bluuebunny/crossref_metadata_2025 huggingface dataset:
Internal fixation of displaced femoral neck fractures in patients older than 70 years
Authors: Cordero-Ampuero J. , García-Cimbrelo E. , Munuera L.
Published: January 2018

Introduction:

To analyse results and risk factors for osteosynthesis of displaced femoral neck fractures in patients older than 70 years.

Patients and Methods:

From 1992 to 2000, 183 consecutive patients over 70 with displaced femoral neck fractures were treated by closed reduction and fixation with cannulated screws and followed up prospectively for two years. Pain at rest and pain with walking, return to previous functional and walking ability, and need for additional surgery were evaluated.

Results:

Six patients died, while 149 were followed up for a minimum of two years: 82 (55%) were asymptomatic, 19 (12.8%) had mild pain, 39 (26.1%) required arthroplasty and 9 (6%) were too ill for further surgery. Poor quality reduction (p=0.008) and poor quality osteosynthesis (p= 0.064) were risk factors for failure. Fifty patients (33.6%) presented with non-union: 6/50 were asymptomatic, 34/50 required arthroplasty, and 10/50 were very ill. Ischaemic necrosis appeared in ten cases (6.7%) (five asymptomatic and five requiring arthroplasty).

Conclusions:

Reduction and fixation of displaced femoral neck fractures achieved good results in 68% of patients over 70, but re-operation became necessary in 32% of them; this made internal fixation advisable only for selected patients who were very active. The main risk factors were poor-quality reduction followed by poor osteosynthesis.
Clinical and radiological results of impaction bone allograft technique in acetabular revisions associated with massive bone stock deficiencies: Four to seven years follow-up study
Authors: El-Kawy S. , Hay D. , Drabu K.
Published: January 2018

Introduction:

We conducted this retrospective study to evaluate the medium-term results of impaction bone allograft technique when used on its own with cemented cups in acetabular revisions associated with massive bone loss.

Patients and Methods:

This study involved 28 hips in 27 patients classified as severe acetabular deficiencies (Paprosky type 3) secondary to aseptic loosening. All were revised with impacted morsellised bone allograft using fresh-frozen and freeze-dried bone together with cemented rim bearing UHMWP (28 mm I.D.) cups and followed for an average of 72 months (range 48 to 91 m). Clinical assessment was based on the Harris Hip Score (HHS). Radiological assessment included measurement of cup migration using image analysis computer software as well as assessment of graft incorporation.

Results:

Clinically, HHS improved from pre-operative average of 24.9 to average of 78 at the last follow-up. One hip was revised at 12 months postoperatively due to aseptic loosening. Survivorship for the cup with endpoint revision for any reason was 96.4%. Radio-logically, the average of superior migration was 1.53 mm; average of medial migration was 0.59 mm. 92.8% of hips showed radiographic evidence of graft incorporation. Cup survival rate with aseptic loosening as endpoint was 92.85%.

Conclusion:

The technique of impaction bone grafting using morsellised fresh frozen bone allograft appears to be a valuable biological option in such patients, with encouraging results, but further follow-up is required to establish the longer term outcome of these reconstructions.
Total hip replacement in identical twins with Scheie Mucopolysaccharidosis
Authors: Pietri M. , Sorriaux G. , Valle A. González della , Salvati E. A.
Published: January 2018

Scheie Syndrome is an autosomal recessive metabolic storage disease with distinct skeletal findings known as “dysostosis multiplex”. This paper reports on identical twins with Scheie Syndrome who required total hip arthroplasty for early osteoarthritis of the hip. The surgical approach and exposure was particularly demanding due to the stiffness imposed by the soft tissues arising from infiltration of glycosaminoglycans. The small femoral head and acetabulum limited the diameter of the acetabular component and subsequently the prosthetic head diameter that could be safely utilized without compromising the thickness of the polyethylene liner. Twenty-two millimeter heads with a standard polyethylene insert were therefore utilized in the two arthroplasties performed in 1998 in the first twin, and a 28 mm head with a highly cross linked polyethylene liner, in the arthroplasty performed on the second twin in 2003. This is a relevant issue considering that these patients required an arthroplasty at a young age. Hip arthroplasty relieved pain, improved ambulation and provided a better range of motion in our two patients. There were no peri-operative complications. Long-term survivorship of total hip replacement in this population is not yet known.
Subsidence Pattern of a Cementless Straight Titanium Alloy Femoral Stem - A Radiographic Study with EBRA-FCA
Authors: Eingartner C. , Ilchmann T. , Dieter J. , Weise K.
Published: January 2018

