Executing an extended retinacular flap containing the blood supply for the
Aims. Ganz’s studies made it possible to address joint deformities on both the femoral and acetabular side brought about by Perthes’ disease.
Ganz's studies made it possible to address joint deformities on both femoral and acetabular side brought by the Legg-Calvè-Perthes disease (LCPD).
Avascular femoral head necrosis in the context of gymnastics is a rare but serious complication, appearing similar to Perthes’ disease but occurring later during adolescence. Based on 3D CT animations, we propose repetitive impact between the main supplying vessels on the posterolateral femoral neck and the posterior acetabular wall in hyperextension and external rotation as a possible cause of direct vascular damage, and subsequent femoral head necrosis in three adolescent female gymnasts we are reporting on. Outcome of hip-preserving head reduction osteotomy combined with periacetabular osteotomy was good in one and moderate in the other up to three years after surgery; based on the pronounced hip destruction, the third received initially a total hip arthroplasty.Aims
Methods
The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint. Records of 251 consecutive infants with a mean age of 89 days (SD 47), diagnosed with DDH between January 2015 and December 2018, were retrospectively reviewed. Inclusion criteria for patients with DDH were: younger than 180 days at the time of diagnosis; ultrasound Graf classification of IIc or greater; treatment by Pavlik harness or Tübingen splint; and no prior treatment history. All patients underwent hip ultrasound every seven days during the first three weeks of treatment and subsequently every three to four weeks until completion of treatment. If no signs of improvement were found after three weeks, the Pavlik harness or Tübingen splint was discontinued. Statistical analysis was performed.Aims
Methods
Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively.Aims
Methods
The aim of this study was to report the long-term results of rotational acetabular osteotomy (RAO) for symptomatic hip dysplasia in patients aged younger than 21 years at the time of surgery. We evaluated 31 patients (37 hips) aged younger than 21 years at the time of surgery retrospectively. There were 29 female and two male patients. Their mean age at the time of surgery was 17.4 years (12 to 21). The mean follow-up was 17.9 years (7 to 30). The RAO was combined with a varus or valgus femoral osteotomy or a greater trochanteric displacement in eight hips, as instability or congruence of the hip could not be corrected adequately using RAO alone.Aims
Patients and Methods
Aims. The aims of this study were to review the surgical technique for a combined
Severe femoral head deformities due to Perthes' disease are characterized by limitation of ROM, pain, and early degeneration, eventually becoming intolerable already in early adulthood. Morphological adaptation of the acetabulum is substantial and complex intra- and extraarticular impingement sometimes combined with instability are the underlying pathologies. Improvement is difficult to achieve with classic femoral and acetabular osteotomies. Since 15 years we have executed a head size reduction. With an experience of more than 50 cases no AVN of the femoral head was recorded. In two hips fracture of the medial column of the neck has been successfully treated with subsequent screw fixation. The clinical mid-term results are characterized by substantial increase of hip motion and pain reduction. Surgical goal is to obtain a smaller head, well contained in the acetabulum. It should become as spherical as possible and the gliding surface should be covered with best available cartilage. Together, it has to be accomplished under careful consideration of the blood supply to the femoral head. In the majority of cases acetabular reorientation is necessary to optimize joint stability. Femoral head segment resections without guidance is difficult. Therefore, 3D-simulation for cut direction and segment size including the implementation of the resultant osteotomy configuration was developed using individually manufactured cutting jigs. First experience in five such cases have revealed good results. The forthcoming steps are the improvement of computer algorithm and automation. Goal is that with first cut decision the other cuts are automatically determined resulting in optimal head size and sphericity.
We have previously described the mid- to long-term
results of conventional simple varus intertrochanteric osteotomy
for osteonecrosis of the femoral head, showing that 19 of the 26
hips had good or excellent results. We extended the follow-up to
a mean of 18.1 years (10.5 to 26) including a total of 34 hips in
28 patients, with a mean age at surgery of 33 years (19 to 53).
There were 18 men and ten women and 25 hips (74%) had a satisfactory
result with a Harris hip score ≥ 80. In all, six hips needed total
hip replacement (THR) or hemiarthroplasty. The collapse of the femoral
head or narrowing of the joint space was found to have progressed
in nine hips (26%). Leg shortening after osteotomy was a mean of
19 mm (8 to 36). With conversion to THR or hemiarthroplasty as the
endpoint, the ten-year survival rate was 88.2% (95% confidence interval
(CI) 82.7 to 93.7) and the 20-year survival rate was 79.7% (95%
CI 72.1 to 87.3); four hips were converted at ten years and other
two hips were converted at 20 years. Shortening of the leg after osteotomy remains a concern; however,
the conventional varus half-wedge osteotomy provides favourable
long-term results in hips with less than two-thirds of the medial
part of the femoral head affected by necrotic bone and with normal
bone superolaterally.
