bluuebunny/crossref_metadata_2025 huggingface dataset:
The Minimal Invasive Surgery Anterior Approach with Supine Patient Positioning: A Step-Wise Introduction of Technique
Authors: Böhler N. , Hipmair G.
Published: January 2018

The purpose of the review is to report the modified Smith-Peterson technique for use with minimal invasive total hip arthroplasty (MIS THA) with supine patient positioning. The modified Smith-Peterson technique allows for direct visualisation of the acetabulum and is an internerval approach. The MIS anterior approach with supine patient positioning offers a complete intermuscular and internervous access to the hip joint. The use of this technique yields a reduction of muscular trauma, intraoperative bloodloss, and postoperative rehabilitation. The reduction of soft tissue trauma may lead to minimal postoperative pain. While cosmesis is never a reason for using MIS, it does yield great patient satisfaction. The MIS anterior approach with supine patient positioning is a safe and reproducible method, offering an alternative option in MIS THA.
A Prospective Randomized Clinical Trial Comparing Metal-On-Metal Total Hip Arthroplasty and Metal-On-Metal Total Hip Resurfacing in Patients Less than 65 Years Old
Authors: Vendittoli P.-A. , Lavigne M. , Roy A.-G. , Lusignan D.
Published: January 2018

The purpose of this prospective randomised study is to compare the early clinical results of the metal-on-metal hip resurfacing to metal-on-metal THA. Two hundred and ten hips were randomised between August 2003 and January 2006 (191 subjects). One hundred and two hips were implanted with an uncemented titanium tapered stem, and an uncemented titanium acetabular component and 28 mm metal-on-metal bearing (THA group) and 103 hips received a hybrid metal-on-metal surface replacement arthroplasty (SRA group). No significant difference was found with the WOMAC or Merle d'Aubigné-Postel scales. However, a significantly higher activity level was found in the SRA group (UCLA score 6.3 versus 7.1, p= 0.037) and a greater percentage of the SRA patients returned to heavy or moderate activities at one - year postoperatively (72% versus 39%, p=0.007). No patient in either group presented with thigh pain one year after surgery. Both techniques present similar complication rates (0.15). This study supports the theory of better functional recovery in the short-term favouring the SRA when compared to THA. The clear benefit of surface replacement arthroplasty over THA is proximal femoral bone preservation. However, the long term survivorship of the SRA will determine the real value of the theoretical advantage.
A Radical Approach to Minimally Invasive Total Hip Replacement: Surgical Technique and Pre-Clinical Test Data
Authors: Verdonschot N. , Willems M.M.M. , Stungo B. , Slomczykowski M. , Gibbons P. , Kriek H.R. , Revie I.
Published: January 2018

Currently total hip replacement surgery using minimally invasive techniques is a fast developing field. However, all reports concern adaptations of surgical techniques with adapted instruments using conventional implants. These conventional implants limit the minimal invasiveness to some extent. In this paper a new system is reported featuring a new surgical approach, new instrumentation and a new implant design. The purpose of this study was to introduce the system and to assess the feasibility of the system in terms of stability, range of motion and wear characteristics. The pre-clinical tests indicated that the factor of safety for this type of design is smaller than for conventional implants. However, the results show adequate performance of the system, which suggests that further development and testing is justified to advance the system for clinical use.
Alteration of the Hip Joint Centre during Acetabular Reaming
Authors: Baad-Hansen T. , Kold S. , Fledelius W. , Nielsen P. T. , Soballe K.
Published: January 2018

Change of the hip joint centre location during preparation of the acetabular cavity for the acetabular component can affect the outcome of total hip arthroplasty. Deviations from the preoperative geometry can compromise an otherwise successful operation with regard to hip dislocations, leg length inequality and range of motion of the hip joint. Eighteen acetabula from pelvic specimens were measured before and after acetabular reaming to determine the change of hip centre location. Two different acetabular reamers were applied to the acetabular cavity: a chamfered reamer intended for minimal invasive hip surgery (MIS) and a conventional hemispherical reamer. An optical 3D scanning system created 3D models of the cavities prior to and after the reaming procedure. The two 3D models were merged into a single 3D model and displacements in all three dimensions were calculated The results showed no significant difference between MIS and conventional reaming with regard to transition vector length (p=0.9). The mean length of the transition vector was 3.6 mm (SD. 2.4 mm). Our findings suggest that the alteration of the hip centre location is not influenced by the changes made to the MIS reamers in comparison with conventional reamers. In comparison with previous studies the drift of the hip centre caused by the acetabular reaming is reduced due to new reaming techniques and prosthesis designs.
Fatal Pulmonary Embolism, Death Rates and Standardised Mortality Ratios after Primary Total Hip Replacement in a Joint Replacement Centre
Authors: Khan A. , Kiryluk S. , Fordyce M.J.F.
Published: January 2018

We determined retrospectively the postoperative mortality and fatal pulmonary embolism (PE) rates in 1275 consecutive primary total hip replacements (THR) in the six-week period after surgery at an orthopaedic hospital. Patients were traced by questionnaires, outpatient appointments and by telephone. Post-mortem records were used to verify cause of death. Follow-up was 100%.