EBRA (Ein Bild Roentgen Analyse) is a computer-aided algorithm to assess migration of endoprosthetic components. Stem subsidence is measured in comparable radiographs, as defined by the software. Recent studies showed an improved accuracy of EBRA-FCA as compared to standard methods. For the BiCONTACT® cementless femoral component, a prospective follow-up study of 250 cases has provided excellent results, with a survival rate of 97.1% after 11 years. For this migration study 93 hips with a complete radiographic follow-up (>10 x-rays) over 120 months were included. Seventy-one stems were be measured; in 22 stems the measurement was impossible due to heterotopic ossification. Thirty-two hips (45.1%) showed initial subsidence within the first 24 months but no later, and 11 hips (15.5%) had a late onset of subsidence. In nine hips (12.7%) continuous sinking could be found. Nineteen hips (26.8%) had irregular patterns of migration. In 31.0% the overall migration was between 0.5–1mm after 120 months. Six stems (8.5%) had an absolute amount of subsidence exceeding 2mm after 120 months (one more than 3 mm). The mean subsidence was 0.2mm after three months and six months, 0.3mm after 12 months and reached 0.5mm after 10 years. EBRA-FCA is a practicable method to assess migration of the femoral component. There seems to be initial subsidence for about one half of the stems but further movements are rare, which might be a sign for osseo-integration. The radiographic findings correspond to the excellent clinical performance of this stem in long-term follow-up.
Radiological study of THA after mini-incision technique
Authors: Hart R. , ŠtipčÁk V. , Janeček M. , Višňa P.
Published: January 2018

Mini-incision procedures reduce perioperative blood loss, postoperative pain, time of the postoperative recovery, length of the surgical scar, and hospitalisation time. Implant malposition and poor stability are potential risks for compromising long-term results. Between September 2000 and February 2002 (18 months), 120 cemented primary total hip arthroplasties for primary osteoarthritis were performed at the authors' institutions. In 60 of these cases selected at random, a posterolateral mini-incision up to 10 cm was used. Sixty other THAs were implanted through a standard posterolateral approach. The radiological measurements of the inclination and anteversion of the cup and stem position were performed and statistically evaluated by use of Mann-Whitney U and Bartlett tests. In the mini-incision group the average inclination angle was 42.3° (range 36° to 52°) and the anteversion angle 13.6° (range 6° to 21°). The femoral component coronal alignment was within 3° of neutral position in 54 cases (90.0 %). In the standard implanted group the average cup inclination angle was 42.4° (range 35° to 50°) and anteversion angle 13.6° (range 8° to 24°). Fifty-three stems (88,3 %) were implanted correctly. Statistical analysis found no significant difference in component position between the two groups.

There are therefore no potential risks of compromising long-term results after the mini-incision procedure. The authors are encouraged to continue this technique.
Pain and Satisfaction after Hip Replacement: The Patient's Perspective at 5 - 12 Years
Authors: Mehta J. S. , Kiryluk S. , Fordyce M. J. F.
Published: January 2018

We present the results of a postal evaluation of 1700 hip replacements performed in 1560 patients at a specialist joint replacement centre. This 5 – 12 year follow-up assesses the patient's perspective of satisfaction, pain levels, revision and dislocation rates, subjective issues related to the prosthetic hip and limitations to daily activities.

Our adjusted response rate was 81.4%, with 89.2% of the respondents being satisfied with their hip replacement; 4.1% were dissatisfied, and 5.0% were unsure. 79% of patients reported no pain or slight pain, 14.5% had moderate pain and 2.6% had severe pain. 4.6% of the hip replacements had been revised, and 4.1% had dislocated. The hip was felt to be a limiting factor in their life by 18.4% of patients. The use of a questionnaire has provided long-term follow-up data at far less cost and considerably less inconvenience to the patient than a clinical review. We conclude that pain and patient satisfaction could be used as a simple screening tool for the vast majority of the patients. In those that have moderate or severe pain or express a lack of satisfaction for any reason, further clinical and radiological assessments could be carried out.
Ceramic-on-ceramic versus ceramic-on-polyethylene bearings in total hip arthroplasty: Results of a multicenter prospective randomized study and update of modern ceramic total hip trials in the United States
Authors: Bal B. Sonny , Aleto T.J. , Garino J.P. , Toni A. , Hendricks K.J.
Published: January 2018

One reason why otherwise well-functioning total hip replacements have a finite service life is eventual aseptic loosening of the implants because of osteolysis induced by wear particles from the artificial bearing. Pain and osteolysis from wear debris can manifest even in the absence of aseptic loosening. Total hip replacements with ceramic-on-ceramic articulations have shown less wear both in vitro and in vivo. A randomized prospective clinical trial was conducted to compare the outcomes of ceramic-on-ceramic articulations to ceramic-on-polyethylene articulations. Two-year data are of interest because premature failures of ceramic femoral heads usually occur by this time interval. Of 500 patients enrolled in this trial, half received total hip replacements with alumina-on-alumina bearings, while the other half had ceramic-on-polyethylene bearings. At the two-year follow-up, 444 patients (217 study group and 227 control group) were available for review. The clinical and radiographic outcomes between the groups were comparable, and reflected the typical results of primary total hip replacements. No complications related to spontaneous failures of the ceramic bearings were observed at this early follow-up period. Further follow-up is needed to confirm these findings over the long-term, but the short-term safety of alumina ceramic bearings in hip replacements reported in other recent reports is further validated by our findings.
Time saving during acrylic bone cement setting in femoral stem implantation of hip arthroplasty: A prospective, double-blind, randomised study
Authors: Gallart X. , Riba J. , Garcia S. , Combalia A. , Esteban P. L. , Marmolejo C.
Published: January 2018

In order to reduce the final stages of cementing time and intra-operative time, we analysed the behaviour pattern of a quick-setting cement. Quick-setting cement permits easy and adequate manipulation, which reduces surgical time and also the technical problems caused by waiting for setting to be completed. In order to verify the efficacy of faster cement, a double-blind randomised study was carried out comparing a type of traditional cement with quick-setting cement. Two groups of 20 patients were compared. The results show that the fast cement reduces setting time by an average of one minute and 55 seconds (p < 0.01) and presents similar manipulation characteristics to those of conventional cement.
Primary hip replacement in young osteoarthritic patients – current practices in one UK region
Authors: Mundy G.M. , Esler C.N.A. , Harper W.M.
Published: January 2018

Approximately 10% of primary hip replacements performed each year for osteoarthritis are in patients aged 55 or younger. These patients have a longer life expectancy and a higher activity level than an older cohort, which may translate to higher revision rates.

