bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiologic Evaluation of the Cement Mantle in the Femoral Shaft. A Comparative Study Using a Fast-Set or a Standard-Set Cement
Authors: Gallart X. , Martínez F. , García S. , Riba J. , Combalía A. , Ballesteros J. , Elefante F. , Calonego G. 
Published: January 2018

Introduction At present a wide spectrum of cement types are available for cemented total hip arthroplasty (CTHA). All types have the same objective, i.e. to prolong the life of the implant for as long as possible. The purpose of this study was to compare the radiologic cement mantle of CTHA using cement with fast or standard setting characteristics. Method A prospective comparative study of patients who underwent CTHA was performed: the first group received fast setting cement (Cemex System Fast), the second group received standard setting cement (Cemex System). A radiologic evaluation of the cement mantle was done using Barrack's classification. In order to give the study clinical relevance we assembled Barrack's classification in two groups: 1) Low risk group (Types A and B); 2) High risk group (Types C and D). According to ISO 5833:2002, the international standard was used to perform physico-chemical (polymerization temperature, setting time) and mechanical testing (compression strength, bending strength and bending modulus). Results The fast setting cement showed a shorter setting time and a higher polymerization temperature. The mechanical performances of both cements met the ISO limits. At a mean follow-up of 23 months (11–37 months) no statistically significant radiological difference was found in the radiologic cement mantle between the two groups either in the post-operative X-ray evaluation (p=0.32) or in the last follow-up (p=0.72). Statistical evaluation was done comparing the two subgroups, i.e. low risk and high risk. Conclusions The use of fast or standard setting cement does not produce any difference in the quality of the radiologic cement mantle in the short-term. Both cements comply with ISO 5833 requirements.
Morphological Variations of Residual Hip Dysplasia in the Adult
Authors: Ganz R. , Leunig M. 
Published: January 2018

Common understanding of residual hip dysplasia of the adult characterizes it as a uniform, anterolateral insufficiency of femoral head coverage; the proximal femur may or may not have increased valgus and antetorsion. This view is reflected by the parameters used for quantification but also by the classic surgical approaches to compensate or correct the deformity. More than two decades of dedication to hip dysplasia and its surgical treatment, but also the application of modern diagnostic tools such as magnetic resonance arthrography have allowed us to portray hip dysplasia more polymorphically showing a number of additional aspects with pathophysiologic, therapeutic and prognostic valence. The rim in acetabular dysplasia shows a variety of pathomorphologies ranging from hypertrophy and tearing of the labrum including fatigue fracture of the rim to degeneration with ganglion formation within the labrum, the capsule or the acetabular bone. Such rim pathology may explain sudden onset of pain but also influences the prognosis of joint preserving surgery. It is a rather new understanding that the acetabular morphology in hip dysplasia is not uniform. Pure lateral and pure anterior deficiency of coverage are small but interesting subgroups. Together with the frequent retroversion of the acetabulum these morphological and spatial aspects require special attention for a precise individual correction of the deformity. Finally, minor morphological abnormalities of the antero-lateral head-neck junction have been found to favor impingement after correction of the acetabulum. Knowledge of this problem has prompted a routine check of internal rotation in flexion during surgery and eventual arthrotomy and osteochondroplasty of the impinging site of the head and neck junction.
Surgical Treatment of Hip Dislocation in Early Infancy
Authors: Lotito F.M. , Sadile F. , Cigala F. 
Published: January 2018

The necessity to operate on hip dislocation has decreased because the natural history of this congenital disease has been completely changed by using clinical and ultrasonographic screening. At present in our country surgical reduction is indicated in the rare cases of true congenital severe hip dislocation or in the few cases missed during screening. Our long experience in the treatment of such pathology since the start of the 1960s is summarized in this paper in which we describe our indications in surgical treatment of dislocated and subluxated hips affected by DDH. We point out our approach to open the dislocated hip laterally explaining the advantage of this particular and not common approach. We also describe the radiological assessment necessary to evaluate residual dysplasia in order to plan the necessary pelvic or femoral osteotomy to correct these residual joint alterations.
Wagner's Spherical Periacetabular Osteotomy: Long Term Results
Authors: Zagra L. , Corbella M. , Giacometti Ceroni R. 
Published: January 2018

