This study examines patient characteristics, indications for conversion, surgical and anaesthetic technique, peri-operative management and complications of surgery in this small and challenging group of patients. In the six years from 1994 to 1999, 33
In the past orthopaedic surgeons have kept their hands off from spontaneous or artificial fused hips, because those hips were painless, and the result of any further surgical procedure would be doubtful. In our days the need for conversion hip arthroplasty became a demand of patients having a better quality of life. In this paper we report on our results and the perioperative complications following conversion surgery. Between 1993 and 2002 thirty-one hips of twentyfive patients (18 males, 7 females) were converted from totally stiff hip to total hip arthroplasty in the two most frequented orthopaedic hospitals in Budapest, Hungary (Semmelweis University, Medical School, Dept. of Orthopaedics &
Hospital of Hospitaller Brothers of St.John of God, Dept. of Orthopaedics). The mean age of the patients was 47.2 years (ranging from 14 to 75 years) at the time of surgery. The average follow up was 50.7 months (2–176). At our 25 patients the hips became stiff 15.7 years ago as an average (3–61). Spontaneous fusion occured in 14 cases due to Bechterews disease (spondylitis ankylopoetica). In 4 cases fused hips were converted following arthrodesis procedures. There was no significant difference between each groups, spontaneous ankylosis and surgical fusion were similar, they were evaluated as stiff hips on the same way. The indication for surgery was in most cases a painful lumbar spine or osteoarthritic knee joint on the ipsilateral side. The surrounding joints are obviously overloaded and overused because of the stiff hip joint, even though if the hip is painless. 27 cemented and 4 uncemented hip prostheses were implanted. The mean duration of
The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole DHS in Garden I and II neck of femur fractures in patients more than 60 years with a minimum follow up of one year. We retrospectively reviewed 51 consecutive patients aged more than 60 years who underwent DHS fixation for Garden I and II fractures. Demographics, fracture classification, time to surgery, pre-operative AMTS, preoperative posterior tilt angle, quality of reduction, pre and post-operative haemoglobin(hb), creatinine and comorbidities were analysed for correlation with AVN using Chi-Square test, Independent Sample and paired t test. There were 40 (78.4%) females and the mean age of the cohort was 77 years. 28 and 23 were Garden I and II NOF fractures respectively. Union was observed in all our patients except one(kappa =1). 12/51(23.5%) developed AVN of the femoral head. Statistically significant higher incidence of AVN was noted in patients with a pre-op tilt angle > 200 (p = 0.006). The mean drop in Hb was higher in patients who developed AVN (21.5 g/L) versus the non-AVN group (15.9 g/L) (p = 0.001). There was no difference in AVN rates with respect to laterality, mean time to surgery, pre-op AMTS and Charlson comorbidity index. 4/52 (7.6%) had re-operations (one hardware prominence, two
Aim. The most frequent mechanical failure in the osteosynthesis of intertrochanteric fractures is the cut-out. Fracture pattern, reduction quality, tip-apex distance or the position of the cervico-cephalic screw are some of the factors that have been associated with higher cut-out rates. To date, it has not been established whether underlying bacterial colonization or concomitant infection may be the cause of osteosynthesis failure in proximal femur fractures (PFF). The primary objective of this study is to assess the incidence of infection in patients with cut-out after PFF osteosynthesis. Method. Retrospective cohort study on patients with cut-out after PFF osteosynthesis with endomedullary nail, from January 2007 to December 2020. Demographic data of patients (such as sex, age, ASA), fracture characteristics (pattern, laterality, causal mechanism) and initial surgery parameters were collected (time from fall to intervention, duration of surgery, intraoperative complications). Radiographic parameters were also analyzed (tip-apex distance and Chang criteria). In all cut-out cases, 5 microbiological cultures and 1 anatomopathological sample were taken and the osteosynthesis material was sent for sonication. Fracture-related infection (FRI) was diagnosed based on Metsemakers et al (2018) and McNally et al (2020) diagnostic criteria. Results. Of the 67 cut-out cases, 16 (23.9%) presented clinical, analytical or microbiological criteria of infection. Of these sixteen patients, only in 3 of them the presence of an underlying infection was suspected preoperatively. A new osteosynthesis was performed in 24 cases (35.8%) and a
Cheilectomy is a recommended procedure for early stage osteoarthritis of the 1st metatarsophalangeal joint. Although improvement in symptoms has been reported in many studies, long term performance is not well understood. It is thought that significant numbers of patients require subsequent arthrodesis or arthroplasty. We report on a large cohort of patients receiving this procedure and on complications, and mid-term outcome. This is a retrospective study looking at all patients undergoing cheilectomy for hallux rigidus between November 2007 and August 2018. Departmental database was used to record outcome measures including: postoperative wound infection, patient reported improvement in pain and incidence of further surgical interventions like revision cheilectomy, conversion to arthrodesis and arthroplasty. Osteoarthritis was staged radiographically using PACS (Hattrup and Johnson classification). A total of 240 feet in 220 patients (20 bilateral surgeries) were included with 164 females (75%) and 56 males (25%), the median age being 55 years (range 22–90 years). Radiological assessment showed 89 stage 1 arthritis (42%), 105 stage 2 (50%), 17 stage 3 (8%) and 9 patients were excluded due to unavailable radiographs. 5 patients (2%) had superficial wound infections. There were 16 further surgeries (7%); 12 arthrodesis (5%), 3 revision cheilectomy and 1