The death rate from PE was 0.16% (CI 0.04% - 0.57%) and the all-cause mortality rate was 0.47% (CI 0.22% - 1.02%). All deaths were within the first 10 days during the initial hospitalisation. The patient mortality was compared with the population mortality for England and Wales, using standardised mortality ratios (SMRs). The SMR for both sexes combined was 1.08 (CI 0.4 - 2.36). We observed a lower mortality in females (SMR=0.58; CI 0.07 - 2.09) but a higher mortality in males (SMR=1.91; CI 0.52 - 4.9) during the first 42 postoperative days compared to the general population.

Fatal PE after THR without routine chemical thromboprophylaxis is uncommon. The death rate in patients undergoing THR appears to be similar to that in the general population.
Metal-on-Metal Total Hip Joint Replacement: A Minimum Follow-Up of Five Years
Authors: Sharma S. , Vassan U. , Bhamra M.S.
Published: January 2018

The search for an ideal bearing surface for hip arthroplasty is ongoing. Over 1000 metal-on-metal total hip replacements have been performed at our institution since 1993. A review of 215 primary hip arthroplasties performed using Metasul® (Sulzer, Winterthur, Switzerland) metal-on-metal articulation with a minimum follow-up of five years is presented.

Six patients were lost to follow-up, leaving 209 hips for review. The average follow-up was 7.33 years (range 5–11.4 years). The mean preoperative Harris Hip Score (HHS) was 39.8 and mean postoperative hip scores rose to 89.5, 87.3, 88.4 and 85.8 at 1-year, 3-year, 5-year and final follow-up respectively. Two hips were revised for acetabular loosening and none due to loosening of the femoral stem. Implant survivorship was 95.5% at 12 years. No untoward systemic effects were noted in the cohort.

Metasul® metal-on-metal articulation has shown satisfactory results in the medium term with regard to osteolysis and aseptic loosening. Level of evidence: IV (Case series)
Constrained Liners for Recurrent Dislocations in Total Hip Arthroplasty
Authors: Knudsen R. , Ovesen O. , Kjaersgaard-Andersen P. , Overgaard S.
Published: January 2018

This study reports the results and complications from treating recurrent hip dislocations with a constrained liner (CL) after total hip arthroplasty (THA).

Forty patients who had a CL inserted as a secondary prophylactic treatment were retrospectively reviewed after a median observation period of 27 months (range 7–77 months).

During the observation period five patients had to be revised: one for deep infection and four on account of re-dislocations.

Our results indicate that patients with recurrent THA dislocations can be treated with a CL and has a satisfactory low complication rate and a relatively low risk of re-dislocation.
Hip Osteoplasty by an Anterior Minimally Invasive Approach for Active Patients with Femoroacetabular Impingement
Authors: Ribas M. , Marín-Peña O.R. , Regenbrecht B. , De La Torre B. , Vilarrubias J.M.
Published: January 2018

Femoroacetabular regularization in hip impingement is currently performed by means of trochanter osteotomy and hip dislocation or more recently by means of hip arthroscopy We present a novel alternative through a unique mini-invasive anterior approach. Our first series consisted of 35 hips (32 patients) with a mean follow-up of 29.2 months. Range of motion (ROM) and clinical scores were evaluated preoperatively at six weeks, three months, six months and one-year follow-up (FU). Impingement test was negative in 33 out of 35 cases six weeks after surgery. Mean hospitalisation time was 2.6 days (2–5 days). Mean improvement in internal rotation was 23° (p= 0.006) and 21° in flexion (p=0.011). There was a significant improvement in hip score according to the Merle dAubigné evaluation (13.8 points preoperative vs. 16.9 at one-year visit) (p=0.017). No Trendelenburg, heterotopic calcifications or osteonecrosis were observed. Complications related to the femorocutaneous nerve appeared in six cases (17.1%) although all but one were neuroapraxia and disappeared before one year. Mean rehabilitation time was 4.4 weeks. We conclude that the anterior surgical approach for the treatment of femoroacetabular impingement enables early resumption of sport while accuracy in bone resection is maintained.
Anteversion of the Acetabular Component in Obese Patients
Authors: Pirard E. , De Lint J.A.
Published: January 2018

The purpose of this study was to investigate the relation between the acetabular anteversion in primary total hip replacement (THR) and obesity We hypothesised that the more difficult exposure of the acetabulum in obese patients through the posterolateral approach might compromise a proper acetabular cup positioning. More specifically we expected to find an inverse relation between the BMI and the acetabular cup anteversion.

