bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is There a Need for Conservative Surgery in DDH Adult Patients? Lessons Learned after 30 Years Experience
Authors: Flecher X. , Aubaniac J.M. , Parratte S. , Argenson J.N. 
Published: January 2018

The aim of the present study is to set out our thirty-year experience in conservative surgical management of developmental dysplasia of the hip (DDH) in the young adult, using either periacetabular or intertrochanteric osteotomies. All the patients have the same radiographic assessment which allows evaluating the lateral center edge angle, the obliquity of the acetabular roof by the HTE and the anterior centre edge angle. According to the Hip Study Group classification, hips were classified as average DDH when VCE and VCA are between 25° and 21°, severe between 20° and 5° and extreme below 5°. The study of the articular congruency is conducted through the surgical profile evaluating the S/FH ratio (S=projected acetabulum surface, FH=1/2 projected femoral head surface) and recentring radiographs by abduction. The presence of osteoarthritis is evaluated according to Tönnis. An additional CT-scan with intraarticular injection may actually be realized. No hip arthroscopy was performed. Several original modifications have been realized, including a single intrapelvian approach allowing all the cuts and a modification of the ischial cut (“2/3 PAO”) in order to leave the posterior horn attached to the ischium when the S/FH ratio is below 3/4. The femoral posterior head coverage is then not modified whereas the periacetabular fragment is moved anteriorly. In our experience, PAO is an effective procedure for patients under 30 years of age without intraarticular damage and with average or severe DDH, to avoid a total hip arthroplasty in the future. For patients over 30 years old with a beginning of osteoarthritis or extreme DDH, it seems reasonable to avoid a major operation and maybe to consider less invasive techniques to delay a total hip arthroplasty.
Results of acetabular wiremesh and autograft in protrusio acetabuli
Authors: Coll G. Figueras , De Erenchu J. Salazar Fernández , Burniol J. Roca 
Published: January 2018

Between 1990 and 2005, 25 acetabular reconstructions in 25 patients were performed using autogenous morcellized bone-graft and acetabular wiremesh due to acetabular bone stock loss. The most frequent preoperative diagnosis in our patients were severe hip arthrosis (50%), and rheumatoid arthritis (15%). The mean follow up was 8.6 years (range 2–15 years). The most frequent long-term complication was the appearence of radiolucent lines. A cemented acetabular cup was used in all cases. Preoperative mean Harris Hip Score was 42.3, rising to 90.6 at follow-up after surgery. None of the patients had any loosening of the acetabular component and only one had radiolucent lines >2mm which did not progress. Kohler's line remained intact in all cases. Results of this study suggests bone-grafting and acetabular wiremesh is an effective and simple method to arrest the progresion of acetabular protrusio.
Exeter-Ogee total hip replacement using the Hardinge approach; the ten to twelve year results
Authors: Myers G.J.C. , Morgan D. , O'Dwyer K. 
Published: January 2018

We reviewed 131 consecutive primary total hip replacements implanted into 127 patients between 1995 and 1997. Surgery was performed through a Hardinge approach using the Exeter universal stem in combination with the Ogee Elite acetabular component. Five of 131 hips have required revision. The ten year survival analysis demonstrates: 95.3% survival with revision for any cause as the end point; 98.9% with revision for aseptic loosening of the stem as the endpoint, 98.1% revision for aseptic loosening of the acetabular component as the endpoint. There were no cases of dislocation. Our findings show that the Exeter universal stem in combination with the Ogee Elite acetabular component can be inserted through a Hardinge approach in a district general setting with results comparable to surgery performed in a specialist unit and through a posterior approach.
Accuracy of intraoperative cultures in primary total hip arthroplasty
Authors: Picado C.H.F. , Garcia F.L. , Chagas M.V. , Toquetão F.G. 
Published: January 2018

