Aims. Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or
As Total Hip Replacement (THR) rates increase healthcare providers have sought to reduce costs, while at the same time improving patient safety and satisfaction. Up to 50% of patients may be appropriate for Day Case THR, and in appropriately selected patients’ studies show no increase in complication rate while affording a significant cost saving and maintaining a high rate of patient satisfaction. Despite the potential benefits, levels of adoption of Day Case THR vary. A common cause for this is the perception that doing so would require the adoption of new surgical techniques, implants, or theatre equipment. We report on a Day-Case THR pathway in centres with an established and well-functioning Enhanced Recovery pathway, utilising the
Introduction. While additional resources associated with direct anterior (DA) approach total hip arthroplasty (THA) such as fluoroscopy, staff, and special tables are well recognized, time consumption is not well studied. The purpose of this study was to analyze anesthesia and surgical time in DA and
Aims. The aims of this study were to assess the exposure and preservation of the abductor mechanism during primary total hip arthroplasty (THA) using the
The Posterior and Lateral approaches are most commonly used for Total Hip Arthroplasty (THA) in the United Kingdom (UK). Fewer than 5% of UK surgeons routinely use the Direct Anterior Approach (DAA). DAA THA is increasing, particularly among surgeons who have learned the technique during overseas fellowships. Whether DAA offers long-term clinical benefit is unclear. We undertook a retrospective analysis of prospectively collected 10-year, multi-surgeon, multi-centre implant surveillance study data for matched cohorts of patients whose operations were undertaken by either the DAA or
Introduction: Despite the advances in total hip arthroplasty (THA), a dislocation after THA remains a disturbing complication. Dislocation after revision hip arthroplasty has been an underemphasized cause of failure in revision hip arthroplasty despite its higher dislocation rate than after primary THA. The effectiveness of posterior soft tissue repair in the
Periprosthetic femur fracture (PFF) is a major complication following total hip arthroplasty (THA) that carries significant morbidity, mortality, and economic burden. Currently, uncemented stems are highly preferred in primary THA, but have been associated with higher risk of PFF compared to cemented stems. The use of collared stems in uncemented primary THA has shown promise in reducing PFF rates postoperatively. This retrospective study included 2,294 uncemented primary THAs using the
Range of Motion (ROM) assessments are routinely used during joint replacement to evaluate joint stability before, during and after surgery to ensure the effective restoration of patient biomechanics. This study aimed to quantify axial torque in the femur during ROM assessment in total hip arthroplasty to define performance criteria against which hip instruments can be verified. Longer term, this information may provide the ability to quantitatively assess joint stability, extending to quantitation of bone preparation and quality. Joint loads measured with strain-gaged instruments in five cadaveric femurs prepared using
Introduction. The hip hemiarthroplasty in
The direct superior approach (DSA) is a modification of the
Introduction: Various surgical approaches have been described for the hip joint but the optimal surgical approach for total hip replacement remains controversial. The lateral approach &
the
The mini-incision
The purpose of this study was to investigate the influence of surgical approach on femoral stem version in THA. This was a retrospective database review of 830 THAs in 830 patients that had both preoperative and postoperative CT scans. All patients underwent staged bilateral THAs and received CT-based 3D planning on both sides. Stem version was measured in the second CT-scan and compared to the native neck axis measured in the first CT-scan, using the posterior condyles as the reference for both. Cases were performed by 104 surgeons using either a direct anterior (DAA, n=303) or posterior (PA, n=527) approach and one of four stem designs: quadrangular taper, calcar-guided short stem, flat taper and fit-and-fill. Sub-analyses investigated changes in version for low (≤5°), neutral (5–25°) and high (≥25°) native version subgroups and for the different implant types. Native version was not different between approaches (DAA = 12.6°, PA = 13.6°, p = 0.16). Overall, DAA stems were more anteverted relative to the native neck axis vs PA stems (5.9° vs 1.4°, p<0.001). This trend persisted in hips with high native version (3.2° vs -5.3°, p<0.01) and neutral native version (5.3° vs 1.3°, p<0.001), but did not reach significance in the low native version subgroup (8.9° vs 5.9°, p=0.13). Quadrangular taper, calcar-guided, and flat taper stem types had significantly more anteversion than native for DAA, while no differences were found for PA. Stems implanted with a direct anterior approach had more anteversion than those implanted with a
A combined anterior and posterior surgical approach
is generally recommended in the treatment of severe congenital kyphosis,
despite the fact that the anterior vascular supply of the spine
and viscera are at risk during exposure. The aim of this study was
to determine whether the surgical treatment of severe congenital thoracolumbar
kyphosis through a single
We investigated the relationship of the inferior gluteal nerve to gluteus maximus by dissecting the muscle in 12 fresh-frozen and formalin-treated cadavers. The anatomy was recorded using still digital photography. The course of the inferior gluteal nerve was carefully traced and was noted to enter the deep surface of gluteus maximus approximately 5 cm from the tip of the greater trochanter of the femur. The susceptibility of the nerve to injury during a
Aims. Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied. Methods. In an observational cohort study on 8,031 FNF patients with THA between January 2005 and December 2014, Swedish Arthroplasty Register data were linked with the National Patient Register, recording the total dislocation rates at one year and revision rates at three years after surgery. The cumulative incidence of events was estimated using the Kaplan-Meier method. Cox multivariable regression models were fitted to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of dislocation, revision, or mortality, stratified by surgical approach. Results. The cumulative dislocation rate at one year was 8.3% (95% CI 7.3 to 9.3) for patients operated on using the
