destructive arthropathy (RDA) of the hip is a disease of unknown etiology characterized by a rapid destruction of the acetabular and femoral aspects of the hip joint. The purpose of this study was to assess the outcome of cementless total hip replacement in this category of patients.

Methods

A prospective study was performed of all cases of rapidly destructive arthropathy treated by cementless total hip replacement between 1998 and 2005. There were 6 female patients (8 hips) meeting the criteria of RDA. Median age at surgery was 74 years (range 64–83). Using the Paprosky classification of acetabular defects, five hips had a type 2B acetabular defect and three a type 3A acetabular defect. In all cases a cementless prosthesis was used. In two cases a shelf plasty of the acetabulum was added. Radiographic and clinical follow-up was performed up to 9 years postoperatively (mean follow-up 69 months, range 24–104 months).

Results

At radiographic follow-up, no signs of prosthetic loosening or migration were seen. Harris Hip Score improved from 25.8 (SD 7.3, range 11–34) preoperatively to 88.3 (SD 9.7, range 71–98) at latest follow-up.

Conclusion

Cementless total hip replacement in patients with rapidly destructive arthropathy led to a good result in a series of eight cases at midterm follow-up.
8-Year follow-up after Cementless Hip Arthroplasty with a Second Generation Spongy Metal Total Hip Replacement
Authors: Gollwitzer Hans , Gerdesmeyer Ludger , Horn Carsten , Diehl Peter , Töpfer Andreas , Gradinger Reiner
Published: January 2018

We studied a consecutive series of 81 cementless total hip arthroplasties in 80 patients using the second generation ESKA cementless spongy metal hip replacement. The study end-point was implant revision and both function as well as satisfaction with treatment outcome were assessed.

Mean age at the time of surgery was 50.9 years [range 23–73]. No patient was lost to follow-up and 75 patients (76 hips) could be included in the final analysis at a mean follow-up of 7.9 years [range 7.0–10.0]. Survival rate without loosening as the end-point was 100% for the femoral component and 99% for the acetabular component (one cup revision). Two cups and one stem had to be revised for recurrent dislocation, resulting in a total implant survival at follow-up of 99% for the femoral component and 96% for the acetabular component. Very good functional results were obtained with a mean Merle d' Aubigné score of 15.5 ± 2.9 at 7.9 years after surgery. Satisfaction with treatment outcome was reported in 88%. 95% of patients would recommend the performed procedure to a friend. Perioperative complications without revision occurred in eleven patients (14%).

We report excellent survival rates of the cementless spongy metal hip arthroplasty at a mean follow-up of eight years, particularly considering the young age of many of the patients.
Early Results and Patient Satisfaction after Total Hip Arthroplasty using a Minimally Invasive Anterolateral Approach
Authors: Walde Tim Alexander , Blattgerste Dirk , Sehmisch Stefan , Kuttler Wolfgang , Walde Hans-Joachim , Köster Georg
Published: January 2018

Rehabilitation and patient satisfaction following a modified anterolateral approach for implantation of a total hip replacement (THR) were reviewed following 72 consecutive cases.

The Harris Hip and merle d'Aubigné Scores were recorded at 6 and 12 weeks postoperatively. The patient's satisfaction with regard to the surgical result and the need for analgesia for mobilization were recorded. Rehabilitation was assessed by postoperative crutch use.

Significant improvements of the Harris Hip and merle d'Aubigné scores were demonstrated. All patients thought their surgical outcome was good or better. 2 patients needed pain medicine on an irregular basis and 4 patients used crutches at 12 weeks.

This study demonstrates patient satisfaction and satisfactory rehabilitation following a modified anterolateral approach for minimally-invasive implantation of THR.
A New Radiographic Method of Measuring Femoral Offset. The Sundsvall Method
Authors: Kjellberg Martin , Englund Erling , Sayed-Noor Arkan S.
Published: January 2018

Restoring femoral offset (FO) is an important factor for the success of total hip arthroplasty (THA). However, earlier methods of measuring FO do not take in consideration the positioning of the acetabular component. In this study we introduce and evaluate a new radiological method of measuring FO as the horizontal distance between the femoral axis and the midline of the pelvis, at the height of the lateral tip of the greater trochanter.

Ten patients operated with THA underwent a plain radiographic examination of the pelvis (AP view) and a CT scanogram for the pelvis and lower limbs (scout view). The radiological FO measurement using the new method was initially compared to FO measurement on CT scanogram and subsequently to the traditional radiological method of measuring FO. We tested the interobserver reliability and the intraobserver reproducibility of the new method.

