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Bone & Joint Open
Vol. 4, Issue 6 | Pages 408 - 415
1 Jun 2023
Ramkumar PN Shaikh HJF Woo JJ Haeberle HS Pang M Brooks PJ

Aims

The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate.

Methods

This retrospective analysis identified 267 hips from 224 patients who underwent an hip resurfacing arthroplasty (HRA) from a single fellowship-trained surgeon using the direct lateral approach between 2007 and 2019. Inclusion criteria was minimum two-year follow-up, and age younger than 40 years. Patients were followed using a prospectively maintained institutional database.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_3 | Pages 23 - 23
1 Mar 2021
Kelley S Maddock C Bradley C Gargan M Safir O
Full Access

The use of total hip arthroplasty in adolescents for end-stage degenerative hip disease is controversial with few reported outcomes in the literature. The purpose of the study was to report the outcomes of total hip arthroplasty in a cohort of adolescents managed by a multidisciplinary team of paediatric and adult orthopaedic surgeons from a single centre. A multidisciplinary clinic consisting of paediatric and adult hip surgeons was established in 2013 to identify, treat and prospectively follow adolescents who would potentially beneift from a total hip arthoplasty. To date 29 consecutive adolescent patients (20 female, 9 male, 32 hips) with end stage degenerative hip disease have undergone cementless primary total hip arthroplasty. Mean age at decision to treat was 15.7 years (age 11.4–18.5). Ten different underlying paediatric specific pathologies were documented including DDH, cerebral palsy, JIA, skeletal dysplasias, SCFE and idiopathic chondrolysis. Three patients had bilateral staged procedures. Clinical baseline and outcomes were measured using Oxford Hip Score (OHS), WOMAC score and ASKp scores. Radiographic follow-up was conducted at 6 weeks, 6 months and yearly thereafter. Post-operative complications were recorded. Twenty-five hips were eligible for minimum 2-year follow-up scoring at a mean 2.7 years (2.0–3.6 years). No intraoperative complications occurred. One case of recalcitrant postoperative psoas tendonitis occured. OHS improved from 25 (7–43) to 41 (23–48). WOMAC improved from 48 (12–8) to 12 (1–44), and ASKp improved from 78% (33–98%) to 93% (73–100%). Radiographic review revealed acceptable alignment of all components with no signs of loosening or wear. No revision of components was required. One patient died at 6 months post op from an unrelated condition. The early term results of total hip arthroplasty in adolescents from our multidisciplinary program are encouraging. Improvements in quality of life to normal values were seen as were hip scores consistent with satisfactory joint function. Depite the range of complex and varied causes of arthritis seen in this population the establishment of combined paediatric and adult orthopaedic surgical teams appears to be a successful model to manage end-stage degenerative hip disease in adolescents


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_8 | Pages 6 - 6
1 Aug 2020
Wilson I Gascoyne T Turgeon T Burnell C
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Total hip arthroplasty (THA) is one of the most successful and commonly performed surgical interventions worldwide. Based on registry data, at one-year post THA, implant survivorship is nearly 100% and patient satisfaction is 90%. A novel, porous coated acetabular implant was introduced in Europe and Australia in 2007. Several years after its introduction, warnings were issued for the system when used with metal-on-metal bearings due to adverse local tissue reaction, with one study reporting a 24% failure rate (Dramis et al. 2014). A subsequent 2018 study by Teoh et al. showed that the acetabular system had a survival rate of 98.9% at five years when used with conventional polyethylene or ceramic bearing surfaces. The current study was conducted to determine the safety and effectiveness of the acetabular system using standard highly-crosslinked polyethylene (XLPE) and ceramic liners at five-year follow-up. Our hypothesis was that the acetabular system would exhibit survivorship comparable to other acetabular components on the market at five-year follow-up.

