Sciatic Nerve Palsy (SNP) is a recognised complication in Primary Total Hip Replacement after a transtrochanteric or a posterior approach (5). It is considered to be caused by direct trauma to the nerve during surgery. In our unit this complication was rare with an incidence of < 0.2% over the past ten years. However we know describe six cases of sciatic nerve palsy occurring in 355 consecutive primary THRs (incidence 1.60%) performed in our unit from June 2000 to June 2001. Each of these sciatic nerve palsies we believe was due to postoperative haematoma in the region of the sciatic nerve. To our knowledge there are only five reported cases in the literature of sciatic nerve palsy secondary to postoperative haematoma (1). (Each of the six patients who developed SNP was receiving prophylactic anticoagulation). Cases recognized early and drained promptly showed earlier and more complete recovery. Those in whom diagnosis was delayed and were therefore managed expectantly showed no or poor recovery. More than usual pain the buttock, significant swelling in the buttock region and sciatic nerve tenderness associated with signs of sciatic nerve irritation may suggest the presence of haematoma in the region of the sciatic nerve. It is therefore of prime importance to be vigilant for the signs and symptoms of sciatic nerve palsy in the early post operative period because if recognized and treated early the potential injury to the sciatic nerve may be reversible

Background. Sciatic nerve palsy is a relatively rare, but one of the serious complications after total hip arthroplasty (THA). The prevalence of nerve palsy after THA has been reported to range from 0.3% to 3.7%. Previous authors have speculated that causes could include overlengthening, compression from a hematoma, from extruded metylmethacrylate, or from retractor placement, or laceration from a screw used in the acetabular component. Leg lengthening more than 4 cm was associated with sciatic nerve palsy in the past literature. But there is no report about maximum safety leg lengthening to prevent sciatic nerve palsy significantly. The purpose of this study was to identify the safety rage of leg lengthening to prevent sciatic nerve palsy in THA for the patients with adult hip dislocation. Methods. Forty two consecutive patients47 jointswith Crowe type â?¢ or â?£ were performed THA. Nine joints were Crowe type â?¢ and thirty eight joints were type â?£ in this study. All patients were female. The average age at the time of surgery was 63.3 years (range, 40–77 years). The average patient body weight was 50.5 kg and the average height was 150 cm (body mass index: 22.3 kg/m. 2). The average follow-up was 9.9 years (range, 1–21). See Table1 The socket was placed at the level of the original acetabulum, and femoral shortening osteotomy was performed in 27 joints. Leg lengthening (LL) was defined the vertical distance from the tip of greater trochanter to the tear drop line. The mean LL was 3.1 cm (range, 1.5–6.7 cm). Clinical Harris hip score and sciatic nerve palsy was retrospectively assessed from the patients records. The correlation between LL, the percent LL (cm) divided by body height (cm) (%LL/BH) and the incidence of sciatic nerve palsy was investigated. Results. There were two sciatic nerve palsy (4.3%). These leg lengthening were 5.2 cm and 6.7 cm, respectively. These patients had complete recovery of neurological function. A significant correlation between the amount of LL and the incidence of sciatic nerve palsy was identified. LL more than 5 cm and %LL/BH â?§ 3.6 were significant risk factors of sciatic nerve palsy (p=0.0194, p=0.0028). See table2.3 Body mass index, preoperative hip flexion, previous operations were not associated with sciatic nerve palsy. Harris hip scores improved from a mean of 57.6 points prior to surgery to an average of 83.1 points at the latest follow-up. Kaplan- Meier survivorship analysis at 5 and 10 years revealed a cumulative survival rate of 94.1% and 64.2% respectively, with any implant revision as the end point. There were six cases of dislocations, which were successfully treated conservatively. Infection was not observed. Conclusions. Leg lengthening more than 5 cm and %LL/BH â?§ 3.6 were significant risk factors of sciatic nerve palsy

