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Bone & Joint Open
Vol. 3, Issue 11 | Pages 867 - 876
10 Nov 2022
Winther SS Petersen M Yilmaz M Kaltoft NS Stürup J Winther NS

Aims. Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS). Methods. Retrospectively collected data of 38 patients (39 hips) with pelvic discontinuity treated with revision THA using a custom-made triflange acetabular component were analyzed. Minimum follow-up was two years (mean 5.1 years (2 to 11)). Results. There were eight subsequent surgical interventions. Two failures (5%) of the triflange acetabular components were both revised because of deep infection. There were seven (18%) patients with dislocation, and five (13%) of these were treated with a constraint liner. One patient had a debridement, antibiotics, and implant retention (DAIR) procedure. In 34 (92%) hips the custom-made triflange component was considered stable, with a healed pelvic discontinuity with no aseptic loosening at midterm follow-up. Mean HHS was 80.5 (48 to 96). Conclusion. The performance of the custom triflange implant in this study is encouraging, with high rates of discontinuity healing and osteointegration of the acetabular implant with no aseptic loosening at midterm follow-up. However, complications are not uncommon, particularly instability which we successfully addressed with constrained liners. Cite this article: Bone Jt Open 2022;3(11):867–876


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 567 - 567
1 Aug 2008
Moonot P Kamat Y Eswaramoorthy V Kalairajah Y Field R Adhikari A
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Computer navigation assistance in total knee arthroplasty (TKA) results in more consistently accurate postoperative alignment of the knee prostheses. However the medium and long term clinical outcomes of computer-navigated TKA are not widely published. Our aim was to compare patient perceived outcomes between computer navigation assisted and conventional TKA using the Oxford knee score (OKS).

We retrospectively collected data on 441 primary TKA carried out by a single surgeon in a dedicated arthroplasty centre over a period of four years. These were divided according to use of computer navigation (group A) or standard instrumentation (group B). There were no statistical differences in baseline Oxford knee score (OKS) and demographic data between the groups. 238 of these had at least a one-year follow-up with 109 in group A and 129 in group B. Two year follow-up data was available for 105 knees with 48 in group A and 57 in group B and a three year follow-up for 45 with 21 and 24 in groups A and B respectively. 12 patients had completed four year follow-up with seven and five knees in groups A and B respectively.

The mean OKS at 1-year follow up was 24.98 (range 12– 54, SD 9.34) for group A and 26.54 (range 12– 51, SD 10.18) for group B (p = 0.25). Similarly at 2-years the mean OKS was 25.40 (range 12– 53, SD 9.51) for group A and 25.56 (range 12– 46, SD 9.67) for group B (p = 0.94). The results were similar for three and four-year follow ups with p values not significant. This study thus revealed that computer assisted TKA does not appear to result in better patient satisfaction when compared to standard instrumentation at midterm follow up.

It is known from long term analysis of conventional TKA that mal-aligned implants have significantly higher failure rates beyond eight to ten years. As use of computer navigation assistance results in a less number of mal-aligned knee prostheses, we believe that these knees will have improved survivorship. The differences in OKS between the two groups should therefore be evident after eight to ten years.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_12 | Pages 47 - 47
1 Dec 2022
Sheridan G Clesham K Garbuz D Masri B
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The benefits of HXLPE in total knee arthroplasty (TKA) have not been as evident as total hip arthroplasty (THA). A systematic review and meta-analysis to assess the impact of highly-crosslinked polyethylene (HXLPE) on TKA outcomes compared to conventional polyethylene (CPE) is described. All studies comparing HXLPE with CPE for primary TKA were included for analysis. The minimum dataset included revision rates, indication for revision, aseptic component loosening and follow-up time. The primary outcome variables were all-cause revision, aseptic revision, revision for loosening, radiographic component loosening, osteolysis and incidence of radiolucent lines. Secondary outcome measures included postoperative functional knee scores. A random-effects meta-analysis allowing for all missing data was performed for all primary outcome variables. Six studies met the inclusion criteria. In total, there were 2,234 knees (1,105 HXLPE and 1,129 CPE). The combined mean follow-up for all studies was 6 years. The aseptic revision rate in the HXLPE group was 1.02% compared to 1.97% in the CPE group. There was no difference in the rate of all-cause revision (p = 0.131), aseptic revision (p = 0.298) or revision for component loosening (p = 0.206) between the two groups. Radiographic loosening (p = 0.200), radiolucent lines (p = 0.123) and osteolysis (p = 0.604) was similar between both groups. Functional outcomes were similar between groups. The use of HXLPE in TKA yields similar results for clinical and radiographic outcomes when compared to CPE at midterm follow-up. HXLPE does not confer the same advantages to TKA as seen in THA