Retrospectively 323 consecutive THRs were studied. From the postoperative radiograph the acetabular anteversion was calculated from the acetabular cup projection and the Body Mass Index (BMI) was calculated from the patient's records. In the pooled data no statistical significant correlation could be established between the calculated anteversion and the BMI, nor between the inclination angle of the cup and the BMI.
Zirconia Heads in Perspective: A Survey of Zirconia Outcomes in Total Hip Replacement
Authors: Piconi C. , Maccauro G. , Angeloni M. , Rossi B. , Learmonth I.D.
Published: January 2018

Zirconia ball heads have been implanted successfully from the late 1980s, but reports of wear and fractures have raised concerns about this ceramic biomaterial. This paper reviews the literature on clinical wear of zirconia-polyethylene bearings, zirconia head degradation and fractures, analysing the different factors that have led to clinical failure, such as material source, manufacturing process and type of polyethylene. The results underline the need for more homogeneous clinical series. Careful follow-up of patients with zirconia-polyethylene bearings is recommended.
Medium-Term Follow-Up Series Using a Modular Distal Fixation Prosthesis to Address Proximal Femoral Bone Deficiency in Revision Total Hip Arthroplasty. A 5- to 9-Year Follow-Up Study
Authors: Tamvakopoulos G.S. , Servant C.T.J. , Clark G. , Ivory J.P.
Published: January 2018

We reviewed a series of 39 patients (40 cases) receiving the Link MP stem in revision hip arthroplasty. Average follow-up was 68 months (range 60–115 months).

Proximal femoral defects were classified using the Endo-Klinik and Paprosky classifications. Indications included: osteolysis 13 cases; septic loosening 8 cases; periprosthetic fractures 18 cases; metastatic bone disease 1 case.

We found 92.5% overall survival rate, average Harris Hip Score past two years of 67 and average Oxford Hip Score past five years of 43. We found no implant failure or loosening.

Complications included: 4 deep infections (2 revised to excision arthroplasty), 5 dislocations (1 revision of the proximal modular segment for impingement).

We concluded that revision was successful in cases of peri-prosthetic fractures, septic and aseptic loosening. We advocate use of cerclage wires to prevent peri-operative fractures and use of proximal modular segments with CCD angle of 126° to avoid dislocation.
Clinical Outcome following a Modified Approach for Psoas Lengthening for Coxa Saltans in Adults
Authors: Komarasamy B. , Vadivelu R. , Kershaw C.J.
Published: January 2018

Internal snapping often resolves with conservative treatment but persistent significant symptoms may require surgical treatment. Different surgical approaches have been suggested in the literature with varying results. We describe a modified surgical approach for internal snapping of hip in adults with good results.

Patients who failed conservative treatment for internal snapping over 11/2 years were included. A skin crease incision was made just lateral to the ASIS in supine position. The psoas tendon was reached sub-periosteally along the internal iliac surface and a hole was made in periosteum. Then the tendon was hooked into the wound and divided releasing its musculotendinous junction. The patients were allowed to mobilise as able in the postoperative period.

There were 8 snapping hips (7 patients, 6 females) with average age of 30 years (17–51 yrs). The mean follow-up was 11 months. The average duration of symptoms before operation was 4.5 years (range 2–10 years). Painful symptomatic clicking was relieved in all patients. Two patients felt slight weakness of hip flexion. One patient had temporary neuropraxia of lateral cutaneous nerve of thigh. The diagnosis is made by ultrasound or examination for a palpable click. Surgical correction of snapping is considered after failure of conservative treatment. Different extrapelvic (medial and iliofemoral) and intrapelvic extraperitoneal approaches have been described with varying results. With our slightly modified intrapelvic and subperiosteal approach through oblique inguinal incision in adults, psoas muscle release at musculotendinous junction seems a safe and effective method and could be used as an alternative surgical approach for treatment of internal snapping of hip in adults.
Accuracy of Femoral Templating in Reproducing Anatomical Femoral Offset in Total Hip Replacement
Authors: Davies H. , Foote J. , Spencer R.F.
Published: January 2018

Restoration of hip biomechanics is a crucial component of successful total hip replacement. Preoperative templating is recommended to ensure that the size and orientation of implants is optimised. We studied how closely natural femoral offset could be reproduced using the manufacturers' templates for 10 femoral stems in common use in the UK.

A series of 23 consecutive preoperative radiographs from patients who had undergone unilateral total hip replacement for unilateral osteoarthritis of the hip was employed. The change in offset between the templated position of the best-fitting template and the anatomical centre of the hip was measured. The templates were then ranked according to their ability to reproduce the normal anatomical offset. The most accurate was the CPS-Plus (Root Mean Square Error 2.0 mm) followed in rank order by: C stem (2.16), CPT (2.40), Exeter (3.23), Stanmore (3.28), Charnley (3.65), Corail (3.72), ABG II (4.30), Furlong HAC (5.08) and Furlong modular (7.14). A similar pattern of results was achieved when the standard error of variability of offset was analysed.