(Case) 79-year-old woman. Past history, in 1989, right femur valgus osteotomy. in 1991, THA at left side. Follow-up thereafter. Hyaluronic acid injection for both knee osteoarthritis. (Clinical course)Her right hip pain getting worse and crawling indoors from the beginning of July 2013. We did right hybrid THA at August 2013(posterior approach, TridentHA cup, Exeter stem, Biolox Forte femoral head 28mm). But immediately, she dislocated twice than the third day after surgery because she became a delirium. It has been left by nurse for about 6 hours because of the midnight after the second dislocation. Next morning, check the dislocation limb position, closed reduction wasdone under intravenous anesthesia. As a result of waking up from the anesthesia, and complained of paralysis and violent pain in the right leg backward. A right lower extremity nerve findings, there is pain in the lower leg after surface about the calf, there was no apparent perception analgesia. Toe movement is weak, but the G-toe planter anddorsiflexion possible about M2, and neurological symptoms to relieved by flexion(above 70 degrees) of the right hip joint. Therefore, we thought that she suffered anterior dislocation of the sciatic nerve by the stem neck (retraction), judged to closed reduction was impossible, open reduction surgery was performed after waitingat hip flex position. But paralysis is gradually worsened during waiting surgery, toes movement had become impossible to operating room admission. Sciatic nerve is caught in front of the stem neck as expected, operative findings were able to finally reduction after removing the femoral head after dislocation. Anteversion of the cup was changed to 25 degrees from 15 degrees, and changed to 32mm diameter metal head and polyethylene liner. And we needed Intensive Care Unit(ICU) management after surgery for prevent recurrence of dislocation. Fitted with a hip brace for her, has not been re-dislocation. The sciatic nerve palsy improved in three months after the operation, the patient became able to walk without a cane. (Summary) We experienced a rare case suffered anterior dislocation of the sciatic nerve by the stem neck, and she had a good result after open reduction surgery

Hip resurfacing arthroplasty (HRA) is a bone conserving alternative to total hip arthroplasty. We present the early 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic (CoC) HRA in an international multi-centric cohort. Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMS) in the form of the Forgotten Joint Score (FJS), HOOS Jr, WOMAC, Oxford Hip Score (OHS) and UCLA Activity Score were collected preoperatively and at 1- and 2-years post-operation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis/loosening and heterotopic ossification formation. 200 patients were identified to have reached 2-year follow-up. Of these, 185 completed PROMS follow-up at 2 years. There was significant improvement in HOOS (p< 0.001) and OHS (p< 0.001) and FJS (p< 0.001) between the pre-operative and 2-year outcomes. Patients reported improved pain (p<0.001), function (p<0.001) and reduced stiffness (p<0.001) as measured by the WOMAC score. Patients had improved activity scores on the UCLA Active Score (P<0.001) with 53% reporting return to impact activity at 2 years. There was no osteolysis and the mean acetabular cup inclination angle was 41deg and the femoral component shaft angle was 137deg. No fractures were reported over but there was one sciatic nerve palsy with partial recovery. Two patients were revised; one at 3 months for pain due to a misdiagnosed back problem and another at 33 months for loosening of the acetabular component with delamination of the titanium ingrowth surface. CoC resurfacing at 2-years post-operation demonstrate promising results with satisfactory PROMS

