The goals of any rehabilitation protocol should be to control pain, improve ambulation, maximise range-of-motion, develop muscle strength and provide emotional support. Over 85% of TKR patients will recover knee function regardless of which rehabilitation protocol is adopted but the process can be facilitated by proper pain control, physical therapy and emotional support. The remaining 15% of patients will have difficulty obtaining proper knee function secondary to significant pain, limited pre-operative motion and/or the development of arthrofibrosis. This subset will require a special, individualized rehabilitation program which may involve prolonged oral analgesia, continued physical therapy, more diagnostic studies and occasionally manipulation. Controlling pain is the mainstay of any treatment plan. The program described herein has been used at Ranawat Orthopaedics over the last 10 years in more than 2000 TKRs.
All current methods of cup placement use anterior pelvic plane (APP) as the reference. However, the majority of studies investigating the measurement of anteversion (AV) and abduction angles (AA) are inaccurate since the effect of pelvic tilt and obliquity are not considered. The aim of this study was to describe a reproducible, novel technique for functional cup positioning using internal and external bony landmarks and the transverse acetabular ligament (TAL). The pelvic obliquity and tilt are measured on the pre-operative weight bearing AP and lateral pelvic radiographs. Intra-operatively, the highest point of the iliac crest is identified and a line is drawn to the middle of the greater trochanter with knee flexed to 90 degrees and leg thigh horizontal to the floor, parallel to the APP. The cup is placed parallel to the TAL and inside the anterior acetabular wall notch, and then is adjusted for the femoral anteversion, pelvic tilt and obliquity. The angle between the drawn line and the cup handle is the operative anteversion. 78 consecutive total hip replacements (76 patients) were performed using this technique. The functional cup orientation was measured on post-operative weight bearing pelvic radiographs using EBRA software.Introduction
Methods
Ceramic femoral heads have proven to be more scratch resistant with better wettability and improved wear characteristics compared to metal heads in the laboratory setting. The objective of this study was to compare long-term survivorship and in vivo wear rates of ceramic and metal femoral heads against conventional polyethylene articulation in young patients. Thirty-one matched pair of alumina and metal femoral heads against conventional polyethylene in young patients (≤ 65 years) were analyzed for wear and failures for mechanical reasons. The match was based on gender and age at the time of surgery. All procedures were performed between June 1989 and May 1992 by a single surgeon via posterolateral approach, using non-cemented RB (Ranawat-Bernstein) stems, HG II (Harris-Galante) cups, 4150 conventional polyethylene and 28mm femoral heads. Hospital for Special Surgery (HSS) hip score was used for clinical analysis. Wear measurements were performed between the initial anteroposterior standing pelvis radiographs, at a minimum of one year after the index procedure to eliminate the effect of bedding-in period, and the latest follow-up. Two independent observers analyzed polyethylene wear rates using the computer-assisted Roman 1.70 software. In revision cases, the wear rates were calculated from radiographs prior to revision surgery. A pair student t test was performed to analyze the statistical difference. Two-tailed ρ values less than 0.05 were considered statistically significant.Introduction
Materials and Methods
Studies have documented encouraging results with the use of fluted, tapered, modular, titanium stems in revision hip arthroplasty with bone loss. However, radiographic signs of osseointegration and patterns of reconstitution have not been previously categorized. 64 consecutive hips with index femoral revision using a particular stem of this design formed the study cohort. Serial radiographs were retrospectively reviewed by an independent observer. Bone loss was determined by Paprosky's classification. Osseointegration was assessed by a slight modification of the criteria of Engh et al. Femoral restoration was classified according to Kolstad et al. Pain and function was documented using Harris Hip Score (HHS).Introduction
Materials and Methods
It is not uncommon to encounter patients with atypical hip or lower extremity pain, ill-defined clinico-radiological features and concomitant hip and lumbar spine arthritis. It has been hypothesized that an anaesthetic hip arthrogram can help identify the source of pain in these cases. The purpose of this study is to analyze our experience with this technique in order to verify its accuracy. We undertook a retrospective analysis of 204 patients who underwent a hip anesthetic-steroid arthrogram for diagnostic purposes matching our inclusion criteria. Patient charts were scrutinized carefully for outcomes of arthrogram and treatment. Harris Hip Score was used to quantify outcome.Introduction
Methods