The aim of this investigation was to assess the diagnostic accuracy of intraoperative cultures for the early identification of patients who are at risk of infection after primary total hip arthroplasty. Four or six swabs were obtained immediately before the wound closure in 263 primary total hip replacements. Patients with a maximum of one positive culture were denoted as patients with a normal profile and did not receive any treatment. Patients with two or more positive cultures, with the same organism identified, were denoted as patients with a risk profile and received treatment with a specific antibiotic as determined by the antibiogram for six weeks. The follow-up ranged from a minimum of one year to five years and eleven months, concentrating on the presence or absence of infection, which was defined as discharge of pus through the surgical wound or as a fistula at any time after surgery. The accuracy of this procedure (number of cases correctly identified in relation to the total number of cases) in the group of 152 arthroplasties in which 4 swabs per patient were collected was 96%. In the group of 111 arthroplasties in which 6 swabs per patient were collected the accuracy was 95.5%. We conclude that the collection of swabs under the conditions described is a method of high accuracy (above 95%) for the evaluation of risk of infection after primary total hip arthroplasty.
Uncemented stems in hip replacement - hydroxyapatite or plain porous: Does it matter? Based on a prospective study of HA Omnifit stems at 15-years minimum follow-up
Authors: Epinette J.-A. , Manley M.T. 
Published: January 2018

For many years, acrylic cement has been regarded as the unique available means for a long term and secure fixation of components in hip arthroplasty. A new generation of uncemented implants coated in hydroxyapatite (HA) has arisen since the mid-1980s, aiming to provide a “biological interface” between metal and surrounding bone, and thus the hydroxyapatite interface was defined some years ago as a distinct entity from both cemented and “plain porous” fixation. Based upon our 20-year experience with the HA Omnifit stem, this paper aims to discuss the efficiency of hydroxyapatite as a means of fixation for femoral components in hip arthroplasty, then examine whether the addition of a calcium phosphate layer induces any adverse effects, and finally make comparisons between HA-coated versus porous hip stems reported in the literature. With respect to fixation of femoral components in hip arthroplasty we report excellent results from the partially coated HA Omnifit stem in our series, with 99.20% of survival rate at 17-year follow-up, these results being consistent and similar to other HA series in the literature. HA “uncemented” fixation can therefore be considered reliable and efficient. Furthermore, two decades of hydroxyapatite coatings have resulted in the identification of no major adverse effects. In fact calcium phosphate ions participate in the physiological turn-over of bone remodelling, and the HA coating is replaced by new bone formation without any fibrous tissue layer. Since HA particles are biodegradable and do not produce any inflammatory reaction in the surrounding bone, fears of osteolysis or third body wear due to HA debris have not been confirmed. Finally, comparison between HA versus plain porous femoral components through the literature has demonstrated better results with HA than porous alone both in terms of the quantity and quality of bone remodelling, and the potential migration and subsidence of the stem.
Medium term results of the collum femoris preserving hydroxyapatite coated total hip replacement
Authors: Gill I.R. , Gill K. , Jayasekera N. , Miller J. 
Published: January 2018

We describe the survival of 75 collum femoris preserving (CFP) hydroxyapatite (HA) coated uncemented total hip replacement stems with a mean follow-up of 43 months (range 12–60). Patients were assessed using the Harris Hip Score. Radiographs were evaluated using Gruen zones and DeLee and Charnley zones. The criteria for failure were revision or impending revision. The mean Harris Hip Score was 50 preoperatively improving to 94 at final review with 3 patients lost to follow-up. One cup was revised for aseptic loosening, whilst none of the stems required revision. Survivorship was 97% and 100% at 3 years for the cup and stem respectively. Our findings suggest that the medium term results of the CFP stem are excellent.
The Thrust Plate Prosthesis in the Treatment of Osteoarthritis of the Hip. Clinical and Radiological Outcome with Minimum 5-year follow-up
Authors: Corner J.A. , Rawoot A. , Parmar H.V. 
Published: January 2018