Total hip arthroplasty (THA) for congenital hip dysplasia (CDH) presents a challenge. In high-grade CDH, key surgical targets include cup placement in the anatomical position and leg length equality. Lengthening of more than 4 cm is associated with sciatic nerve injury, therefore shortening osteotomies are necessary. We present our experience of different shortening osteotomies including advantages and disadvantages of each technique. 89 hips, in 61 pts (28 bilateral cases), for high CDH were performed by a single surgeon from 1997 to 2022. 67 patients were female and 22 were male. Age ranged from 38 to 68 yrs. In all patients 5–8cm of leg length discrepancy (LLD) was present, requiring shortening femoral osteotomy. 12 patients underwent sequential proximal femoral resection with trochanteric osteotomy, 46 subtrochanteric, 6 midshaft, and 25 distal femoral osteotomies with simultaneous valgus correction were performed. All acetabular prostheses were placed in the true anatomical position. We used uncemented high porosity cups. Patients were followed up for a minimum of 12 months. All osteotomies healed uneventfully except 3 non-unions of the greater trochanter in the proximal femur resection group. No femoral shaft fractures in proximally based osteotomies. No significant LLD compared to the unaffected or reconstructed side. 2 patients suffered 3 and 5 degrees malrotation of the femur in the oblique sub-trochanteric group. 3 patients suffered transient sciatic nerve palsies. Shortening femoral osteotomies in the treatment of DDH are necessary to avoid injury to the sciatic nerve. In our series, we found transverse subtrochanteric osteotomies to be the most technically efficient, versatile and predictable in their clinical outcome, due to the ability to correct rotation and preserve the metaphyseal bone integrity, allowing for better initial stem stability. Distal femoral osteotomies allowed for controllable correction of valgus knee deformity

Cup-cage constructs are one of several methods commonly used to treat severe acetabular bone loss during contemporary revision total hip arthroplasty. The purpose of this study was to provide a long-term results of the technique with emphasis on implant survivorship, radiographic results, and clinical outcomes for both full and half cup-cage reconstructions. We identified 57 patients treated with a cup-cage reconstruction for major acetabular bone loss between 2002–2012. All patients had Paprosky Type 2B through 3B bone loss, with 60% having an associated pelvic discontinuity. Thirty-one patients received a full cup-cage construct, and 26 a half cup-cage. Mean age at reconstruction was 66 years, 75% were female, and the mean BMI was 27 kg/m. 2. Mean follow-up was 10 years. The 10-year cumulative incidences of any revision were 14% and 12% for the full and half cup-cage construct groups, respectively. Of the 9 revisions, 3 were for dislocation, 2 for aseptic loosening and construct failure (both were pelvic discontinuities), 1 for adverse local tissue reaction, and 1 for infection with persistent pelvic discontinuity. The 10-year cumulative incidences of revision for aseptic loosening were 4.5% and 5% for the full and half cup-cage constructs, respectively. Of the unrevised cases, incomplete and non-progressive zone 3 radiolucent lines were observed in 10% of patients in each group. Three patients experienced partial motor and sensory sciatic nerve palsies (2 in the full and 1 in the half cup-cage group). Both the full and half cup-cage cohorts demonstrated significantly improved Harris hip scores. Full and half cup-cage reconstructions for major acetabular defects were successful at 10 years in regards to acetabular fixation without appreciable differences between the two techniques. However, zone 3 radiolucent lines were not uncommon in association with discontinuities, and dislocation continues to be a problem

Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiologic outcomes, and complications of the “acetabular distraction technique” for the management of CPD during revision hip arthroplasty. Patients with CPD, who underwent acetabular revision between 2014 and 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, pre-operative acetabular bone loss, duration of follow-up, clinical and radiologic outcomes, and survivorship were evaluated. In all, 46 patients with a mean follow-up of 34.4 (SD=19.6, range: 24–120) months were available for evaluation. There were 25 (54.3%) male, and 21 (45.7%) female patients, with a mean age of 58.1 (SD=10.5, range: 40–81) years at the time of revision surgery. Based on the Paprosky classification of acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type 3b, 3a, and 2c defects. All patients were managed using the Trabecular Metal™ Acetabular Revision System; 16 patients required additional Trabecular Metal™ augments. The mean HHS improved from 50.1 (SD=7.6, range: 34.3 – 59.8) pre-operatively, to 86.6 (SD=4.2, range: 74.8 -91.8) at the last follow-up. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 (78.3%) patients showed healing of the pelvic discontinuity. The Kaplan-Meier construct survivorship was 97.78% when using re-revision for aseptic acetabular loosening as an endpoint. The acetabular distraction technique has good clinical and radiologic outcomes in the management of CPD during revision hip arthroplasty