Introduction. In osteonecrosis of the
Method. The anteroposterior pelvic radiographs of 84 children (87 hips with developmental dysplasia) seen between 1995 and 2004 were reviewed retrospectively. Each radiograph was photographed digitally and converted to the negative using Microsoft Photo Editor. Arthrograms were also assessed at the time of
We reviewed the clinical outcome of arthroscopic femoral osteochondroplasty for cam femoroacetabular impingement performed between August 2005 and March 2009 in a series of 40 patients over 60 years of age. The group comprised 26 men and 14 women with a mean age of 65 years (60 to 82). The mean follow-up was 30 months (12 to 54). The mean modified Harris hip score improved by 19.2 points (95% confidence interval 13.6 to 24.9; p <
0.001) while the mean non-arthritic hip score improved by 15.0 points (95% confidence interval 10.9 to 19.1, p <
0.001). Seven patients underwent total hip replacement after a mean interval of 12 months (6 to 24 months) at a mean age of 63 years (60 to 70). The overall level of satisfaction was high with most patients indicating that they would undergo similar surgery in the future to the contralateral hip, if indicated. No serious complications occurred. Arthroscopic femoral osteochondroplasty performed in selected patients over 60 years of age, who have hip pain and mechanical symptoms resulting from cam femoroacetabular impingement, is beneficial with a minimal risk of complications at a mean follow-up of 30 months.
Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and
Introduction: High developmental hip dislocation is the most severe anatomic constitution type in developmental dysplasia of the hip (DDH). After the age of 30–40 years the pseudo-articulation often becomes painful and requires advanced treatments. To restore limb length dislocation must be reduced by soft tissue release. If the reduction overreaches 40 mm the risk for nerve-damage increases dramatically. Reducing the dislocation, one-step soft tissue releases and slow release by continuous iliofemoral distraction were invented. In this study we report a combination of a one-step soft tissue release and slow continuous iliofemoral distraction in patients requiring over 40 mm distraction for uncemented THA. Material and Methods: Between 1998 and 2007 20 procedures in 19 patients with an age of 42.5 years (18–69 years) and a leg-length discrepancy of >
4 cm were performed. For 5.6 years (1–12 years) patients were followed-up clinically and radiographically. The treatment consisted of a two-step procedure. 1st operation: Soft tissue releases combined with the implantation of the THA components and placement of the external distraction apparatus. In the interval period slow iliofemoral distraction of 1mm–1.5 mm per day was conducted. Neurovascular signs and distraction was regularly monitored until the desired length was achieved. 2nd operation: the external fixation device was removed before applying the acetabular PE-inlay and the
Surgeons remain concerned that ceramic hip prostheses may fail catastrophically if either the head or the liner is fractured. We report two patients, each with a ceramic-on-ceramic total hip replacement who sustained high-energy trauma sufficient to cause a displaced periprosthetic acetabular fracture in whom the ceramic bearings survived intact. Simultaneous fixation of the acetabular fracture, revision of the cementless acetabular prosthesis and exchange of the ceramic bearings were performed successfully in both patients. Improved methods of manufacture of new types of alumina ceramic with a smaller grain size, and lower porosity, have produced much stronger bearings. Whether patients should be advised to restrict high-impact activities in order to protect these modern ceramic bearings from fracture remains controversial.
The object of this work was to retrospectively study the recommendations and the results of cruent reduction of idiopathic congenital displacement of the hip following ineffective orthopaedic treatment. From 1993 to 2001, 15 cruent reductions were performed in 11 children (seven girls and four boys). Initially, the 15 hips were treated by orthopaedic techniques (Pavlik harness and/or slow reduction according to the Sommerville-Petit method). Four of these have benefitted from surgical treatments after orthopaedic treatment proved to be ineffective (psoas tenotomy, Salter osteotomy). At the time of the cruent reduction the mean age was 24 months (range 9 months to 5 years). For the surgical reduction, always associated with a shortening-derotation osteotomy of femur, the Smith-Petersen antero-medial approach was used. In five of these cases, the cruent reduction was complemented by Salter osteotomy. The mean post-surgical follow-up is 5.6 years (from 1 to 9 years). In none of the hips studied was recurrence of the dislocation observed. The functional outcome, studied by Mackay criteria, is good for all the hips. No significant dysmetria of the lower limbs was present. According to the radiological criteria in the classification of Severin outcome was good or excellent in 12 hips and average in three hips. According to the Bucholz and Ogden classification, six hips showed signs of necrosis as a result of the orthopaedic treatment. The surgical treatment did not cause necrosis in the remaining nine hips. Recourse to a surgical procedure can result because of the anatomical obstacles typical of specific dislocations. Surgical reduction must be considered as an operation to preserve the hip; this operation is suitable at about 1 year of age if progressive orthopaedic practices are ineffective. Before 2 years of age, the cotyloid cavity can continue to develop after