We utilized a regional hip register (Trent and Welsh Arthroplasty Audit Group (TWAAG)) to review current surgical practice in this age group.

From 01/01/2000 – 31/12/2002, we were notified of 7,678 primary THRs for osteoarthritis. Of these 911 (11.7%) were performed on patients aged 55 or less. Age, gender, grade of lead operating surgeon, type of femoral and acetabular prostheses implanted, fixation method, femoral head size and bearing surfaces were recorded. There were 434 males and 477 females, with an age range of 16–55. Thirty-five femoral and 33 acetabular components were identified: 61.7% of femoral prostheses were cemented; 67.4 % of acetabular prostheses were uncemented. Fifty per cent of implants had a metal/UHMWPE bearing. Other bearing surfaces comprised ceramic/UHMWPE 28.7%, metal/metal resurfacing 13.8% and ceramic/ceramic 7.5%. Consultants performed 84.5% of procedures.

The study indicates that there does not appear to be a clear consensus as to component choice or optimum fixation method in the younger patient.
Mortality after proximal hip fracture in the Singapore population
Authors: Lin K.H. , Lim Y.W. , Wu Y.J. , Lam K.S.
Published: January 2018

The aims were to prospectively assess the mortality risk following proximal hip fractures, identify factors predictive of increased mortality and to investigate the time trends in mortality with comparison to previous studies.

Prospectively collected data from 68 consecutive patients who had been admitted to a regional hospital from May 2001 to September 2001 were reviewed. The mean age of the patients was 79.3 years old (range, 55–98) and 72.1% females. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a two-year follow-up period.

The acute in-hospital mortality rate at six months, one year and two years was 5.9% (4/68), 14.7% (10/68), 20.6% (14/68) and 25% (17/68) respectively. One-year and two-year mortality for those patients who were 80 or older was significantly higher than for other patients and the number of co-morbid illnesses also had significant effect. Cox regression was performed to determine the significant predictors for survival time. It was noted that patients 80 years or older were at higher risk of death compared with those less than 80 years as well as those with higher number of co-morbid illnesses. Our mortality rates have not declined in the past 10 years when compared with previous local studies. We conclude that for this group of patients studied, their mortality at one year and two years could be predicted by their age group and their number of co-morbid illnesses.
MRSA-free Elective Orthopaedic Surgery. A Dedicated Elective Orthopaedic Ward Free from MRSA Alexandra Hospital, Redditch, UK
Authors: Datta A. , Gardner A. , Bell K.
Published: January 2018

Deep infection complicating arthroplasty surgery carries a heavy financial and emotional burden on any orthopaedic service. The cost of hospital acquired infection is estimated at £1 billion per year by the National Audit Office. Healthcare associated infection is an area currently under great scrutiny.

The Alexandra Hospital, Redditch, has developed a dedicated elective orthopaedic ward free from methicillin-resistant Staphylococcus aureus (MRSA) that delivers high quality and high volume major joint replacement surgery through rigorous infection control.

Between October 2001 and December 2002, the Alexandra Hospital had an infection rate of 0.21% for total knee replacements compared to the national rate of 2.1% p= 0.002 (CI 0.00005-0.01) The infection rate for total hip replacements was 1.31% compared to 3.8% nationwide. p= 0.01 (CI 0.004- 0.03).

The total number of joint replacements performed per year, utilising the same number of elective beds, increased from 482 in 2001 to 629 in 2002.

We believe that the MRSA screening policy and subsequent altered bed utilisation have contributed to lowering the rate of infection and improved efficiency.

We have developed a safe, effective and efficient orthopaedic unit within the framework of an acute NHS trust. We believe the practical changes and modest investment that have been made within our department can be repeated in other units around the country with relative ease.
The false profile arthrogram in developmental dysplasia of the hip
Authors: Aslam N. , Wainwright A. , Benson M.K.
Published: January 2018

Arthrography is useful in the evaluation and treatment of developmental dysplasia of the hip. The authors describe the additional diagnostic value obtained from a “false profile” arthrogram. The “false profile” arthrogram allows assessment of anterior acetabulum cover, femoral neck anteversion and hip joint subluxation (instability), which may not be apparent on other views.
Outcome of hip arthroplasty in octogenarians compared with younger patients
Authors: Gray A. , Walmsley P. , Moran M. , Brenkel I.J.
Published: January 2018

This prospective study aimed to ascertain if octogenarians undergoing primary hip arthroplasty experienced a similar clinical outcome and complication rate as younger patients.