Hip resurfacing arthroplasty (HRA) is a bone conserving alternative to total hip arthroplasty. We present the early 1 and 2-year clinical and radiographical follow-up of a novel ceramic-on-ceramic (CoC) HRA in a multi-centric Australian cohort. Patient undergoing HRA between September 2018 and April 2021 were prospectively included. Patient-reported outcome measures (PROMS) in the form of the Forgotten Joint Score (FJS), HOOS Jr, WOMAC, Oxford Hip Score (OHS) and UCLA Activity Score were collected preoperatively and at 1- and 2-years post-operation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis/loosening and heterotopic ossification formation. 209 patients were identified of which 106 reached 2-year follow-up. Of these, 187 completed PROMS at 1 year and 90 at 2 years. There was significant improvement in HOOS (p< 0.001) and OHS (p< 0.001) between the pre-operative, 1-year and 2-years outcomes. Patients also reported improved pain (p<0.001), function (p<0.001) and reduced stiffness (p<0.001) as measured by the WOMAC score. Patients had improved activity scores on the UCLA Active Score (p<0.001) with 53% reporting return to impact activity at 2 years. FJS at 1 and 2-years were not significantly different (p=0.38). There was no migration, osteolysis or loosening of any of the implants. The mean acetabular cup inclination angle was 41.3° and the femoral component shaft angle was 137°. No fractures were reported over the 2-year follow-up with only 1 patient reporting a sciatic nerve palsy. There was early return to impact activities in more than half our patients at 2 years with no early clinical or radiological complications related to the implant. Longer term follow-up with increased patient numbers are required to restore surgeon confidence in HRA and expand the use of this novel product. In conclusion, CoC resurfacing at 2-years post-operation demonstrate promising results with satisfactory outcomes in all recorded PROMS

We sought to determine the short to medium-term clinical and radiographic outcomes using a short stem in young adults with a proximal femoral deformity (PFD). We prospectively studied 31 patients (35 hips) with PFDs treated with an uncemented primary THA using a short stem with cervicometaphyseal fixation between 2011–2018. There were 19 male (23 hips) and 12 female (12 hips) patients, with a mean BMI of 26.7±4.1 kg/m. 2. Twelve cases had a previous surgical procedure, and six of them were failed childhood osteotomies. Mean age of the series was 44±12 years, mean follow-up was 81±27 months and no patients were lost to follow-up. PFDs were categorized according to a modified Berry´s classification. Average preoperative leg-length discrepancy (LLD) was −16.3 mm (−50 to 2). At a mean time of 81 months of follow-up, survival rate was 97% taking revision of the stem for any reason and 100% for aseptic loosening as endpoints. No additional femoral osteotomy was required in any case. Average surgical time was 66 minutes (45 to 100). There was a significant improvement in the mHHS score when comparing preoperative and postoperative values (47.3±10.6 vs. 92.3±3.7, p=0.0001). Postoperative LLD was in average 1 mm (−9 to 18) (p=0.0001). According to Engh's criteria, all stems were classified as stable without signs of loosening. Postoperative complications included 1 pulmonary embolism, 1 neurogenic sciatic pain, 1 transient sciatic nerve palsy that recovered completely after six months, and 2 acute periprosthetic joint infections. One patient suffered a Vancouver B2 periprosthetic femoral fracture 45 days after surgery and was revised with a modular distally fixed uncemented fluted stem. A type 2B short stem evidenced promising outcomes at short to medium-term follow up in young adult patients with PFDs, avoiding the need for corrective osteotomies and a revision stem