A prospective, non-randomized study was conducted from February 2009 to June 2017 at eight sites in Canada and the USA. One hundred fifty-five hips were enrolled and 148 hips analyzed after THA indicated for degenerative arthritis. At five-year follow-up, 103 subjects remained for final analysis. All patients received a zero, three, or multi-hole R3 acetabular shell with Stiktite porous coating (Smith & Nephew, Inc., Memphis, TN, USA). Standard THA surgical techniques were employed, with surgical approach and either of a XLPE or ceramic bearing surface chosen at the discretion of the surgeon. The primary outcome was revision at five-years post-op with secondary outcomes including the Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), radiographic analysis, and post-operative adverse events. Data and outcomes were analyzed using summary statistics with 95% confidence intervals, t-tests, and Wilcoxon Rank tests.

At five-year follow-up the overall success rate was 97.14% (95% CI: 91.88–100). When analyzed by liner type, the success rate was 96.81% (95% CI: 90.96–99.34) for polyethylene (n=94) and 100% (95% CI: 71.51–100) for ceramic (n=11), with no significant difference between either liner type (p=1). There were three revisions during the study (1.9%), two for femoral stem revision post fracture, and one for deep infection. The HHS (51.36 pre-op, 94.50 five-year), all 5 HOOS sub-scales, and WOMAC (40.9 pre-op, 89.13 five-year) scores all significantly improved (p < 0 .001) over baseline scores at all follow-up points. One (0.7%) subject met the criteria for radiographic failure at one-year post-op but did not require revision. Six (1.8%) of the reported adverse events were considered related to the study device, including four cases of squeaking, one bursitis, and one femur fracture.

Results from this five-year, multicenter, prospective study indicate good survivorship for this novel, porous coated acetabular system. The overall survivorship of 97.14% at five-year follow-up is comparable to that reported for similar acetabular components and aligns with previous analyses (Teoh et al. 2018).


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 31 - 36
1 Jun 2019
Nam D Nunley RM Clohisy JC Lombardi AV Berend KR Barrack RL

Aims

Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study’s purposes were to determine differences in pain based on surgical approach (direct anterior (DA) vs posterolateral (PL)) and PL approach incision length.

Patients and Methods

This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year’s follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80).


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 84 - 90
1 Jun 2019
Charette RS Sloan M Lee G

Aims

Total hip arthroplasty (THA) is gaining popularity as a treatment for displaced femoral neck fractures (FNFs), especially in physiologically younger patients. While THA for osteoarthritis (OA) has demonstrated low complication rates and increased quality of life, results of THA for acute FNF are not as clear. Currently, a THA performed for FNF is included in an institutional arthroplasty bundle without adequate risk adjustment, potentially placing centres participating in fracture care at financial disadvantage. The purpose of this study is to report on perioperative complication rates after THA for FNF compared with elective THA performed for OA of the hip.

Patients and Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2008 and 2016 was queried. Patients were identified using the THA Current Procedural Terminology (CPT) code and divided into groups by diagnosis: OA in one and FNF in another. Univariate statistics were performed. Continuous variables were compared between groups using Student’s t-test, and the chi-squared test was used to compare categorical variables. Multivariate and propensity-matched logistic regression analyses were performed to control for risk factors of interest.


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 867 - 874
1 Jul 2018
Makarewich CA Anderson MB Gililland JM Pelt CE Peters CL

Aims

For this retrospective cohort study, patients aged ≤ 30 years (very young) who underwent total hip arthroplasty (THA) were compared with patients aged ≥ 60 years (elderly) to evaluate the rate of revision arthroplasty, implant survival, the indications for revision, the complications, and the patient-reported outcomes.