Significantly better (p=0.019) improvement in mean Harris hip score (SD) was seen 18 months after surgery in the younger cohort: 43.4 (SD 13.8) compared with 39.8 (SD 10.6). Length of hospital stay was longer (p<0.001) in the octogenarians: 12.9 days (SD 7.0) days versus 10.1 (SD 4.7) with a higher blood transfusion rate of 40% compared with 28% (p = 0.009). No significant differences in infection, dislocation, thromboembolism or 90-day mortality rates were found.

Conclusions: octogenarians are more likely to require blood transfusions and a longer hospital stay, with less improvement in clinical outcome at 18 months after primary hip arthroplasty.
EBRA-Digital release 2003 versus 1998: A comparison of instrument repeatability for measuring implant migration and wear
Authors: Tiernan J.P. , Gordon A. , Hamer A.J. , Stockley I. , Wilkinson J.M.
Published: January 2018

EBRA-Digital is an established method for measuring implant migration after total hip arthroplasty using digitized radiographs that has recently undergone a change in the software platform that may influence its precision. We assessed the precision of EBRA-Digital 2003 release and compared it to the previous 1998 release using consecutive, standardized, plain radiographic examinations made on the same day after repositioning in 29 patients. The precision of implant migration and wear measurements was similar between the two software releases, although analysis times were quicker using the 2003 release (p<0.01). Image file compression at a ratio of 30 resulted in poorer measurement precision for some variables. The EBRA 2003 software platform has similar precision to the previous release and allows faster measurement of implant migration and wear. The level of image file compression that is used affects the precision of these measurements.
Acetabular Centre-Edge Angles Revisited: Applications and Limitations in Patients with Acetabular Dysplasia Undergoing Periacetabular Osteotomy
Authors: Puloski S.K.T. , Leunig M. , Ganz R.
Published: January 2018

This study evaluates the application and limitations of the acetabular centre-edge angles as described by Wiberg (LCE) and Lequesne (VCA) in a group of adult patients with acetabular dysplasia that were treated with periacetabular osteotomy. Fifty hips in patients with a mean age of 30 years (range, 17–45) were identified and a number of radiographic indices were compared pre and post osteotomy. The potential for measurement variation in both the LCE and VCA angle was evaluated and relationships between the centre-edge angles and other radiographic indices were determined. While all hips displayed some degree of lateral deficiency only 19 (40%) of these cases displayed a “classic” lateral and anterior deficiency while 12 (20%) were in fact retroverted. The mean VCA in hips with primarily anterior and lateral deficiency (–6.7°±12.5) was significantly lower (p<0.01) than those with uniform deficiency (5.1°±8.3) or those with retroverted acetabuli (8.9°±13.3). Overall the mean VCA angle of 2.3° (SD±12.7) and LCE angle of 3.4° (SD±9.3) was corrected to 25.8° (SD±11.6) and 28.6° (SD±8.7) following osteotomy. The VCA and LCE angles were not correlated (r=0.35) and the LCE angle showed no significant correlation to other lateral coverage indices (Tönnis, Sharp). No correlation was seen either in the post osteotomy values, or in the absolute degree of correction. An alternate VCA (aVCA), identifying the most anterior aspect of the acetabular margin as the reference point, was significantly larger (p<0.001) but did correlate (r=0.77) with the traditional VCA. Potential sources of error in measurement were identified and are reviewed.
The Influence of Implant Design on Periprosthetic Bone Remodelling of two Types of uncemented HA-Coated Hip Stems. A Two-Year Follow-up Study Using Dexa
Authors: Van Der Wal B.C.H. , Rahmy A.I.A. , Grimm B. , Blake G.M. , Heyligers I.C. , Tonino A.J.
Published: January 2018

Proximal bone resorption and an increased fracture rate in the ABG-I stem has been shown. For these reasons the ABG-I stem design was changed to the ABG-II. In this study periprosthetic bone loss around the ABG-I vs ABG-II is compared to verify if the design changes resulted in improved proximal bone preservation.

Methods

51 patients were randomised to either the ABG-I or ABG-II hip prosthesis. Periprosthetic BMD change at various time points was measured using DEXA. Between the two groups (age, gender, weight etc.) no statistical difference was encountered. Compared to the baseline at two years the ABG-II preserved bone better proximally (e.g. zone 7: ABG-II: −3.7%, ABG-I: −11.9%, p=0.05) than the ABG-I. Distally, the trend was opposite and less bone loss was measured for the ABG-I than the ABG-II in zones 3, 4 and 5 (n.s.).

Conclusion

this study confirms the philosophy behind the design changes from the ABG-I to ABG-II stem where increased elasticity, more proximal HA-coating, a shorter and distally polished stem, were meant to reduce proximal bone resorption. In future this may lead to fewer periprosthetic fractures and to less complicated revision surgery.
Long-Term Results of an Uncemented Straight Femoral Shaft Prosthesis
Authors: Eingartner C. , Heigele T. , Volkmann R. , Weise K.
Published: January 2018