Introduction and Objective. Osteoarthritis of the knee joint is common in old age population in every part of world. Pain is the major source of disability in patients with osteoarthritis of the knee joint. Subchondral bone marrow is richly innervated with nociceptive pain fibers and may be a source of pain in patients with symptomatic degenerative joint disease. Current therapy for managing bone marrow oedema is core decompression (CD), combining core decompression and injection of hydroxyapatite cement or autologus chondrocyte supplementtion. But all of this work has been done in femoral head and authors documented good result with minimal complication. There are various studies in literature suggesting treatment to repair BME by restoring support and relieving abnormal stresses with accepted internal fixation and bone stimulating surgical techniques in relieving knee OA pain. In this study, we present efficacy of knee arthroscopy with adjunctive core decompression and supplementation with structural scaffold to improve self-rated visual analog scale (VAS) pain scores, rate of
Purpose. Patellofemoral arthroplasty (PFA) has experienced significant improvements in implant survivorship with second-generation designs. This has renewed interest in PFA as an alternative to total knee arthroplasty (TKA) for younger, active patients with isolated patellofemoral osteoarthritis (PF OA). The decision to select PFA over TKA balances the clinical benefits of sparing healthy knee compartments and ligaments against the risk of downstream
Revision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure following rTKA. The purpose of this study is to compare the outcomes following rTKA between patients undergoing index rTKA and those who had been previously revised. This retrospective, observational study reviewed patients who underwent unilateral, aseptic rTKA at an academic orthopaedic speciality hospital between June 2011 and April 2020 with > one-year of follow-up. Patients were dichotomized based on whether this was their first revision procedure or not. Patient demographics, surgical factors, postoperative outcomes, and re-revision rates were compared between the groups.Aims
Methods
Introduction. Total hip arthroplasty (THA) is the most common surgery performed for complications of bipolar arthroplasty. The present study evaluated the functional results and complications associated with this surgery. Patients and Methods. Forty eight hips (48 patients) who had conversion of bipolar arthroplasty to THA between 1998 June and 2013 June, and who were followed-up for more than one year were evaluated. Twenty one hips had conversion surgery to THA using a Fitmore cup with metal-on-metal articulation (28 mm head). Six hips had surgery using the SecurFit cup and three hips, using the Lima LTO cup with ceramic-on-ceramic articulation (28 mm or 32 mm head). Eighteen hips had surgery using a large head metal-on-metal bearing: –MMC (seven hips), ACCIS (six hips) and Magnum (five hips). The average time of follow-up duration was 3.9 years (range, 1.0–11.3). There were 22 men and 26 women between the ages of 28 and 80 years (average, 68.9 years) at the time of conversion surgery.
Our primary aim was to assess reoperation-free survival at one year after the index injury in patients aged ≥ 75 years treated with internal fixation (IF) or arthroplasty for undisplaced femoral neck fractures (uFNFs). Secondary outcomes were reoperations and mortality analyzed separately. We retrieved data on all patients aged ≥ 75 years with an uFNF registered in the Swedish Fracture Register from 2011 to 2018. The database was linked to the Swedish Arthroplasty Register and the National Patient Register to obtain information on comorbidity, mortality, and reoperations. Our primary outcome, reoperation, or death at one year was analyzed using restricted mean survival time, which gives the mean time to either event for each group separately.Aims
Methods
Introduction. Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure. Methods. We included patients who underwent concurrent pelvic and proximal femoral osteotomies by the senior surgeon (JNOH) with a minimum follow-up of 5 years. A modified triple pelvic interlocking osteotomy was performed to correct acetabular inclination and/or version with a concurrent proximal femoral osteotomy to correct valgus/varus and/or rotational alignment. We assessed functional scores, radiological paramenters,
Introduction. Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure. Methods. We included patients who underwent concurrent pelvic and proximal femoral osteotomies by the senior surgeon (JNOH) with a minimum follow-up of 5 years. A modified triple pelvic interlocking osteotomy was performed to correct acetabular inclination and/or version with a concurrent proximal femoral osteotomy to correct valgus/varus and/or rotational alignment. We assessed functional scores, radiological paramenters,