Patients and Methods

We retrospectively reviewed all patients who underwent primary THA between January 2000 and May 2015 from our institutional database. A total of 145 very young and 1359 elderly patients were reviewed. The mean follow-up was 5.3 years (1 to 18). Logistic generalized estimating equations were used to compare characteristics and the revision rate. Survival was evaluated using Kaplan–Meier curves and hazard rates were created using Cox regression.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_6 | Pages 4 - 4
1 Mar 2017
Sidhu G Kaur H
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Introduction & aims. Total hip replacement is an excellent treatment option for people with late stage degenerative hip disease. In addition to marked reduction in pain and improvement in sleep, most people regain range of motion, physical ability and quality of life. This study aimed at the functional outcomes of large diameter heads in THR patients. Method. This study is an analysis of a cohort of patients undergoing total hip replacement performed at our hospital from November 2011 to July 2013. A total of 70 hips, 40 males and 30 females, were operated upon with large diameter femoral heads. The mean age was 50.38 years (range 40–59 years). In our cohort, 32 patients had AVN of femur head, 19 had post traumatic secondary degeneration, 10 had RA, 6 had AS and 3 patients had OA of hip. The follow-up data included local complications, Harris Hip Score, medical complications, readmission, activity status and use of a walking aid. Results. Harris hip score at final follow up was, 33 cases had excellent, 26 cases had good result. None of the patient had fair or poor result. Two cases of superficial infection were observed. One case of dislocation was observed in post operative period which was reduced under GA and patient was given abduction brace. The mean follow up was 16.31 months ranging from 6 to 32 months. During the follow up, we had mortality of two patients. One died at 14 months due to myocardial infarction and the cause of other died due to CVA at 10 months follow up. Conclusions. Lower dislocation rate and better range of motion in majority of cases reinforces the advantage of large diameter head in THR in young and active patients. For any figures or tables, please contact authors directly (see Info & Metrics tab above).


The Bone & Joint Journal
Vol. 98-B, Issue 1 | Pages 6 - 13
1 Jan 2016
Cheung AC Banerjee S Cherian JJ Wong F Butany J Gilbert C Overgaard C Syed K Zywiel MG Jacobs JJ Mont MA

Recently, the use of metal-on-metal articulations in total hip arthroplasty (THA) has led to an increase in adverse events owing to local soft-tissue reactions from metal ions and wear debris. While the majority of these implants perform well, it has been increasingly recognised that a small proportion of patients may develop complications secondary to systemic cobalt toxicity when these implants fail. However, distinguishing true toxicity from benign elevations in cobalt ion levels can be challenging.

The purpose of this two part series is to review the use of cobalt alloys in THA and to highlight the following related topics of interest: mechanisms of cobalt ion release and their measurement, definitions of pathological cobalt ion levels, and the pathophysiology, risk factors and treatment of cobalt toxicity. Historically, these metal-on-metal arthroplasties are composed of a chromium-cobalt articulation.

The release of cobalt is due to the mechanical and oxidative stresses placed on the prosthetic joint. It exerts its pathological effects through direct cellular toxicity.

This manuscript will highlight the pathophysiology of cobalt toxicity in patients with metal-on-metal hip arthroplasties.

Take home message: Patients with new or evolving hip symptoms with a prior history of THA warrant orthopaedic surgical evaluation. Increased awareness of the range of systemic symptoms associated with cobalt toxicity, coupled with prompt orthopaedic intervention, may forestall the development of further complications.

Cite this article: Bone Joint J 2016;98-B:6–13.


Bone & Joint 360
Vol. 4, Issue 6 | Pages 20 - 21
1 Dec 2015

The December 2015 Spine Roundup360 looks at: Ketamine in scoliosis surgery; Teriparatide in osteoporotic spinal fractures; Trabecular metal in the spine?; Revision surgery a SPORTing chance?; The course of degenerative lumbar spondylolisthesis; Hip or lumbar spine: a common conundrum


