While
Aims. This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Methods. The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted
The metal on metal implants was introduced without the proper stepwise introduction. The ASR resurfacing hip arthroplasty (RHA) withdrawn due to high clinical failure rates and the large diameter head
Aims. The aim of this study was to evaluate the diagnostic accuracy of the absolute synovial polymorphonuclear neutrophil cell (PMN) count for the diagnosis or exclusion of periprosthetic joint infection (PJI) after total hip (THA) or knee arthroplasty (TKA). Methods. In this retrospective cohort study, 147 consecutive patients with acute or chronic complaints following
Aims. Total hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following
Acetabular component positioning is commonly referenced with the pelvis in the supine position in direct anterior approach
Dislocation is one of the most common complications in total hip arthroplasty (THA) and is primarily driven by bony or prosthetic impingement. The aim of this study was two-fold. First, to develop a simulation that incorporates the functional position of the femur and pelvis and instantaneously determines range of motion (ROM) limits. Second, to assess the number of patients for whom their functional bony alignment escalates impingement risk. 468 patients underwent a preoperative
Aims. Transfusion after primary total hip arthroplasty (THA) has become rare, and identification of causative factors allows preventive measures. The aim of this study was to determine patient-specific factors that increase the risk of needing a blood transfusion. Methods. All patients who underwent elective
Smartphone-based apps that measure step-count and patient reported outcomes (PROMs) are being increasingly used to quantify recovery in total hip arthroplasty (THA). However, optimum patient-specific activity level before and during
Aims. The aim of this study was to determine whether total hip arthroplasty (THA) for chronic hip pain due to unilateral primary osteoarthritis (OA) has a beneficial effect on cognitive performance. Methods. A prospective cohort study was conducted with 101 patients with end-stage hip OA scheduled for
We report the outcome of 320 primary Total Hip Arthroplasties (THA) with minimum 10-year follow-up (range 10–17 years, mean 12.6 years), performed by a single surgeon in Tauranga New Zealand, with the Exeter Contemporary Flanged all-polyethylene cup and Exeter femoral stem via a posterior approach. The aim of the study is to compare the results with the published results from the design centre and create a baseline cohort for further outcomes research in this centre. All patients were prospectively followed at 6 weeks, 1 year, 5 years, 10 years, (and 15 years when available). Of 333 cases that matched the inclusion criteria, 13 procedures in 12 patents were excluded because of concomitant bone grafting and/or supplementary cage fixation, leaving 320 primary THA procedures in 280 patients, including 26 bilateral procedures in 13 patients. Mean follow-up of the surviving cases was 12.6 (range 5.0-17.1) years. There were 12 revisions – 2 for fracture, 5 for instability, 1 for impingement pain and 4 for infection. There were no revisions for aseptic cup loosening. Kaplan-Meier survivorship with revision for aseptic loosening as the endpoint was 100% at 15.0 years (with minimum 40 cases remaining at risk). All-cause acetabular revision in 12 cases result in a Kaplan-Meier survival of 95.9% (95% CI: 93.5 to 98.3%). Cemented
Aims. Iliopsoas impingement occurs in 4% to 30% of patients after undergoing total hip arthroplasty (THA). Despite a relatively high incidence, there are few attempts at modelling impingement between the iliopsoas and acetabular component, and no attempts at modelling this in a representative cohort of subjects. The purpose of this study was to develop a novel computational model for quantifying the impingement between the iliopsoas and acetabular component and validate its utility in a case-controlled investigation. Methods. This was a retrospective cohort study of patients who underwent
Aims. Large acetabular bone defects encountered in revision total hip arthroplasty (THA) are challenging to restore. Metal constructs for structural support are combined with bone graft materials for restoration. Autograft is restricted due to limited volume, and allogenic grafts have downsides including cost, availability, and operative processing. Bone graft substitutes (BGS) are an attractive alternative if they can demonstrate positive remodelling. One potential product is a biphasic injectable mixture (Cerament) that combines a fast-resorbing material (calcium sulphate) with the highly osteoconductive material hydroxyapatite. This study reviews the application of this biomaterial in large acetabular defects. Methods. We performed a retrospective review at a single institution of patients undergoing revision