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

The aim of this study was to determine the efficacy and cost-effectiveness of the use of predonation of autologous blood for the periacetabular osteotomy. We carried out a retrospective single surgeon series study looking at patient demographics, intraoperative blood loss, volume of red cells returned (by cell salvage and allogenic/autologous transfusion), and comparing pre- and postoperative haemoglobin levels in those that predonated and those that did not. One hundred and twenty-two procedures were performed on 107 patients between 1996 and 2005. An initial audit (22 procedures) revealed high wastage (45% returned) of allogenic blood. A predonation protocol was initiated and subsequently 100 procedures in 91 patients were performed. In 82 procedures, the patients were eligible for predonation. A total of 226 units of autologous blood were predonated and 92% was used. Only 13 of these patients (16%) required additional allogenic transfusion for unforeseen excessive blood loss intraoperatively A set protocol for predonation reduces the need for allogenic transfusion and involves minimal wastage. In a procedure which has significant blood loss, we suggest that preoperative autologous donation is a safe and cost effective method of managing blood loss.
Cup Inclination Angle of Greater than 50 Degrees Increases whole Blood Concentrations of Cobalt and Chromium ions after Metal-on-metal Hip Resurfacing
Authors: Hart A.J. , Buddhdev P. , Winship P. , Faria N. , Powell J.J. , Skinner J.A. 
Published: January 2018

A cup inclination angle greater than 45 degrees is associated with increased wear rates of metal on polyethylene (MOP) hip replacements. The same maybe true for metal on metal (MOM) hips yet this has not been clearly shown. We measured the acetabular inclination angle from plain radiographs, and whole blood metal ion levels using Inductively Coupled Plasma Mass Spectrometry of 26 patients (mean Harris Hip Score 94 and mean time post op of 22 months) with Birmingham Hip Resurfacings. We identified a threshold level of 50° cup inclination. Below this threshold, the mean whole blood cobalt and chromium were 1.6ppb and 1.88ppb respectively; above this threshold, the mean blood cobalt and chromium were 4.45ppb and 4.3ppb respectively. These differences were significant cobalt (p<0.01) and chromium (p=0.01). All patients above the threshold had metal levels greater than any of the patients below the threshold. For 14 patients, who returned one year later for a repeat blood metal level measurement, cobalt and chromium levels were very similar. The effect of an acetabular inclination angle of greater than 50 degrees on wear rates of MOM hips, as measured through blood metal ion levels, appears to be similar to that seen with MOP hips. Additionally, our new analytical methods may allow blood metal levels to be used as a realistic biomarker of in vivo wear rate of MOM hips. The implication is that metal levels can be minimised with optimal orientation of the acetabular component.
Quality of Life in Different Age Groups after Metal-On-Metal Hip Resurfacing Arthroplasty
Authors: Papavasiliou A.V. , Villar R.N. 
Published: January 2018

Hip resurfacing arthroplasty is known to improve quality of life (QoL) and allow increased activity levels in young patients. It is, however, traditionally offered to the younger age group of patients, largely those aged under 60 years. We studied 42 consecutive patients (42 hips) aged 60 years or over (mean age 64) and 41 consecutive patients (42 hips) under this age (mean age 49), all of whom had undergone a metal-on-metal hip resurfacing arthroplasty. A modified Harris hip score was translated to QoL scores using the Rosser Index Matrix immediately pre-operatively and at six weeks, six months, one year and four years after surgery. We found a significant improvement in QoL for both groups (p<0.0001) but no difference between the two groups. The maximum improvement was reached one year after surgery. Implant survival at four years was also similar (97.6% for group I and 100% for group II). We thus conclude that in carefully selected active patients aged 60 years and over, hip resurfacing arthroplasty provides significant and equal QoL improvement as it does for those under this age with similar implant survival. For this reason, age alone should not influence a surgeon's decision to proceed with a hip resurfacing arthroplasty.
Use of Irradiated Bone Graft for Impaction Grafting in Acetabular Revision Surgery: A Review of Fifty Consecutive Cases
Authors: Mehendale Sanchit , Learmonth Ian D. , Smith Evert J. , Nedungayil Suneel , Maheshwari Rohit , Hassaballa Mo A. 
Published: January 2018

