bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Implant Design on Periprosthetic Bone Remodelling of two Types of uncemented HA-Coated Hip Stems. A Two-Year Follow-up Study Using Dexa
Authors: Van Der Wal B.C.H. , Rahmy A.I.A. , Grimm B. , Blake G.M. , Heyligers I.C. , Tonino A.J. 
Published: January 2018

Proximal bone resorption and an increased fracture rate in the ABG-I stem has been shown. For these reasons the ABG-I stem design was changed to the ABG-II. In this study periprosthetic bone loss around the ABG-I vs ABG-II is compared to verify if the design changes resulted in improved proximal bone preservation. Methods 51 patients were randomised to either the ABG-I or ABG-II hip prosthesis. Periprosthetic BMD change at various time points was measured using DEXA. Between the two groups (age, gender, weight etc.) no statistical difference was encountered. Compared to the baseline at two years the ABG-II preserved bone better proximally (e.g. zone 7: ABG-II: −3.7%, ABG-I: −11.9%, p=0.05) than the ABG-I. Distally, the trend was opposite and less bone loss was measured for the ABG-I than the ABG-II in zones 3, 4 and 5 (n.s.). Conclusion this study confirms the philosophy behind the design changes from the ABG-I to ABG-II stem where increased elasticity, more proximal HA-coating, a shorter and distally polished stem, were meant to reduce proximal bone resorption. In future this may lead to fewer periprosthetic fractures and to less complicated revision surgery.
Anterior or Posterior: Does the Surgical Approach to the Hip Influence the Quality of the Femoral Cement Mantle?
Authors: Sanghrajka A.P. , Whittingham-Jones P.M. , Higgs D. , Caruana J. , Blunn G. , Briggs T.W.R. 
Published: January 2018

The purpose of this study was to determine whether the surgical approach to the femoral neck during total hip arthroplasty affects the quality of femoral cement mantle in terms of thickness and defects, both of which have been implicated in the development of aseptic loosening. A retrospective radiological review of 50 Stanmore Hip femoral stems inserted using the anterior approach and 50 inserted via the posterior approach was performed, with analysis by zone of cement mantle thickness and number of defects. This study demonstrates that the anterior approach is associated with an increase in the frequency of deficiencies in the cement mantle. We recommend that surgeons using the anterior approach are wary of this increased risk and adopt measures, such as the use of distal centralisers, to minimise its occurrence.
Evaluation of the Learning Curves Associated with Uncemented Primary Total Hip Arthroplasty Depending on the Experience of the Surgeon
Authors: Flamme C.H. , Stukenborg-Colsman C. , Wirth C.J. 
Published: January 2018

The aim of the paper is to prove and to portray the learning curve in total hip arthroplasty. This prospective study included 168 patients who were operated on by three surgeons, all demonstrating different degrees of experience in performing total hip arthroplasty. Perioperative complications and postoperative radiographs were analysed. Patients were re-examined clinically and radiologically five years postoperatively. In addition, a second study with 41 patients was performed, evaluating especially the learning curve of the highly skilled surgeon in using a femoral neck prosthesis. Radiological complications presented by the first 84 operated patients (2nd study: 25 hips) were significantly higher than those in the following 84 patients (2nd study: 26 hips). The learning curve of all surgeons was completed after 20 operations regardless of their experience. Clinical results at follow-up were not influenced by the learning curve. Intensive preoperative planning and exchange of experiences will reduce the length of the learning curve within and outside every clinic.
Acetabular Dome Retroversion: Radiological Appearance, Incidence and Relevance
Authors: Dora C. , Leunig M. , Beck M. , Simovitch R. , Ganz R. 
Published: January 2018

Interest in acetabular version arose from the study of unstable developmental dysplastic hips (DDH). Initial studies and clinical observations described the dysplastic hip as being excessively anteverted. Doubts on this view arose from analysis of complications such as persistent posterior subluxation after acetabular reorienting procedures. Computed tomography fails to determine conclusively whether or not the dysplastic acetabulum is abnormally anteverted. Controversy evolves from different methods of measuring and from the fact that the acetabular opening gradually spirals from mild anteversion proximally to increasing anteversion distally. This renders the measurement of version dependent on pelvic inclination and the level of the transverse CT scan slice. On an orthograde pelvic radiograph, both pelvic inclination and rotation can be controlled. Therefore, acetabular version is best estimated based on the relationship of the anterior and posterior acetabular rims to each other on an orthograde pelvic radiograph. Acetabular retroversion has been found to be a characteristic feature of specific hip disorders such as post-traumatic dysplasia, proximal femoral focal deficiency and bladder exstrophy. In addition, acetabular retroversion has been described in DDH as well as in dysplastic hips in the context of neuromuscular and genetic disorders. Iatrogenic acetabular retroversion can also result from corrective pelvic osteotomies in childhood. Finally, retroverted acetabula may be found in otherwise nondysplastic hips. The relevance of acetabular retroversion is twofold: First, it demands a more individualized approach to acetabular dysplasia because the presence of retroversion will affect the manner in which the corrective osteotomy should be done. Second, the long-term effect of acetabular retroversion is harmful.
Intrapelvic Protrusion of a Dynamic Hip Screw
Authors: Garcia S. , Popescu D. , Gallart X. , Riba J. 
Published: January 2018

The sliding hip screw, sometimes called the dynamic hip screw (DHS) has been a successful method for treating hip fractures. Nevertheless, mechanical complications of this system have been reported from time to time. They are mainly the result of instability of the fracture, bone quality and technical errors occurring during surgery. We report a case of an intrapelvic protrusion of a sliding screw after a basicervical fracture was treated with a DHS and a 6.5 mm cannulated screw, and its surgical solution using a hybrid total hip arthroplasty. In our case we think the mechanical failure was due mainly to technical errors during surgery. Despite that, we believe the sliding hip screw is the implant of choice for basicervical fractures. Using an additional K-wire during the technique is sufficient to avoid rotation of the proximal fragment and no additional fixation is necessary.
Ultra-Short Stems with Proximal Load Transfer: Clinical and Radiographic Results at Five-Year Follow-Up
Authors: Santori F.S. , Manili M. , Fredella N. , Tonci Ottieri M. , Santori N. 
Published: January 2018

Bone stock preservation is crucial when performing THR in young patients. Following this philosophy, an original ultra-short custom-made implant with extensive proximal load transfer was developed. It presents three very innovative features: absence of the diaphyseal portion of the stem, a well defined lateral flare with load transfer on the lateral column of the femur and a very high femoral neck cut. These innovations resulted in a very conservative implant both of the bone stock and the soft tissues. In this study we reviewed the X-rays of 111 patients with 131 primary total hip replacements performed with this implant. The average pain score using the Harris Hip Score system, at an average of five years after surgery, was 42 of 44 points; 95 per cent (124) of the patients had no or slight pain. We had no cases of thigh pain. None of the patients required a femoral stem revision. Two cases had to be re-operated for polyethylene liner exchange but the femoral implant was stable and left in place. At five years, all implants appeared radiographically stable with well maintained proximal bone stock. It was concluded that the geometry of this implant provides significant initial stability, which seems to be preserved throughout a long follow-up period. This study validates the assumption that torsional loads can be controlled even without the diaphyseal portion of the stem and that neck preservation combined with lateral flare support guarantees a more natural loading of the femur.
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.
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.
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.
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.
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.