Aims: Evaluation of: 1/ early clinical and radiographic results of total hip arthroplasty (THA) made by standard lateral direct approach, 2/ early clinical and radiographic results of THA made by minimal lateral approach, 3/ comparison of results of THA in these two groups. Material and methods: Prospective study of 120 THAs (60 cementless and 60 cement) done in 120 patients due to degenerative changes was made. 60 THAs made by minimal lateral approach consist study group. 60 THAs made by direct lateral approach consist of control group. Mean age of 120 patients (98 women and 22 men) was 45 y.o. (range: 32–61 y.o.). Follow-up time in study group was from 6 to 12 months (mean: 8,5 months). Follow-up time in control group was from 10 to 16 months (mean: 10,5 months). Mean preoperative functional status of the study group was 44,5p in Harris hip score. Radiographic evaluation of the results was made according to criteria of Joined Committee of The Hip Society, AAOS and SICOT. Results: Clinical results in 6 months after THA were: 92p. in study group and 88p. in control group. In all 120 cases in both groups radiographic results were very good – there were no differences between control and study group. Incidence of complications were similar in both groups. Conclusions: THA with minimal invasive approach has proved its value in the treatment of hip degenerative changes as regarding short-time results. Clinical and radiographic results of THA made by standard or minimal invasive approaches are comparable. Successful THA with minimal invasive approach is a matter of excellent operative technique and experience with standard hip approaches, and not special instruments

Introduction: Hip Surgical Dislocation (SHD) according the technique described by Ganz et al. is a safe and powerful tool to access intra-articular hip pathology in adults. Some indications may also arise in younger patients to correct slipped capital femoral epiphysis or femoral neck deformities. Materials and Methods: From 2004 to 2008 we have selected 45 patients on whom the procedure was done to treat femoroacetabular impingement (FAI). The average follow up time is 3 years, and patient mean age 26 years. The indications for SHD were:. mixed FAI in 26 cases,. pure cam FAI in 6 cases and. pure pincer FAI in 13 cases. 42 hips where graded as Tönnis 0 and 2 as Tönnis 1. All patients where evaluated according to the non arthritic hip score (NAHS – McCarthy et all) before and after the surgery at 3, 6, 12, 24 and 36 months. Osyrix. ®. software was used to measure radiographic parameters. The numeric variables where treated using SPSS for windows (paired t student test). Surgical Technique: In all 45 cases we did SHD, acetabular and/or femoral head neck junction trimming and labrum refixation. In half cases an anterior step trochanteric osteotomy was done and in 7 cases additional relative neck lengthening was performed. Results: The average alfa angle measured in the standard crosstable view x ray was 72° before surgery and 36° after surgery (p=0,0001). The NAHS before surgery was 40,8 average: 9,71 – pain; 6,9 – symptoms; 9 – function and 6,9 – activities and after surgery 76,38 average (p= 0,0001) 17,5 – pain (p= 0,0001); 12,9 – symptoms (p= 0,0001); 16 - function (p= 0,0001) and 14,9 - activities (p= 0,0001). All patients improved motion, specially flexion, internal rotation (p= 0,0001). The results did not differ significantly in the patients who had a trochanteric anterior step osteotomy. One patient had a total hip replacement for ongoing osteoartrithis. We had no avascular necrosis so far and no neurovascular damage. Trochanteric screw removal was done in 3 cases for local irritation. We had 2 capsule adhesions, released shortly after using arthroscopy. Conclusions: SHD is a demanding technique with full access to femoral head and acetabular deformities as well as cartilage or labral tears. It can be done safely with a low complication rate. The best results are achieved in young patients without degenerative cartilage and significant labrum changes. Hip degenerative changes contraindicates this procedure. Modification of trochanteric osteotomy does not seem to influence results

Purpose: Femoroacetabular impingement (FAI) is a precursor to osteoarthritis (OA) of the hip. To investigate the fate of impingement abnormalities we analyzed the contralateral hip in patients undergoing THA for advanced FAI. Our purpose was to determine the bilaterality of FAI abnormalities, and to describe the prognosis of these deformities. Method: We reviewed 508 patients ≤50 years of age treated with THA. Radiographic review identified 70 hips that had OA secondary to FAI (71% cam, 5% pincer, 24% combined). Bilaterality was determined radiographically, and the fate of the contralateral hip was analyzed by determining radiographic presence and progression of OA, and the need for subsequent THA. Results: 71% of the patients were male and the average age was 43.2 years. The contralateral hip was analyzed on radiographs over an average 9 year period (range, 4–30 years). 100% of the contralateral hips had radiographic features of FAI. 49 (70%) of the contralateral hips demonstrated degenerative disease. 14 had advanced OA at presentation, 41 had progressive joint space narrowing, 25 had progression of Tonnis OA grade and 26 underwent subsequent THA. Statistical analysis showed that alpha angle, LCEA, joint space width, and head-neck ratio have strong predictive value for subsequent THA (p< 0.05). Conclusion: This study demonstrates that FAI abnormalities are commonly bilateral and are associated with OA progression in the majority of hips. Patients diagnosed with FAI should have both hips monitored, and joint preservation surgery or THA considered when appropriate

Aims: 1. Analysis of indications for THA in young adults with osteoarthrosis, 2. Evaluation of clinical and radiological end results, 3. Investigation of complications after metal-to-metal THA. Material: 75 THAs with metal-tometal cementless endoprosthesis in 75 patients which had been operated between 1997–2002 were retrospectively evaluated. There 50 women and 25 men (mean age: 39 years old). The mean time of follow-up was 2,8 years (form 6 to 48 months). Etiologic factors of osteo-arthrosis in operated hips were: idiopathic arthrosis in 50 hips, CHD in 18 hips, post-traumatic lesions in 3 hips, aseptic necrosis of the femoral capitis. Metal-to-metal THA with the cementless endoprosthesis was made in all evaluated cases with: Alloclassic systeml Ð 66, other systems Ð 9.Methods: The clinical evaluation was performed with Merle dñAbugine score. The radiological evaluation of THA was based on criterion proposed by joined committee of The Hip Society, SICOT and AAOS. Results: The mean postoperative clinical result in the study group is 5,5 p. in Merle dñAbugine score. Radiological result was very good in all hips. Conclusions: The study supports the satisfactory results of the THA with the metal-to-metal cementless endoprosthesis in reconstructive surgery of the hip with degenerative changes in young adults

Introduction: In order to investigate the relationship between the degeneration of the acetabular cartilage and the radiological staging of osteonecrosis of the femoral head, the following study was performed. Materials and Methods: Acetabular cartilage with sub-chondral bone was taken from the superior dome from 34 hips from 30 patients undergoing total hip arthroplasty due to osteonecrosis of the femoral head. The specimens were stained with hematoxylineosin and safranin-O, and were evaluated as to the thinning of cartilage, fibrillation, clefts, and proliferation of chondrocytes. There were 18 females and 12 males with an average age of 49 years. We used the radiological staging system proposed by the working group of the Specific Disease Investigation Committee under the auspices of the Japanese Ministry of Health, Labor and Welfare. There were eight hips in stage IIIA disease (collapse of the femoral head less than 3 mm), 19 hips in stage IIIB disease (collapse 3 mm or greater), and seven stage IV disease hips. Results: All 34 specimens showed histological abnormalities. In eight stage IIIA hips, six hips were mild and two were moderate histological degeneration. In 19 stage IIIB hips, five hips were mild, six were moderate, and eight had severe arthrosis. Seven stage IV hips had severe arthrosis. Discussion: Although the radiographs cannot demonstrate early degeneration of cartilage, degenerative changes were present in all stage III hips. Histological degenerative changes in stage IIIB hips were more severe than those in stage IIIA hips. These findings should be kept in mind in treating patients with osteonecrosis of the femoral head

The February 2013 Hip & Pelvis Roundup³⁶⁰ looks at: amazing alumina; dual mobility; white cells and periprosthetic infection; cartilage and impingement surgery; acetabulum in combination; cementless ceramic prosthesis; metal-on-metal hips; and whether size matters in failure.