Residual acetabular dysplasia leads to hip arthritis as a consequence of insufficient femoral head coverage which causes abnormal pressure on the joint cartilage. Spherical periacetabular osteotomy, described by H. Wagner, improves the acetabular coverage of the head. This surgical technique has been performed by the senior author, in Galeazzi Orthopaedic Institute of Milan, Italy since 1979. The purpose of this study is to evaluate the clinical and radiographic results of 14 patients affected by acetabular dysplasia and operated before 1985 by the same surgeon with this technique. The analysis of long term results (follow-up longer than 20 years) has shown that it is possible to achieve good clinical outcomes and to delay the need for total hip arthroplasty if a precise surgical technique is employed and if the correct indications are followed. Obese patients or hips with X-ray signs of osteoarthritis show the worst results in our experience. Our attitude is nowadays: full indication of spherical periacetabular osteotomy in dysplasia of the adolescent, indication in young adult patients only when some symptom is present, very rare indication in arthritis and only in very mild cases in young patients.
Evolution of Surgical Techniques for the Treatment of Angular and Torsional Deviation in DDH: 20 Years Experience
Authors: Grappiolo G. , Spotorno L. , Burastero G. 
Published: January 2018

The anatomical abnormalities associated with developmental dysplasia of the hip (DDH) increase the complexity of hip arthroplasty In addition, previous femoral osteotomy can deform the proximal femur. Noncemented cups and stems are specifically designed for dysplasia to recover the true acetabular region in Crowe grade IV and sometimes Crowe grade III; additional surgical procedures are required. The purpose of the study was to analyse the surgical procedure and then the reconstructive options in DDH. From 1984 until now, total arthroplasty has been performed, on dysplastic hips, in 2,101 patients for 2,308 hips (207 patients bilateral 9% rate). All the procedures were perfomed by the senior authors (LS, GG) at the same hospital specialised in elective hip surgery. More than 80% of patients came from Northern Italy. The average age was 51 (range 32–83), 565 cases had involved a previous femoral osteotomy. Out of these 2,308 cases, 128 cases needed treatment for corrections of femoral side deformity; 64 cases were subjected to a greater trochanter osteotomy. In 12 cases, proximal femur shortening was involved. In 9 cases, rotational abnormality and shortening were controlled with a distal femur osteotomy. Fifty-five cases were treated by a shortening subtrochanteric osteotomy that allows corrections of any deformity. Only noncemented stems were used. Long-term results in these patients are consistently inferior (70% survival rate at 15 years) compared to those in the non-DDH population (97.7% survival at 15 years). On the femoral side, early failures are the reflection of a learning curve and are due to insufficient fixation of the osteotomy. The more promising outcomes are those involving a shortening subtrochanteric osteotomy.
“Conus” Uncemented Stem in Developmental Hip Dysplasia
Authors: Cherubino P. , Zatti G. , D'angelo F. , Murena L. , Monzeglio D. 
Published: January 2018

The purpose of this study was to evaluate 115 “Conus” uncemented stems at an average follow-up of 6 years (2–9 years). Seventeen patients were lost at follow-up for a final number of 98 stems in 75 patients. The clinical outcome of 71 hips (72%) was graded excellent, 25 (25%) were good, one (2%) fair and one (2%) poor. The average Harris Hip Score increased from 49.35 before operation to 96.30 at the time of the last follow-up. None of the stems implanted required a revision for aseptic or septic loosening. Cortical hypertrophy or radiolucencies were never seen in any of the stems evaluated. Heterotopic ossification was seen in one hip (1%). Modification of the calcar was observed in 29 hips (30%) and they consisted in a slight rounding off of the proximal medial edge of the cut femoral neck. These results encourage the use of this versatile stem which showed a good primary and secondary stability, with a good load distribution along the femur.
Modular Stems in DDH
Authors: Benazzo F. , Cuzzocrea F. , Stroppa S. , Ravasi F. , Dalla Pria P. 
Published: January 2018