Impaction bone grafting is a useful technique in the armament of a revision hip surgeon. Traditionally fresh frozen allograft has been used for this technique. However there are concerns about the transmission of viral proteins and prions through this form of allograft. As a result irradiated bone graft has been favoured in some centres. There is no long term series describing the results of impaction bone grafting using irradiated bone. This paper reviews a consecutive series of 50 cases of acetabular revision surgery performed between 1995 and 2001 and followed up over a mean period of 45 months. The preoperative bone defect was graded by the Paprosky classification. There were 2 cases of type 1a, 9 type 2a, 15 type 2b, 7 type 2c, 10 type 3a and 7 type 3b. All cases were followed up clinically and radiologically. Case notes were reviewed for primary prosthesis, operative details and reason for revision. The radiographs were evaluated for signs of bone incorporation, remodelling, loosening and migration of the acetabular component. There were 5 cases of aseptic loosening at the end of the follow up period. One patient had recurrent dislocation and was revised. 20 cases (40%) showed changes suggestive of bone incorporation, while only 3 cases (6%) showed remodelling. Clinically a good or excellent outcome with absence of pain was achieved in 35 patients (70%). The results suggested that acetabular impaction bone grafting using irradiated bone graft is comparable to fresh frozen allograft. The low percentage of remodelling remains a concern and warrants further studies.
Early Results of a New Highly Porous Modular Acetabular Cup in Revision Arthroplasty
Authors: Ramappa Manjunath , Bajwa Ali , Kulkarni Ashwin , Mcmurtry Ian , Port Andrew 
Published: January 2018

Background The ‘Tritanium’® (Stryker, New Jersey, USA) highly porous acetabular cup is a new implant used in revision hip arthroplasty. Aim To determine the early results of this device. Methods A prospective study of 43 acetabular component revisions performed using the implant between March 2007 and February 2008 was undertaken. All procedures were performed at a single centre with standard approach and follow up. Results The mean age of patients at surgery was 66 years. Mean follow up was 18.2 months. AAOS classification revealed 17% type 1, 49% type 2, 24% Type 3 and 5% Type 4 defects at surgery. 5% had no bone defect. Bone graft was used to in 73% of patients. Mean Harris Hip Score improved from 68 pre-operatively to 86 at the last follow-up. Cup integration was seen in 95% of patients by 6 weeks. One patient with pelvic discontinuity had symptomatic aseptic loosening which was revised. Conclusion The ‘Tritanium'acetabular cup has been successful in achieving rapid osseointegration with few complications. The management of pelvic discontinuity continues to be a challenge.
Radiographic Assessment of Biomechanical Parameters following hip Resurfacing and Cemented Total Hip Arthroplasty
Authors: Robb Curtis , Harris Richard , O'dwyer Kevin , Aslam Nadim 
Published: January 2018

Resurfacing hip arthroplasty and total hip replacement both aim to restore anatomical parameters. Leg length and offset discrepancy can result in altered joint reaction forces, and are associated with increased wear, dislocation, and decreased patient satisfaction. This study assesses the accuracy of leg length and offset restoration after either a Birmingham Hip Resurfacing (BHR) or a cemented total hip replacement (THR). Standardised antero-posterior radiography was performed on two groups of 30 patients with unilateral primary osteoarthritis undergoing either a cemented total hip or resurfacing. The normal contra-lateral hip was used as the control. Leg length and offset were measured pre-operatively with no significant difference between the two groups. Cup offset, femoral offset, total offset and leg length of the prosthesis and normal side were measured by two observers and mean measurements were analysed by a paired t test. Leg lengths in each group did not differ significantly from the normal side, THR 0.53 mm (95% CI -2.4 to 3.4 mm) but BHR implantation did result in mean leg shortening of -1.9 mm (95% CI -4.5 mm to 0.6 mm). Cup offset differed significantly from normal anatomy in both groups, as did femoral and total offset for the total hip replacement group. However, femoral offset was restored in the Birmingham resurfacing group. When the THR group was compared against the BHR group we found no difference between restoration of leg lengths (p = 0.21) and cup offset (p = 0.30) but femoral (p = 0.0063) and total offset (p = 0.03) were restored more accurately with a BHR.
Osteolysis of the Greater Trochanter following Reattachment of hip Abductors using Polyester Suture in Total Hip Arthroplasty
Authors: Kundra Rakesh K. , Karim Sabeeha N , Lawrence Trevor 
Published: January 2018