We observed a wide variation in the ability of the femoral prosthesis templates to reproduce normal femoral offset. This variation was independent of the seniority of the observer. The templates of modern polished tapered stems with high modularity were best able to reproduce femoral offset. The current move towards digitisation of X-rays may offer manufacturers an opportunity to improve template designs in certain instances, and to develop appropriate computer software.
Increased Mortality among Patients Sustaining Hip Fractures Requiring Surgery in a District General Hospital
Authors: Hamilton P.D. , Whelan A. , Isaacs D. , Mestha P. , Armitage A. , Skyrme A.
Published: January 2018

Fractures of the femoral neck are a common condition the incidence of which continues to rise. Associated mortality remains very high and knowledge of factors contributing to this high mortality is crucial in understanding outcome for both patient and surgeon. A retrospective review of 1254 patients operated on for fracture neck of femur was conducted to identify mortality at 30 days, 90 days and one year. Age, type of fracture, sex and waiting time for surgery were evaluated along with mortality for 47 patients who sustained their fracture while already inpatients with other concurrent illnesses.

Those patients who sustained an inpatient fracture were found to have significantly higher mortality at 30 days, 90 days and one year. We concluded that these patients represent a very high-risk group that needs special consideration in management of their fracture and concurrent medical condition to reduce their high mortality.
Analysis of Clinical Data in Patients with Girdlestone Arthroplasty: A New Score
Authors: Molfetta L. , Bassetti M. , Benvenuti M. , Caldo D.
Published: January 2018

Girdlestone's arthroplasty is an uncommon surgical procedure; it is performed in patiens with recurrent infection of the hip, polymicrobic sepsis or after multiple revisions. The number of hip replacements all over the world is always increasing, so the total number of prosthesis infections also continues to rise, although the relative incidence is lower than in the past. For this reason Girdlestone's arthroplasty must be a well-known procedure to hip surgeons. Clinical assessment of such patients cannot be performed with common hip ratings (e.g. Harris Hip Score) since hip instability, low range of motion, limb shortening and severe muscle loss are common. The patient's independence in daily living activity and freedom from pain should be the surgeon's main goals. We propose a specific clinical score for the outcome of the procedure, which is not to be found in the current literature as far as the authors are aware. The score can be useful for comparative clinical trials, for legal medicine purposes, etc. To illustrate it, we present 20 cases of Girdlestone's arthroplasty out of 265 hip revisions performed in our hospital. The outcome of the procedure in our patients was clinically good in eight cases, intermediate in ten cases, and bad in two cases. We believe the performing of such an intervention is justified when indicated by clinical signs, as we analyse them in our work. Our clinical score has been shown to be adequate to assess the clinical presentation of such patients.
Bilateral Periprosthetic Stress Fractures in a Juvenile Chronic Arthritis Patient Secondary to Bilateral Genu Valgum
Authors: Al-Khateeb H. , Meir A. , Singer G.C.
Published: January 2018

Lateral insufficiency fractures following total hip replacement have been reported with the femoral stems positioned in varus, together with osteopenia of the lateral femoral cortex. Any abnormal alignment of the lower limbs, such as genu valgum, will alter the load distribution across the femoral cortices, and repetitive loading during walking will predispose the bones to stress fractures at any stress riser point, such as the tip of a femoral component. Bilateral femoral stress fractures post total hip replacements have not been previously described.

We present a 55-year-old woman, diagnosed with juvenile idiopathic arthritis, who had undergone bilateral total hip replacements and bilateral knee replacements. The knees 15 years postoperatively were in valgus and the left knee was extremely stiff, flexing to just 5°. The patient presented with bilateral thigh pain, with plain radiographs confirming bilateral periprosthetic fractures of the femur at the tip of well-fixed femoral components. There was no history of injury and her hips were functioning well up to this time. The patient required revision of both hips to long-stem uncemented components, bypassing the fractures, and revision of both knees to stemmed semi-constrained implants, thereby correcting the alignment of both lower limbs. Both fractures healed and the patient is currently pain-free and mobile with walking aids.

Surgeons must remain aware that when implants are in situ, abnormal alignments will lead to abnormal forces, and stress fractures are likely to occur at any stress riser around the implant. Avoiding malalignment will avoid this complication.
Non-Union in an Unnoticed Neck Fracture in Resurfacing Total Hip Arthroplasty
Authors: Falez F. , Casella F. , La Cava F. , Favetti F.
Published: January 2018

The renewed popularity of resurfacing hip arthroplasty (RHA) in the last five years has generated a remarkable quantity of scientific contributions based on mid- and short-term follow-up. In spite of some large series with extremely low complication rates, more than one paper has reported a consistent early revision rate as a consequence of biological or biomechanical failure. Two major complications are commonly described with resurfacing implants: avascular necrosis and neck fracture. A close relationship between these two events has been suggested, but not firmly demonstrated, while surgical exposure and implant positioning seem to be better understood as potential causes of failure.