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_6 | Pages 63 - 63
1 Apr 2018
Shon W Han S Lee D Kim H
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Background. Recent clinical studies have suggested that systemic metal ion levels are significantly elevated at midterm follow-up after ceramic-on-metal (COM) bearing. However, it is not clear whether there is a correlation between patient- and surgical-related factors including the lifestyle and elevated levels of serum metal ions following COM total hip arthroplsty (THA). Material and Methods. Two hundred and one patients (234 hips) including 121 COM patients (140 hips) and 80 non-COM patients (94 hips) were enrolled in accordance with the inclusion criteria. The patients were divided into three groups based on the type of surgical bearings used. The Harris Hip Score (HHS), University of California, Los Angeles (UCLA) activity scale score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were measured, and radiographs were obtained for the analysis. Serum metal ion levels of cobalt and chromium were measured using a high-resolution inductively coupled plasma mass spectrometry. Patient- and surgical-related factors were analyzed to determine which group of patients is at a high risk of metal ion-related problems. Results. Significantly higher serum levels of Co and Cr were detected in the serum of the COM THA group (Co: 1.86±4.0 µg/L, range: 0.30 to 34.20 µg/L; Cr: 1.81±2.87 µg/L, range: 0.10 to 27.80 µg/L) than in the serum of the non-COM THA group (Co: 0.27±0.14 µg/L, range: 0.15 to 0.90 µg/L; Cr: 0.19±0.25 µg/L, range; 0.10 to 2.30 µg/L) (p<0.001). The HHS in the COM group was significantly better than that in the non-COM group (p=0.013). The total ROM of the THAs was significantly greater in the 36-mm COM THA group (272.7°, range: 200°–345°) than in the non-COM group (248.5°, range: 135°–300°) (p<0.001). No radiolucency, osteolysis, or loosening was found during the follow-up radiographic examination. The serum Co levels of patients who achieved the squatting position were significantly higher than those of patients who could not squat (Co: p=0.033; Cr: p=0.074). The serum Co and Cr levels of patients who achieved the kneeling position were significantly higher than those of patients who could not kneel (Co: p=0.049; Cr: p=0.031). There was no significant difference between the two groups in the cross-legged sitting position. The metal ion levels of the COM THA group correlated with the total ROM (Co: p=0.0293; Cr: p=0.0399), and those of the patients who were capable of squatting and kneeling were significantly higher than those of the patients who were unable (p<0.05). However, age, BMI, acetabular cup position and patient activity did not show significant correlations with the serum metal ion levels. Conclusions. Patients who underwent a 36-mm COM THA had good clinical outcomes with an excellent hip function at the short and midterm follow-up intervals. However, high levels of metal ions were detected in the serum of COM THA patients. We found that COM THA patients who were capable of greater ROMs, squatting, and kneeling are at risk of metal ion-related problems


Bone & Joint Open
Vol. 3, Issue 10 | Pages 815 - 825
20 Oct 2022
Athanatos L Kulkarni K Tunnicliffe H Samaras M Singh HP Armstrong AL

Aims

There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery.