The Modulus (Lima-Lto) system has been created on the association of a conical stem and a modular neck in order to address the so called “difficult hip”. Modularity can maximize the options for a correct reconstruction in a total hip replacement of the coxofemoral anatomy as well as biomechanics. Modulus should be used in CDH, primary hip arthritis, the sequelae of osteotomies and in each case in which we face a congenital or acquired hip deformity. The Modulus stem has been commonly utilised in association with the Delta cup (Lima-Lto) with the chance to use big diameter heads (32–36 mm) and ceramic on ceramic coupling. Modulus has been used in association with Delta cup since November 2002. 51 patients affected by CDH have been treated. Clinical and radiographic results can be considered very good. The average evaluation based on Merle D'Aubigné schedule is equal to 17.5 with a significant increase in the results with respect to the preoperatory score (with an average score equal to 10). In the light of the above, Modulus should be considered a valuable system to optimize the results of total hip replacement also in those more complex situations with a modified femoral morphology, allowing the restoration of a normal biomechanics in terms of off-set and anteversion with benefit in terms of stability and length of the implant as well as in terms of satisfaction of the patient as far as limb length and ROM are concerned. The association of Modulus with big diameter heads gives a higher guarantee in terms of duration of the implant and restoration of the functionality in young patients with a serious deformity and increased functional demands.
The relationship of the orientation of the transverse acetabular ligament and acetabular labrum to the suggested safe zones of cup positioning in total hip arthroplasty
Authors: Archbold H.A.P. , Slomczykowski M. , Crone M. , Eckman K. , Jaramaz B. , Beverland D.E. 
Published: January 2018

Background There is a need to develop and validate a method for establishing cup orientation that is patient specific and independent of the anterior pelvic plane. It is our hypothesis that the transverse acetabular ligament and acetabular labrum can be used to do this. The objective of this study is to define the orientation of the plane formed by the transverse acetabular ligament and acetabular labrum and to examine whether these local landmarks lie within the limits of acceptance for cup positioning. Methods Twenty-five consecutive patients, who were being investigated for labral tears with a MRI arthrogram of the hip, were enrolled in this prospective study. The orientation of the transverse acetabular ligament-labrum plane was determined by manually selecting points on the transverse acetabular ligament and labrum. The best-fit plane through these points was determined and its operative orientation expressed with respect to a constructed pelvic coordinate system. Results The operative anteversion of the transverse acetabular ligament-labrum plane ranged from 5.3-36.1° (mean 23.0° ± 7.4° standard deviation). The inclination ranged from 38.4-50.3° (mean 45.6° ± 3.2° standard deviation). Conclusions The transverse acetabular ligament and acetabular labrum offer a possible solution to the many difficulties involved in cup placement during total hip arhroplasty This paper highlights the variation in the orientation of these local acetabular landmarks and questions the logic of a set target for cup positioning.
Cement as a locking mechanism for screw heads in acetabular revision shells – a biomechanical analysis
Authors: Laflamme G.Y. , Alami G.B. , Zhim F. 
Published: January 2018

In acetabular revisions, polyethylene (PE) liners are often cemented into metal shells on top of acetabular screw heads. This study investigates the possibility of using this technique to obtain “fixed-angle” acetabular screws - a concept that has not yet been reported in the literature. Two groups of screws (n=8) were inserted into Trabecular Metal revision shells (Zimmer), into which PE liners were then cemented. Screws in Group 1, inserted in the shell's pre-fabricated holes, were countersunk, whereas screws in Group 2 were inserted in custom-drilled holes that make their heads protrude into, and interdigitate with, the overlying cement mantle. Perpendicular loading was then applied to the screw shafts both statically to failure and cyclically. A greater stiffness was observed for the protruding screws upon static loading; and while the countersunk screws all failed at the screw-cement junction (53.44 ± 8.33 N), the protruding screws all failed at the screw shaft (1049.79 ± 32.12 N) – a 20-fold difference (p < 0.05). Under cyclic loading, only the protruding screw head specimen did not fail, undergoing an overall displacement within the limits of osseointegration. These results support the hypothesis that the protrusion of an acetabular screw head into an overlying cement mantle significantly increases its angular stability. Provided other variables are favorable, this “locking effect” may increase the initial stability of the whole implant, thus improving the ultimate success of complex acetabular revisions.
Ten-year results of a bone-preserving low-modulus composite total hip replacement stem
Authors: White S.P. , Lee M.B. , Galpin J. , Learmonth I.D. 
Published: January 2018