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_22 | Pages 46 - 46
1 May 2013
Haddad F
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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 conversion to arthroplasty were analysed. There were a total of 90 males and 60 females. The average age group was 32 years (27 to 46 years). All patients underwent osteoplasty of the CAM lesion and stabilisation/ repair of the labral tears. A comparison of pre procedure non arthritic hip scores with the scores at latest follow up (minimum 1 year, maximum 3 years) showed a significant improvement (56 vs 86; p <0.01). There were 2 re operations for unresolved symptoms and 1 conversion to arthroplasty for continued pain associated with significant loss of articular cartilage. Perineal numbness was noted in 9 patients all of which resolved. No other major complications were noted in this series. Hip impingement symptoms resolved in all cases and a good (20 %) to excellent (75%) outcome was reported. Arthroscopic management of CAM type FAI is associated with subjective and objective improvement in hip function at early follow up. Longer follow-up is necessary to analyse the ability of this procedure to arrest progression of degenerative hip disease


Bone & Joint 360
Vol. 2, Issue 1 | Pages 14 - 16
1 Feb 2013

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.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 9 | Pages 1193 - 1201
1 Sep 2012
Hamilton HW Jamieson J

It is probable that both genetic and environmental factors play some part in the aetiology of most cases of degenerative hip disease. Geneticists have identified some single gene disorders of the hip, but have had difficulty in identifying the genetics of many of the common causes of degenerative hip disease. The heterogeneity of the phenotypes studied is part of the problem. A detailed classification of phenotypes is proposed. This study is based on careful documentation of 2003 consecutive total hip replacements performed by a single surgeon between 1972 and 2000. The concept that developmental problems may initiate degenerative hip disease is supported. The influences of gender, age and body mass index are outlined. Biomechanical explanations for some of the radiological appearances encountered are suggested. The body weight lever, which is larger than the abductor lever, causes the abductor power to be more important than body weight. The possibility that a deficiency in joint lubrication is a cause of degenerative hip disease is discussed. Identifying the phenotypes may help geneticists to identify genes responsible for degenerative hip disease, and eventually lead to a definitive classification


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 40 - 40
1 Sep 2012
Oliver MC Railton P Faris P Kinniburgh D Parker R MacKenzie J Werle J Powell J
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Purpose. Elevated blood metal ions are associated with the early failure of the Hip Resurfacing Arthroplasty. The aim of this study was to analyse our prospective database of Hip Resurfacing Arthroplasty patients, to independently review the outliers with elevated blood metal ions and to determine whether a screening program would be of value at our institution. Method. In 2004 a ten year prospective longitudinal study was set up to evaluate the clinical effectiveness and safety of Metal on Metal Hip Resurfacings in young, active adults with degenerative hip disease. Six hundred and four patients have enrolled in this multi-surgeon prospective study with strict inclusion criteria for Hip Resurfacing Arthroplasty. All have received the same implant design. All have completed validated functional outcome questionnaires at baseline, three and six months, then annually. A sub-cohort of 196 patients underwent whole blood chromium and cobalt analysis at the same time periods. Metal on metal bearings have a running in period of a minimum of six months before a steady state wear pattern is attained. We chose five parts per billion for Cobalt or Chromium as our threshold value. This value corresponds to the workplace exposure limit in the United Kingdom to Cobalt in whole blood. Therefore patients with ion levels greater than five parts per billion after six months were recalled for independent review, including further metal ion analysis. Results. Twenty two patients were recalled. Twenty one patients (32 Hip Resurfacing Arthroplasties) were reviewed. At latest review 11 patients (15 Hip Resurfacing Arthroplasties; eight females) had levels greater than five parts per billion. Mean follow up was 59.8 months (47–78). Mean age at surgery was 48.7 years (37–55). Median femoral component size was 50 millimetres (42–54). Mean acetabular anteversion was 18.3 degrees (−5.2 43.0). Mean acetabular inclination was 46.1 degrees (33.1–57.1). Mean cobalt and chromium levels were 8.82 parts per billion (3.49 18.42) and 9.15 parts per billion (3.79 24.33). Patients with ion levels greater than five parts per billion were associated with inferior functional scores (p= 0.018), inferior hip flexion (p=0.01) and mal-positioned acetabular components (p=0.023). All symptomatic patients were female. Conclusion. It is reassuring that the majority do not have elevated metal ions (185/196; 94.4%). That said, blood metal ion screening of Hip Resurfacing Arthroplasties aids in the early detection of problematic cases. Comprehensive clinical review should follow as patient safety is paramount. The early detection of problematic cases is advantageous to the surgeon and patient. Revision surgery for an established pseudotumour has been found to be technically challenging, often with a poor outcome