Purpose: Acetabular fractures in elderly patients are difficult problems with various treatment options. Our institution treats many of these patients with percutaneous acetabular fixation. We reviewed medical records and contacted patients to determine the rate of conversion to total hip arthroplasty. Method: Our institutional trauma database was searched for all patients age 60 and older who had been treated with percutaneous screw fixation for an acetabular fracture. Seventy-nine consecutive patients (80 fractures) were identified. Medical records were examined to obtain peri-operative and follow-up information regarding the hospital course and conversion to total hip arthroplasty. A survivorship anaylsis was created with conversion to total hip arthroplasty as the censored event, and standard Kaplan-Meier curves were constructed. Five categorical variables were used to test for differences in survival of the native hip: age, sex, simple versus complex fracture pattern, closed versus limited open reduction, and occurrence of a medical complication. Results: Seventy-five fractures had adequate clinical follow-up with a mean of 3.9 years (range 0.5 – 11.9 years). Average blood loss was 69 cc and there were no postoperative infections. 19/75 (25%) were converted to total hip arthroplasty at a mean time of 1.4 years after the index procedure. Survivorship analysis demonstrated a cumulative survival of 65% at 11.9 years of follow-up. There were no
Recently, there has been a reluctance to perform hip arthrodesis. The number of patients requiring the conversion from hip arthrodesis to arthroplasty has also decreased. We present the functional results following conversion of hip arthrodesis to total hip arthroplasty at a specialist hip centre. 76 patients who underwent conversion of hip arthrodesis to total hip arthroplasty between 1963 and 2000 at the Centre for Hip Surgery, Wrightington Hospital, were included in this retrospective study. 9 patients died of unrelated causes and 7 patients were lost to follow up. The functional scoring was performed using the Merle d’Aubigné and Postel score. The mean age at the time of surgical hip arthrodesis was 16.7 years and at the time of conversion was 48.7 years. Back pain is the most common indication for the conversion. All the patients were pleased with the clinical outcome following
The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome. Prospectively collected data of a consecutive single-surgeon cohort, operated for FAI between January 2005 and January 2015, were retrospectively studied. The cohort comprised 393 hips (365 patients; 71% male (n = 278)), with a mean age of 34.5 years (SD 10.0). Over the study period, techniques evolved from open surgical dislocation (n = 94) to a combined arthroscopy-Hueter technique (HA + Hueter; n = 61) to a pure arthroscopic technique (HA; n = 238). Outcome measures of interest included modes of failures, complications, reoperation, and patient-reported outcome measures (PROMs). Demographic, radiological, and surgical factors were tested for possible association with outcome.Aims
Methods
Femoroacetabular impingement is defined as abnormal abutment between the femoral head, or the femoral head-neck junction, and the acetabulum. It is now established that FAI is a major etiological factor in the development of osteoarthritis (OA) of the hip. FAI is increasingly recognized as a cause of hip pain in young active individuals. Clinical features of FAI include pain in the groin but this may also be felt in the gluteal region, trochanteric region, or in the thigh. Symptoms most commonly begin as an intermittent discomfort, often during or following periods of repetitive hip motion e.g. running, walking, progressing to more constant and intense pain. Stiffness is common, with reductions in the range of hip flexion, and internal rotation in particular. Patients may also complain of clicking, popping, or snapping sensations in the affected hip. Operative treatment of FAI is principally aimed at removing cam lesions and increasing femoral head-neck offset (osteochondroplasty), and treating associated soft tissue lesions such as labral tears. Acetabular recession with labral reattachment is increasingly used for pincers lesions but great care is needed to ensure that the overall coverage of the hip is not reduced. As proficiency with arthroscopic techniques has improved, arthroscopic osteochondroplasty and labral debridement/repair has become increasingly popular for the treatment for FAI, with promising functional results in a range of studies. 150 consecutive patients who underwent hip arthroscopy for CAM type FAI with minimum 1 year follow up were prospectively studied. Patient satisfaction, non-arthritic hip score, re-operations and
Salvage Total Hip Arthroplasty (THA) presents a viable solution following failed treatment of a hip fracture. Several studies have suggested higher complication rate including high dislocation rate associated with salvage THA. The present study evaluates the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of a hip fracture and comparison made to Primary THA in osteoarthritis (OA). Between 1992 and 2007, 53 patients with a mean age of seventy years were treated with THA after the failed treatment of a hip fracture under the care of a single surgeon. The indication for
Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed.Aims
Methods
This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement.Aims
Methods
Introduction. Joint preserving procedures have gained popularity in an attempt to delay arthroplasty in young, dysplastic hips. Excellent results can be achieved with peri-acetabular osteotomy (PAO) in congruent non-arthritic hips. The role of salvage procedures such as the Shelf acetabuloplasty remains undefined. This study aims to determine the long-term survival and functional outcome following Shelf acetabuloplasty and to identify factors that influence outcome. Patients/Materials & Methods. This is a retrospective, consecutive, multi-surgeon, case series from a UK referral centre. 125 Shelf procedures were performed between 1987–2013 on 117 patients for symptomatic hip dysplasia. Mean age was 33 years (15–53). Mean follow-up was 10 years (1–27). Radiographic parameters measured included pre-operative arthritis, acetabular-index, centre-edge-angle, joint congruency, subluxation and femoral sphericity. Oxford Hip and UCLA scores were collected at follow-up. Failure was defined as