We found an excellent agreement between the new radiological method and the CT measurement and between the new radiological method and the traditional radiological method. We also found an excellent interobserver reliability and an intraobserver reproducibility of the new method. We believe the new method is easier than and as reliable as previously described methods.
Femoro-Acetabular Impingement: Can Indirect MR Arthrography be Considered a Valid Method to Detect Endoarticular Damage? A Preliminary Study
Authors: Pozzi Grazia , Stradiotti Paola , Parra Cleber Garcia , Zagra Luigi , Sironi Sandro , Zerbi Alberto
Published: January 2018

To assess the effectiveness of indirect Magnetic Resonance arthrography (i-MRa) in the detection of chondral and labral lesions related to femoro-acetabular impingement (FAI) a series of 21 hip joints in 17 patients with a clinical diagnosis of FAI were examined either with standard MR imaging, i-MRa and direct-MR arthrography (d-MRa). Sensitivity and accuracy of i-MRa in detecting chondral, labral and tardive lesions were calculated and compared with standard MR. The agreement in detecting endoarticular damage between i-MRa and d-MRa and the interobserver agreement was assessed by K statistic (p<0.05). Finally the presence of trocanteric bursitis was evaluated. I-MRa showed higher values of both sensivity and accuracy than standard MR in detecting chondral damage, with an increase to 92% for the first item and 95% for the second. The same was noticed in labrum evaluation with an increase to 88% and 90% respectively. The level of agreement between i-MRa and d-MRa in detection of chondral lesions was excellent, substantial for the labral damage and absolute for early osteoarthritic changes. An excellent interobserver agreement resulted in detection of both chondral and labral damages with i-MRa. In 6 hips (28,5%) we also found the presence of peri-trochanteric soft tissue inflammation that indicated the possibility of extrarticular involvement in FAI. Indirect-MRa can be considered a valid method of assessing endoarticular damage related to FAI, in comparison to d-MRa. It should be performed instead of standard MR if d-MRa is not available.
Early Catastrophic Failure of a Porous-Coated Acetabular Cup due to Bead Shedding. A Case Report
Authors: Hsu Andrew R. , Vaughn Zackary , Huddleston James I.
Published: January 2018

We present a patient in whom an uncemented porous-coated acetabular cup underwent early catastrophic failure due to debonding and was successfully managed with a revision total hip arthroplasty. Early bead shedding of an acetabular cup leading to a sudden component failure requiring revision surgery is a rare event.
Strategies of Hip Management in Neuromuscular Disorders: Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita
Authors: Canavese F. , Sussman M. D.
Published: January 2018

Joint contractures, subluxation and dislocation are common problem in children with neuromuscular disorders. Medical, surgical and rehabilitative approaches can be used to maintain patient function and comfort. Contracture release, hip dysplasia correction and procedures to address or prevent hip subluxation or dislocation, are not always necessary since patients can be asymptomatic and surgical treatment will not always be successful in maintaining a reduced hip. In fact, controversy surrounds the management of hip disorder in children with Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita.

Patients with neuromuscular disorders also frequently develop a progressive scoliosis with pelvic obliquity which may affect sitting balance and become painful. Most subluxations and dislocations have the tendency to occur on the high side of a tilted pelvis. Spinal stabilisation is sometimes necessary to improve the pelvic tilt and to prevent further increase.

The present article provides an overview of the current strategies of hip management in neuromuscular disorders.
Strategies of Hip Management in Myelomeningocele: To do or not to do
Authors: Swaroop V.T. , Dias L.S.
Published: January 2018

Paralytic hip dislocation in myelomeningocele is common and can be a complicated problem. This review summarizes results of surgical techniques employed in this patient population in order to achieve and maintain reduction of paralytic hip dislocations. This review also examines the controversial question of whether or not hip surgery in patients with myelomeningocele provides improved functional results. Finally this paper suggest appropriate goals and recommendations for treatment of the paralytic hip dislocation in myelomeningocele.
“Postural Management” to Prevent Hip Dislocation in Children with Cerebral Palsy
Authors: Picciolini O. , Albisetti W. , Cozzaglio M. , Spreafico F. , Mosca F. , Gasparroni V.
Published: January 2018

Muscolo-skeletal disorders and hip deformity play a key role on future development of motor and adaptive functions in children with cerebral palsy (CP). Lateral migration of the femoral head increases on average 7.7% per year and may progress in association with acetabular dysplasia to hip dislocation. Conservative preservation of muscle length and balance may prevent or reduce femoral head migration and acetabular dysplasia.

Equipment for position lying, sitting, and standing is an established method of maintaining muscle length and joint range. French approach (Le Métayer et al) include the use of customised plaster cast orthoses, for sitting and standing positions, called siège moulé and gouttière, tailor-made according to the child's muscolo-skeletal characteristics and motor abilities.

At our department, hips with clinical and radiological evidence of displacement unresponsive to pharmacological and surgical treatment were treated with postural management. The two cases we show in this paper underwent a physiotherapy programme (neurodevelopment treatment) twice a week and a seated postural programme 5 hours a day with the siège moulé. Hip radiographs were measured with the migration percentage (MP) described by Reimers.