Methods

Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 75 - 75
1 Oct 2018
Robinson RP Summers S
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Introduction. Modularity in femoral stem designs allow surgeons to independently control leg length, offset, and femoral version in revision or complex primary THA cases. Initial enthusiasm in these modular stems has been tempered by recognition of modular junction failures. This study evaluates mean 5-year clinical results and survival rates of a 3-part titanium alloy modular femoral implant with unique taper geometries and a metaphyseal plasma spray surface. The current results are presented after pre-market independent fatigue testing performed by Orthopaedic Laboratory (Greenwald) and previously published early clinical results in 2006. Low plasticity burnishing (LPB) was added in 2005 to further strengthen the neck metaphyseal modular junction. The modular stem component is a polished cylindrical splined clothespin design. Our hypothesis is that these unique modular junctions succeed in offering the advantages of modularity without failure at this midterm follow-up period. Methods. Between May 2010 and July 2016, 32 total hip arthroplasties were performed using a 3-part femoral stem with neck-metaphyseal-stem modular junctions. Surgeries were either the final stage of a two-stage revision for infection, revision THR for loosening, or a revision of a previous non-prosthetic replacement procedure. Patients were entered into an IRB-approved registry and followed with x-rays, HHS, Oxford scores, and patient satisfaction scores. Patients who failed to return for routine follow-up were contacted by phone or email. Two patients had died with their implants intact. Six patients could not be reached for an updated follow-up. One stem was revised for loosening at 33 months due to failed osseointegration in a patient with chronic renal failure. This removed stem was submitted for taper exam and sectioning. Results. There were 23 patients for evaluation at a mean 61 months (range 21–98). Mean patient age at implantation was 56 (range 25–88), BMI was 27 (range 20–40). There were no modular junction failures. Modular junctions examined in the retrieved implant did not demonstrate any abnormalities other than normal wear properties. HHS and OHS scores both improved between pre-op and final follow-up, 23 to 85 and 17 to 43, respectively. Average patient satisfaction score at final follow-up was 9.8 out of 10 (min 8, max 10). Radiographic examination showed stem subsidence > 2mm and radiolucencies around the metaphyseal cone in 1 patient, the same patient who required implant removal. Radiolucencies were seen along the polished stem tip in 43% of cases, spot welding at the distal metaphyseal cone in 67% of cases, and mild proximal-medial stress shielding in 33% of cases. Conclusion. This unique 3-part modular stem with metaphyseal fixation shows good functional and radiographic results at 5-year follow-up. There were no junctional failures. One stem was removed due to failure to osseointegrate and showed no worrisome taper abnormalities. Spot welding is common around the plasma spray metaphyseal cone. Implant removal, if necessary, only requires disruption of the metaphyseal fixation. Further follow-up will be important to confirm our confidence in this unique stem design


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 48 - 48
1 Oct 2018
Galea VP Connelly JW Matuszak SJ Rojanasopondist P Bragdon CR Huddleston JI Rubash HE Malchau H
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Introduction. Within the field of arthroplasty, the use of patient-reported outcome measures (PROMs) is becoming increasingly ubiquitous in an effort to employ more patient-centered methods of evaluating success. PROMs may be used to assess general health, joint-specific pain or function, or mental health. General and joint-specific questionnaires are most often used in arthroplasty research, but the relationship between arthroplasty and mental health is less well understood. Furthermore, longitudinal reports of PROM changes after arthroplasty are lacking in the literature. Our primary aim was to quantify the improvement in general, joint-specific, and mental health PROMs following total hip arthroplasty (THA) as well as the extent of any deterioration through the 7 years follow-up. Our secondary aim was to identify predictors of clinically significant PROM decline. Methods. A total of 864 patients from 17 centers across 8 countries were enrolled into a prospective study. Patients were treated with components from a single manufacturer, which have been shown to be well-functioning in other studies. Patients completed a battery of PROMs preoperatively, and at one, three, five, and seven years post-THA. Changes in PROMs between study visits were assessed via paired tests. Postoperative trends for each PROM were determined for each subject by the slope of the best-fit line of the four postoperative data points. Significant PROM deterioration was defined as one literature-defined minimum clinically important difference over 5-years. Binary logistic regressions were used to identify independent predictors of significant decline in the EuroQol (EQ-5D) visual analogue scale (VAS) for Health State, 36-Item Short Form Survey (SF-36) physical composite summary (PCS), and SF-36 mental composite summary (MCS). Results. A total of 417 completed all study visits (70% of currently eligible). All patients experienced significant improvements in all hip-specific and most general health PROMs 1-year post-THA (all p ≤ 0.002). In addition, a significant number of patients experienced a reduction in anxiety/depression following THA (p < 0.001). Hip specific PROMs remained excellent through 7-years, but most general and mental health PROs declined by the 7-year visit. A total of 133 patients (32%) experienced significant deterioration in the EQ-5D Health State. Age greater than 60 years (odds ratio (OR) = 1.9; p = 0.002) and obesity (OR = 1.7; p = 0.036) were independently predictive of EQ-5D Health State decline. A total of 58 patients (14%) experienced significant deterioration in the SF-36 PCS. Independent predictors of significant SF-36 PCS decline were lower preoperative SF-36 MCS (OR = 0.9; p = 0.002) and obesity (OR = 2.6; p = 0.009). A total of 229 patients (55%) experienced significant deterioration in the SF-36 MCS. Age greater than 60 years was predictive of significant SF-36 MCS decline (OR = 1.8; p = 0.017). Conclusion. For most patients, hip-specific PROMs will remain near the 1-year level through 7-years follow-up. Except for those with lower preoperative mental health or with obesity, gauging a patient's hip-related status at 1-year is sufficient to extrapolate their trajectory through midterm follow-up. Some patients experience mental health improvements following THA, but the majority experience a decline within 7 years of their surgery, especially older patients. Similarly, age-related decreases in general health are expected, following initial improvement 1 year after THA. Obese patients are also more likely to experience general health deterioration post-THA. By addressing the modifiable risk factors for PROM decline, the positive effects of THA may be better sustained over time


Bone & Joint Open
Vol. 4, Issue 11 | Pages 832 - 838
3 Nov 2023
Pichler L Li Z Khakzad T Perka C Pumberger M Schömig F

Aims

Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date.