Different techniques have been described to address massive bone loss of the acetabulum in revision hip surgery. aMace has gained popularity as it provides customization aiming to restore hip centre and provide good initial stability in cases of large non-contained defects. It takes into account quality of host bone. Its porous defect filling scaffold provides an excellent surface for osteointegration. Our aim was to assess the short and mid-term outcomes of patients who underwent revision surgery using aMace system. Ethical approval was obtained. A retrospective study included all patients who had aMace between June 2013 and October 2022 allowing for a minimum of 12-months follow-up. Patients’ demographics, indication, bone-loss severity, reconstruction details, re-operation, complications, mortality, pain and function were assessed. 52 cases were performed by 13 surgeons with median 51 months follow-up. Median age was 72.7 years. 86.5% were female. Average BMI was 25.3. Average ASA grade was 3. 65% were classified as Paprosky IIIB and 32% were IIIA. 73% were found to have poor bone quality on CT. Main indication for aMace was massive bone loss/discontinuity secondary to aseptic loosening in 88.5%. 77% underwent single-stage revision. 53.8% had 2 or more previous revisions. 71% underwent stem revision in the same setting. 77% received a dual mobility bearing. Re-operation rate was 5.7% for instability and femoral PPF. LLD was reported in 9.6%. Permanent Sciatic nerve palsy occurred in 3.8% of the cases. 30-days mortality was 1.9%. Statistically significant post-op improvements in pain and mobility were reported (p<0.001). None of the acetabular components have been revised. Our study shows satisfactory surgical outcomes with a relatively low complication rate and significant pain and mobility improvements in the early to mid-term stages. We recommend these costly cases to be done in highly specialist centres adopting MDT approach

This large UK multicentre study evaluates clinical outcomes and identifies factors associated with local complication following PFR for non-oncological conditions. 132 patients across four UK centres underwent PFR from 01/08/2004-28/03/2023 with median follow-up of 1.9 (Q10.5-Q34.2) years. 75 (56.8%) patients were female and the mean age was 74.0 (SD 11.7) years. 103 (78%) patients had Charleston Comorbidity Index ≥3. ASA class was III or IV in 66.6%. Indications were infected revision (39, 29.5%), periprosthetic fracture (36, 27.3%), acute trauma (30, 22.7%), aseptic revision (17, 12.9%), failed trauma (nine, 6.8%) and complex primary arthroplasty (one, 0.8%). The primary outcome was the local complication rate. Secondary outcomes were systemic complications, reoperation and mortality rates. Comparisons were made with t-tests and Chi2 tests to investigate patient and surgical factors associated with local complication. Statistical significance was p<0.05. There were 37(28.0%) local complications. These were 18 (13.6%) dislocations, eight (6.1%) prosthetic joint infections, four (3.0%) haematomas, three (2.3%) superficial infections, one (0.8%) wound dehiscence, one (0.8%) sciatic nerve palsy and one (0.8%) femoral perforation. Dislocation mostly occurred in conventional articulations (12, 9.1%) followed by dual-mobility cups (three, 2.3%), constrained cups (two, 1.5%) and hemiarthroplasty (one, 0.8%). Median time to local complication was 30 (Q14-Q3 133) days. Seven (5.3%) patients developed a systemic complication. Thirty-three (25.0%) patients underwent reoperation. Thirty-day and one-year mortality rates were 3.8% and 12.1%, respectively. Longer surgical waiting times (7.9 \[SD 16.9) versus 2.6 \[SD 4.4\] days, p<0.001) and longer operating times (212.5 \[SD 71.8\] versus 189.4 \[SD 59.3\] mins, p=0.0450) were associated with local complication. Due to its high complication rate, PFR should be a salvage option when performed for non-oncological indications. Conventional articulations should be avoided. PFR should be delivered in a timely manner and ideally as dual-consultant cases to reduce operating time