The first consecutive series of 250 implantations of an uncemented, proximally anchored straight femoral shaft prosthesis in 236 patients is included in this prospective follow-up study. Average time of follow-up evaluation was 11.8 years (range 10.6 - 13.7 years). At follow-up, 41 patients with 44 hips had died and three could not be located. Eight hips were revised, two for infection, one for recurrent dislocation, two for rapid subsidence due to component undersizing and one for aseptic loosening of a varus-malaligned stem; two radiologically well-fixed stems were revised during acetabular revision. Survival estimate showed an overall survival of 96.6% after 14 years (confidence limits: 98.4% (upper) and 92.8% (lower)). The median Harris hip score at time of follow-up was 81.4 points; clinical results were compromised by high loosening rates (68.8%) of the threaded cup, which had been used in 165 of the 250 cases. Radiologically, tiny reactive lines (< 2mm) were frequently present in the distal zones of the femoral shaft, but could be found in the proximal anchoring zone in only one case. In conclusion, the long-term follow-up results with this femoral component are encouraging and are comparable to those of modern techniques of cementing in primary total hip arthroplasty.
Limb Length Restoration during Total Hip Arthroplasty: Use of a Caliper to Control Femoral Component Insertion and Accurate Acetabular Placement Relative to the Transverse Acetabular Ligament
Authors: Pooler Archbold H.A. , Mohammed M. , O'brien S. , Molloy D. , McCONWAY J. , Beverland D.E.
Published: January 2018

Current methods for restoring or preserving limb length following total hip arthroplasty largely depend on restoring the distance between a fixed point on the pelvis and femur. Each of these techniques allows length correction to be made by combining the effects of both acetabular and femoral height into a single measurement. These methods help to minimise inequality but are anatomically flawed, as they do not allow independent control of placement of the femoral and acetabular components which both contribute to leg length. To address this we present and evaluate a technique that uses a caliper to control the vertical placement of the femoral component and the transverse acetabular ligament to control the vertical height of the acetabular component. Limb lengths were measured in 200 patients who had undergone primary total hip arthroplasty using this technique. Using this method 94% had a postoperative limb length inequality that was 6mm or less (average, +0.38mm). The maximum measured limb length inequality was ±8mm.
A Radiological and Laboratory Assessment of Polyethylene Wear in Failed Total Hip Replacement
Authors: Bisbinas I. , Tripsianis G. , Cunningham J.L. , Learmonth I.D.
Published: January 2018

This study assessed the reliability of radiological assessment of polyethylene wear in loose total hip replacements (THRs) by comparing it with a laboratory assessment using the shadowgraph technique. It was performed in Avon Orthopaedic Centre, Southmead Hospital, from September 1997 to June 1998. True linear wear depth measured using the shadowgraph technique was 42% greater than that determined from the radiological femoral head eccentricity in standard non-weightbearing plain x-rays. There was an inverse statistically significant correlation between cup inclination angle and the volumetric wear rate. The linear wear rate, as determined with the shadowgraph technique, was greater in retrieved cups during the first six years postoperatively, but reduced to a lower level in cups retrieved after that time of service.
Anterior or Posterior: Does the Surgical Approach to the Hip Influence the Quality of the Femoral Cement Mantle?
Authors: Sanghrajka A.P. , Whittingham-Jones P.M. , Higgs D. , Caruana J. , Blunn G. , Briggs T.W.R.
Published: January 2018

The purpose of this study was to determine whether the surgical approach to the femoral neck during total hip arthroplasty affects the quality of femoral cement mantle in terms of thickness and defects, both of which have been implicated in the development of aseptic loosening. A retrospective radiological review of 50 Stanmore Hip femoral stems inserted using the anterior approach and 50 inserted via the posterior approach was performed, with analysis by zone of cement mantle thickness and number of defects.

This study demonstrates that the anterior approach is associated with an increase in the frequency of deficiencies in the cement mantle. We recommend that surgeons using the anterior approach are wary of this increased risk and adopt measures, such as the use of distal centralisers, to minimise its occurrence.
Long-Term Clinical and Radiographic Outcome of the PPF System in Ceramic-On-Polyethylene Hip Bearings
Authors: Legenstein R. , Huber W. , Ungersboeck A. , Boesch P.
Published: January 2018

From 1990 to 1991 we implanted 176 non-cemented proximal press-fit (PPF) total hip arthroplasties (THA) with ceramic-on-polyethylene articulation in 170 patients. Of these, 119 patients (122 THA) were followed from 104 to 129 months. Four cups have been revised for aseptic loosening, but revealed no radiolucencies of the stem. Two infections and two dislocations occurred. The median postoperative Harris hip score was 91. Ninety-eight per cent of the patients were satisfied with the outcome, 83% were free of pain and 67% walked without a limp. Serial radiographs showed stable fixation with bone ongrowth in nearly all arthroplasties except for four cups. Stem radiolucencies were first seen within 12 months, but were of no clinical relevance. Proximal periprosthetic bone resorption of the stem was seen in 18%. Radiolucencies occurred because of polyethylene debris-induced granulomas. The PPF system yields satisfactory long-term results in patients with primary and secondary hip osteoarthritis and dysplasia.
The Distribution of Cement Penetration into Bovine Acetabular Bone Utilising Various Pressurisation Techniques
Authors: Kalairajah Y. , Gray J.M. , Ripley L.G. , Ricketts D.M.
Published: January 2018