Methods

Patients treated for IPOS from January 2006 to December 2020 were included. Patient demographics, parameters upon admission and discharge, radiological imaging, and microbiological results were retrieved from medical records. CT and MRI were analyzed for epidural, paravertebral, and intervertebral abscess formation, vertebral destruction, and endplate involvement. Pathogens were identified by CT-guided or intraoperative biopsy, intraoperative tissue sampling, or implant sonication.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 186 - 186
1 Mar 2013
Jassim S Patel S Wardle N Tahmassebi J Middleton R Shardlow D Stephen A Hutchinson J Haddad F
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Introduction. In Total Hip Arthroplasty (THA), polyethylene wear reduction is key to implant longevity. Oxidized Zirconium (OxZi) unites properties of a ceramic bearing surface and metal head, producing less wear in comparison to standard Cobalt-Chromium (CoCr) when articulating with Cross-linked polyethylene (XLPE) in vitro. This study investigates in vivo polyethylene (PE) wear, outcomes and complications for these two bearing couples in patients at 5 year follow-up. Methods. 400 patients undergoing THA across four institutions were prospectively randomised into three groups. Group I received a cobalt-chrome (CoCr) femoral head/ cross-linked polyethylene (XLPE) liner; Group II received an OxZi femoral head/ ultrahigh molecular weight polyethylene (UHMWPE) liner; Group III received an OxZi femoral head/XLPE liner. All bearing heads were 32 mm. Linear wear rate was calculated with Martell computer software. Functional outcome and complications were recorded. Results. At median follow-up of 3.7 years, implant survivorship was 98% across all groups with no difference in SF-36, WOMAC, pain score or complications (p > 0.05). After the first 12 months of creep, rate of linear wear over 3 years was 0.07 mm for Group I, 0.16 mm for Group II, and 0.03 mm/year for Group III. A significant difference was detected when using UHMWPE (p = 0.012) but not when using XLPE (P = 0.75). Conclusion. At midterm follow-up, an XLPE acetabular liner is more important in reducing wear than the femoral head bearing. There is a trend towards lower wear when coupling OxZi rather than CoCr with XLPE; further long-term analysis is recommended to observe this pattern


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 303 - 303
1 Jul 2011
Papalexandris S Dogiparthi K van Niekerk L
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Aims: The purpose of the study was to assess the mid-term knee functional results after Medial Patellofemoral Ligament (MPFL) reconstruction with single semitendinosus autograft in patients with patellofemoral instability. Methods and Results: Knee function was assessed in 45 patients (46 knees) who underwent MPFL reconstruction with semitendinosus autograft. The tibial insertion of the semitendinosus was preserved whereas the free end, after stripping of the tendon from the musculo-tendinus junction was rerouted through the most distal part of the medial intermuscular septum proximally to the adductor tubercle, to the superomedial border of the patella, where it was fixed. Clinical and radiological evidence of patellar instability and MPFL rupture or deficiency was documented prior to surgery. Knee function was assessed preoperatively and postoperatively with the use of Kujala, Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores. There were 34 male and 11 female patients with an average age of 32.5 years, ranging from 17 to 60 years. The minimum follow up was 2 years with an average of 33.5 months (range 24–54 months). Fourteen patients (30%) presented a degree of patellofemoral dysplasia. All knee functional scores significantly improved postoperatively. Kujala score improved from 57.7 to 77.1, Tegner score improved from 3.06 to 5.26, IKDC score improved from 51.2 to 75.44 and Lysholm score improved from 58.7 to 79.3. One of the patients required revision of the MPFL reconstruction due to traumatic redislocation of the patella. Conclusions: At a midterm follow-up, reconstruction of the MPFL with rerouting of the semitendinosus tendon is an effective method with improved function in all patients. Maximum improvement was achieved within the first six postoperative months. Heterogeneity of our population may have affected some of our results


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 113 - 113
1 Mar 2013
Cho YJ Lee J Chun YS Rhyu KH Kwak S Ji H Won YY Yoo M
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Purpose. To evaluate the radiological changes after metal on metal resurfacing arthroplasty. Materials and Methods. Between December 1998 and August 2004, 166 hips in 150 patients who underwent metal resurfacing arthroplasty and followed up more than 4 years. Their mean age at the time of operation was 37.3 years(range, 15–68 years) and mean period of follow-up was 6.1 years(range, 48–95 months). The cause of arthroplasty included 115 avascular necrosis, 43 osteoarthritis, 7 ankylosing spondylitis, 1 haemophilic arthropathy. All patients had anteroposterior, translateral radiographs of the hip made preoperatively and each follow-up visit, and we analyzed radiographic findings such as radiolucencies or impingement signs around implant, neck narrowing and heterotopic ossification. Results. There was a no significant difference between preoperative and postoperative Harris hip score and range of motion. The mean stem-shaft angle was 137.4°, and 55.4% were ranged 130° to 140°. The mean inclination of acetabular component was 44.9°. There were no radiolucent lines or osteolytic lesion around the acetabular components, but 3 hips showed radiolucency around the head-neck junction(1.8%) and 4 hips showed radiolucent line around the stem (2.4%). 12 hips had impingement signs around the head-neck junction (7.2%), and 2 cases showed neck narrowing (1.2%). 3 cases had some heterotopic ossification (1.8%). In 12 cases with impingement signs, the stem-shaft angle and inclination of acetabular component were lower than control group. Pseudotumor was not found in this cohort. Conclusions. This study demonstrates no serious radiological problems till the midterm follow-up after resurfacing arthroplasty, but osteolytic lesion such as radiolucent line around head-neck junction, neck narrowing can be a potential cause of failure in future. Even though the radiolucent line around stem of femoral component revealed no subjective symptom yet, it suggests the micromotion of femoral component which can lead to femoral component loosening. The most common radiological findings, impingement signs, seem not to have clinical significance


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 274 - 274
1 Jul 2008
VIENNE P RAMSEIER L SCHOENIGER R GERBER C Norman E
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Purpose of the study: Recurrent deformity in adulthood after successful treatment of clubfoot in childhood is exceptional. Patients experience subjective instability of the hindfood associated with progressive varus deformity and osteoarthritis of the subtalar joint. The purpose of this study was to analyze outcome after double arthrodesis in the specific situation. Material and methods: Nine patients aged 41 years on average (range 18–64 years) were reviewed clinically and radiologically at mean 43 months follow-up after double arthrodesis (subtalar and Chopart). Time between the primary surgery and arthrodesis was 25 years on average (range 8–37 years). Clinical outcome was assessed with the AOFAS system. Plain x-rays were analyzed. Results: The AOFAS score improved from 42 points preoperatively to 67 points on average at last follow-up (maximum 90 points). Improvement in pain was less pronounced, 27 points preoperatively and 13 points at last follow-up. Ankle motion did not decrease significantly. There was a non-significant progression of the ankle joint osteoarthritic degeneration in 71% of patients. Subjectively, the patients were moderately satisfied with the postoperative alignment of the hindfoot. Conclusion: Double arthrodesis is often the only alternative for adults with recurrent clubfoot deformity causing pain and subjective instability of the hindfoot. The results in our series did not reveal any significant progression of the ankle joint degeneration at midterm follow-up of three years. Pain and subjective instability were improved, though the physiological alignment of the hindfoot could not be totally restored


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 339 - 339
1 May 2006
Goodmanson P Evensen K Sptzer A Habelow B Suthers K
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Purpose: Proximal femur fracture occurring at the time of femoral canal preparation or insertion of the femoral component is a recognized complication of primary total hip arthroplasty. Methods: Two hundred seventy three consecutive primary THAs were reviewed retrospectively for occurrence of intraoperative fracture. 146 cemented femoral components and 127 cementless femoral components were implanted. Intraoperative management of non- or minimally-displaced proximal femur fractures involved placement of either one or two cerclage cables, with postoperative weightbearing to tolerance using an assistive device for approximately six weeks. Results: Eight (2.9%) hips sustained an intraoperative non- or minimally-displaced fracture of the proximal femur: six (75%) occurred using cementless stems and two (25%) occurred using cemented stems. At an average follow-up of 57 months (R 26–90 months), all patients in the fractured cohort have remained radiographically stable, with well-fixed femoral components showing no evidence of subsidence. All of the patients in this fractured group have achieved good or excellent functional results. Conclusions: Midterm follow-up results suggest that non- or minimally-displaced proximal femur fractures occurring at the time of primary THA can safely and effectively be managed by placement of single or multiple cerclage cables, and without significant modification of standard postoperative rehabilitation protocols. No compromise in functional outcome has been observed with this treatment method


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 275 - 275
1 Mar 2004
Herrera A Mart’nez A Canales V Cuenca J Panisello J
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Aims: The purpose of our study was to evaluate the results of using a longitudinal oblong revision (LOR) cup in the management of types III and IV acetabular defects. Methods: Thirty-þve longitudinal oblong revision (LOR) cups were used to reconstruct 29 type III and 6 type IV acetabular defects. Defects were þlled with morcellized allografts in all cases. Structural allografts were used in 2 cases. All patients were followed up for 2 to 6 years (mean, 3.3 years). Results: At latest follow-up, 32 cups were stable (91.4%) and 3 had migrated (8.6%). Two of these cups failed one year after surgery and one four years postoperatively. We found a signiþcant relation between an incomplete cup contact with the acetabular rim and the subsequent failure (p=0.042). The postoperative abduction angle was signiþcantly increased in the group of unstable cups (p=0.032). Pain, limp, use of walking aids, functional level and limb-length discrepancy signiþcantly improved postoperatively (p< 0.0001). Conclusions: For patients with type III and IV acetabular defects, this implant provided encouraging clinical results and showed satisfactory stability at early to midterm follow-up


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 453 - 453
1 Jul 2010
Cuomo P Campanacci D Beltrami G Scoccianti G De Biase P Sensi L Capanna R
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Proximal tibia reconstruction after oncologic resection is challenging due to bone stock and extensor mechanism restoration. From 1997 to 2007 19 patients (mean age: 39±16 years old) underwent proximal tibia oncologic intra-articular resection with wide margins. Primary diagnosis included giant cell tumor, osteosarcoma, chondrosarcoma and a failed osteoarticular allograft in 10, 4, 3 and 2 patients respectively. Tibial resection length was 10.4±3.4 cm in 18 knees. In one patient with chondrosarcoma the entire tibia was resected. Three patients received preoperative and postoperative chemotherapy, one only postoperative. Reconstruction was performed with an allograft-prosthesis composite implant and direct suture of the host patellar tendon to the allograft one. Fresh frozen allograft and modular Link prosthesis were used for reconstruction. Five to six weeks of knee immobilization in extension followed the operation. A transient peroneal nerve palsy was observed in three patients. Two patients with a stiff knee underwent an open release after less than one year from index surgery. One patient had a local recurrence from osteosarcoma and underwent an above knee amputation. No patient developed distant metastasis at follow-up. After 59±37 months none of the patients had implant revision for mechanical complications. One patient had 2-stage implant revision for deep infection. A minor allograft resorption with aseptic drain was observed in one patient who underwent surgical debridement. One other patient had a moderate allograft resorption. Knee flexion was 96±12 degrees. All the patients but two could reach complete knee extension and only two had a minor extensor lag (less than 15 degrees). In conclusion intrarticular tibia resection and allograft-prosthesis composite replacement ensures satisfactory oncologic and functional results at a midterm follow-up


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 148 - 148
1 Sep 2012
Gottliebsen M Rahbek O Soballe K Stilling M
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Background. An increasing number of hip prostheses are inserted without bone cement. Experimental research has shown that hydroxyapatite (HA) coated implants are strongly fixated in the bone, which is believed to reduce the likelihood of prosthetic loosening. However, in recent years, there has been much debate about the role of HA particles in third-body polyethylene (PE) wear and formerly we have shown the revision rate to be high among older-design HA coated cups. Purpose. We hypothesized increased PE wear-rate using HA coated acetabular components in comparison with non-HA coated components (control group). Materials and Methods. We performed a retrospective comparative clinical study based on two patient populations identified in the Danish Hip Arthroplasty Registry (October 2006). All patients had primary total hip arthroplasty (THA) between 1997 and 2001 with cementless Mallory-Head acetabular components. One group received HA coated acetabular components (75 patients, 77 hips). The other group received identical components without HA (70 patients, 73 hips). In all cases the liner was similar and 28 mm metal femoral heads were used. All patients were invited for a radiographic follow-up in 2007. The AP radiographs were analysed for two-dimensional (2D) polyethylene wear using the semi-automated PolyWare software. All cases of non-responders, stem revisions, hip dislocations and patients with less than 5 years of follow-up were excluded from the analysis. Findings/Results. The 2D linear PE wear-rate of 0.18 mm/year (SD 0.09) was higher (P<0.001) in the group with HA coated cups (n = 54) compared with 0.12 mm/year (SD 0.07) in the group of non-HA coated cups (n = 35). The Effect size of the difference in linear PE wear-rate, established as Cohen's d, was large (0.9). The time of follow-up was similar (p = 0.11) in the HA group (7.2 years) versus the non-HA group (7.6 years). There was no case-mix concerning distribution of gender and operated side in the groups; however, the mean age was lower (P = 0.001) in the HA group (57 years) compared with the non-HA group (63 years). Conclusions. We found a significantly increased PE wear rate in HA coated acetabular components at midterm follow-up. The patients with HA coated cups were younger on average, and this might partly explain the findings because the activity level expectedly is higher in younger patients. Still an effect size of 0.9 is large and should raise concern and supplement considerations in future clinical decisions on component selection. A randomized (RSA) study on newer type crosslinked polyethylene liners is recommended to bring about more information on the clinical performance and longevity of HA coated acetabular components


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 145 - 145
1 Mar 2010
Yoo M Cho Y Kim K Chun Y Rhyu K Roh J Kang C
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The purpose of this study is to evaluate short to mid-term clinical and radiological results of metal on metal resurfacing arthroplasty in osteonecrosis of the femoral head (ONFH). 185 hips of 169 patients who underwent metal on metal resurfacing arthroplasty using Birmingham Hip Resurfacing system (Midland Medical Technololgies, Birmingham, UK) between December 1998 and May 2005 were available for this study and all cases were followed up over 3 years. All preoperative diagnoses were ONFH. The extents of necrotic area were analyzed by preoperative MRI scanning. Their mean age at the time of operation was 37.7(range, 16–67) years old and mean period of follow-up was 88(range, 36–113) months. For the clinical assessments, Harris hip scores, UCLA activity scores, pain and ROM were evaluated. Radiological changes such as radiolucencies around the stem, impingement sign, neck narrowing, osteolysis around head and neck junction, loosening of implants, heterotopic ossifications were evaluated in the serial antero-posterior, translateral radiographs of the hip joint. Preoperative necrotic area was average 42.7(range, 11.5–60) %. Clinically, the average Harris hip score was improved from 85.2 points to 97.1 points at final follow-up. Average UCLA activity scores at the last follow-up was 8.8 and almost of the patients showed high activity and returned to their original job. ROM were very satisfactory. Radiologically, the mean inclination of acetabular component was 48.0°. There were no radiolucent lines around the acetabular components, but 3 cases showed radiolucent lines around the stem of femoral components. Osteolytic lesions were noticed in 10 cases around head-neck junction. Nine hips had impingement signs around the head-neck junction. There was no case which showed evidence of stress shielding. Moderate neck narrowing were shown in 3 cases. There were 6 cases of heterotopic ossification. One hip had a revision surgery to a total hip arthroplasty using big metal ball because of loosening of acetabular component. There was no patient complained limb length discrepancy and no infection, dislocation, thigh pain. The midterm performance of metal on metal resurfacing arthroplasty in ONFH was very excellent in the aspects of pain relief, ROM of hip joints, rehabilitation and return to preoperative activity and minimization of common complications of conventional total hip arthroplasty. There was no mechanical failure related to the osteonecrosis and we can conclude that performing resurfacing arthorplasty in osteonecrosis less than 50% of extent can be justified. However, performing resurfacing arthroplasties in osteonecrosis of femoral heads needs meticulous surgical techniques and longer learning curve to prevent early failure. Even though our midterm follow-up study revealed excellent results, more long-term follow-up studies are mandatory to determine the survivorship and to verify the problems related to the increased serum metal ion and metal ion toxicity after resurfacing arthroplasty


Bone & Joint Open
Vol. 2, Issue 10 | Pages 813 - 824
7 Oct 2021
Lerch TD Boschung A Schmaranzer F Todorski IAS Vanlommel J Siebenrock KA Steppacher SD Tannast M

Aims

The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version?

Methods

A retrospective, review board-approved, controlled study was performed including 120 hips in 86 consecutive patients with symptomatic FAI or hip dysplasia. Pelvic CT scans were reviewed to calculate parameters for sagittal balance (pelvic incidence (PI), PT, and sacral slope), anterior pelvic plane angle, pelvic inclination, and external rotation of the iliac wing and were compared to a control group (48 hips). The 120 hips were allocated to the following groups: AR (41 hips), hip dysplasia (47 hips) and cam FAI with normal acetabular morphology (32 hips). Subgroups of total AR (15 hips) and high acetabular anteversion (20 hips) were analyzed. Statistical analysis was performed using analysis of variance with Bonferroni correction.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XL | Pages 171 - 171
1 Sep 2012
Shen B Lai O Yang J Pei F
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Background and Objective. Total hip arthroplasty (THA) has been applied to treat pain and disability in patients with post-traumatic arthritis after acetabular fracture for many years. However, the midterm and long-term results of THA for this unique population are still controversial. According to previous studies, we found that uncemented acetabular reconstructions were usually performed in patients who were most likely to have the best results and an abnormal acetabular structure was usually the reason for THA failure. In this study, we evaluated the midterm results of using uncement acetabular components to treat posttraumatic arthritis after acetabular fracture. In addition, we investigated the effects of different acetabular fracture treatments and fracture patterns on THA. Materials and Methods. Between January 2000 to December 2003, 34 uncemented acetabular reconstructions were performed in 34 patients for posttraumatic arthritis after acetabular fractures. Among them, 31 patients underwent complete clinical and radiographic follow-up for an average of 6.3 years (range, 3.1–8.4 years). There were 22 men and 9 women. The patients' average age was 51 ± 12 years (range, 27–74 years) at the time of arthroplasty. The average interval from fracture to THA was 5.58 ± 4.42 years (range, 0.75–17.5 years). Of the 31 patients, 19 had undergone ORIF (open-reduction group) and 12 had received conservative treatment for the acetabular fractures (conservative-treatment group). Then, 14 had simple pattern fractures (simple group) and 17 had complex pattern fractures (complex group). After midterm follow-up, the radiographic and clinic results of the different groups were compared. Results. During 6.3 years' follow up, no infection occurred and no revision was needed in the 31 patients. In the open-reduction and conservative-treatment groups, the respective averages for duration of surgery, intraoperative blood loss, and amount of blood transfused were 138 ± 29 minutes and 98 ± 16 minutes (P < .001), 726 ± 288 mL and 525 ± 101 mL (P = .01), and 1,130 ± 437 mL and 1,016 ± 422 mL (P = .62). In the complex group and the simple group, the respective averages for duration of surgery, intraoperative blood loss, and amount of blood transfused were 132 ± 28 minutes and 109 ± 31 minutes (P = .042), 741 ± 221 mL and 536 ± 248 mL (P = .02), and 1,100 ± 414 mL and 1,075 ± 456 mL (P = .91). The average Harris Hip Score increased from 49 ± 15 before surgery to 89 ± 5 in the latest follow up, and 29 patients (94%) had either excellent or good results. The average Harris Hip Score for the open-reduction group and the conservative-treatment group increased to 87 ± 6 and 91 ± 3 (P = .07), respectively, after surgery; for the complex group and the simple group, it increased to 88 ± 6 and 90 ± 4 (P = .25), respectively. There was no significant difference between the open-reduction group and the conservative-treatment group or between the complex group and the simple group regarding the number of hips with excellent and good results. Of our 31 patients, none had a change in acetabular component abduction of >4°. The average horizontal migration of cup was 1.48 ± 0.46 mm (range, 0.7–2.33 mm), and the average vertical migration was 1.41 ± 0.54 mm (range, 0.5–2.51 mm). The average rate of polyethylene liner wear was 0.25 ± 0.11 mm/y (range, 0.03–0.41 mm/y). Average wear rates were 0.25 ± 0.12 mm/y and 0.24 ± 0.11 mm/y for the open-reduction group and the conservative-treatment group (P = .72), respectively, and 0.24 ± 0.13 mm/y and 0.26 ± 0.10 mm/y in the complex group and the simple group (P = .67), respectively. The average rate of polyethylene wear for all patients was positively related to BMI (r = .36; P = .047). After THA, all 31 patients had a reconstructed hip center within 20 mm of vertical and horizontal symmetry compared with the contralateral hip, including 27 patients (87%) with anatomic restoration and 4 patients with reconstructed hip center between 10–20 mm of vertical and horizontal symmetry. Anatomic restoration was positively related to fracture treatment (r = .48; P = .006), but it had no relation to fracture pattern (r = .16; P = .40). Conclusion. Uncement acetabular reconstruction following acetabular fracture had favorable midterm results. Fracture treatments and patterns are associated with increased operative time and hemorrhage amount. Open reduction and internal fixation of fracture favours anatomic restoration of hip rotational center


Bone & Joint 360
Vol. 8, Issue 5 | Pages 16 - 19
1 Oct 2019