Nerve palsy occurring after elective primary total hip arthroplasty (THA) is a devastating complication because of its effect on motor strength, walking ability, potential for pain, and unexpected nature. In general, the nerve distribution involved is the peroneal branch of the sciatic nerve, and the level of involvement is usually mixed motor and sensory. Prior publications have associated limb lengthening, dysplasia and use of the posterior approach to be associated with a higher incidence of nerve palsy. In the literature, the incidence of sciatic nerve palsy is estimated to be 0.2 to 1.9%. We examined the rate of sciatic nerve palsy after THA performed by the joint replacement service at Hospital for Special Surgery between the years 1998–2013. Each case was matched with 2 controls that underwent THA and did not develop postoperative neuropathy. Controls were matched by surgical date having been within 7 days of their matched case's surgery date. Patient and surgical variables were reviewed using data from patient charts and the institution's total joint replacement registry. A multivariable logistic regression model was created to identify potential risk factors for neuropathy following THA while adjusting for potential confounders. We found that, of 39,056 primary THA cases, there were 81 cases of sciatic nerve palsy, giving an incidence of 0.21%. The factors with the greatest odds ratios for nerve palsy were: history of smoking (OR=3.45); history of spinal stenosis (OR=4.45), and time of day of 1PM or later (OR=3.98). We did not find limb lengthening, dysplasia, or type of fixation to be associated with nerve palsy. In conclusion, post-surgical neuropathy has a low incidence after primary THA, but at our institution, was associated with several factors. Spine-related comorbidities, such as spinal stenosis and lumbar spine disease, and smoking history should be closely monitored to inform the patient and surgeon for the potential increased risk of postoperative neuropathy following THA

Nerve palsy occurring after elective primary total hip arthroplasty is a devastating complication because of its effect on motor strength, walking ability, potential for pain, and unexpected nature. In general, the nerve distribution involved is the peroneal branch of the sciatic nerve, and the level of involvement is usually mixed motor and sensory. Prior publications have associated limb lengthening, dysplasia and use of the posterior approach to be associated with a higher incidence of nerve palsy. In the literature, the incidence of sciatic nerve palsy is estimated to be 0.2–1.9%. We examined the rate of sciatic nerve palsy after THA performed by the joint replacement service at Hospital for Special Surgery between the years 1998 and 2013. Each case was matched with 2 controls that underwent THA and did not develop post-operative neuropathy. Controls were matched by surgical date having been within 7 days of their matched case's surgery date. Patient and surgical variables were reviewed using data from patient charts and the institution's total joint replacement registry. A multivariable logistic regression model was created to identify potential risk factors for neuropathy following THA while adjusting for potential confounders. We found that, of 39,056 primary THA cases, there were 81 cases of sciatic nerve palsy, giving an incidence of 0.21%. The factors with the greatest odds ratios for nerve palsy were: history of smoking (OR=3.45); history of spinal stenosis (OR=4.45), and time of day of 1PM or later (OR=3.98). We did not find limb lengthening, dysplasia, or type of fixation to be associated with nerve palsy. In conclusion, post-surgical neuropathy has a low incidence after primary THA, but at our institution, was associated with several factors. Spine-related comorbidities, such as spinal stenosis and lumbar spine disease, and smoking history should be closely monitored to inform the patient and surgeon for the potential increased risk of post-operative neuropathy following THA