However, it may happen that neither avascular necrosis nor neck fracture can be clearly recognised in a failed resurfacing implant: it is what we have directly experienced, with a missed fracture at the head-neck junction, evolved in non-union, beneath the dome of the femoral component.

The present report, besides a brief clinical history, tries to give a possible interpretation of such an unusual complication.
The Cemented Custom Femoral Stem - a 10 Year Review
Authors: O'brien S. , Wilson R.K. , Hanratty B.M. , Thompson N.W. , Wallace M.E. , Nixon J.R. , Engela D.W. , Orr J.F. , Isaac G.H. , Beverland D.E.
Published: January 2018

We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10 - 11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review - all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.
Our First Experience with Extended Proximal Femoral Osteotomy for Revision Hip Surgery
Authors: Tulic G. , Dulic B. , Vucetic C. , Todorovic A.
Published: January 2018

Introduction

The extended proximal femoral osteotomy (EPFO) is a demanding but useful techniquefor revision of both cemented or noncemented femoral components.

Materials and methods:

Between 2000 and 2004 we performed extended proximal femoral osteotomy (EPFO) in 25 cases during revision hip surgery The main indication for doing revision surgery was aseptic loosening of both total hip arthroplasty (THA) components (18 patients), whilst in the remaining 7 patients the indications were: aseptic loosening of acetabular component in three patients, septic loosening of THA in two patients, recurrent dislocation of the THA because of incorrectly positioned femoral component in one patient and aseptic loosening of cemented hip hemiarthroplasty in one patient.

Results

There were 14 women and 11 men. The mean follow-up was 22 months. The average time to revision was 8.3 years. The mean age at the time of revision was 70.3 years (range 55 to 81). At the time of the last control examination all osteotomy sites had healed with signs of remodelling. The mean time to union ranged from 11 weeks to 6 months, shown by the bridging callous formation in both radiographic projections. Bone remodelling occured in all patients by 12 months and no complications such as nonunion, excessive fragment migration or wire breakage were found.

Conclusion

In our experience, the extended proximal femoral osteotomy when properly indicated represents an efficient and reliable technique in revision hip surgery.
Slipped Upper Femoral Epiphysis in a Child with Spondyloepiphyseal Dysplasia Tarda: A Rare Coincidence?
Authors: Arumilli B.R.B. , James L. , Bruce C. , George H.
Published: January 2018

We present a report of a child with Spondyloepiphyseal dysplasia tarda (SED) presenting with non-traumatic, insidious onset hip pain with limited internal rotation. Radiographs revealed a left sided stable slipped upper femoral epiphysis (SUFE). To our knowledge an association between these two pathologies has not been reported previously in the literature and hence a tentative commom etiopathogenesis between SED and SUFE is discussed. Patients who have SED often develop hip pain as part of the natural history of the condition. This case highlights the need to be vigilant regarding the potential for SUFE as a cause of hip pain rather than attributing it to the dysplasia itself in these patients.
Etiology of Developmental Hip Dysplasia or Dislocation: Review Article
Authors: Koureas G. , Wicart P. , Seringe R.
Published: January 2018

There is no consensus in the literature regarding the impact of several, so-called, etiological factors in the appearance of developmental dysplasia or dislocation of the hip (DDH). Furthermore, the mechanism explaining the appearance of a dislocated or subluxated hip in the perinatal period is not well defined. The latter explains, as well, the different terms used to describe the same clinical entity. Terms like congenital dislocation of the hip (CDH), developmental dysplasia/dislocation of the hip or teratological dislocation of the hip are usually applied for the description of the same condition. Constitutional and mechanical disorders are accused of encouraging the evolution of an antenatal or neonatal hip towards instability, subluxation or even dislocation. An understanding of the predisposing factors as well as the natural history is essential in order to prevent and/or treat them effectively as well as to decide on the most appropriate nomenclature. A review of the multiple published theories affirms that the determining predisposing factors for hip dislocation or subluxation are mechanical and are associated with intra-uterine posture in full hip flexion, adduction and external femoral rotation together with abnormal pressure on the greater trochanter tending to expel the femoral head in a supero-posterior direction relative to the acetabulum. The role of genetic factors is secondary, but present, and can influence the natural history of a patient if the primary mechanical and postural factors are not inhibited.
Shelf Arthroplasty by Minimal Invasive Surgery: Technique and Results of 76 Cases
Authors: Chiron P. , Laffosse J.M. , Bonnevialle N.
Published: January 2018