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 500 - 500
1 Nov 2011
Nehme A Chemaly R Jabbour F Moufarrej N El Khoury G Hajjawi A Telmont N
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Purpose of the study: Although the association between femoroacetabular impingement and degenerative hip disease has been well established, there is no way to detect a subgroup of hips with radiographic signs of impingement which will progress to degeneration. In addition, the majority of publications on the topic have been conducted in populations of patients with an overtly degenerative hip, where the incidence of signs of impingement is higher. There has not been any study searching for the presence of signs of impingement in a symptom free population. For this reason, we searched for signs of femoroacetabular impingement in a general population and attempted to find correlations with degenerative hip disease. Material and method: We examined 200 computed tomography (CT) series of the pelvis performed for reason other than an orthopaedic indication. Four hundred hips were thus analysed with the Amira 4.1 3D software. We measured the classical coxometric parameters, orientation of the acetabulum, alpha angle, and presence or not of a bulge at the head-neck junction. Cartilage thickness was also mapped using a precise protocol. Cartilage thickness less than 0.25mm was considered for the purpose of this study to indicate degenerative disease. All data were processed with SPPS 17.0. Results: There were 103 men and 97 women, mean age 58 years and 59 years respectively. The mean alpha angle was 55.7. Retroversion was noted in 20% of hips and 28% exhibited an anterior bulge at the head-neck junction. The mean cartilage thickness at the anterosuperior part of the hip was 37mm. Degenerative disease was present in 28 patients (14%) whose mean cartilage thickness at the anterosuperior portion of the joint was 21 mm. There was no significant correlation between cartilage thickness and acetabular orientation, alpha angle, presence of a bulge at the head-neck junction. Only age was significantly correlated with degenerative disease r=−0.158 [p< 0.0]. Discussion: Among the parameters currently considered to be risk factors for degenerative disease of the hip joint, age alone was statistically linked with reduced cartilage thickness in our symptom-free population. This would suggest that the essential mechanism underlying degenerative disease remains to be discovered. Conclusion: Our findings suggest we should be prudent when proposing corrective surgery for femoroacetabular impingement. Such surgery should be reserved for symptomatic patients


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 522 - 522
1 Nov 2011
Descamps S Boisgard S Texier CH Bouillet B Levai J
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Purpose of the study: The purpose of this work was to report the outcome at minimum ten years follow-up of cemented Muller total hip arthroplasty (THA) with a metal-on-metal bearing and a CLS cup. Material and methods: From June 1995 to August 1997, 110 THA were implanted in 102 patients for degenerative hip disease. At last follow-up, 23 patients had died, four were lost to follow-up, and 67 were reviewed. Mean age was 56 years (29–71). BMI: 26.2 (17.9–33.6). Mean follow-up was 12 years (10–13). The same operative technique was used for all implantations: transgluteal approach, Palacos Gentamycine. ®. cement, straight femoral stem, Muller prosthesis made of Protasul. ®. 10, with a Metasul. ®. head and a CLS cup with a polyethylene sandwich Metasul. ®. insert. Outcome was assessed clinically with the Merle score, radiographically searching for signs of loosening using the Harris criteria for the femoral component and the Hodgkinson criteria for the acetabular component. Migration was measured with the Nunn method for the cup and the Sutherland method for the femur. Dobbs actuarial survival was determined. Results: Nine patients (9THA) underwent revision for acetabular migration (n=4), cup fracture by cam effect (n=1), psoas syndrome (n=2), retarded hypersensitivity (n=1), infection (n=1). At last follow-up, the clinical outcome was good or very good (n=64), fair (n=2), poor (n=1). Radiologically, for the femur: lucent lines (n=0), osteolysis (n=4), migration (n=0); for the cup: lucent line < 1mm stable and non migrating (n=3), global lucent line with migration > 5mm (radiological loosening) (n=1). No correlation between clinical and radiographic outcomes. Survival was 89.4±7.6% for revision outside infection and 92.6±6.9% for aseptic loosening. Discussion: The failures at ten years were all acetabular, but related to various causes. Defective fixation could be related to the implant design or to the use of a hard-on-hard bearing increasing peripheral stress. Hypersensitivity and a cam effect related directly to using the metal-on-metal bearing. The psoas syndrome was not related to the type of cup. Conclusion: Use of a metal-on-metal bearing, which theoretically improves wear, leads to other constraints in terms of fixation, technique, and context which must be taken into consideration to improve outcomes