Introduction. Pelvic discontinuity is a challenging complication. One treatment option that has garnered enthusiasm is acetabular distraction. This method obtains stability via distraction of the discontinuity and placement of an oversized socket (± augments) and elastic recoil of the pelvis. The aims of this study were to report implant survivorship, radiographic results, clinical outcomes, and complications of acetabular distraction for pelvic discontinuity in the largest series to date. Methods. We retrospectively identified all revision THAs with a Paprosky 3B defect and pelvic discontinuity between 2005 and 2017. Of the 162 patients, 32 were treated with distraction. The mean distraction achieved was 5mm (range, 3–8mm). In addition to distraction with a hemispherical cup, augments were utilized in 3 and cages in 19. The mean age at revision was 68 years with 75% female. Mean follow-up was 3 years. Results. The 2-year survivorships free from revision for aseptic loosening, revision, and reoperation were 95%, 75%, and 69%, respectively. There were 3 revisions including one for instability, one for infection, and one for aseptic loosening. At last follow-up, 16 patients had radiographic evidence of cup osteointegration to ilium and ischium, 13 to ilium only, and 3 without evidence of osteointegration (two distracted 3mm and one distracted 6mm). 19 discontinuity lines persisted while 13 had radiographically healed. Only those with osteointegration to both ilium and ischium had evidence of bone graft consolidation and discontinuity line healing. Mean HHS improved from 43 preoperatively to 77 postoperatively (p<0.0001). The most common complication was a postoperative sciatic nerve plasy in 4 patients (13%) of which 3 partially recovered. Conclusion. Pelvic discontinuities treated with acetabular distraction had a 2-year survivorship free from aseptic looseing of 95%. While nearly 2/3. rd. of discontinuity lines persisted, 91% of patients had radiographic evidence of osteointegration of the acetabular component. However, 13% of patients had a sciatic nerve palsy. For any tables or figures, please contact the authors directly

Sciatic nerve injury remains a significant and devastating complication of total hip arthroplasty. Incidence as quoted in the literature ranges from 0.08% in primary joint replacement to 7.5% in revision arthroplasty. While as urgent exploration is recommended for nerve palsies associated with pain, management of sciatic nerve palsy with little or no pain is still controversial. In light of this, many patients with persistent palsies are often not referred to our specialist centre until after 6 months post-injury. The aim of this study was to review the outcomes of surgical intervention in patients presenting with sciatic nerve palsy more than 6 months after total hip arthroplasty. This retrospective cohort study identified 35 patients who underwent exploration and neurolysis of the affected sciatic nerve. All patients had documented follow-up at 1, 3, 6, 12 and 18 months to assess sensory and motor recovery. Patients were scored for sensory and motor function in the tibia and common personal nerve divisions, pre and post-operatively. The scoring system devised by Kline et al (1995) was used. Pre-operative electrophysiology was also reviewed. We found a statistically significant functional recovery following neurolysis of the sciatic nerve (p<0.01). A statistically significant relationship was also found between time to neurolysis and recovery of tibial nerve function (p = 0.02), such that greater delay to neurolysis was associated with poorer recovery. There was no significant relationship between time to neurolysis and recovery of common peroneal nerve function (p = 0.28). Our results indicate that the neurolysis of the sciatic nerve, six months or more post injury is associated with functional recovery. We feel that without surgical exploration this clinical improvement would not have occurred. Therefore, we believe that neurolysis plays a vital role at any stage of sciatic nerve injury. However, early presentation to a specialist unit is associated with better outcomes

Total hip arthroplasty (THA) in teenagers is uncommon and previously associated with poor survival rates. However it is sometimes the only option remaining to relieve pain and improve function in patients with advanced hip disease. We report on the clinical and radiological outcomes of THA in teenage patients. Medical records and radiographs of all consecutive teenage patients undergoing THA at a tertiary referral centre between 2006–2011 were reviewed. Mean follow-up was 3.4 years (range 0.6–6.8) with 9 patients having at least 5 years follow-up. Post-operative Harris hip, Oxford hip (OHS) and University of California Los Angeles (UCLA) activity scores were recorded. 51 THAs were performed in 43 patients (21 male, 22 female) with a mean age of 17 years (range 12–19). The 5 most common indications were slipped upper femoral epiphysis osteonecrosis 15 (29.4%), developmental hip dysplasia osteonecrosis 5 (9.8%), multiple/spondylo-epiphyseal dysplasia 5 (9.8%), chemotherapy-induced osteonecrosis 4 (7.8%) and idiopathic osteonecrosis 4 (8.2%). 46 (90%) were uncemented THAs and 5 (10%) were reverse hybrid THAs with 7 computer assisted design/manufacture (CADCAM) femoral implants. Articular bearings were ceramic/ceramic in 40 (78.4%), metal/metal 6 (11.8%), metal/polyethylene 3 (5.9%) and ceramic/polyethylene 2 (3.9%). The survival rate was 96% with 2 acute head revisions for 1 sciatic nerve palsy and 1 instability. Other complications (8.2%) included 1 dislocation, 1 sciatic nerve palsy that resolved, 1 surgical site infection and 1 unexplained pain. At latest follow-up, the mean Harris hip score was 90 (68–99), OHS was 42 (32–48) and UCLA activity score was 6 (4–9). Radiological analysis showed 2 patients with lucent lines around the acetabular component, but no signs of osteolysis or wear. As one of the largest studies on teenagers undergoing THA, we report good clinical and radiological outcomes at short to intermediate term follow-up