A cementless composite femoral stem was developed with the aim of reducing bone loss secondary to stress shielding. Thirty-one stems were implanted in 27 patients, combined with a cementless acetabular component with polyethylene bearing surface in 30 cases and a bipolar head in 1 case. Patients were followed-up annually with clinical and radiographic evaluation. Fourteen hips underwent dual X-ray absorptiometry (DEXA) scans to monitor postoperative bone mineral density around the stem. The mean follow-up was 10.1 years. The mean Harris hip score improved from 57 to 92. To date, no stem has required revision. All stems are radiographically stable. Acetabular component revision has been required in 8 cases; 3 for liner dissociation and 5 for polyethylene wear. Radiographs and DEXA scans have shown some improvement in bone mineral density (BMD) between the 2 and 5-year follow-up. A cohort of patients displayed improvement in radiographic appearance and BMD in Gruen zone 7. This stem shows evidence of proximal bone preservation and has excellent results at medium to long-term follow-up. The limiting factor in our cohort of patients has been the polyethylene bearing surface.
Revision of the Birmingham Hip Resurfacing cup: Technical notes and the use of a Novel Technique to Overcome Unique Problems
Authors: Sandiford N.A. , Kabir C. , Muirhead-Allwood S.K. , Skinner J. , Nuthall T. 
Published: January 2018

The number of hip resurfacing procedures performed in the United Kingdom has doubled in the last four years reflecting its popularity among orthopaedic surgeons. Of the available options the Birmingham Hip Resurfacing (BHR) prosthesis has been the most popular choice in this country. Despite this revision rates have been shown to be higher in the resurfacing group compared to the total hip arthroplasty group particularly in the early postoperative period. Revision of the BHR acetabular component is technically demanding due to several unique design features of this component. We discuss these features and describe a novel reliable and reproducible technique for revision of the BHR cup.
Optimizing for Head Height, head Offset, and Canal Fit in a Set of Uncemented Stemmed Femoral Components
Authors: Khmelnitskaya E. , Mohandas P. , Walker P.S. , Muirhead-Allwood S.K. 
Published: January 2018

When inserting an uncemented hip stem, the objectives are to obtain a close fit of the stem in the canal and anatomic head placement. Our goals were to formulate a set of stems which would satisfy these two objectives, and to test the resulting templates on sequential radiographs of hip replacement patients. Using 98 cases for which a custom primary hip had been designed, thirteen dimensional parameters for a hip stem were defined, most importantly proximal medial width (PMW), proximal lateral width (PLW), head offset (HOF), head height (HHT), mid-stem diameter (BD), and distal diameter (DD). These parameters were analyzed in 155 patients' radiographs, and the resulting data were evaluated to obtain the optimal combinations of parameters. A 14–size stem system was defined and evaluated on the AP radiographs of 103 successive hip replacement patients. For each stem diameter between 11 and 17mm, two pairs of PMW and PLW values, equivalent to ‘varus’ and ‘valgus’ shapes, provided the best fit for the population of radiographs. The template analysis showed that out of 103 cases, 93% of offsets were within 4mm of ideal, while 81% of heights were within 1mm of ideal, and 99% were within 4mm of the ideal. Canal fit was within 1.5mm in the proximal-medial Gruen Zone 7 in 58% of the cases. The dimensional parameters of the 14 size system enabled the close matching of the important dimensional parameters simultaneously. The error that did occur could largely be corrected by modular heads and by minor canal broaching. By providing two stem shape variations for each stem diameter, our system achieved an accurate head center position while simultaneously obtaining a sufficiently close fit in the canal.
The Mayo Conservative hip: Experience from a District General Hospital
Authors: Gilbert Rob E. , Salehi-Bird Seema , Gallacher Peter D. , Shaylor Phillip 
Published: January 2018