Acetabular implant position is important for the stability, function, and long-term wear properties of a total hip arthroplasty (THA). Prior studies of acetabular implant positioning have demonstrated a high percentage of outliers, even in experienced hip surgeons, when conventional instruments are used. Computer navigation is an attractive tool for use in
Aims. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common orthopaedic procedures requiring postoperative radiographs to confirm implant positioning and identify complications. Artificial intelligence (AI)-based image analysis has the potential to automate this postoperative surveillance. The aim of this study was to prepare a scoping review to investigate how AI is being used in the analysis of radiographs following
Aims. Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods. Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established. Results. We recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus baseline, including final follow-up (p < 0.001). Elementary fractures had higher SF-36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF-36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of patients failed to attain the MCID after five years (38.1%; 40/105). Conversion to
Aims. The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs). Methods. We reviewed a prospective cohort of 647 patients undergoing full or partial rTHA at a single high-volume centre with a minimum of two years’ follow-up. The reasons for revision were classified as: infection; aseptic loosening; dislocation; structural failure; and painful
As the American population ages and a trend toward performing total hip arthroplasty (THA) in younger patients continues, the number of Americans undergoing
Aims. In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip. Methods. The study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary total knee and hip arthroplasties (TKA, THA) between 2011 and 2017. Patients waiting longer than the recommended 180 days Canadian national standard were compared to patients waiting equal or less than the standard WT. The primary outcome measure was acute LoS postoperatively. Secondarily, patient demographics, comorbidities, and perioperative parameters were correlated with LoS with multivariate regression. Results. A total of 11,833 TKAs and 6,627 THAs were included in the study. Mean WT for TKA was 348 days (1 to 3,605) with mean LoS of 3.6 days (1 to 98). Mean WT for
Aims. As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80. Methods. A retrospective review of 10,251 consecutive
Aims. To investigate the extent of bone development around the scaffold of custom triflange acetabular components (CTACs) over time. Methods. We performed a single-centre historical prospective cohort study, including all patients with revision
Femoral trans-trochanteric rotational osteotomy(TRO) is widely used for the younger patients who have idiopathic osteonecrosis of femoral head. However, it usually converts to
Introduction. Accurate acetabular cup orientation could lead to successful surgical results in total hip arthroplasty (THA). We introduce a novel CT-based three-dimensional (3D) planning system, HipCOMPASS (Fig.1) and TARGET (Fig.2), which enable to design suitable alignment not only cup also surgical devices calculatingly, according to each pelvic inclination. Patients and Methods. We performed
Arthritis of the hip is a relatively common problem in patients with neuromuscular disorders due to muscle imbalance around the hip from weakness, paralysis, contractures and spasticity. Neuromuscular disorders such as cerebral palsy, Parkinson's disease, poliomyelitis, previous cerebrovascular accident (CVA) and Charcot arthropathy have been considered by many to be contraindications to total hip arthroplasty (THA). The presence of certain anatomic abnormalities (excessive femoral anteversion, acetabular dysplasia, leg length discrepancy (LLD) and coax valga) and significant soft tissue contractures, muscle imbalance, and muscular weakness make
Aims. Dual mobility (DM) bearings are an attractive treatment option to obtain hip stability during challenging primary and revision total hip arthroplasty (THA) cases. The purpose of this study was to analyze data submitted to the American Joint Replacement Registry (AJRR) to characterize utilization trends of DM bearings in the USA. Methods. All primary and revision
Introduction. Accurate acetabular cup orientation could lead to successful surgical results in total hip arthroplasty (THA). We introduce a novel CT-based three-dimensional (3D) planning system, HipCOMPASS (Fg.1) and TARGET (Fig.2), which enable to design suitable alignment not only cup also surgical devices calculatingly, according to each pelvic inclination. Patients and methods. We performed
An outpatient total hip arthroplasty (THA) will be defined as a
The goal is to avoid letting femoral deformity force suboptimal implant position/fixation. Suboptimal implant position has an adverse effect on hip biomechanics and often on hip function and durability. Classification - Practical approach to femoral deformities: categorise into 3 main groups: 1.) Very proximal, 2.) Subtrochanteric, 3.) Distal. Management of distal deformities: Most can be ignored if there is sufficient room to place conventional femoral implant. Management of proximal deformities: Option 1: Use implants that allow satisfactory positioning despite deformity…or… Option 2: Remove the deformity. Management of subtrochanteric level deformities: These are the most difficult. Problems: 1.) Too proximal to ignore, 2.) Too distal to bypass. Main treatment options: 1.) Resurfacing
Osteolysis is one of a major cause of failure that affect long term survival rate in
(Introduction). Metal on Metal (MoM)
Proximal load fixation in
Intra-operative fractures of the femur are on the rise mainly due to the increased use of cementless implants and the desire to get a tight press fit. The prevalence has been reported to be between 1–5% in cementless THAs. The key to preventing these fractures is to identify patients at high risk and careful surgical technique. Surgical risk factors include the use of cementless devices, revision hip surgery, the use of flat tapered wedges and MIS surgery. Patient factors that increased risk include increasing age, female gender, osteopenia and rheumatoid arthritis. These risk factors tend to be additive and certainly when more than one is present extra caution needs to be taken. Surgical technique is critical to avoid these intra-operative fractures. Fractures can occur during exposure and dislocation, during implant removal (in revision THA), during canal preparation and most commonly during stem insertion. In both primary, and especially in revision,
Arthritis of the hip is a relatively common problem in patients with neuromuscular disorders due to muscle imbalance around the hip from weakness, paralysis, contractures and spasticity. Neuromuscular disorders such as cerebral palsy, Parkinson's disease, poliomyelitis, previous cerebrovascular accident (CVA) and Charcot arthropathy have been considered by many to be relative contraindications to total hip arthroplasty (THA). The presence of certain anatomic abnormalities (excessive femoral anteversion, acetabular dysplasia, leg length discrepancy (LLD) and coax valga) and significant soft tissue contractures, muscle imbalance, and muscular weakness make
Introduction: The goal is to avoid letting femoral deformity force suboptimal implant position/fixation. Suboptimal implant position has an adverse effect on hip biomechanics and often on hip function and durability. Classification: Practical approach to femoral deformities: categorise into 3 main groups: Very proximal, Subtrochanteric, Distal. Management: Management of distal deformities: Most can be ignored if there is sufficient room to place conventional femoral implant. Management of proximal deformities: Option 1: Use implants that allow satisfactory positioning despite deformity…or… Option 2: Remove the deformity. Management of subtrochanteric level deformities: These are the most difficult. Problems: Too proximal to ignore, Too distal to bypass. Main treatment options: Resurfacing
Aim. Prosthetic joint infection (PJI) is a major complication in
Background. Fifteen to twenty percent of patients presenting for total hip arthroplasty (THA) have bilateral disease. While simultaneous bilateral
Collagen and hyaluronic acid are two major components of intervertebral disc (IVD). They give resistance and hydration to Nucleus Pulposus. In this study, we assessed the impact of Collagen (COLL) and Hyaluronic acid-Tyramine (THA) contents on the mechanical properties and the structure of composite hydrogels. For this purpose, a range of composites were obtained using a 4 mg/mL collagen concentration and different COLL/
Arthritis of the hip is a relatively common problem in patients with neuromuscular disorders due to muscle imbalance around the hip from weakness, paralysis, contractures and spasticity. Neuromuscular disorders such as cerebral palsy, Parkinson's disease, poliomyelitis, previous cerebrovascular accident (CVA) and Charcot arthropathy have been considered by many to be relative contraindications to total hip arthroplasty (THA). The presence of certain anatomic abnormalities (excessive femoral anteversion, acetabular dysplasia, leg length discrepancy (LLD) and coax valga) and significant soft tissue contractures, muscle imbalance, and muscular weakness make
Malposition of cups and stems in
Objective. Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) bring relief of pain and functional disability to patients with end stage osteoarthritis, however the literature on their impact on patients’ level of physical activity (PA) is scarce. Methods. Cross-sectional study, performed in 2012, in 515 patients who underwent
Background. The short stem prosthesis showed good results in patients with primary osteoarthritis. However, there were a few studies about the short stem
The transgluteal approach (TG) offers a user-friendly alternative to the heavily promoted anterior approach (DA) to total hip arthroplasty (THA). Our purpose is to illustrate the advantages and details of the technique, illustrate the surgical anatomy that differentiates TG from the “traditional posterior” technique, and point out the surprising similarities to the DA. Unlike the traditional posterior
Background. With the rising demand for primary total hip arthroplasty (THA), there has been an emphasis on reducing the revision burden and improving patient outcomes. Although studies have shown that primary THA effectively minimizes pain and restores normal hip function for activities of daily living, many younger patients want to participate in more demanding activities after their operation. The purpose of this study was to examine the relationship between age, gender and patient satisfaction after total hip arthroplasty. Methods. With IRB approval, 2 groups of subjects were enrolled in this study: (i) 143 patients at an average of 25 months (range 10–69 months) post-primary
Background. Because of the long life expectancy of young total hip arthroplasty (THA) patients and the limited durability of prosthetic implants in young patients, surgeon's always must take into account that the primary THA will be revised in the future. Therefore, not only the survival of the primary total hip in young patients is important, but we would also like to accentuate the revisability of a primary THA in this specific and high demanding patient population. Methods. Based on our philosophy, we always use cemented hip in young patients, if needed with acetabular bone impaction grafting. 343 consecutive cemented
Introduction. The purpose of this retrospective study was to review the outcome of
Dislocation after
The alumina on alumina articulation in
Mini-posterior technique advantages: Familiar anatomy; Widely applicable; Predictable (and thus preventable) sources of errors; Demonstrated functional advantages over the 2-incision
While total hip arthroplasty (THA) has been shown successful at relieving pain and improving function in patients with coxarthrosis, wear and instability remain leading causes for revision surgery. Highly crosslinked polyethylene (HXPE) has significantly reduced wear and osteolysis but volumetric wear associated with the use of larger diameter ball heads may be an issue in the long-term. Finally, concerns with femoral taper corrosion have increased the utilization of ceramic ball heads in recent years. Ceramic on ceramic articulations are optimised for both minimizing implant wear and instability. It is biocompatible, wettable, and possesses the lowest in vitro and in vivo wear rates among all bearing couples. In fact, wear rates are lowest when the ceramic ball head size is maximised. Additionally, modern ceramic on ceramic
Intra-operative fractures of the femur are on the rise mainly due to the increased use of cementless implants and the desire to get a tight pressfit. The prevalence has been reported to be between 1–5% in cementless total hip arthroplasties (THAs). The key to preventing these fractures is to identify patients at high risk and careful surgical technique. Surgical risk factors include the use of cementless devices, revision hip surgery, the use of flat tapered wedges and MIS surgery. Patient factors that increased risk include increasing age, female gender, osteopenia and rheumatoid arthritis. These risk factors tend to be additive and certainly when more than one is present extra caution needs to be taken. Surgical technique is critical to avoid these intra-operative fractures. Fractures can occur during exposure and dislocation, during implant removal (in revision THA), during canal preparation and most commonly during stem insertion. In both primary and especially in revision
18 Patients with SCD and 2ndry Osteoarthritis of their hips due to Avascular Necrosis underwent uncemented
Economic data, clinical outcome studies, and anatomical studies continue to support the Superior Hip Approach as a preferred approach for improved safety, maximal tissue preservation, rapid recovery, and minimised cost. Clinical studies show exceedingly low rates of all major complications including femur fracture, dislocation, and nerve injury. Economic data from Q1 2013 to Q2 2016 demonstrate that CMS-insured patients treated by the Superior Hip Approach have the lowest cost of all patients treated in Massachusetts by an average of more than $7,000 over 90 days. The data show that the patients treated by the Superior Hip Approach have lower cost than any other surgical technique. Matched-pair bioskills dissections demonstrate far better preservation of the hip joint capsule and short external rotators than the anterior approach. Design principles include: Preservation of the abductors; Preservation of the posterior capsule and short external rotators; Preparation of the femur in situ prior to femoral neck osteotomy; Excision of the femoral head, thereby avoiding surgical dislocation of the hip; In-line access to the femoral shaft axis; Ability to perform a trial reduction; Independence from intra-operative imaging; Independence from a traction table; Applicable to at least 99% of
Introduction:. Since2007, we have used CT-based fluoroscopy-matching navigation system (Vector Vision Hip Ver.3.5.2, BrainLAB, Germany) in revision total hip arthroplasty. This system completes the registration procedure semi-automatically by matching the contours of fluoroscopic images and touching 3 adequate points to the contours of 3D bone model created in the computer. Registration procedure using fluoroscopic figures has finished before making surgical incision. It needs no elongation time during the operation. The objective of this study was to evaluate the accuracy of CT-based fluoroscopy-matching navigation system in revision
Background. Assessment of functional outcome after total hip arthroplasty (THA) often involves subjective patient-reported outcome measures (PROMs) whereas analysis of gait allows more objective assessment. The aims of the study were to compare longitudinal changes of WOMAC function score and ambulatory gait analysis after
The aim of this study was to validate the information on operating room ventilation reported to the Norwegian Arthroplasty Register (NAR). We then wanted to assess the influence of operating room ventilation on the rate of revision due to infection after primary THA performed in operating rooms with conventional ventilation, “greenhouse”–ventilation and Laminar Airflow ventilation (LAF). We identified cases of
Prevention of joint dislocation after total hip arthroplasty (THA) is important to keep suitable relationships between surgeons and patients. Capsule has an essential role for stability of joint, especially in hip. Reserving a part of capsule in
Osteoarthritis (OA) of the hip is the most common indication for total hip replacement (THR). Obesity is a risk factor for the development of OA and has recently resulted in patients requiring THRs at much younger ages to relieve pain at the joint capsule and restore mobility. However, the impact of obesity on THR mortality is not well understood. An updated systematic review was performed to identify whether an obese BMI should influence patient selection for surgery. Specifically, the impact of obesity on short-term mortality, long-term mortality, and peri- and post-operative complications was assessed with a particular focus on BMI classes. A comprehensive literature search of Ovid Medline and EMBASE in November 2022 identified relevant papers in accordance with PRISMA methodology. After removing duplicates, 2988 articles underwent strict inclusion and exclusion criteria, resulting in 12 papers for analysis. There was no statistically significant difference in mortality risk between obese and non-obese populations. Obesity was associated with a lower risk of short-term mortality than in the normal weight control group, however there was an increased mortality risk in obese patients long-term likely due to comorbidities. Obese patients were significantly younger than normal BMI and underweight patients. However, the paper found increased mortality risk in underweight and morbidly obese patients. Obese patients did not have an increased risk of mortality when compared to non-obese patients following THR. Obesity may have a protective effect on mortality up to a BMI of 40kg/m2, although this may be influenced by the obesity paradox which states only the healthiest obese individuals are selected for surgery, which could attribute to a lower mortality risk. The greatest risk of mortality and complication was associated with underweight patients. As a result, a BMI greater than 30kg/m2 may not necessitate a hip replacement contraindication. It is important surgeons apply careful consideration and comprehensive risk assessment on patients who require a THR, especially at the BMI extremes.
Introduction. Most Japanese patients who receive total hip arthroplasty (THA) are osteoarthritic and 70% have development dysplasia of the hip. Their stature is shorter than average and their sizes (acetabular cup and femoral stem) are smaller. The Taperloc Microplasty (BIOMET) is a short femoral stem. It was launched on July 2012 in Japan (extended on January 2013). It is essentially a shortened version of the Taperloc stem (35mm shorter than the standard stem). Objectives. We aimed to evaluate the outcomes of minimally invasive anterolateral
Introduction: Although Metal wires and cables are popular tools to fix greater trochanter in revision
We retrospectively reviewed the mid term outcome of 88 MoM
This study presents an unusual recurrent case of pigmented villonodular synovitis (PVNS) around a ceramic-on-metal (COM) hip retrieved at 9-years. PVNS literature relates to metal-polyethylene and ceramic-ceramic bearings. Amstutz reported 2 cases with MOM resurfacing and Xiaomei reported PVNS recurring at 14 years with metal-on-polyethylene
Background:. Hip arthroplasty is very successful in order to alleviate pain and improve health-related quality of life. Health-care costs are constantly growing and the burden of patients with hip disease has increased dramatically. Careful consideration of the patients'need and expectations include not only the proper indication for surgery but also choice of method. Hip resurfacing (HRA) has been popularized during the last decade, being bone conservative, capable to restore the anatomical hip center and lower the risk of dislocation. Some HRA-designs have proven good long-term survival rate while others have shown an unacceptable high amount of loosening and been recalled. Yet, for a selected group of patients HRA may be advantageous to
Background: Metal on metal articulation is known to reduce wear and subsequent development of osteolysis. However, long-term results of
Introduction. The safe zone of the acetabular cup for
Background. The development of T-smart tomosynthesis has greatly improved the imaging quality of
Introduction. The rate of total hip arthroplasty (THA) surgery continues to dramatically rise in the United States, with over 300,000 procedures performed in 2010. Although a relatively safe procedure,
Introduction:. Whole blood metal ion level and clinical outcomes of ceramic-on-metal bearing were comparable to ceramic-on-ceramic
While cemented
Introduction. IBBC (interfacial bioactive bone cement method, Oonishi) (1) is an excellent technique for augmenting cement-bone fixation in the long term. However, the technique is difficult and there are concerns over some points, such as bleeding control, disturbance of cement intrusion to anchoring holes by granules, difficulty of the uniform granular dispersion to the acetabular bone (Zone 1 in particular). To improve this technique, we have modified IBBC (M-IBBC), and investigated the short-term clinical results and radiographic changes. Materials and Methods. K-MAX HS-3
Introduction. We developed original KKS non-cement
The aims of this study were to determine the success of a reconstruction algorithm used in major acetabular bone loss, and to further define the indications for custom-made implants in major acetabular bone loss. We reviewed a consecutive series of Paprosky type III acetabular defects treated according to a reconstruction algorithm. IIIA defects were planned to use a superior augment and hemispherical acetabular component. IIIB defects were planned to receive either a hemispherical acetabular component plus augments, a cup-cage reconstruction, or a custom-made implant. We used national digital health records and registry reports to identify any reoperation or re-revision procedure and Oxford Hip Score (OHS) for patient-reported outcomes. Implant survival was determined via Kaplan-Meier analysis.Aims
Methods
The risk factors for abnormal spinopelvic mobility (SPM), defined as an anterior rotation of the spinopelvic tilt (∆SPT) ≥ 20° in a flexed-seated position, have been described. The implication of pelvic incidence (PI) is unclear, and the concept of lumbar lordosis (LL) based on anatomical limits may be erroneous. The distribution of LL, including a unusual shape in patients with a high lordosis, a low pelvic incidence, and an anteverted pelvis seems more relevant. The clinical data of 311 consecutive patients who underwent total hip arthroplasty was retrospectively analyzed. We analyzed the different types of lumbar shapes that can present in patients to identify their potential associations with abnormal pelvic mobility, and we analyzed the potential risk factors associated with a ∆SPT ≥ 20° in the overall population.Aims
Methods
Introduction. We have compared the middle-term (average follow-up period; 10 years) clinical results of the K-MAX HS-3 tapered stem with those of the previous type having cylindrical tip. Materials and Methods. In K-MAX HS-3
Introduction Modern metal-on-metal hip resurfacing (RHA) was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potentially increased metal ion release. Patients and methods 71 patients (< 65 yrs) were randomly assigned to receive either a RHA (n=38) or a conventional metal-on-metal (MoM)
Previous clinical studies have documented the incidence of squeaking in subjects having a ceramic-onceramic (COC)
Introduction. Optimal implant position is the important factor in the hip stability after
Introduction. The current recommendation by the AAOS in the 2010 clinical practice guidelines for the use of MRI to diagnose a periprosthetic joint infection (PJI) is “inconclusive” given the lack of evidence to support its use. The purpose of this study was to determine the utility of MRI with metal reduction artifact sequencing in diagnosing a periprosthetic joint infection (PJI) after total hip arthroplasty (THA). Methods. 176 patients who underwent MRI with multi-acquisition variable resonance image combination (MAVRIC) to reduce metal artifact for a painful
Background. The goal of total hip arthroplasty (THA) is to reduce pain, restore function but also activity levels for general health benefits or social participation. Thus evaluating
Perioperative fracture during routine
Introduction. Improvements in function after
Introduction. According to the literature, the gait does not return to normal after
The Dall approach is a modified anterolateral approach with osteotomy of the anterior part of the greater trochanter. This approach relatively preserves the soft tissue tension during total hip arthroplasty (THA). We insert the stem and select a ball neck size so as to have a stable hip which will not dislocate easily during the trial reduction. The aim of this study is to evaluate the adequacy of this method, to measure leg length discrepancy and offset discrepancy at postoperative radiographs. We selected patients for inclusion in this study from those who have more than a 120 degree of affected hip flection angle, the opposite hip is almost normal with a low leg length discrepancy (primary OA, osteonecrosis, Crowe 1 secondary OA, femoral neck fracture). All
Several design principles were considered paramount when the surgical technique of performing total hip arthroplasty through an incision in the superior capsule without dislocation of the hip joint was developed. These design principles include: Preservation of the abductors; Preservation of the posterior capsule and short external rotators; Preparation of the femur in situ without dislocation of the hip; In-line access to the femoral shaft axis; Ability to perform a trial reduction; Independence from intraoperative imaging; Independence from a traction table; Applicable to at least 99% of
When performing revision total hip arthroplasty using diaphyseal-engaging titanium tapered stems (TTS), the recommended 3 to 4 cm of stem-cortical diaphyseal contact may not be available. In challenging cases such as these with only 2 cm of contact, can sufficient axial stability be achieved and what is the benefit of a prophylactic cable? This study sought to determine, first, whether a prophylactic cable allows for sufficient axial stability when the contact length is 2 cm, and second, if differing TTS taper angles (2° vs 3.5°) impact these results. A biomechanical matched-pair cadaveric study was designed using six matched pairs of human fresh cadaveric femora prepared so that 2 cm of diaphyseal bone engaged with 2° (right femora) or 3.5° (left femora) TTS. Before impaction, three matched pairs received a single 100 lb-tensioned prophylactic beaded cable; the remaining three matched pairs received no cable adjuncts. Specimens underwent stepwise axial loading to 2600 N or until failure, defined as stem subsidence > 5 mm.Aims
Methods
Introduction. Resorptive bone remodeling secondary to stress shielding has been a concern associated with cementless total hip arthroplasty (THA). At present, various types of cementless implants are commercially available. The difference in femoral stem design may affect the degree of postoperative stress shielding. In the present study, we aimed to compare the difference in bone mineral density (BMD) change postoperatively in femurs after the use of 1 of the 3 types of cementless stems. Methods. Ninety hips of 90 patients who underwent primary cementless THA for the treatment of osteoarthritis were included in this study. A fit-and-fill type stem was used for 28 hips, a tapered-rectangular Zweymüller type stem was used for 32 hips, and a tapered-wedge type stem was used for 30 hips. The male/female ratio of the patients was 7/21 in the fit-and-fill type stem group, 6/26 in the tapered-rectangular Zweymüller type stem group, and 6/24 in the tapered-wedge type stem group. The mean age at surgery was 59.9 (39–80) in the fit-and-fill type stem group, 61.7 (48–84) in the tapered-rectangular Zweymüller type stem group and 59.6 (33–89) in the tapered-wedge type stem group. To assess BMD change after
Introduction. The current recommendation by the AAOS in the 2010 clinical practice guidelines for the use of MRI to diagnose a periprosthetic joint infection (PJI) is “inconclusive” given the lack of evidence to support its use. The purpose of this study was to determine the utility of MRI with metal reduction artifact sequencing in diagnosing a periprosthetic joint infection (PJI) after total hip arthroplasty (THA). Methods. 176 patients who underwent MRI with multi-acquisition variable resonance image combination (MAVRIC) to reduce metal artifact for a painful
Consecutive patients undergoing primary THA were consented from the practices of 3 arthroplasty surgeons. One surgeon performed all DAA
There has been great enthusiasm over the last few years for the mini-anterior, or, the Direct Anterior (DA) approach. As the title of this session suggests there is a perception that there are features of this approach that result in an unusually rapid recovery with “early” return to a high level of function. There have also been claims of improved implant placement and limb length restoration. This is presumably a result of the use of intra-operative imaging. When originally described, it was stated that the DA permitted
Late aseptic loosening of total hip arthroplasty (THA) components due to wear debris especially sub-micron Polyethylene induced osteolysis has been identified to be the major cause for revision. Therefore, the use of wear resistant designs and materials is imperative for the long-term success of articulating implants. One of the most promising articulations for
Introduction. There is great interest in technologies to improve the accuracy and precision in placing implants for total hip arthroplasty (THA). Malik et al. (J Arthroplasty, 2010) showed that an imageless navigation system could be used to produce accurate measures of acetabular cup alignment compared to a CT-based alignment method using an imaging phantom. In this study we sought to compare the precision of an image-based navigation system with post-operative CT scans in a clinical patient cohort who received navigation-assisted
We evaluated 3 cases of ceramic-on-ceramic
Peri-operative fracture during routine
Over the past 10 years, the orthopedic community has witnessed an increased interest in more conservative surgical techniques for hip arthroplasty. During this time, second-generation hip resurfacing and minimally invasive surgery enjoyed extensive marketing attention. After a decade of this renewed interest, both of these methods have met with serious concerns. As hip resurfacing numbers decline, both patients and surgeons are looking for other potentially successful conservative treatments to
Introduction. Total hip arthroplasty is considered to be one of the most successful orthopaedic interventions. Acetabular component positioning has been shown to affect dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. The safe zones of acetabular component positioning have previously been described by Lewinnek et al. as 5 to 25 degrees of cup version and 30 to 50 degrees of inclination. Callanan et al. later modified the inclination to 30 to 45 degrees. Our aim was to assess whether
Introduction: In total hip arthroplasty, the angle of acetabular component is a critical factor for the postoperative dislocation and the longevity of prostheses. The angle is principally determined in relation to anterior pelvic plane. It is reported that the pelvis tends to tilt posteriorly along with aging. Furthermore, the pelvic tilt might change after
Introduction. In
BACKGROUND. Many patients who underwent a
INTRODUCTION. Patients less than 60 years old have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older patient cohorts, possibly to due higher activity, a higher incidence of deformity and greater probability of prior surgery. Ceramic-on-ceramic bearing surfaces have been proposed for use in young and active individuals due to their low wear, low risk of adverse biologic reaction, and long-term survivorship. We assessed the clinical results and long-term survivorship of uncemented ceramic-on-ceramic