Sciatic nerve palsy is a troublesome complication of total hip arthroplasty, and may be caused by direct injury or over-traction at the time of the operation. We investigated the effects of over-traction on the blood flow of the sciatic nerve by placing the hip and knee joints in various positions. Twenty hip joints of 10 adult dogs were examined. Using a posterior surgical approach, the sciatic nerve was exposed and a site 1 cm distal to the greater trochanter was selected for blood-flow measurement. The blood-flow was measured using a Laser Doppler Flowmetry, with the hip and knee joints at various positions. Blood flow decreased as flexion angle increased and internal rotation angle of the hip joint increased, and decreased with as flexion angle of the knee joint decreased. When we positioned the hip joint at 160 degrees of flexion and 30 degrees of internal rotation and the knee joint at 0 degrees of flexion, we found that the mean blood-flow decreased by 69% from the value measured when the hip joint was at 90 degrees of flexion and the knee joint was 90 degrees of flexion. When knee flexion was 90 degrees there was no significant difference in average blood flow between 30 degrees of internal rotation of the hip and 0 degrees internal rotation. When knee flexion was 0 degrees there was a significant difference in average blood flow between 30 degrees of internal rotation of the hip and 0 degrees of internal rotation. Our results suggest that surgeons should pay attention to extension of the knee and the flexion and internal rotation positions of the hip to prevent sciatic nerve palsy as a complication of total hip arthroplasty

Uncontained acetabular defects with loss of superior iliac and posterior column support (Paprosky 3) represent a reconstructive challenge as the deficient bone will preclude the use of a conventional hemispherical cup. Such defects can be addressed with large metallic constructs like cages with and without allograft, custom tri-flange cups, and more recently with trabecular metal augments. An underutilised alternative is impaction bone grafting, after creating a contained cavitary defect with a reinforcement mesh. This reconstructive option delivers a large volume of bone while using a small-size socket fixed with acrylic cement. Between 2005 and 2014, 21 patients with a Paprosky 3B acetabular defect were treated with cancellous, fresh frozen impaction grafting supported by a peripheral reinforcement mesh secured to the pelvis with screws. A cemented all-polyethylene cup was used. Pre-operative diagnosis was aseptic loosening (15 cemented and 6 uncemented). The femoral component was revised in 10 patients. Post-operative course consisted of 3 months of protected weight bearing. Patients were followed clinically and radiographically. One patient had an incomplete post-operative sciatic palsy. After a mean follow up of 47 months (13 to 128) none of the patients required re-revision of the acetabular component. One asymptomatic patient presented with aseptic loosening 9 years post-operatively. Hardware failure was not observed. All patients had radiographic signs of graft incorporation and bone remodeling. There were no dislocations. The early and mid-term results of revisions of large acetabular defects with this technique are encouraging. Reconstitution of hip center of rotation and bone stock with the use of a small-size implant makes this technique an attractive option for large defects. Longer follow-up is needed to assess survivability

Aims

The purpose of this study is to report our updated results at a minimum follow-up of 30 years using a first generation uncemented tapered femoral component in primary total hip arthroplasty (THA).

Aims

Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures.