The two most common surgical approaches used in primary hip arthroplasty are the anterolateral and posterolateral approach. While both approaches have potential advantages and disadvantages in comparison to the other, there are no reports with sufficient power to compare their effect on post-operative function and quality of life. This prospective cohort study evaluates and compares the independent effect of surgical approach on function and quality of life among patients who have received their total hip arthroplasty through one of these techniques. Results suggest that there is no significant difference in function or quality of life among these respective cohorts. The purpose of this study was to evaluate and compare the effect of anterolateral versus posterolateral approach on function and quality of life following primary total hip arthroplasty. There is no significant difference in outcome as a result of surgical approach. Significance: This is the first report with sufficient power to evaluate and compare outcomes of these two approaches among high volume hip surgeons. This study suggests that surgeons need not worry that the anterolateral or posterolateral approach may compromise patient function or generic quality of life more-so than the alternative approach. Univariate and regression analyses demonstrate similar outcomes on WOMAC, Oxford-12, SF-12 and satisfaction among cohorts of patients receiving the anterolateral or posterolateral approach for primary total hip arthroplasty. A prospective evaluation of function and quality of life outcomes was performed on patients receiving the anterolateral or posterolateral approach for primary hip arthroplasty. All participating surgeons were considered to be high volume arthroplasty surgeons. One hundred and sixty procedures were followed and provided complete outcomes data including WOMAC, Oxford, SF-12, and satisfaction scores. Univariate analyses demonstrated no differences among the two cohorts with regards to baseline variables. Regression analyses were performed for the outcome measures with surgical approach treated as an independent covariate while controlling for other potential confounders. The results suggest that there is no independent effect of surgical approach on patient reported outcomes. This suggests that the surgeon should continue to employ the approach which is the most familiar and most likely to result in consistent results in their clinical environment.
The mean, maximum patella maltracking in extension for the TKA group as compared to the patelloplasty group (p=0.025), reduced to near normal with the augmentation patella (p=0.301).
Investigation patella tracking, we found a statistically significant difference between the TKA before and after patelloplasty, that was rectified by the insertion of the augmentation patella.
In clinical studies of cemented total hip arthroplasty (THA), polished stems produce less slippage at the bone-cement interface than roughened stems. Our objective is to assess the effect of stem-cement debonding on the bone-cement interface shear behaviour of hip implants using simplified axisymmetric stem-cement-aluminum models. We emulated the femoral stems using stainless steel tapered plugs with either a rough (i.e. bonded) or smooth (i.e. unbonded) surface finish. Three different taper angles (5°, 7.5°, 10°) were used for the unbonded constructs. Non-tapered and tapered (7.5°) aluminum shells were used to emulate the diaphyseal and metaphyseal segments of the femur. In all cases, the cement-aluminum interface was designed to have the same shear strength as has been reported for bone-cement interfaces (~8 MPa). The test involved applying axial compressive loading at a rate of 0.02 mm/s until failure. Six specimens were tested for each combination of the parameters. The unbonded stems sustained about twice as much load as the bonded stem, regardless of taper angle, and the metaphyseal model carried 35-50% greater loads than the diaphyseal models before shear failure or slippage. The unbonded constructs reached peak load with excessive displacement due to creep of the cement mantle while the bonded constructs failed in shear at the cement-aluminum interface. This result supports the hypothesis that the wedging forces created in the unbonded construct increase the compression forces across the aluminum-cement interface, thereby increasing its shear resistance. A finite element analysis predicted that the cement could withstand the hoop stress under these loading circumstances and this prediction was confirmed by visual inspection of the cement after each test. Our results suggest that smooth or unbonded stems should sustain less slippage and shear damage at the bone-cement interface than roughened or bonded stems due to the wedge-induced compressive stress; this increased load capacity will be particularly valuable when the condition of the bone-cement interface is suboptimal.