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 1 | Pages 108 - 110
1 Jan 2011
Rajakulendran K Strambi F Buly J Field RE

Developmental dysplasia of the hip predisposes to premature degenerative hip disease. A number of operations have been described to improve acetabular cover and have achieved varying degrees of success. We present the case of an 84-year-old woman, who underwent a shelf procedure to reconstruct a dysplastic hip 75 years ago. To date, the shelf remains intact and the hip is asymptomatic. We believe this represents the longest documented outcome of any procedure to stabilise the hip


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 594 - 594
1 Oct 2010
Froberg L Christensen F Overgaard S Pedersen N
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Introduction: Poor long-time results in patients with Legg-Calvé-Perthes disease (LCP) are most often due to degenerative hip disease. The purpose of this study was to investigate if patients with LCP have an increased rate of total hip replacement (THR) compared to sex- and age-matched persons. Material and Methods: 167 LCP patients presented to our institution from 1941 to 1962. All patients were treated conservatively by a Thomas splint. Retrospectively medical records and radiographs were retrieved. Data from the Danish Hip Replacement Register and the Registries of the National Board of Health were collected to get information regarding the number of the patients who had a THR. Radiographs of sex- and age-matched controls for the follow-up group were obtained from The Copenhagen City Heart Study. The following criteria for exclusion were applied. emigrated persons,. persons lost to follow-up and. patients with previous surgery to pelvis or lower limbs. 135 patients (156 hips) were enrolled in this study and 32 patients (35 hips) were excluded. Results: 20 hips out of 156 hips in patients with LCP have had a THR. Mean age at operation for the women was 50 years and 44 years for the men. None of the sex- and age-matched persons have had a THR. Conclusion: LCP patients had a significantly higher risk of THR surgery compared to sex- and age-matched control persons, (p< 0.00 [OR= 49.0 (CI 8.2-infinite)])


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 306 - 306
1 May 2010
Mouttet A Philippot R Farizon F Vallotton P Ibnou-Zekri N
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Introduction: In the last years, the use of second generation cementless anatomical stems has generated an increasing interest in primary total hip arthroplasty. They are believed to offer long term stability through appropriate stress transfer and bone remodelling in the proximal femur. We conducted a monocentric prospective study on a homogeneous series of total hip replacements performed with a cementless anatomic, hydroxyapatite-coated stem. The purpose of the study was to evaluate the contribution of this implant in terms of clinical and radiological results at a minimum 5-year follow-up. Material and Methods: The continuous homogeneous series included 176 THA performed between September 1997 and December 1998 by a single surgeon with the same implant system (SPS femoral stem and Hilock acetabular cup, Symbios Orthopédie SA). Indications were restricted to primary or secondary degenerative hip diseases. Revisions were excluded. Patients were reviewed for clinical performance (Harris hip score), satisfaction, and radiological outcome. The radiological analysis (implant migration, Ara and Engh scores, Brooker classification) was performed by an independent surgeon unaware of the clinical performance outcome. The survival curve was determined with the Kaplan-Meier method at 95% confidence interval, using exclusively implant revision as the criteria for failure. Results: The follow-up rate in the series was 93.2%. The five-year implant survival was 98.8%. Two revisions were recorded: one for early instability due to excessive joint laxity after surgery, one due to recurrent dislocation following improper cup positioning during surgery. The clinical improvement was obvious, as the Harris hip score improved significantly (p< 0.0001) from 32.9±1.2 preoperatively to 93.1±0.8 at five years follow-up. Pain was the item exhibiting the largest improvement with only 10.2% of patients complaining of mild pain at last follow-up. The radiological analysis revealed a high stability of the femoral implant with Ara and Engh scores reaching 5.0±0.2 and 20.7±0.5 respectively. The migration remained low at 2.4 mm ±0.3 (p=0.02) and had no incidence on the clinical outcome. Heterotopic ossifications at various grades were observed in a large proportion of patients (65.1%). The polyethylene wear rate was 0.075 mm/yr in the series, below most values commonly reported for Ø28mm PE inserts. Discussion: The survival rate of the SPS stem is comparable with that of other published series at same follow-up. Both the stem and cup implants used provided good clinical and radiological results at five years. The objectives of good integration and stability of the cementless anatomical stem appeared to be met, despite a significant rate of heterotopic ossifications. The excellent clinical and radiological results recorded at five years should be confirmed at longer follow-up