Most mechanical failures of acetabular fixation within ten years of primary cemented hip replacement are attributable to a failure to achieve good initial fixation of bone and cement. Several studies have suggested that to achieve good fixation between bone and cement between 3 mm and 5 mm of cement penetration into bone is desirable. Whilst several acetabular cement pressurisation systems exist, little is known about the effects of cement pressurisation on the pattern of penetration of cement into cancellous bone within the pelvis. The current paper assesses the penetration of bone cement into bovine acetabular bone by various pressurisation techniques. We found that pressurisation with the use of a swab in glove or the DePuy pressuriser led to improvement in cement penetration both in terms of maximum depth and also percentage cover of the cup by cement (p < 0.05). There was no significant difference in mean maximal penetration between the use of the pressuriser and the swab in a glove technique (p = 0.3). If only a plain cup was used as a pressuriser, the penetration achieved was significantly lower in comparison to use of a pressuriser (p < 0.02). When compared to previously documented acrylic models, the pattern of intrusion noted in the bovine model was different: penetration was lower at the equatorial and base regions of the acetabulum.
Early Diagnosis of Delayed Vascular Injury Associated with Revision Total Hip Arthroplasty
Authors: Chana R. , Alva K. , McMILLAN P. , Slater G.
Published: January 2018

We describe a case report where the acetabular prothesis migrated medially into the pelvis over a period of four years, following revision hip arthroplasty. This was an acute on chronic progressive displacement that caused a slow bleed from the left external iliac artery. Contrast computed tomography is the investigation of choice to diagnose such an injury and demonstrate the slow bleed as opposed to digital subtraction angiography (DSA) arteriogram.
Evaluation of the Learning Curves Associated with Uncemented Primary Total Hip Arthroplasty Depending on the Experience of the Surgeon
Authors: Flamme C.H. , Stukenborg-Colsman C. , Wirth C.J.
Published: January 2018

The aim of the paper is to prove and to portray the learning curve in total hip arthroplasty. This prospective study included 168 patients who were operated on by three surgeons, all demonstrating different degrees of experience in performing total hip arthroplasty. Perioperative complications and postoperative radiographs were analysed. Patients were re-examined clinically and radiologically five years postoperatively. In addition, a second study with 41 patients was performed, evaluating especially the learning curve of the highly skilled surgeon in using a femoral neck prosthesis.

Radiological complications presented by the first 84 operated patients (2nd study: 25 hips) were significantly higher than those in the following 84 patients (2nd study: 26 hips). The learning curve of all surgeons was completed after 20 operations regardless of their experience. Clinical results at follow-up were not influenced by the learning curve.

Intensive preoperative planning and exchange of experiences will reduce the length of the learning curve within and outside every clinic.
Distal Femoral Stem Tip Resection for Thigh Pain Complicating Uncemented Total Hip arthroplasty. Five Patients Followed up for 6–10 Years
Authors: Kandel L. , Kligman M. , Sekel R.
Published: January 2018

Thigh pain after total hip arthroplasty can be a significant management problem both to patient and surgeon. In many cases, the pain is caused by femoral stem impingement due to its varus position. We present the technique of resection of a segment of distal femoral stem through a minimal incision as treatment of this problem. Five patients with a follow-up of 6 to 10 years are discussed. In all patients thigh pain was explained by the radiographic appearance of the varus stem position and reactive bone formation around the tip of the stem. A bone window was created and resection of the tip of the stem was performed. Four of the patients completely recovered after surgery and one patient, with Paget's disease, required additional interventions due to stress fracture. This is a very simple and effective method of treatment of thigh pain due to femoral stem impingement in healthy bone.
Acetabular Dome Retroversion: Radiological Appearance, Incidence and Relevance
Authors: Dora C. , Leunig M. , Beck M. , Simovitch R. , Ganz R.
Published: January 2018

Interest in acetabular version arose from the study of unstable developmental dysplastic hips (DDH). Initial studies and clinical observations described the dysplastic hip as being excessively anteverted. Doubts on this view arose from analysis of complications such as persistent posterior subluxation after acetabular reorienting procedures.

Computed tomography fails to determine conclusively whether or not the dysplastic acetabulum is abnormally anteverted. Controversy evolves from different methods of measuring and from the fact that the acetabular opening gradually spirals from mild anteversion proximally to increasing anteversion distally. This renders the measurement of version dependent on pelvic inclination and the level of the transverse CT scan slice. On an orthograde pelvic radiograph, both pelvic inclination and rotation can be controlled. Therefore, acetabular version is best estimated based on the relationship of the anterior and posterior acetabular rims to each other on an orthograde pelvic radiograph.

Acetabular retroversion has been found to be a characteristic feature of specific hip disorders such as post-traumatic dysplasia, proximal femoral focal deficiency and bladder exstrophy. In addition, acetabular retroversion has been described in DDH as well as in dysplastic hips in the context of neuromuscular and genetic disorders. Iatrogenic acetabular retroversion can also result from corrective pelvic osteotomies in childhood. Finally, retroverted acetabula may be found in otherwise nondysplastic hips.

The relevance of acetabular retroversion is twofold: First, it demands a more individualized approach to acetabular dysplasia because the presence of retroversion will affect the manner in which the corrective osteotomy should be done. Second, the long-term effect of acetabular retroversion is harmful.
Psoas Abscess Associated with Infected Total Hip Arthroplasty: A Case Report
Authors: Plaza R. , Soriano A. , Tomàs X. , Gallart X. , Garcia S.
Published: January 2018

Psoas abscess (PA) is an uncommon disease and its diagnosis is difficult. It can be primary or secondary. Primary abscesses are of unknown origin and are presumably caused by haematogenous or lymphatic spread from a distant infectious focus. Secondary PA is caused by spreading from a contiguous infected structure, such as vertebrae (espondilodiscitis) or mesenteric abscesses (Crohn's disease). PA infrequently has been associated with an infection of total hip arthroplasty (ITHA). The correct diagnosis in these cases is difficult due to the clinical similarities between PA and ITHA. Since connection between PA and ITHA is established through the acetabulum, we consider that computed tomography (CT) is the most accurate radiological test because of its efficacy in evaluating the bone structure, and the optimum therapeutic strategy is two-stage replacement surgery. We report one case of PA associated with ITHA and a review of the previous literature.
The Shortcomings of Computer-Aided Measurement of Migration for the Prediction of Failure of Three Forms of Acetabular Fixation by Survival Analysis and Migration Study to Ten Years
Authors: Scott G. , Nakagawa S. , Orhan Z. , Freeman M.
Published: January 2018

We studied, to ten years, migration by vertical displacement and angular change using a digitizer and standard radiographs and survival of three methods of acetabular fixation in primary hip replacement. Two implants were uncemented metal-backed components, one version of which was hydroxyapatite-coated. Both types had 28 mm polyethylene inserts. The third type was a cemented all-polyethylene cup with a 28 mm internal diameter. All cups articulated with a Freeman neck-retaining stem. The purpose was to see if the early migration data predicted the long-term outcome and could be used to forecast implants that would fail for the purpose of pre-market assessment. No statistical differences were found between the groups in the parameters studied. At the threshold accuracies of our migration measurements (three millimetres and three degrees) at three years, we could not identify components that would subsequently fail. However, migration less than these threshold values and the absence of radiolucent lines were strongly associated with implant survival at ten years. Our system was insufficiently accurate for pre-market surveillance.
Os Acetabuli in Femoro-Acetabular Impingement: Stress Fracture or Unfused Secondary ossification Centre of the Acetabular Rim?
Authors: Martinez A.E. , Li S.M. , Ganz R. , Beck M.
Published: January 2018

Ossicles located at the acetabular rim are generally referred to as unfused secondary ossification centres and are named “os acetabuli”. They are also observed in severely dysplastic hips, where they are considered as fatigue fractures of the acetabular rim due to overload. In a retrospective study, we evaluated the radiographs of 495 patients, who were treated surgically for femoro-acetabular impingement. In 18 hips (15 patients) a large osseous fragment at the anterolateral acetabular rim was found. All patients presented radiographically with a femoral head showing an aspherical extension producing a “cam” impingement. Sixteen hips had a retroverted acetabulum, indicating anterior overcover. Preoperative MRIs available in 12 patients showed the presence of a fragment composed of labrum, articular cartilage and bone. The gap between the stable acetabulum and the rim fragment had a vertical orientation. All patients had been exposed to a physically demanding profession or contact sport and in 15 hips no memorable traumatic episode was present. The mechanism leading to this acetabular rim fragment is thought to be fatiguing due to femoro-acetabular impingement. The aspheric portion of the head is jammed into the acetabulum and with time causes a stress fracture of the retroverted portion of the acetabulum. True “Os acetabuli” are morphologically similar, but the orientation of the cartilaginous growth plate is more parallel to the joint surface, in contrast to the hips in the current study, where the separation line was perpendicular to the joint surface. The clinical importance is that the presence of an acetabular rim fragment in the non-dysplastic hip must raise suspicion of femoro-acetabular impingement.
Dissociation and Implantation of Exeter Femoral Instrumentation during Total Hip Arthroplasty
Authors: Walsh J.C. , O'shea K. , Devitt A.T.
Published: January 2018

Proprietary femoral plug introducers are routinely used to insert intramedullary plugs during total hip arthroplasty The cement restrictor pin from an Exeter intramedullary plug introducer may become detached during insertion of the cement restrictor plug, or during sponge packing of the femur. We suggest some precautions that should be taken to prevent this from occurring and advise that the patient is unlikely to experience any long-term adverse reactions to the presence of the restrictor pin in the intramedullary canal.
Intrapelvic Protrusion of a Dynamic Hip Screw
Authors: Garcia S. , Popescu D. , Gallart X. , Riba J.
Published: January 2018

The sliding hip screw, sometimes called the dynamic hip screw (DHS) has been a successful method for treating hip fractures. Nevertheless, mechanical complications of this system have been reported from time to time. They are mainly the result of instability of the fracture, bone quality and technical errors occurring during surgery.

We report a case of an intrapelvic protrusion of a sliding screw after a basicervical fracture was treated with a DHS and a 6.5 mm cannulated screw, and its surgical solution using a hybrid total hip arthroplasty. In our case we think the mechanical failure was due mainly to technical errors during surgery.

Despite that, we believe the sliding hip screw is the implant of choice for basicervical fractures. Using an additional K-wire during the technique is sufficient to avoid rotation of the proximal fragment and no additional fixation is necessary.
Bone Remodelling in THA: A Comparative DXA Scan Study between Conventional Implants and a New Stemless Femoral Component. A Preliminary Report
Authors: Albanese C.V. , Rendine M. , De Palma F. , Impagliazzo A. , Falez F. , Postacchini F. , Villani C. , Passariello R. , Santori F.S.
Published: January 2018

Periprosthetic bone loss is a major cause for concern in patients undergoing total hip arthroplasty (THA). There are many different factors that may determine the pattern of bone loss and bone remodelling following THA, such as the quality of the bone before the hip replacement, skeletal bone mass at the time of the operation, material and method of fixation and implant design. Recent developments in dual-energy X-ray absorptiometry (DXA) have made it possible to quantify bone mineral density (BMD) to evaluate changes around the prosthesis and to measure bone stock and bone density redistribution after a total hip replacement. In this cross-sectional multicentre clinical study the DXA method was used to compare bone mass after uncemented THA of a custom-made stemless design with five groups of conventional cementless implants (Alloclassic, Mayo, CFP, IPS, ABG). The adaptive bone changes of the proximal femur three years after implantation were evaluated. Periprosthetic BMD was measured in 130 subjects in the seven regions of interest (ROI) based on Gruen zones. Significant differences were found between the stemless implant and the other five groups in zones 1, 4 and 7. The CFP, IPS, and ABG groups showed decreased BMD in ROI 1, and the Mayo, IPS and Alloclassic in ROI 7. An increased BMD in ROI 4 was observed in the Mayo, IPS, ABG and Alloclassic groups. The results of the present study suggest that a conservative stemless implant with complete proximal load transfer produces a homogeneous and more physiological redistribution of bone density, allowing maintenance of proximal periprosthetic bone stock.
Ultra-Short Stems with Proximal Load Transfer: Clinical and Radiographic Results at Five-Year Follow-Up
Authors: Santori F.S. , Manili M. , Fredella N. , Tonci Ottieri M. , Santori N.
Published: January 2018

Bone stock preservation is crucial when performing THR in young patients. Following this philosophy, an original ultra-short custom-made implant with extensive proximal load transfer was developed. It presents three very innovative features: absence of the diaphyseal portion of the stem, a well defined lateral flare with load transfer on the lateral column of the femur and a very high femoral neck cut. These innovations resulted in a very conservative implant both of the bone stock and the soft tissues. In this study we reviewed the X-rays of 111 patients with 131 primary total hip replacements performed with this implant. The average pain score using the Harris Hip Score system, at an average of five years after surgery, was 42 of 44 points; 95 per cent (124) of the patients had no or slight pain. We had no cases of thigh pain. None of the patients required a femoral stem revision. Two cases had to be re-operated for polyethylene liner exchange but the femoral implant was stable and left in place. At five years, all implants appeared radiographically stable with well maintained proximal bone stock.

It was concluded that the geometry of this implant provides significant initial stability, which seems to be preserved throughout a long follow-up period. This study validates the assumption that torsional loads can be controlled even without the diaphyseal portion of the stem and that neck preservation combined with lateral flare support guarantees a more natural loading of the femur.
Early Outcomes following Minimally Invasive Total Hip Arthroplasty Using a two-Incision Approach versus a Mini-Posterior Approach
Authors: Tanavalee A. , Jaruwannapong S. , Yuktanandana P. , Itiravivong P.
Published: January 2018

We evaluated early clinical results and radiographic findings of MIS THA using 2-incsion approach and mini-posterior approach. A consecutive series of 35 patients (40 hips) with 2-incision THA and a consecutive series of 35 patients (36 hips) with mini-posterior THA performed in the same period were evaluated. The patient groups were not randomised. At the mean follow-up of 20.2 months (range, 12–36 months), the 2-incision group had significantly earlier ambulation, driving ability and return to work. However, it had significantly more operative time, blood loss, blood transfusion and complications. Regarding radiographic findings of 2-incision group and mini-posterior group, the mean radiographic acetabular abduction of was 46.7 degrees (89% was within 35–55°) and 44.8 degrees (84% was within 35–55°), respectively. The femoral stem was in neutral position in 80% and 83%, respectively. There was no statistical difference of the implant position between groups. Although MIS 2-incison THA provided faster, early ambulation than the mini-posterior THA, surgeons have to weigh the advantages and disadvantages of this technique including, increased operative time, blood loss and their familiarity with similar standard incisions and landmarks.
Two-Incision Total Hip Replacement: Intra-Operative Fluoroscopy versus Imageless Navigation for Cup Placement
Authors: Lee M.S. , Kuo C.-H. , Senan V. , Chen W.-J. , Chen L.-H. , Ueng S.W.N.
Published: January 2018

The purpose of this study was to describe the surgical technique and to investigate results of a modified two-incision total hip replacement using either intraoperative fluoroscopy or imageless navigation. Twenty-nine patients (30 hips) with a minimum follow-up of one year were enrolled in this study. The patients were evaluated at 3, 6, 12 weeks, 6 months, and 1-year. The functional recovery as represented by the Harris hip score and WOMAC scale were better in the fluoroscopy group of patients at the early postoperative stage (3 wks). Thereafter, both groups showed rapid recovery with no difference in scores. Injury to the lateral femoral cutaneous nerve was the most commonly seen complication and it occurred in 6 hips (fluoroscopy 2; imageless 4). The symptoms were transient and resolved in 6 months in all 6 cases. This study demonstrated that the role of intraoperative fluoroscopy could safely be replaced by an imageless navigation system for the MIS-2 THA.