Shelf arthroplasty is an old technique which by a classical approach, proposed by Lance in 1925, had a low morbidity rate and long term known results. A minimal invasive approach reduces the magnitude of the operation, its consequences and might allow one to broaden its indications. The approach is 4 cm long at the anterolateral part of the hip, through the space between tensor fascia latae and gluteus muscles. A 3×3 cm cortical-cancellous autograft is applied using a guide wire positioned by fluoroscopy and the osteosynthesis is based on a cannulated screw. 76 cases were reviewed over two years (4.6 years average, 2–8 years). The average hospitalization period lasted for three days; patients have to respect partial weight bearing for two months and no one has been placed in a re-education center. 75% patients had a completely painless hip without limiting their activity. 93% shelves are consolidated with a callus in three months; 6% nonunion was due, in part, to a technical mistake. No infection, no phlebitis, no palsy of the cutaneo lateral nerve has been evidenced.
Is There a Need for Conservative Surgery in DDH Adult Patients? Lessons Learned after 30 Years Experience
Authors: Flecher X. , Aubaniac J.M. , Parratte S. , Argenson J.N.
Published: January 2018

The aim of the present study is to set out our thirty-year experience in conservative surgical management of developmental dysplasia of the hip (DDH) in the young adult, using either periacetabular or intertrochanteric osteotomies.

All the patients have the same radiographic assessment which allows evaluating the lateral center edge angle, the obliquity of the acetabular roof by the HTE and the anterior centre edge angle. According to the Hip Study Group classification, hips were classified as average DDH when VCE and VCA are between 25° and 21°, severe between 20° and 5° and extreme below 5°. The study of the articular congruency is conducted through the surgical profile evaluating the S/FH ratio (S=projected acetabulum surface, FH=1/2 projected femoral head surface) and recentring radiographs by abduction. The presence of osteoarthritis is evaluated according to Tönnis. An additional CT-scan with intraarticular injection may actually be realized. No hip arthroscopy was performed.

Several original modifications have been realized, including a single intrapelvian approach allowing all the cuts and a modification of the ischial cut (“2/3 PAO”) in order to leave the posterior horn attached to the ischium when the S/FH ratio is below 3/4. The femoral posterior head coverage is then not modified whereas the periacetabular fragment is moved anteriorly.

In our experience, PAO is an effective procedure for patients under 30 years of age without intraarticular damage and with average or severe DDH, to avoid a total hip arthroplasty in the future. For patients over 30 years old with a beginning of osteoarthritis or extreme DDH, it seems reasonable to avoid a major operation and maybe to consider less invasive techniques to delay a total hip arthroplasty.
The transverse acetabular ligament may be used to align the acetabular cup in total hip arthroplasty
Authors: Pearce C.J. , Sexton S.A. , Davies D.C. , Khaleel A.
Published: January 2018

Accurate positioning of the acetabular component in total hip arthroplasty is essential to minimise the risk of dislocation and preserve the range of movement of the hip. It also affects polyethylene wear and the rate of osteolysis. Although there are many tools available to the surgeon to aid placement of the acetabular component, errors still occur, especially in version. We conducted a study of 14 cadaveric hips to investigate whether the transverse acetabular ligament can be used to align implanted cups with the correct degree of anteversion. Radiographic measurement revealed that all of the implanted cups were found to lie within the ‘safe zone’ for anteversion, when aligned with the ligament.
Results of acetabular wiremesh and autograft in protrusio acetabuli
Authors: Coll G. Figueras , De Erenchu J. Salazar Fernández , Burniol J. Roca
Published: January 2018

Between 1990 and 2005, 25 acetabular reconstructions in 25 patients were performed using autogenous morcellized bone-graft and acetabular wiremesh due to acetabular bone stock loss. The most frequent preoperative diagnosis in our patients were severe hip arthrosis (50%), and rheumatoid arthritis (15%).

The mean follow up was 8.6 years (range 2–15 years). The most frequent long-term complication was the appearence of radiolucent lines.

A cemented acetabular cup was used in all cases. Preoperative mean Harris Hip Score was 42.3, rising to 90.6 at follow-up after surgery. None of the patients had any loosening of the acetabular component and only one had radiolucent lines >2mm which did not progress. Kohler's line remained intact in all cases.

Results of this study suggests bone-grafting and acetabular wiremesh is an effective and simple method to arrest the progresion of acetabular protrusio.
Exeter-Ogee total hip replacement using the Hardinge approach; the ten to twelve year results
Authors: Myers G.J.C. , Morgan D. , O'Dwyer K.
Published: January 2018

We reviewed 131 consecutive primary total hip replacements implanted into 127 patients between 1995 and 1997. Surgery was performed through a Hardinge approach using the Exeter universal stem in combination with the Ogee Elite acetabular component.

Five of 131 hips have required revision. The ten year survival analysis demonstrates: 95.3% survival with revision for any cause as the end point; 98.9% with revision for aseptic loosening of the stem as the endpoint, 98.1% revision for aseptic loosening of the acetabular component as the endpoint. There were no cases of dislocation.

