Intro: Anatomical abnormality associated with
Aims. Accurate positioning of the acetabular component is essential for achieving the best outcome in total hip arthroplasty (THA). However, the acetabular shape and anatomy in
Intro. Sciatic nerve injury (SNI) is a rare and potentially devastating complication after total hip arthroplasty (THA). Neural monitoring has been found in several studies to be useful in preventing SNI, but can be difficult to practically implement during surgery. In this study, we examine the results of using a handheld nerve stimulator for intraoperative sciatic nerve monitoring during complex THA requiring limb lengthening and/or significant manipulation of the sciatic nerve. Methods. We retrospectively reviewed a consecutive series of 11 cases (9 patients, 11 hips) with either
Introduction. The aim of this study was to compare patient reported outcomes, radiographic measurements, and survival free from total hip arthroplasty (THA) in patients who underwent periacetabular osteotomy (PAO) for mild, moderate, or
Introduction. The purpose of this study was to demonstrate postoperative improvement and high satisfaction rates after a surgical approach that includes arthroscopic labral repair only, in patients with borderline dysplasia, without instability. Methods. Between September 2009 and December 2011, patients less than 50 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle between 20 and 25, were included in this study. Patients with Tönnis grade 2 or greater, hip joint space narrowing,
Purpose. The purpose of this study was to demonstrate postoperative improvement and high satisfaction rates after a surgical approach that includes arthroscopic labral repair only, in patients with borderline dysplasia, without instability. Methods. Between September 2009 and December 2011, patients less than 50 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle between 20 and 25, were included in this study. Patients with Tönnis grade 2 or greater, hip joint space narrowing,
The aim of this study was to evaluate the reliability and validity of a patient-specific algorithm which we developed for predicting changes in sagittal pelvic tilt after total hip arthroplasty (THA). This retrospective study included 143 patients who underwent 171 THAs between April 2019 and October 2020 and had full-body lateral radiographs preoperatively and at one year postoperatively. We measured the pelvic incidence (PI), the sagittal vertical axis (SVA), pelvic tilt, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis to classify patients into types A, B1, B2, B3, and C. The change of pelvic tilt was predicted according to the normal range of SVA (0 mm to 50 mm) for types A, B1, B2, and B3, and based on the absolute value of one-third of the PI-LL mismatch for type C patients. The reliability of the classification of the patients and the prediction of the change of pelvic tilt were assessed using kappa values and intraclass correlation coefficients (ICCs), respectively. Validity was assessed using the overall mean error and mean absolute error (MAE) for the prediction of the change of pelvic tilt.Aims
Methods
Introduction. The anatomic abnormalities associated with the dysplastic hip increase the complexity of hip arthroplasty, in addition previous femural osteotomy can deformate proximal femur. Despite the fact that uncemented cup and stems are specifically designed for dysplasia to recover the true acetabular region in Crowe IV and sometimes Crowe III additional surgical procedure are required. Purpose of the study is to verify surgical procedures and explore reconstruction options on
Introduction. We present our experience of the coned hemi-pelvis (‘ice-cream’ cone) implant, using an extended posterior approach to the hip joint, in the management of pelvic bone loss and pelvic discontinuity. Methods. Retrospective study conducted utilising a prospectively collected database. Patients who underwent an ice-cream cone reconstruction between August 2004 – September 2011 were identified. All had a posterior approach to the hip. Femur prepared in the standard fashion. A variety of femoral components used. Demographic data was recorded along with the indication for surgery and outcomes. Results. 16 patients identified. Mean age was 62.2 years. 5 (31.25%) male. 11 (69.75%) female. Indications included; multiple hip revision surgery 4(25%); post Gridlestones for
Introduction: The anatomic abnormalities associated with the dysplastic hip increase the complexity of hip arthroplasty, in addition previous femural osteotomy can deformate proximal femur. Despite the fact that uncemented cup and stems are specifically designed for dysplasia to recover the true acetabular region in Crowe IV and sometimes Crowe III additional surgical procedure are required. Purpose of the study is to analize surgical procedure and then reconstruction options on
Introduction and Objectives: We compared the clinical and radiological results in patients under and over 40 years of age who had received a non-cemented alumina-alumina hip replacement. Materials and Methods: We studied 337 Cerafit acetabular cups implanted in 4 hospitals in association with Multicone-Hydroxyapatite stems with alumina-alumina bearing surfaces. Group 1 consisted of 63 patients under 40 years of age and group 2 of 274 patients over 40 years of age. Mean follow-up was 59.0 months. Demographic data and clinical and radiological results of both groups were compared. Results: There were no cases of primary arthritis in group 1, however