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 139 - 139
1 Mar 2010
Tanaka Y
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We report the review of performance and problems of Metasul Hip System with metallic sliding face during mean time of 11 years or longer. Subjects and methods: Twenty-three joints in 22 patients. 17 females and 5 males treated using cementless Metasul THA in our hospital from November of 1995 to April of 1998 were selected as subjects. The mean age at the time of surgery was 59 years, and disease included degenerative hip disease in 16 joints, femoral head necrosis in 5 joints, and rheumatoid arthritis in 2 joints. Mean follow-up period was 11 years and 3 months. We have investigated clinical results (JOA score), stem fixation by radiography (Engh), setting angle of socket, and presence or absence of osteolysis by CT, and the poor cases after surgery and problems were clarified. Results: Clinical results (JOA score) were improved from preoperative mean of 41.3 points to mean of 89.3 points at the time of investigation. Stem fixation examination by radiography (Engh) for bone ingrown resulted in 95% in ingrown and 5% in ingrown suspension, showing excellent fixation. The abduction angle of the socket was 38.8±4.5 degrees, and the anteversion angle was 14.6±7.7 degrees, revealing that precise surgery was conducted. There were no joints which showed loosening in stem or socket, but CT imaging showed osteolysis in 5 joints (22%) in the stem side and 12 joints (52%) in the acetabular side. Dislocation in Poly Liner occurred in 4 cases which needed revision surgery with accumulated survival rate of 82.6. Summary: When cementless Metasul Hip System was used, fixation of stem/metal shell was excellent, but there were problems in thickness and fixation of Poly Liner. Due to augmentation of activity, backside wear occurred, and osteolysis or dislocation of the liner was induced. THA System such as M2a which improves these defects using metallic liner may be promising hereafter


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 1 | Pages 16 - 23
1 Jan 2009
Philippon MJ Briggs KK Yen Y Kuppersmith DA

Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded. Ten patients refused to participate leaving 112 in the study. There were 62 women and 50 men. The mean age of the patients was 40.6 yrs (95% confidence interval (CI) 37.7 to 43.5). At arthroscopy, 23 patients underwent osteoplasty only for cam impingement, three underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. The mean follow-up was 2.3 years (2.0 to 2.9). The mean modified Harris hip score (HHS) improved from 58 to 84 (mean difference = 24 (95% CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Ten patients underwent total hip replacement at a mean of 16 months (8 to 26) after arthroscopy.

The predictors of a better outcome were the pre-operative modified HHS (p = 0.018), joint space narrowing ≥ 2 mm (p = 0.005), and repair of labral pathology instead of debridement (p = 0.032).

Hip arthroscopy for femoroacetabular impingement, accompanied by suitable rehabilitation, gives a good short-term outcome and high patient satisfaction.