bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior Capsular Repair in Total Hip Arthroplasty Performed for Late-Presenting Displaced Femoral Neck Fractures
Authors: Arac S. , Boya H. , Ozcan O. , Oztekin H.H.
Published: January 2018

Dislocation after total hip arthroplasty performed for femoral neck fractures occurs frequently due to the significantly higher range of movement of the postoperative hip joint. Proper wound closure can prevent the loss of structural support provided by the capsule and myofascial structures, and is essential for postoperative hip stability. On 32 consecutive patients (four men, 28 women; mean age 64 years, range 48–83 years) with unilateral late-presenting displaced femoral neck fractures, a careful anterior capsule repair technique during total hip arthroplasty was performed by a single surgeon between 1997 and 2000. At one-year follow-up, no dislocation had occurred in any patient. Intraoperative protection and careful anatomic reattachment of the hip joint capsule may increase the stability of the hip joint after total hip arthroplasty and lead to a lower incidence of dislocation.
Greater Trochanteric Pain after Total Hip Arthroplasty: The Incidence, Clinical Outcome and Associated Factors
Authors: Sayed-Noor A.S. , Sjödén G.O.
Published: January 2018

We evaluated any residual pain around the hip joint 11 to 23 months post-surgery in 172 consecutive patients who underwent total hip arthroplasty (THA) for primary or secondary osteoarthritis during 2002 at Sundsvall Hospital, Sweden.

Patients with suspected greater trochanteric pain (GTP) were matched with controls from the same cohort. The two groups were assessed with the Western Ontario and McMaster Universities Arthrosis Index (WOMAC) and were examined for localised tenderness over the trochanteric area by algometer. The pre- and postoperative radiographs including femoral offset were evaluated.

We found that 21 patients (12%) had GTP with a male to female ratio of 1:6. The WOMAC index revealed a reduction in the clinical outcome in this group. An associated factor of significance was postoperative uncorrected lengthening of the operated limb equal to or more than one centimetre. We found no correlation between the prevalence of GTP and body weight or length, femoral offset or size of the prosthetic components used.
In Vitro Monitoring of Hoop Strains during Impaction Grafting of the Femur
Authors: Farooq M.A. , Clements J.P. , Miles A.W.
Published: January 2018

A test was designed to monitor hoop strains around the proximal femur during impaction grafting. Four electrical resistance strain gauges were attached to Sawbone femurs just below the level of the lesser trochanter. Experimentation with these femoral models included the use of a device called an “impactometer”, which delivered controllable impaction energies. Test material used was ovine morsellised bone graft prepared from sheep femoral condyles. Instruments used were “X-change” revision instruments from the Exeter hip system. Maximum strains occurred at the medial and lateral cortices and there were lesser strains on anterior and posterior cortices. These findings raise questions about the quality of impaction anterior and posterior to the femoral stem. At the medial and lateral gauges significant differences in levels of strain were recorded at the three different levels of impaction. An individual hoop strain was found to have three components: peak, rapid drop and slow drop. The strain level did not drop back to the starting point at the end of the drop phase but dropped only halfway back to the starting level. This resulted in a rise in strain levels in a stepladder pattern. Strains continued to rise significantly when the impaction process was continued beyond the endpoint of impaction. Early recognition of the endpoint of impaction can save the weak femoral bone from unnecessary high levels of hoop strain.
A New Technique to Improve Cup Inclination Accuracy in Primary Total Hip Arthroplasty
Authors: González Della Valle A. , Beksac B. , Peterson M.G.E. , Salvati E.A.
Published: January 2018

Accurate inclination and anteversion of the acetabular component is paramount to achieve a stable total hip arthroplasty, prevent prosthetic dislocation and minimize long- term wear. We present and evaluate a simple new technique to improve consistency in cup inclination during primary total hip arthroplasty, based on information available from the preoperative plan. The technique consists of assessing the distance and relationship between the inferomedial border of the acetabular cup and the inferomedial margin of the teardrop, with the use of a measuring probe. This simple surgical gesture improved consistency in cup inclination during total hip arthroplasty.
Total Hip Replacement Using Hemi-Circumferential Interposition Acetabuloplasty for Acetabular Deficiency in Post-Perthes Deformities: Technique and Long-Term Results
Authors: Haverkamp D. , Eijer H. , Marti R.K.
Published: January 2018

We describe a technique of hemi-circumferential interposition grafting that allows placement of the cup in the anatomical position of the original acetabulum in the rare cases of post-Perthes or Perthes-like deformities of the femoral head combined with a steep and shallow acetabulum. This technique was performed on 10 hips (9 patients, with an average age of 56 years).

One revision was performed for septic loosening after 2.1 years; however, the graft was well integrated and provided sufficient support for the revision cup. All the others had a good clinical and radiological result after an average of 11.4 years with an average Harris Hip Score of 97.

The authors have found this an easy-to-use method, which can give an excellent, long-lasting result. It also provides important bone stock for possible subsequent revisions.
The Quality of Web-Based Information on Hip Resurfacing Arthroplasty: A Cross-Sectional Survey
Authors: Kwong Y. , Kwong F.N. , Costa M.L.
Published: January 2018

The Internet has become an important source of information for patients. Websites offering medical information are not subject to peer-review. The aim of this study was to evaluate the quality of information available on the web regarding hip resurfacing arthroplasty.

The search term ‘hip resurfacing’ was entered into five commonly used general search engines. The 20 highest-ranked websites from each engine were reviewed, after eliminating duplicate and non-relevant sites. Each site was then given a quality score (maximum of 20) according to predefined general and specific criteria.

Our search identified 40 unique websites. Commercial websites were the most common (n=17). Quality scores ranged from 8 to 18, indicating that the quality of information on the web varied widely. The mean score for all sites was 11.7, SD 2.6, and only four websites scored >15. Fifteen sites did not mention the disadvantages or complications specific to hip resurfacing.

The quality of information on the Internet regarding hip resurfacing is variable. Only four sites out of 40 were deemed to be of high quality. Orthopaedic surgeons need to be aware of these limitations, and take the lead in educating and counselling their patients.
Evaluation and Treatment of Young Adults with Femoro-Acetabular Impingement Secondary to Perthes' Disease
Authors: Eijer H. , Podeszwa D.A. , Ganz R. , Leunig M.
Published: January 2018

Hip pain and loss of motion in young adults with previous Legg-Calve-Perthes-Disease may be caused by anterior femoro-acetabular impingement. Eleven patients (12 hips) with the chief complaint of groin pain and significant proximal femoral deformity were treated. Gadolinium-enhanced magnetic resonance arthrography in ten patients indicated labral injury and adjacent acetabular cartilage lesions in nine hips. A surgical dislocation of each hip confirmed that there was impingement induced intra-articular injury consistent with the pathology indicated on the MRI. Reshaping of the femoral head, with correction of the femoral head/neck offset, and treatment of the acetabular rim pathology was performed for each hip in conjunction with other procedures for the proximal femur. Correction of the impingement and increased range of motion could be visualized intra-operatively At a mean follow-up of 33 months, half of all patients were pain-free and all had improvement in pain compared with preoperatively Ten patients had an improved range of motion and two a slight decrease. No additional necrosis following the dislocation of the femoral head was seen.
The Trochanteric Gamma Nail versus the Dynamic Hip Screw: A Prospective Randomised Study. One-Year Follow-Up of 146 Intertrochanteric Fractures
Authors: Ovesen O. , Andersen M. , Poulsen T. , Nymark T. , Overgaard S. , Röck N.D.
Published: January 2018

In a prospective, randomized trial we compared the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in the treatment of 146 intertrochanteric fractures. Follow-up was after four and 12 months. The operation time was significantly shorter in the DHS group. At discharge the need for walking aids was less in the DHS group. There were no differences in intraoperative blood loss, medical complications, mortality or length of hospital stay. Major fracture complications occurred twice as often in the TGN group compared with the DHS group, however they were not statistically significant. Any potential for the TGN leading to a less invasive procedure and a more rapid postoperative mobilisation could not be demonstrated. Compared with the TGN we prefer the DHS for most intertrochanteric fractures in a setting where the majority of these fractures are treated by younger doctors and not by highly specialized hip/trauma surgeons. The TGN may have advantages in selected intertrochanteric fractures.
Early Clinical Experience with a Metaphyseal Loading Implant: Why have a Stem?
Authors: Kulkarni M. , Wylde V. , Aspros D. , Learmonth I.D.
Published: January 2018

This is a prospective cohort study of patients undergoing total hip replacement using an uncemented, proximally coated stem with a short tapered distal stem. Patients with a minimum of 24 months of clinical and radiological follow-up were included in this study.

There were 18 males and 34 females. Average age at surgery was 40 years. The diagnoses included developmental dysplasia of the hip in 20 patients, osteoarthritis in 15, avascular necrosis of the femoral head in nine, and inflammatory arthritis in three. Average follow-up was 46 months (range 25–78). There was no evidence of subsidence of any stem at the final follow-up. Interface buttressing was observed in 52 patients on the AP view and in 32 on the lateral view. This was seen in Gruen zones 1, 7, 8 and 14. Heterotopic ossification was seen in 15 patients. Distal cortical hypertrophy was seen in three patients. Three patients had one episode of dislocation and two patients had superficial wound infection. None of the hips has been revised and there was no radiological evidence of aseptic loosening.

The high percentage of patients exhibiting condensation of the bone and interface buttressing at the lower reaches of the metaphysis suggest the objective of proximal loading is being achieved. We believe that early stability and durable biological fixation can be achieved by this cementless implant, in which the stem is designed to avoid any contact with the diaphyseal cortex.
Improved Accuracy of Acetabular Component Position and Leg Lengths with the Two-Incision Total Hip Replacement Technique
Authors: Shinar A.A. , Calendine C. , Hamilton A.
Published: January 2018

We sought to determine whether a non-originating surgeon early in his experience with the MIS two-incision technique for THA could place components with appropriate accuracy. Thirty five consecutive hip replacements performed between July of 2003 and March of 2004 using the two-incision technique were closely matched by height and weight with an equal number of control small incision arthroplasties. The two-incision surgeries were performed after the surgeon's twentieth case and prior to the surgeon's fifty sixth two-incision case. We assessed immediate postoperative films for leg length discrepancy and acetabular position, and compared the two groups by chi squared analysis. Both leg length accuracy and abduction angle were significantly superior with the two-incision technique. No arthroplasty performed with the two-incision technique had a leg length discrepancy of more than 10 mm, versus five in the control group (p<0.025). The abduction of one cup fell outside the 35–49° range in the two-incision group, while ten did so in the control group (p<0.01). With this study, we have shown that a non-originating surgeon early in his experience with the MIS two-incision technique can place acetabular components and equalise leg lengths with superior precision. We believe the fluoroscopic control and supine position greatly enhance the surgeon's accuracy, and more than compensate for the potentially decreased direct vision with this technique.
A Modified Two-Incision Minimally Invasive Total Hip Arthroplasty: Technique and Short-Term Results
Authors: Yoon T.-R. , Bae B.-H. , Choi M.-S.
Published: January 2018

Between 2003 and 2005, a total of 425 consecutive cases with a modified two-incision minimally invasive total hip arthroplasty (THA) were performed at our hospital. We analysed 225 cases with greater than 12 months follow-up clinically and radiographically. The mean operative time was 70 minutes. Patients could walk on crutches at 1.5 days and discontinued crutch use at an average of 3 weeks. Patients were able to walk upstairs without support at 4 weeks. Radiographic analysis showed the mean lateral opening angle and anteversion of the acetabular components were 43.0° and 17.3°, and 97% of the femoral stems were in neutral alignment. There was no radiographic evidence of component migration or subsidence at the most recent follow-up. Therefore, from these early results, a modified two-incision THA was found to be an excellent surgical modality, which allows early rehabilitation and does not increase complications when compared to other MIS two-incision THA techniques.
Minimally Invasive Anterolateral Surgical Approach for Total Hip Arthroplasty: Early Clinical Results
Authors: Röttinger H.
Published: January 2018

The purpose of this study is to describe our early experience in the development and use of a minimally invasive, anterolateral approach to the hip joint for total hip arthroplasty (THA). This approach uses a specific intraoperative protocol involving leg positioning to maximise exposure and hip joint visualisation. Between October, 2004 and December, 2004, we operated on 18 male and 29 female patients without selection and in consecutive order. The average patient age at surgery was 66 years (range 28 to 86 yrs) with an average body mass index (BMI) of 26 (range 18 – 36) and with a majority of patients presenting with osteoarthritis as the primary indication for surgery. The average length of the skin incision was 8 cm and the average incision-to-suture time was 45 minutes. The preoperative average Harris Hip Score was 38 and improved to 70 at 10 days postoperatively, and 92 at three and six months. Similarly, the HHS average pain component score increased from 12.6 preoperatively to 39 at 10 days postoperatively, and 40 at three and six months. An exact neutral implantation of the stem was found in 48% of the patients, between one to three degrees out of neutral in 40% and greater than four degrees of varus in 12%. The average inclination angle of the cup was measured at 44 degrees. No intraoperative or perioperative complications of any kind occurred in this series of 47 consecutive patients. From our experience, the MIS AL approach for THA with patients in the lateral position can be applied without restrictions for patient indication. Improved results can be observed when using the MIS AL approach, especially in the early postoperative phase. Since the abductors can be completely spared during the surgery, improved long-term results may be expected. Moreover and when necessary, an operative expansion is always possible without difficulties. Overall, the approach yields promising results.
A Lateral Minimal-Incision Technique in Total Hip Replacement: A Prospective, Randomized, Controlled Trial
Authors: Speranza A. , Iorio R. , Ferretti M. , D'arrigo C. , Ferretti A.
Published: January 2018

Minimally invasive surgery has become a trend over the last few years in all aspects of orthopaedic surgery, including total hip arthroplasty So-called “mini-incision” techniques involve limiting the length of the skin incision to ≤ 10 cm with use of either an anterior, lateral or posterior approach. Between March 2004 and December 2005 one hundred consecutive unilateral total hip replacements were performed by the same senior surgeon in our institute. All patients were randomly assigned to study group (group A) or control group (group B). In group A (50 patients) the skin incision was ≤ 8 cm; in group B (50 patients) the skin incision was standard (about 12–14 cm). Patient demographic data, including sex, age, height, weight, BMI, diagnosis and preoperative Harris hip score were recorded. Other criteria evaluated included the perioperative and postoperative complications, the surgical time, the blood loss, the length of the incision, the acetabular and stem positions, the length of hospital stay, Harris Hip Score (HHS) and the WOMAC osteoarthritis index at six months. No significant differences were found between the groups with respect to the average surgical time, the acetabular and stem position, the length of hospital stay and the Harris Hip Score (HHS) and the WOMAC osteoarthritis index at six months. A significant lower blood loss was found in the mini-incision group. A higher percentage of peri-operative complications was recorded in Group A (two stupor of sciatic nerve and one fracture of the greater trochanter). On the basis of our experience we could speculate that minimally invasive surgery should be directed to the new surgical approach with muscle sparing, instead of a shorter skin incision using standard approaches.
The Safety of Hip Injection with Corticosteroid in the Diagnosis and Treatment of Osteoarthritis
Authors: Karuppiah S.V. , Gibson P.
Published: January 2018

Introduction

Injection of steroid and local anaesthetic into hip and knee joints has been a recommended treatment for osteoarthritic pain for decades. There have been recent studies showing a higher incidence of infection leading to early revision of joint prostheses in patients who have had corticosteroid injections prior to joint replacement surgery.

Objective

The aim of our study was to determine if there is any risk of infection in patients undergoing total hip arthroplasty (THA) after a hip joint injection.

Patients and Methods

A retrospective search was conducted using the hospital computer database to identify patients who underwent hip injection and subsequent THA between 2000 and 2004. The study included a review all case notes to specifically identify prosthetic infection or early joint replacement surgery.

Results

One hundred and twenty-eight patients had hip joint injections and subsequently underwent successful total hip replacement. In this study there was no evidence of associated risk of prosthetic infection or early revision of total hip arthroplasty after hip joint injection with corticosteroids (average time of follow-up 3.2 years).

Conclusions

Hip injection is safe provided a strict aseptic protocol is maintained. The time period of pain relief with hip injection is limited (average 2 months). For diagnostic purposes injections with local anaesthetic only is recommended. A large randomised control study would probably further substantiate these findings.
Separation of the Apex Hole Eliminator Screw in Four Failed Hybrid Total hip Arthroplasties
Authors: Comba F. , Buttaro M.A. , Piccaluga F.
Published: January 2018

Advancement or separation of the apex hole eliminator screw in uncemented Duraloc 100 cups (DePuy®, Warsaw, Indiana, USA) has been recently reported as a radiographic finding without clinical effects.

We report four patients with a separation of the apex hole eliminator screw in Duraloc 300 uncemented cups and aseptic failures of a hybrid total hip arthroplasty (acetabular osteolysis and femoral stem loosening). Revision surgery was performed when disabling pain and radiographic signs of loose components were present.

Although difficult to determine, a relationship between the screw migration and the failure could have existed in these cases. Migration of the screw might not only be interpreted as a radiographic, clinically irrelevant finding. Its presence should alert the orthopaedic surgeon that the prosthesis is exposed to high intraarticular fluid pressures.
Bilateral Total Hip Arthroplasty in Siblings with Stickler Syndrome
Authors: Banerjee D. , Anderson J.A. , Taveras N.A. , González Della Valle A.
Published: January 2018

Stickler Syndrome is an infrequent autosomal dominant connective tissue disorder. The most prevalent mutation affects type II collagen gene and results in abnormalities in cartilage, vitreous and nucleus pulposus. Orthopaedic manifestations include joint hyper- mobility and pain with early development of secondary osteoarthritis. The condition has a predilection for the femoral head and patients usually present in their third to fourth decade with secondary hip arthritis. We report on two siblings with Stickler Syndrome who presented with hip osteoarthritis in their third decade of life and underwent staged bilateral total hip arthroplasties (THA). The patients experienced pain relief and improved quality of life after surgery.
Modular Femoral Head Dissociation after Dislocation and Entrapment in Reconstruction Ring: A Case Report
Authors: Buttaro M. , Comba F. , Piccaluga F.
Published: January 2018

Dissociation of modular components is an infrequent potential complication characteristically unique to modularity. We present a patient in whom dissociation of the modular femoral head occurred at attempted closed reduction after dislocation, with the intraoperative findings including entrapment of the head between the rim of a reconstruction ring and the acetabular bone. In the case a dislocation in a patient that was previously reconstructed with a reinforcement ring and a modular femoral stem occurs, dissociation of the modular head should be considered as an extremely uncommon complication that does not outweigh the advantages given by modularity.
Factors Influencing Length of Stay after Primary Total Hip Replacement: The Role of Anaesthesia and the Anaesthetist
Authors: Shetty V.D. , Vowler S.L. , Villar R.N.
Published: January 2018

We studied 121 consecutive total hip replacements (THRs) in 109 patients in order to establish the influence of anaesthetic technique, anaesthetist concerned, age of the patient, and body mass index (BMI) on the length of hospital stay after primary total hip replacement. Patients received either general anaesthesia alone (50 THRs) or a combination of general and local anaesthesia (lumbar plexus block; 71 THRs) from three separate anaesthetists. Our analysis showed that those patients who received a combination of anaesthesia showed shorter median length of hospital stay (three days) than those who received general anaesthesia alone (five days; p < 0.0001). The age of the patient was also critical (p = 0.003) as was the anaesthetist concerned (p = 0.01). BMI was unimportant.
A Radiological Study of 3M Capital Femoral Hip Prostheses: An Analysis of Factors Predisposing to Failure
Authors: Kasis A.G. , Farhan M.J. , Elson R.
Published: January 2018

We conducted a radiographic assessment of 180 flanged modular titanium alloy Capital femoral hip replacements. Six significant factors associated with failure are identified. The mean follow-up period was 7.9 years (2.1–16 years) and there were 26 (14%) radiographic failures irrespective of whether these were symptomatic or led to revision. Failure, if it is going to occur, is initiated early, within an average of 1.4 years, and becomes clinically evident very quickly; the remainder appear to sustain more likelihood of stable survival. This is the longest published follow-up and it suggests that the survival is better than indicated in some other series. If the identified prejudicial aspects of surgical technique had not been present, it follows that the results would have been better. Comparison with other published series is attempted.
The Role of Alpha1-Antitrypsin in Total Hip Replacement: A Pilot Study
Authors: Dixon S. , Wood J. , Beetham R. , Abou-Shameh M. , Bannister G.
Published: January 2018

Background

Lungs exposed to particulate debris may be damaged by proteolytic enzymes during phagocytosis. Damage is worse if patients are deficient in a1-antitrypsin (A1AT), which helps neutralise these enzymes. We investigated the possibility that A1AT deficiency contributes to aseptic loosening following total hip replacement (THR) when wear particles are phagocytosed.

Method

A1AT level and phenotype were measured in patients attending for revision THR within 15 years of implantation. Periprosthetic lysis was graded from radiographs by three hip surgeons with an interest in revision, blinded to history and A1AT results. Patients were grouped according to presence of high or low levels of lysis radiologically Mean A1AT levels were calculated for the two groups.

Results

17 patients were recruited, mean age 69.5, mean interval between surgery and onset of pain 8.3 years (2–12). Two were heterozygotes for the less active S form of A1AT and therefore mildly deficient. Time to onset of pain in both was 12 years. Radiographs were available for 12 patients. Combining the results for all reviewers the probability of a difference in the level of A1AT between the high and low lysis groups reached statistical significance (p=0.008). For all reviewers, the mean A1AT level in their high lysis group was raised and greater than that of their low lysis group. Both A1AT-deficient patients were classified as high lysis by all reviewers.

Conclusions

The incidence of A1AT deficiency is only marginally higher in this group than in the general population therefore A1AT deficiency is unlikely to be a common cause of failure of hip replacements. Elevated levels of A1AT in the presence of lysis suggest that A1AT may play a role in the aetiology of aseptic loosening. A1AT-deficient patients may be at increased risk of osteolysis. Further work is needed to evaluate this and to assess vulnerability of A1AT-deficient patients to lysis.
Fracture of two Successive Ring TiMESH Cemented Hip Prostheses
Authors: Gardiner M.D. , Macdowell A.D.
Published: January 2018

We report the unfortunate case of a man who experienced stem failures of both his primary and revision hip arthroplasties. As far as we are aware this is the only reported case of a patient to suffer the misfortune of multiple femoral implant failures.
Results of Total Hip Arthroplasty in Gaucher'S Disease Patients
Authors: Kumar V. , Rushton N.
Published: January 2018

There is controversy regarding the success of total hip arthroplasty (THA) in patients with Gaucher's disease. We present a retrospective study of nine total hip replacements in six patients (four primary THAs and five revisions). Four were female and two were male. All patients were of white ethnic origin. Five hips have required revision surgery for loosened implants (four once only and one twice). The average age at the time of primary THA was 35.3 years (13–54). The average duration between primary THA and first revision was 11.4 years (6–19). The duration between first and second revision in one hip was six years. The follow-up ranged between 2.5 years to 19 years. One patient developed superficial infection postoperatively which settled with wound debridement and antibiotics. Excessive peri-operative blood loss was noted in three patients.
Femoral Stem Tip Orientation and Surgical Approach in Total Hip Arthroplasty
Authors: Vaughan P.D. , Singh P.J. , Teare R. , Kucheria R. , Singer G.C.
Published: January 2018

Introduction

A posterior entry point, a neutral tip position and neutral stem alignment are recommended to avoid a thin cement mantle and ensure an optimal outcome in total hip arthroplasty (THA). Our aim was to highlight any influence of surgical approach in obtaining an optimal stem orientation.

Methods

We examined the post-operative, digitised radiographs of 100 (50 each group) polished, tapered Exeter THA, inserted via the antero-lateral or posterior approaches. Stem tip position was assessed in both coronal and sagittal planes and stem alignment was assessed in the coronal plane. Results: There was a significant difference between the two approaches in the sagittal stem tip position only (p=0.01).

Discussion

Our results illustrate that a neutral stem tip position in THA is significantly more difficult to obtain with an antero-lateral approach, when compared to the posterior approach. A posterior approach to the hip avoids the cuff of glutei that can lever the proximal stem anteriorly causing an anterior entry point and a posterior stem tip position. We also illustrate how the anatomy of the proximal femur in the sagittal plane makes a neutral stem alignment difficult to achieve with either approach.
Antibiotic Distribution in a Bone Cement Spacer Model
Authors: Shiramizu K. , Lovric V. , Leung A.M.D. , Walsh W.R.
Published: January 2018

Purpose

To mix high dose antibiotic powder to the bone cement more easily, Hanssen et al reported mixing the antibiotics with the cement during its liquid phase but made no comments about the relevance of cement viscosity and antibiotic distribution. The purpose of this study was to investigate the effect of the cement mixing technique and cement viscosity on the antibiotics distribution in a cement spacer model.

Methods

Thirty cylindrical models from three groups were examined. Group A was made by mixing the antibiotics with medium viscosity cement prior to adding the liquid monomer (traditional technique). Group B was made by mixing the antibiotics with medium viscosity cement during its liquid phase (Hanssen's technique). Group C was made by traditional technique with low viscosity cement. In all groups 2 g of tetracycline was used. Three 0.1 mm thick cross sections from each spacer model were examined under the fluorescent microscope. The fluorescent spots of tetracycline were calculated automatically in pixels. To evaluate the distribution of the antibiotics in the spacer model, we selected the cross section with the highest number of pixels and the one with the lowest number of pixels from each of the three cross sections and calculated the difference between them. The distribution disequilibrium was compared between group A and B, A and C.

Results

No significant difference was observed in either comparison.

Conclusion

The Hanssen's mixing technique can be used when using high dose antibiotics, and either medium or low viscosity cement could be used in terms of antibiotic distribution.
False Aneurysm of the Superficial Femoral Artery after Total Hip Arthroplasty: A Case Report
Authors: Molfetta L. , Chiapale D. , Caldo D. , Leonardi F.
Published: January 2018

Vascular lesions in hip prosthetic replacement are rare events; it is mandatory to be aware of the risk, though, in order of the vascular bundle's proximity to the surgical field. A 74-year-old patient was admitted to our department for primary hip arthroplasty for osteoarthritis. The patient was healthy but had mild hypertension. A cemented total hip prosthesis was implanted. The patient complained of growing groin pain and swelling from the third postoperative day. The suspicion of a vascular injury arose with worsening pain and low haemoglobin at blood tests. Then ultrasonography scans and digital angiography were performed, showing a superficial femoral artery pseudo-aneurysm. The patient had further surgery to repair the lesion. In the described case, the pseudo-aneurysm might have been caused by the pulling of a Hohmann retractor on arterial vessels possibly affected by atherosclerosis. The final output was favourable, but the authors point out that knowledge of neurovascular anatomy is necessary as well as postoperative surveillance of the clinical presentation of the patient if groin pain or swelling should arise. In the case of suspicion of vascular lesions, ultrasound and angiography will allow diagnosis and confirm the indication for surgical repair.
Hip Sonography: 20 Years Experience and Results
Authors: Graf R.
Published: January 2018

Hip sonography in the “Graf technique” is an important tool to detect early DDH cases and dysplastic hips in the German speaking countries, although hip sonography is still controversially discussed in the English speaking countries. The reason may be different techniques with different classification and outcome. Exact anatomical identification, measurement technique, typing, difference between instability and elasticity with a reproducible “standard plane” is absolutely necessary to make hip ultrasound (US) comparable and reliable.

US screening had reduced open reductions in Germany to 1:4000, in Austria to 0.23 per thousand. Because of the early screening and earlier less aggressive treatment, the overall costs could be reduced by 1/3 in comparison to the pre-ultrasound area.

US screening seems to prevent many, but not all operations and can be recommended as an important tool for prevention.
The Role of Triple Pelvic Osteotomy in Therapy of Residual Hip Dysplasia and Sequel of AVN: Long-Term Experience
Authors: Dungl P. , Rejholec M. , Chomiak J. , Grill F.
Published: January 2018

Triple pelvic osteotomy was performed for sequel of DDH including AVN between 1981 and 2002 for 329 patients (351 hips, 280 females, 49 males, average age at surgery 16.5 years, range 9–41 years, follow-up 4–25 years). A small modification of Steel's technique consisting of strictly subperiostal resection of segment from both pubic and ischial bone was used. Average gain of lengthening extremity was 1.8 cm. The average CE angle was improved from 7.8 to 35.5 degrees. Clinical results were evaluated according to Merle d'Aubigne and reflected to the preoperative clinical and radiological findings. There were 146 hip joints in 128 patients (76%) with excellent results in the group of congruent hips without arthrosis. In 182 hips in 178 patients with hip joints with some deformity, limited ROM and decentration, 40% were excellent, 32% good, 23% fair and 5% unsatisfactory results were achieved. The group of decentrated hip joints in young adults in incongruency limited ROM and sometimes severe arthrosis consisted of 23 monolateral surgeries with 39% unsatisfactory, 39% fair and 22% good results, respectively. No major neurovascular complications were seen. Non-unions were recorded in 19 patients (5.4%), including 2 triple and 2 double non-unions. Based on our long-term experience, we can conclude that triple pelvic osteotomy according to Steel in our modification is a safe method and gives regularly excellent or good results for correction of clinical and radiographic appearance of acetabular dysplasia when there is a proper indication.
Total Hip Replacement in High Riding Developmental Dysplasia of the Hip: Cementless Total Hip Arthroplasty with Femoral Shortening Using a Subtrochanteric Resection
Authors: Tokgozoglu A.M. , Caglar O.
Published: January 2018

Total hip arthroplasty in younger patients with high riding dislocations is a challenging procedure. Although many procedures have been proposed, our preferred technique for this is to insert a small sized cementless acetabular component in the native acetabulum, a small sized cementless femoral component and perform a subtrochanteric oblique cylindrical resection of 4 centimeters. The femur is fixed with a plate using unicortical screw fixation. This technique is preferred to avoid stretching the neurovascular structures. This procedure was performed on 91 hips of 83 patients with a mean age of 45 years, between 1990 and 2005. After 8 years we observed a 10% failure with a good clinical outcome. The Merle d'Aubigne Hip Scores were improved from 10.65 preoperatively to 34.95 postoperatively. Despite a high complication and failure rate the patients were pleased with the final outcome. We continue to recommend this procedure in this unique patient population.
Cemented Femoral Stems in Patients with Ddh
Authors: Garcia-Cimbrelo E.
Published: January 2018

Total hip arthroplasty is the procedure of choice for most adult patients with symptomatic arthrosis secondary to developmental dysplasia (DDH), but it requires complex reconstructive techniques, is usually performed in young patients, and has an increased risk of complications. THA is indicated in presence of severe pain and when osteotomy is contraindicated. The complexity of surgery is related to the degree of dysplasia. Anatomic abnormalities in the acetabulum and femur are the cause of the complexity and complications of this procedure. Acetabular bone deficiency requires reconstructive techniques before implanting the cup at the anatomic acetabular location, such as bone autograft augmentation, implanting the cup at higher level of the hip center and cup medialization. Femoral shortening and special cemented or uncemented stems are currently used to avoid intraoperative complications. While a cemented stem needs metaphyseal femoral shortening, subtrochanteric shortening requires a cementless stem. Because of these patients' age, alternative bearing surfaces, such as alumina-on-alumina couples are recommended when possible. Although the long-term results of total hip arthroplasty in DDH are inferior to those in a general population, the results show a high level of pain relief and functional improvement.
Total hip arthroplasty in hemodialysis and renal transplant patients
Authors: García-Ramiro S. , Cofán F. , Esteban P.L. , Riba J. , Gallart X. , Oppenheimer F. , Campistol J.M. , Suso S.
Published: January 2018

Osteoarticular complications are common in patients with chronic renal failure and they often require implantation of a hip arthroplasty (total or partial) due to osteoarthritis, femoral neck fracture or ischemic necrosis of multifactor aetiology.

Between 1992 and 2005 we operated on eighteen patients (23 hips) with chronic renal failure who were receiving renal replacement therapy (ten haemodialysis and eight renal transplants), and in each case either a total or partial hip arthroplasty was implanted. This group comprised nine women and nine men, with a mean age of 56 years (range: 30–83). Five cases were bilateral. The clinical diagnoses were necrosis (fourteen cases), femoral neck fracture (five cases) and osteoarthritis (three cases).

The main early complications were haemorrhage in seventeen cases (74%) and infection in six cases (33%) (two urinary infections and four of the surgical wound). The late complications involved eight cases (35%) of prosthetic loosening (five aseptic and three septic). The surgery-related mortality rate was 17% (three cases).

Prosthetic hip surgery in patients receiving renal replacement therapy is associated with high morbidity and mortality, thus highlighting the importance of careful patient selection.
Cement venogram: As a Result of high Femoral Cement Pressurisation. A Report of 3 Cases
Authors: Miller D. , Frost A. , Choksey A. , Perkins R.
Published: January 2018

Current femoral cementing techniques for total hip arthroplasty (THA) have improved over recent years. High pressurisation is achieved using a cement gun with a proximal seal and a cement restrictor, maximising the microinterlock at the bone cement interface. However, there are concerns regarding over pressurisation of the femoral canal resulting in an increased risk of cardiorespiratory collapse secondary to embolic phenomena.

We report on three cases over a one year period of cement within a vein (cement venogram) on a post-operative radiograph following THA. We feel that the cement venogram is an important indicator of high pressurisation and that its incidence may be on the increase with improved cementing techniques.
Complication of an Insufficiency Fracture of the Acetabulum
Authors: Angles F. , Coscujuela A. , Tramunt C. , Panisello M. Gonzalez , Portabella F.
Published: January 2018

An 83-year-old woman presented to the emergency department with a history of pain in the left hip of gradual onset over several days. There was no history of trauma and the X rays showed degenerative changes in the hip joint but no apparent fracture. She was sent home after being given reassurance, analgesics and a cane.

Three weeks later she returned unable to mobilise after falling while getting out of bed and injuring the left hip. On this occasion the X-rays showed an acetabular fracture with femoral head protrusio. A CT scan confirmed the diagnosis and also demonstrated the absence of a haematoma in the surrounding soft tissues. The latter is characteristic of insufficiency fractures.

Orthopaedic surgeons require a high index of suspicion for insufficiency fractures of the pelvis, femoral head and femoral neck in elderly osteoporotic patients who complain of hip pain without any history of trauma.
Role of Hip Arthrodesis in Current Practice: Long Term Results following Conversion to Total hip Arthroplasty
Authors: Sirikonda S.P. , Beardmore S.P. , Hodgkinson J.P.
Published: January 2018

Background

Hip arthrodesis was once considered as a preferred treatment option in young people with hip arthritis. The purpose of this retrospective study was to evaluate the long term outcome following conversion of hip arthrodesis to arthroplasty The main indications for conversion were back pain and ipsilateral muscular or knee pain.

Methods

Sixty-eight procedures in 67 patients performed between 1963 and 2000 at Wrightington Hospital were evaluated.

Results

The mean age at the time of hip arthrodesis was 16.7 years (3 to 39 years). The mean age at the time of conversion was 48.7 years (24 to 74 years). The Merle d'Aubigné score improved from a mean of 8.81 pre-operatively to 13.6 at the latest follow-up. Complications included DVT (3 patients), transient foot drop (1 patient), and hepatitis following blood transfusion (1 patient). Seven patients required further revision surgery following conversion.

Conclusions

Arthrodesis remains a sensible and safe treatment option maintaining independent mobility without multiple operations or significant bone loss for 20–30 years which subsequently can be successfully converted to an arthroplasty.
Femoral Revision with Impaction Allografting and an Uncemented Femoral Component
Authors: Nickelsen T.N. , Erenbjerg M. , Retpen J.B. , Solgaard S.
Published: January 2018

A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric®, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral component revision for aseptic loosening was performed on 100 hips. In 14 cases (14%) an intraoperative fracture occurred and 7 patients (7%) had other postoperative complications. Seventeen patients (17%) required further revision, 10 because of aseptic loosening. Of 50 surviving patients with retained implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair.

In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone and implant survival.
The Treatment of Femoral Neuropathy Due to Pseudotumour Caused by Metal-On-Metal Resurfacing Arthroplasty
Authors: Harvie P. , Giele H. , Fang C. , Ansorge O. , Ostlere S. , Gibbons M. , Whitwell D.
Published: January 2018

Concerns now exist about the long-term biological effects of exposure to orthopaedic metal alloys, particularly serum cobalt and chromium ions derived from metal-on–metal wear debris in these patients. A pseudotumour mass complicating metal-on-metal resurfacing arthroplasty has been recognized by orthopaedic oncologists and specialist hip units. Pseudotumours may also present with a major nerve palsy. Two cases of femoral neuropathy due to pseudotumour masses caused by metal-on-metal resurfacing arthroplasty are presented. Preoperative neurophysiological studies showed severe and irreversible pathological changes to nerve function with neurohistopathological evidence of complete nerve destruction with a previously unreported pathological appearance. This may represent a previously unrecognized pathological process, possibly ‘toxic’ in nature, resulting from metal-on-metal wear debris. Prolonged follow-up and detailed clinical assessment of patients after hip resurfacing arthroplasty is advocated with planned and expeditious revision of any patient in whom evidence of femoral neuropathy develops.
Total Hip Arthroplasty in a Patient Affected by Post-Traumatic Acetabular Non-Union: Case Report and Review of the Literature
Authors: Tassinari E. , Sudanese A. , Traina F. , De Fine M. , Toni A.
Published: January 2018

Total hip arthroplasty in the presence of acetabular non-union can be demanding. The irregular anatomy, the defect, and the presence of fibrous and necrotic tissue can hamper insertion of the acetabular component. We present a case of total hip arthroplasty in a patient with post-traumatic necrosis of the femoral head and non-union of the acetabulum and follow-up one year after the operation. Following accurate preoperative planning, removal of the pseudarthrosis material, and the use of the femoral head as an autograft, it was possible to insert the acetabular cup satisfactorily in a single-stage procedure.
Assessment of Outcomes after hip Arthroplasty
Authors: Wylde Vikki , Blom Ashley W.
Published: January 2018

Because of the ever-increasing prevalence of joint replacement, it is important that patient outcomes after surgery are continuously reviewed and monitored, with the aim of optimising outcomes after surgery. Of central importance in assessing outcomes is choosing the most appropriate outcome measure. This article reviews five methods of assessing outcomes after hip arthroplasty, namely radiographic analysis, implant survivorship analysis, surgeon-based outcome measures, performance-related assessment and patient-reported outcome measures. The relative strengths and weaknesses of each method of assessment are discussed, with the aim of aiding the surgeon or researcher in choosing an outcome measure when designing a clinical trial.
Determinants of Heterotopic Ossification after Total Hip Replacement Surgery
Authors: Fransen Marlene , Neal Bruce , Cameron Ian D. , Crawford Ross , Tregonning Garnet , Winstanley Julie , Norton Robyn
Published: January 2018

The ability of various pre- or peri-operative variables to determine the risk of developing moderate to severe heterotopic ossification (HO) six to twelve months after surgery was investigated among 407 patients undergoing elective total hip replacement (THR) surgery and allocated to placebo in a randomised controlled trial evaluating NSAIDS-based prophylaxis for HO. Overall, 11 (30%) of the 37 patients undergoing revision surgery developed moderate to severe HO compared with 58 (16%) of the 370 patients undergoing primary THR; odds ratio (OR) 2.3, 95% confidence interval (CI) 1.1 to 4.9. Among patients undergoing primary THR, mutually adjusted analysis of collected independent risk factors demonstrated that receiving a transfusion of red cells or having general as well as epidural or spinal anaesthesia present as indicators of increased risk for developing moderate to severe HO. Patients who have undergone revision surgery have a significantly increased risk of clinically relevant ectopic bone, while among patients who have undergone primary THR surgery, those with indicators of excessive surgical bleeding are also at increased risk of clinically relevant HO.