This study was performed to assess the relationship between patients’ pre-operative symptoms and their expectations at the time of revision hip arthroplasty. The WOMAC (Western Ontario and McMaster Osteoarthritis Index) scale for osteoarthritis of the hip and the Short Form 36 (SF-36) general health status scale have both been validated for the assessment of the outcome of hip arthroplasty. We prospectively assessed 60 patients using these scales as well as the “expectation WOMAC” that asked the patients to estimate how they expected to feel 6 months after revision hip replacement. All the questions were completed prior to informed consent, and were scored form 1 to 5 with increasing severity with a Likert scale. The maximum possible scores for pain, stiffness and difficulty with physical activity were therefore 25, 10 and 85 respectively. The mean preoperative WOMAC score for pain was 13.4 (CI 12.2.-14.6), for stiffness 5.9 (CI 5.6-6.2) and for physical activity 50.9 (CI 47.2-54.6) The mean expectation WOMAC scores for these modalities were 7.4 (CI 6.2-8.6), 3.5 (CI 3.0-4.0) and 28.1 (CI 24.0-32.2.) respectively. Although there was a wide spread of expectations, we were unable to find any significant correlation between the patients’ preoperative pain and The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk &
Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom. stiffness levels and their expectations for pain and stiffness after revision hip arthroplasty. There was however a statistical association between their preoperative difficulty with physical activity and their expectations for physical activity (r=0.38; p=0.02) There was no significant correlation between the SF-36 scores and the patients’ expectations. The expectations of patients awaiting revision hip replacements are high, and do not appear to be closely related to their level of pre-operative disability. Even patients with severe symptoms have high expectations that in some cases may be unrealistic. The use of the “expectation WOMAC” may help us to identify such patients, and to improve patient education and satisfaction.
This study constitutes the minimum 5-year follow-up (mean 8.8 years; range 5 – 11.5 years) of a consecutive series of 40 proximal femoral allografts performed for failed total hip arthroplasties using the same technique. Nine of these cases had been two stage reconstructions for the management of infected total hip replacements with bone loss. In all these cases the stem was cemented into both the allograft and the host femur. The host bone was resected in 37 cases, and the greater trochanter reattached with a cable grip in 33 cases and with wire and mesh in 3 cases. The patients were reviewed by an independent observer. There were 4 early revisions (10%): one for infection, one for non-union of the allograft host junction, and two following revision of a failed acetabular reconstruction. Three further acetabular revisions have since also been performed. Junctional nonunion was seen in 3 cases (8%), two of which were managed successfully with bone grafting and bone grafting and plating respectively. Instability was observed in 6 cases (15%). Trochanteric non-union was seen in 17 cases (42.5%) and trochanteric escape in 10 of these (25%). The mean Harris Hip Score improved from 39 to 79. Severe resorption involving the full thickness of the allograft was seen in 7 cases. This progressed rapidly and silently but has yet to lead to the failure of any of the reconstructions. Although there was a high early complication rate, the medium term survivorship is excellent, and the clinical outcomes highly satisfactory. The striking observation of severe allograft resorption may be related to a combination of factors. These include the absence of any masking or protective effect that the host bone may have proximally, and surface revascularisation with stress shielding secondary to solid cemented distal fixation. Although continued surveillance is warranted, these results justify the use of structural allografts for selected cases.
This study was performed in order to review the medium term clinical and radiographic outcome of long stem cemented femoral revisions using second generation cementing technique and identify factors predictive of success or failure. 110 long stem revision hip replacements in 106 patients were performed between 1983–1994. There were 51 males and 55 females of an average age of 69 years with a mean follow up of 6.7 years and a minimum follow-up of five years. Clinical assessment included chart review, and assessment by an independent observer using the Harris Hip Score and the Short Form-36. Radiographic review was performed by two independent observers assessing quality of cementing, loosening, trochanteric union, and heterotopic ossification. The cementing technique was evaluated in both the areas of previous fixation, as well as in the new bone below the tip of the previous stem. We reviewed 93 hips in 90 patients, the remainder having either died or been lost to follow-up. 89% of the patients had improved Harris hip score by more than 20 points. Using the Kaplan-Meier method, fifteen-year survivor-ship was calculated at 92.8%. Three (3.2 %) femoral components were revised, six (6.4%) additional femoral components subsided but were not revised; five of these showed poor cementing technique in the virgin zones beyond the area of the previous stem, and two had cortical perforations. Complications included; 7 (7.5%)dislocations, 6 (6.4%) periprosthetic fractures, 2 (2.2%) infections, and 14 (15%) trochanteric non-unions. Most reports of femoral revision with cement in revision total hip arthroplasty have shown poor results. However, there are no reports that rely solely on long-stem components. This study shows that long stem cemented femoral revisions have an excellent medium term survivorship, good clinical results and high satisfaction rates. The quality of distal cementing is of great importance, as distal radiolucencies and poor cement technique are predictive of failure.