We report a specific pattern of osteolysis around bone tunnels on the lateral cortex of the greater trochanter following abductor reattachment using a polyester suture. Radiographs of 395 patients who underwent cemented THA during a four year period between 1999 and 2003 were reviewed. 27 patients had abductor reattachment using number 5 Ethibond™ suture through bone tunnels. These patients displayed a predominantly osteolytic pattern of bone reaction around the greater trochanter bone tunnels. All patients were subsequently reviewed in clinic at 4–7 years following surgery. Three patterns of response were observed around the bone tunnels. Recognition of this unique osteolysis pattern may be important in the investigation of complications following cemented THA.
Long-Stem versus Short-Stem Preformed Antibiotic-Loaded Cement Spacers for Two-Stage Revision of Infected Total Hip Arthroplasty
Authors: Romanò Carlo L. , Romanò Delia , Logoluso Nicola , Meani Enzo 
Published: January 2018

Two-stage revision is the most widely accepted and performed intervention for chronically infected hip prostheses. In recent years short and long stem antibiotic-loaded preformed spacers have become available on the market. The aim of this prospective, comparative study was to assess the safety and efficacy of long stem versus short stem preformed spacers. From year 2000 to 2007 102 consecutive patients underwent two-stage revision of septic hip replacement with a preformed antibiotic-loaded cement spacer and a cementless modular hip revision prosthesis. Patients were divided in two groups: Group L (long stem spacer) (N=60) and Group S (short stem) (N=42) and compared. No systemic toxicity due to local antibiotic release and no spacer breakage were observed in either group. At spacer removal, no statistically significant difference was observed in infection recurrence. After revision, at a mean 4 years follow-up, 2 patients in Group L and 2 in Group S showed infection recurrence. The Harris Hip Score improved in both groups, compared to post spacer implant values: 79.6 ± 15.4 versus 38.4 ± 14.5 in Group L (p < 0.0001) and 82.3 ± 14.4 versus 44.8 ± 16.6 in Group S (p < 0.0001); the difference between groups was not statistically significant. Short and long stem spacers provide comparable low infection recurrence rate and clinical outcome, with negligible risk of breakage and toxicity.
Treatment for Acetabular Dysplasia using the Uncemented RM Acetabular Component – a 20 Year Follow-Up
Authors: Ihle Martin , Mai Sabine , Siebert Werner E. 
Published: January 2018

Our study reports a sub-group of patients with developmental dysplasia from a previously published larger series, with particular emphasis on the use of the uncemented RM acetabular component. We evaluated the long term results of 93 consecutive uncemented THAs in 80 patients using the titanium-coated RM acetabular component and the CLS femoral component in a prospective study. Eighteen hips in 16 patients had osteoarthritis secondary to developmental dysplasia of the hip. The mean follow-up was 19.6 years (18.2 to 20.9). Fourteen patients with 15 hips were clinically and radiographically examined and evaluated. Two patients with 3 hips died. No patient was lost to follow-up. No implant had to be revised, and no cases showed evidence of radiographic loosening. Nine acetabular components were not completely covered by host bone but this did not affect the outcome. At the latest follow-up the mean Harris Hip Score was 92 (81 to 100). The mean annual wear rate was 0.12 mm. The RM acetabular component performed well over 20 years in this selected group of patients. Complete acetabular containment was not needed, thus allowing reliable reconstruction of the anatomical centre of rotation.