Rotational acetabular osteotomy (RAO) is a circumacetabular osteotomy of the acetabulum designed to correct the dysplastic hip. In this procedure, the femoral head is covered with the articular cartilage of the acetabulum and the forces of weight-bearing are distributed more evenly. The purpose of this study was to determine whether RAO is effective in delaying the onset of arthrosis in patients with painful hip dysplasia. We determined the outcome of 20 female patients in whom RAO was performed between 1975 and 1984; all were aged 20 to 29 years at the time of surgery. The pre-operative centre-edge angle of Wiberg was 0 or negative with proximal subluxation of the femoral head. Of these, 10 were lost to follow-up before the age of 42. In these patients, however, radiographs showed no signs of arthrosis at the last follow-up. The remaining 10 patients were examined 15 to 25 years after surgery, when they were 42 to 47 years old. Radiographs revealed findings of arthrosis in only two of them who had had the secondary acetabulum before surgery. To evaluate the efficacy of preventive medicine, it is necessary to compare the results of intervention with the natural course of the disease. Wiberg reported on the natural history of seven female patients with
In
Purpose of the study: Labrum lesions can be an important source of hip pain. Besides the classical causes, certain morophological anomalies can be associated with labrum lesions. The purpose of this work was to study the contribution of plain x-rays to the search for morphological anomalies of the hip in patients with labrum lesions. Materials and methods: Twenty-six patients with labrum lesions were included in this study. The plain x-rays protocol included an anteroposterior view of the pelvis in the standing position, a Lequesne oblique view and a lateral view of the neck in the hip flexion position. Patients with
Objectives/Background: Long-term outcome in THR is multifactorial influenced. Malpositioning leads to complications as early loosening, leg length difference or dislocation of the artificial joint. A proven factor for early losening is a misplacment of the center of rotation or varusposition of the stem. A higher luxation risk results out of high inclination and anteversion angles an reduced soft tissue tension. Aim of this study was to prove the image free navigation software in the modular Navitrack-System to check the implant position based on anatomical intraoperative acquired data. Design/Methods: In 35 consecutive cases we implantet the ACA screwcup and the Optan anatomical stem with use of the Navitrack navigation System. The software calculates al relevant data out of intraopertive probed landmarks. Intraoperative the shifting of the center of rotation, the cup anteversion and inclination, the stem inclination and torsion and the leglength shift is shown in real time. Intraoperative data were compared with postoperative position measurement in plain X-rays and in 15 patients in postoperative CT scans. Results: In all cases navigated implantpositioning was possible. In 3 cases stem positioning was not possible cause of refference loosening. Mean inclination of the cup as shown in the Navigation System was 52 (range 45 – 58 ), mean anteversion was 11 (range -5 – 27). Mean postoperative inclination measured on postoperative X-Ray was 53,8 (range 49 – 60). The difference between the shown values from the CAS System to the postoperative X Ray for the inclination was 1,8 (range -9 – 6). The leg length difference on postoperative X-ray was in mean 3,1 mm, on screenshots 2,8 mm. The difference between screenshot and X ray was in mean 0,83 mm. Conclusions: This study shows, that with the CT free software for the Navitrack-System reliable cup and stem navigation is possible. Whenever the hip joint allows to probe a spherical segment in the femoral head or acetabulum navigated THR is possible without the need of intraoperative fluoroscopy or preoperative CT scan. For leg length control and cup Inclination the data are still promising. Further investigation is necessary for stem axis and cup anteversion according to the navigation based reference coordinate system. Whenever no geometric sphere existent, e.g.
Metal-on-metal hip resurfacing (MOMHR) is a good surgical indication for young active patients. However, it cannot be used in patients with severe CDH and in particular a too short head/neck. To address these cases, a new surgical technique consisting of augmentation of the femoral head with impacted morcellized bone grafts has been developed. 32 osteoarthritis patients following severe congenital insufficiency of the femoral head/neck were treated with MOMHR combined with femoral head augmentation. The required amount of augmentation was calculated on preoperative X-rays and confirmed during surgery. Using special instrumentation, bone chips produced while reaming the socket and trimming the head were impacted on the head to achieve the desired reconstruction and lengthening. Finally, the femoral component was cemented. Mean patient age was 49+ 9 years (18–66). Median head lengthening was 12+ 2 mm. Mean follow up is 4.2 years (3–6). Mean preoperative Harris hip score (HHS) was 58 and at follow-up 95 (p <
0.05). Mean leg lengthening was 2.2 cm (p = 0.001). In all Gruen zones, bone mineral density (BMD) decreased during the first 3 months. At 2 years in zone 1 mean BMD increased to 96.8% (p = 0.009) and in zone 7 to 102.1% (p = 0.05). A correlation was found between valgus positioning of the femoral components and increased BMD (p = 0.005). This impaction bone grafting technique expands the use of MOMHR to patients with
Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed.Objective
Methods