Our findings show that the Exeter universal stem in combination with the Ogee Elite acetabular component can be inserted through a Hardinge approach in a district general setting with results comparable to surgery performed in a specialist unit and through a posterior approach.
Cognitive function and cerebral emboli after primary hip arthroplasty
Authors: Gray A.C. , Torrens L. , Howie C.R. , Christie J. , Robinson C.M.
Published: January 2018

Transcranial Doppler ultrasound has been used to detect cerebral emboli after hip arthroplasty. The cognitive effects of these embolic events are unclear. The aim of this study was to assess cognitive change after primary cemented hip arthroplasty using a range of neuropsychological tests and to measure intraoperative cerebral embolic load. Twenty primary cemented total hip arthroplasties underwent a series of cognitive tests before and at four days after surgery. A range of validated tests assessed: global cognitive function; verbal fluency and speed; immediate and delayed memory recall; attention and mental processing speeds. Intra-operative transcranial Doppler ultrasound monitoring of the middle cerebral artery for embolic signals was also performed. A one-sample Wilcoxon signed-rank test compared median cognitive results post-pre surgery and a Mann-Whitney U test established if there was a cognitive difference between those patients who had detectable cerebral emboli and those who did not. Scatter plot graphs were also used to establish any correlation between the embolic load and clinical cognitive dysfunction. A significant (p<0.01) difference was noted in specific tests assessing mental processing speed, visual searching and sustained and divided attention following surgery. Intra-operative cerebral embolic signals were detected in 11 out of 20 patients and the majority occurred with femoral component cementation and hip reduction. There was no difference in cognitive dysfunction between those patients who had detectable cerebral embolic signals and those who did not and there appeared to be no direct correlation between the size of the embolic load and the level of cognitive dysfunction.
Accuracy of intraoperative cultures in primary total hip arthroplasty
Authors: Picado C.H.F. , Garcia F.L. , Chagas M.V. , Toquetão F.G.
Published: January 2018

The aim of this investigation was to assess the diagnostic accuracy of intraoperative cultures for the early identification of patients who are at risk of infection after primary total hip arthroplasty.

Four or six swabs were obtained immediately before the wound closure in 263 primary total hip replacements. Patients with a maximum of one positive culture were denoted as patients with a normal profile and did not receive any treatment. Patients with two or more positive cultures, with the same organism identified, were denoted as patients with a risk profile and received treatment with a specific antibiotic as determined by the antibiogram for six weeks. The follow-up ranged from a minimum of one year to five years and eleven months, concentrating on the presence or absence of infection, which was defined as discharge of pus through the surgical wound or as a fistula at any time after surgery. The accuracy of this procedure (number of cases correctly identified in relation to the total number of cases) in the group of 152 arthroplasties in which 4 swabs per patient were collected was 96%. In the group of 111 arthroplasties in which 6 swabs per patient were collected the accuracy was 95.5%.

We conclude that the collection of swabs under the conditions described is a method of high accuracy (above 95%) for the evaluation of risk of infection after primary total hip arthroplasty.
‘Pointing’ in the wrong direction - a case of diverticulitis presenting at the hip
Authors: Haleem S. , Clifton R. , Quraishi N.A. , Hallett J.P.
Published: January 2018

We report the case of a 73-year-old lady who was seen with an infected sinus leaking from the wound of a recently inserted right total hip joint prosthesis. Plain radiographs revealed gas shadows in the region of the wound. An intra-operative sinogram showed the sinus to be coming from a pelvic diverticular abscess and the hip to be an innocent bystander. Our case emphasises the importance of having a clear preoperative plan with relevant investigations before a radical operative procedure is undertaken, to avoid unnecessary risk to a non-infected hip prosthesis.
Persistent anterior hip pain in young adults: Current aspects of diagnosis
Authors: Shetty V.D.
Published: January 2018

Persistent anterior hip pain, in young adults, presents a diagnostic and treatment challenge to hip surgeons. Diagnosis, in some cases, is difficult because available diagnostic tools are not very reliable, resulting in a difficult decision making process. This article discusses the possible causes, current knowledge of the condition and outlines a method to approach this difficult problem.
Uncemented stems in hip replacement - hydroxyapatite or plain porous: Does it matter? Based on a prospective study of HA Omnifit stems at 15-years minimum follow-up
Authors: Epinette J.-A. , Manley M.T.
Published: January 2018

For many years, acrylic cement has been regarded as the unique available means for a long term and secure fixation of components in hip arthroplasty. A new generation of uncemented implants coated in hydroxyapatite (HA) has arisen since the mid-1980s, aiming to provide a “biological interface” between metal and surrounding bone, and thus the hydroxyapatite interface was defined some years ago as a distinct entity from both cemented and “plain porous” fixation. Based upon our 20-year experience with the HA Omnifit stem, this paper aims to discuss the efficiency of hydroxyapatite as a means of fixation for femoral components in hip arthroplasty, then examine whether the addition of a calcium phosphate layer induces any adverse effects, and finally make comparisons between HA-coated versus porous hip stems reported in the literature.