The follow-up measurements showed a progressive reduction of MP values of the hip treated, confirming the significant benefit from the combined non surgical approach.

The study supports the evidence that conservative management of hip deformity with siège moulé can be successful if implemented before the development of hip dysplasia.
Relationship between Kinematic Knee Deviations and Femoral Anteversion in Children with Cerebral Palsy
Authors: Piccinini L. , Cimolin V. , Turconi A.C. , Galli M.
Published: January 2018

The aim of the study was to determine the possible correlation between the degree of femoral anteversion and the quantitative data obtained by 3D Gait Analysis (GA) and then to investigate the relationship between femoral anteversion and the reduced knee flexion during swing phase in children with Cerebral Palsy.

Twenty-seven diplegic children with severe rectus femoris spasticity and 20 healthy children (CG) were considered. Clinical evaluation of femoral anteversion, Duncan Ely test and Gait Analysis were performed in all patients. From Gait Analysis data some indices were identified and calculated and statistical analysis performed.

Clinical evaluations made the distinction between patients with excessive femoral anteversion (Group 1) and those with normal value (Group 2). Both groups showed a blunt maximum of knee flexion in swing (KMSw), representative of rectus femoris spasticity, but two different gait strategies were found for the timing of KMSw. Group 1 exhibited a reduced KMSw value with its timing close to normal value and an excessive hip internal rotation (Mean Hip Rotation index), correlated to high femoral anteversion; Group 2 presented a limited KMSw and a significant delay of its timing, with Mean Hip Rotation index close to Control Group. No differences were found for other indices.

The results demonstrated that the presence of reduced KMSw only can be directly connected to excessive femoral anteversion; the coexistence of reduced KMSw and its delayed timing reveals that the rectus femoris spasticity may be due to rectus spasticity added to an incorrect motor selective control. The results are clinically crucial for treatment strategies (derotative femoral osteotomy vs rectus transfer).
D.D.S.H.: Developmental Dysplasia of the Spastic Hip: Strategies of Management in Cerebral Palsy. A New Suggestive Algorithm
Authors: Portinaro N. , Panou A. , Gagliano N. , Pelillo F.
Published: January 2018

Hip problems in cerebral palsy are relatively frequent (25–75%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to alteration caused by spastic muscle forces acting on the femoral head in the acetabular cavity.

The EMMA approach (Early Multilevel Minimally-invasive Approach) has been designed to restore muscle balance, decrease hip migration and prevent bone deformities thereby avoiding future pain with minimal biological cost to the patient. EMMA is suitable for most patients, especially those with increased tone, poor muscle control and selectivity, Reimer Index (R.I.) 20%.

We consider age and R.I crucial prerequisites for treatment steps.

EMMA 1) age 2–4 years, RI 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures).

EMMA 2) age 4–6, RI 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction).

EMMA 3) early bone surgery (growth plates).

This approach has been adopted in the last 4 years to prevent bone deformities and give early mobilisation and early control of the pain. EMMA is simple to apply even in infants, both for hip containment and to decrease spasticity.
Mid-Term Results of an Uncemented Femoral Stem with Modular Neck Options
Authors: Benazzo Francesco , Rossi Stefano M.P. , Cecconi Davide , Piovani Lucio , Ravasi Flavio
Published: January 2018

We prospectively assessed the results of 239 primary total hip replacements performed using a conical stem combined with modular necks of different lengths and inclinations (Modulus System, Lima Corporate San Daniele Del Friuli, Udine, Italia) in 222 patients (50 men, 172 women), undergoing surgery between October 2001 and December 2006 and presenting with anatomical deformities of the proximal femur and/or acetabulum, including developmental dysplasia (DDH), ankylosis, and sequelae of osteotomies or fractures. Such conditions can make hip replacement problematic.

The mean age at the time of surgery was 57.6 years (22 ÷ 83). No patients were lost to follow-up. 3 femoral components underwent revision.

At a mean of 5 years follow-up the Harris Hip Score showed a significant improvement, increasing from 35 preoperatively to a mean of 96.6. Using Kaplan-Meier analysis the survival rate at 5 years was 98.28%.

The Modulus stem showed good mid-term results in terms of survival, as well as clinical and radiographic outcome.
The use of a Constrained Cementless Acetabular Component for Instability in Total Hip Replacement
Authors: Rady Ahmad Emad , Asal Mohammed Kamal , Bassiony Ayman Abdelaziz
Published: January 2018

Recurrent dislocation after total hip arthroplasty is a disabling complication that can be difficult to treat. We evaluated the early clinical and radiographic outcome associated with the use of a constrained acetabular component for instability in total hip arthroplasty

Fifteen patients underwent either primary or revision total hip arthroplasty with a cementless constrained acetabular component for different indications. The mean patient age at surgery was 57.4 years and the mean clinical and radiological follow-up period was 26.4 months. Clinical assessment was performed by the Harris hip score and at the latest follow up patients reported outcome using the Oxford hip score questionnaire. All radiographs were evaluated for evidence of loosening.

Only one patient experienced redislocation with the constrained prosthesis. The average Harris hip score increased from a preoperative mean of 22 (range, 16 - 36) to a postoperative mean of 85 (range, 66–94). Preoperatively, the mean Oxford Hip Score was 48.6, which decreased to 20.5 at the final examination. All but one of the 15 hips had a well-fixed, stable cup. Femoral component stability with bone ingrowth was achieved in 10 cases.

A constrained acetabular component is an effective option for the treatment of hip instability in primary and revision arthroplasty in those at high risk of dislocation. The potential for aseptic loosening requires evaluation by long term studies.
One Stage Bilateral Total Hip Arthroplasty, is it Safe? A Meta-Analysis
Authors: Haverkamp Daniël , van den Bekerom Michel P.J. , Harmse Ivo , Schafroth Matthias U.
Published: January 2018

Controversy has prevailed for many years relating to the safety of one-stage and two-stage total hip arthroplasty (THA) for bilateral disease. We performed a meta-analysis of 1460 studies of which 5 prospective studies met our inclusion criteria. A total of 579 patients had two-stage procedures and 334 had one-stage surgery.

The studies showed a low heterogeneity (I2 =0%) allowing pooling of data. No differences were found in the incidence of major complications (odds ratio 0.72 95%CI: 0.45–1.15). One-stage bilateral THA may therefore be a safe procedure.
Gait Analysis in Adults with Severe Hip Dysplasia before and after Total Hip Arthroplasty
Authors: Marangoz Salih , Atilla Bülent , Gök Haydar , Yavuzer Güneş , Ergin Süreyya , Tokgözoğlu A. Mazhar , Alpaslan Mümtaz
Published: January 2018

Anatomical reconstruction of high riding hips by total hip arthroplasty (THA) and subtrochanteric shortening osteotomy aims to normalise gait pattern and improve functional hip scores. We present the medium-term clinical results of a group of patients with high riding dislocated hips in whom a cementless THA and subtrochanteric shortening osteotomy had been performed. We compared them with their preoperative status, with patients who had undergone a cementless THA for primary osteoarthritis, and also with a group of healthy gender and age-matched controls.

Prospective computerized, three-dimensional gait analyses were performed in 8 female patients with uni-/ or bilateral severe developmental dysplasia of the hip (Group I). Gait analysis was performed preoperatively and at a mean of 12.5 months postoperatively. A group of 8 individuals who received cementless hip replacement for primary osteoarthritis (Group II), and a control group of 8 able-bodied individuals (Group III) were recruited for comparison.

Patients in Group I improved and approached the values of Group II. However both were behind Group III. Limb length discrepancy was reduced from a mean of 4.3 cm (range, 1 – 8 cm) to a mean of 0.8 cm (range, 0 – 2 cm) at the latest follow-up.

Pain was reliably relieved and activities of daily living were improved in patients with high riding developmental dysplasia of the hip, but they were still behind the normal population average. Nevertheless, the results can be as satisfactory as those in patients who undergo a THA for primary osteoarthritis.
Perception of Imposed Leg Length Inequality in Normal Subjects
Authors: O'Brien Seamus , Kernohan George , Fitzpatrick Claire , Hill Janet , Beverland David
Published: January 2018

Lower limb length differences of up to 10mm exist in 60% - 95% of the population. There are usually no symptoms or functional effects. Following Total Hip Arthroplasty (THA), satisfactory clinical results can be spoiled by dissatisfaction due to a change in leg length. Although the change in leg length may be modest in comparison to the normal variation, the patient may perceive this as a leg length discrepancy.

To study the average threshold for perception, artificial leg length discrepancies of 5 mm to 25 mm were created in 30 young healthy adults using calibrated wooden blocks. Responses were recorded and analysed using a chi-squared test for independence and an independent measures t-test. Awareness of leg length discrepancy was related to the magnitude of the discrepancy (X2 (15)= 156.6, P<0.05 on the right side, and X2 (15)= 178.725 P<0.05 on the left side). It was shown that no subject reported a 5mm increase in leg length to be uncomfortable while all subjects were aware of leg length discrepancies of 20 mm and 25 mm. When there was a discrepancy of 10 mm in either lower limb, 29 out of 30 subjects (96.7%) thought there was a difference in leg length. Consequently it is suggested that during total hip arthroplasty the surgeon should aim for a leg length discrepancy of less than 10 mm.