The Mayo Conservative Hip femoral prosthesis has been designed to optimise proximal femoral loading as well as preserving proximal femoral bone stock. Between October 2003 and May 2006, 42 patients (49 hips) underwent total hip replacement (THR) using the Mayo Conservative Hip femoral component. The mean age at operation was 57.8 years (range 44 to 74) and the mean clinical follow up was 3.1 years (range 2.3 to 4.7 years). The aim of our study was to review the short term results of this unorthodox femoral component. We found that 18%° of stems were malaligned ≥ 5° and the prevalence of intra-operative femoral fracture was 4%. We feel this prosthesis is difficult to implant and has an unacceptable fracture rate.
Hip Arthroplasty in Morbidly Obese Patients - Intra-Operative and Short Term Outcomes
Authors: Bennett Damien , Gibson Dessie , O'Brien Seamus , Beverland David E. 
Published: January 2018

Concerns about longer and more difficult operations, increased early post-operative complications and poorer patient outcomes may deter surgeons from performing total hip arthroplasty (THA) on morbidly obese (MO) patients. Intra-operative parameters including operation time, anaesthetic time, wound length and length of hospital stay were compared between 29 MO THA patients (Body Mass Index (BMI) > 40 kg/m2) and 29 age and gender matched THA patients with normal BMI (BMI between 20 and 25 kg/m2) in a single surgeon study. Pre and post-operative Oxford Hip scores, hip range of motion and post-operative complications were also compared. Morbidly obese patients experienced significantly longer operation times (66 minutes) and longer wounds (14.2 cm) compared to normal THA patients (58 minutes and 12.1 cm respectively). However, intra-operative anaesthetic time and length of hospital stay were not significantly different between the MO and normal patients. Improvements in patient outcomes following THA were not significantly different between the MO and normal patients at one year follow-up. Improvements in sagittal range of motion and external rotation were significantly less for MO patients. Intraoperative complication rates were 0% for the MO and 3.5% for the normal patients. Postoperative complication rates were 3.5% for the MO and 0% for the normal patients. THA operation times for MO patients were on average only 8 minutes longer and should not represent a barrier to surgery. Hospital length of stay was not longer for MO patients suggesting they do not represent a greater burden on healthcare resources during THA.
Modified Extended Trochanteric Osteotomy with Preservation of Posterior Structures
Authors: Lakstein Dror , Kosashvili Yona , Backstein David , Safir Oleg , Gross Allan E. 
Published: January 2018

The purpose of the study was to describe the technique and the clinical results of the modified extended trochanteric osteotomy (ETO) with a lateral approach to the hip. This osteotomy differs from those previously described, as it preserves the posterior part of the greater trochanter and its attached external rotators, the aim of this modification being to minimize the rate of hip dislocation. We reviewed the results of 105 extended sliding trochanteric osteotomies performed between January 2000 to January 2008. The indication for surgery was aseptic loosening in 83 cases, periprosthetic fractures in 10 cases, stem fracture in 5 cases, infection in 5 cases and instability in 2 cases. Minimum follow up was 20 months (mean, 65; range, 20–120 months). Mean length of the osteotomy was 17.6 cm (range, 9–30 cm). Mean Harris hip score improved from 39 points preoperatively to 73 at last follow up. Six stems (6%) needed revision for loosening. There was one case (1%) of osteotomy nonunion, and one case (1%) of greater trochanteric fragment nonunion and escape. Four patients (4%) dislocated postoperatively. In conclusion, our series of ETOs reveals a low dislocation rate achieved by preservation of the attachment of the external rotators and posterior capsule, and exhibits a union rate comparable to that of other series. We recommend the use of ETO in revision surgery of cemented stems and cementless well fixed distal ingrowth stems.