With respect to fixation of femoral components in hip arthroplasty we report excellent results from the partially coated HA Omnifit stem in our series, with 99.20% of survival rate at 17-year follow-up, these results being consistent and similar to other HA series in the literature. HA “uncemented” fixation can therefore be considered reliable and efficient. Furthermore, two decades of hydroxyapatite coatings have resulted in the identification of no major adverse effects. In fact calcium phosphate ions participate in the physiological turn-over of bone remodelling, and the HA coating is replaced by new bone formation without any fibrous tissue layer. Since HA particles are biodegradable and do not produce any inflammatory reaction in the surrounding bone, fears of osteolysis or third body wear due to HA debris have not been confirmed. Finally, comparison between HA versus plain porous femoral components through the literature has demonstrated better results with HA than porous alone both in terms of the quantity and quality of bone remodelling, and the potential migration and subsidence of the stem.
Medium term results of the collum femoris preserving hydroxyapatite coated total hip replacement
Authors: Gill I.R. , Gill K. , Jayasekera N. , Miller J.
Published: January 2018

We describe the survival of 75 collum femoris preserving (CFP) hydroxyapatite (HA) coated uncemented total hip replacement stems with a mean follow-up of 43 months (range 12–60). Patients were assessed using the Harris Hip Score. Radiographs were evaluated using Gruen zones and DeLee and Charnley zones. The criteria for failure were revision or impending revision.

The mean Harris Hip Score was 50 preoperatively improving to 94 at final review with 3 patients lost to follow-up. One cup was revised for aseptic loosening, whilst none of the stems required revision. Survivorship was 97% and 100% at 3 years for the cup and stem respectively. Our findings suggest that the medium term results of the CFP stem are excellent.
The Thrust Plate Prosthesis in the Treatment of Osteoarthritis of the Hip. Clinical and Radiological Outcome with Minimum 5-year follow-up
Authors: Corner J.A. , Rawoot A. , Parmar H.V.
Published: January 2018

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA). We present our mid-term results from using the thrust plate prosthesis in young patients with hip arthritis.

We conducted a retrospective review of a consecutive series of patients with a minimum of 5 years follow-up after total hip arthroplasty using the thrust plate prosthesis. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded preoperatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded.

Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41–67) and the mean length of follow-up was 71 months. The HHS improved from a mean of 42 points preoperatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. Eighty-three percent of patients expressed that they were ‘very satisfied’ with the procedure. Implant survivorship was 95% at 5 years follow-up with revision surgery being the end point. Eight patients suffer discomfort when lying on the operated side. Many patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction but the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.
Management of Blood Loss in Periacetabular Osteotomy
Authors: Atwal N.S. , Bedi G. , Lankester B.J.A. , Campbell D. , Gargan M.F.
Published: January 2018

The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonation of autologous blood for the periacetabular osteotomy. We carried out a retrospective single surgeon series study looking at patient demographics, intraoperative blood loss, volume of red cells returned (by cell salvage and allogenic/autologous transfusion), and comparing pre- and postoperative haemoglobin levels in those that predonated and those that did not.

One hundred and twenty-two procedures were performed on 107 patients between 1996 and 2005. An initial audit (22 procedures) revealed high wastage (45% returned) of allogenic blood. A predonation protocol was initiated and subsequently 100 procedures in 91 patients were performed. In 82 procedures, the patients were eligible for predonation. A total of 226 units of autologous blood were predonated and 92% was used. Only 13 of these patients (16%) required additional allogenic transfusion for unforeseen excessive blood loss intraoperatively A set protocol for predonation reduces the need for allogenic transfusion and involves minimal wastage.

In a procedure which has significant blood loss, we suggest that preoperative autologous donation is a safe and cost effective method of managing blood loss.
A new value of proximal femur geometry to evaluate hip fracture risk: True moment arm
Authors: Ulusoy H. , Bilgici A. , Kuru O. , Sarica N. , Arslan S. , Erkorkmaz U.
Published: January 2018

This study was undertaken to determine the influence of proximal femur geometry on hip fracture risk independent of bone mineral density. We examined 34 hip fracture subjects (17 men, 17 women) and 36 control subjects (18 men, 18 women). The control subjects were matched with the hip fracture patients by femoral neck bone mineral density (±0.100 g/cm2). Hip axis length (HAL), femoral axis length (FAL), femoral neck-shaft angle (θ angle), lateral and medial femoral cortical thickness were measured on standart pelvic radiographs. In the literature, there are conflicting views of the relationship between femur geometry and hip fracture risk which may be explained by different definitions of some parameters. We investigated the effect of a new parameter called true moment arm (TMA) on hip fracture risk. Longer TMA may be corelated to higher transmission of impact energy to the femoral neck. Thus it may be useful to define fracture prone individuals. The results of this study showed that HAL, FAL and TMA were significantly longer in the hip fracture subjects compared to the control group (p<0.001). Hip fracture patients had thinner lateral and medial femoral cortical thickness (p<0.001). θ angle was wider in the hip fracture group than in the control group (p<0.001). In conclusion, our study showed that evaluation of TMA in addition to HAL, FAL, θ angle, MCT and LCT can be used to determine of the fracture risk independently of BMD.