Background:. Modified
Introduction:. The routine use of posterior hip dislocation precautions is typically utilized postoperatively following total hip arthroplasty via a posterior surgical approach. This has included use of an abduction pillow and limiting adduction, internal rotation and flexion more than 90 degrees for a minimum of 6 weeks postoperatively. This may slow the course of rehabilitation, increase the length of hospital stay and the total cost of the procedure, and add additional anxiety to the patient. We conducted this study to see if posterior hip precautions are necessary after total hip arthroplasty via a
Aims. It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the
Despite a lack of long-term follow-up, there
is an increasing trend towards using femoral heads of large diameter
in total hip replacement (THR), partly because of the perceived
advantage of lower rates of dislocation. However, increasing the
size of the femoral head is not the only way to reduce the rate
of dislocation; optimal alignment of the components and repair of
the posterior capsule could achieve a similar effect. . In this prospective study of 512 cemented unilateral THRs (Male:Female
230:282) performed between 2004 and 2011, we aimed to determine
the rate of dislocation in patients who received a 22 mm head on
a 9/10 Morse taper through a
Introduction. Computer navigation systems are quite sophisticated intra-operative support systems for the precise placement of acetabular or femoral components in THA. However, few studies have addressed the clinical benefits derived from using a navigation system to achieve precise placement of the implants. The purpose of this study is to investigate the early dislocation rate of navigation-assisted primary THA through a
The angle of inclination of the acetabular component in total hip replacement is a recognised contributing factor in dislocation and early wear. During non-navigated surgery, insertion of the acetabular component has traditionally been performed at an angle of 45° relative to the sagittal plane as judged by the surgeon’s eye, the operative inclination. Typically, the method used to assess inclination is the measurement made on the postoperative anteroposterior radiograph, the radiological inclination. The aim of this study was to measure the intra-operative angle of inclination of the acetabular component on 60 consecutive patients in the lateral decubitus position when using a
The optimum approach for Total Hip Arthroplasty is hotly debated. Many surgeons, especially the newly trained, have been wary of the .
Introduction. Direct anterior approach (DAA) total hip arthroplasty (THA) has been reported to improve early outcomes as compared to
Modified
Introduction and Aims: Minimal Invasive Surgery (MIS) in THR surgery offers potential advantages over standard techniques. A user-friendly surgical technique has been developed via the
Aim. To evaluate efficacy of a one stage
Introduction. The Direct Anterior Approach (DAA) offers potential advantages of quicker rehabilitation compared to
An audit of a group of dislocations (7 out of 66 hip replacements) revealed a problem with the Charnley Golf Ball cup when used with the
Introduction. Traditionally the use of small diameter femoral head (22mm) with the
Introduction. Numerous factors have been hypothesized as contributing to mechanically-assisted corrosion at the head-neck junction of total hip prostheses. While variables attributable to the implant and the patient are amenable to investigation, parameters describing assembly of the component parts can be difficult to determine. Nonetheless, increasing evidence suggests that the manner of intraoperative assembly of modular components plays a critical role in the fretting and corrosion of modular implants. This study was undertaken to measure the magnitude and direction of the impaction forces applied by surgeons in assembling modular head-neck junctions under operative conditions where both the access and visibility of the prosthesis may potentially compromise component fixation. Methods. A surrogate consisting of the lower limb with overlying soft tissue was developed to simulate THR performed via a 10cm incision using the
Traditional
We describe a
1. The indications for ischio-femoral arthrodesis are considered. 2. The technique of operation through an open
Introduction:. The direct anterior approach for total hip arthroplasty has shown to improve multiple early outcome measures. However, criticisms suggest improved results may be due to selection bias and protocol changes. This study compares mini-incision
Introduction. We present our experience of the coned hemi-pelvis (‘ice-cream’ cone) implant, using an extended
Surgical exposure of the ankle is usually obtained by an anterior approach, especially for replacement arthroplasty. The transfibular approach has been popular for arthrodesis. We describe a new
Narrowing of the femoral neck after resurfacing arthroplasty of the hip has been described previously in both cemented and uncemented hip resurfacing. Traditionally hip resurfacing has been performed via a
Introduction and purpose: We present the results of our surgical method involving nerve decompression, reduction and circumferential spinal fusion via
Introduction. The debate regarding the importance of preserving the blood supply to the femoral head (FH) and neck during hip resurfacing arthroplasty (HRA) is ongoing. Several surgeons continue to advocate for the preservation of the blood supply to the resurfaced heads for both the current HRA techniques and more biologic approaches for FH resurfacing. Despite alternative blood-preserving approaches for HRA, many surgeons continue to use the
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 THA via robotic assisted
In 12 patients, we measured the oxygen concentration in the femoral head-neck junction during hip resurfacing through the anterolateral approach. This was compared with previous measurements made for the
Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has rapidly become popular, but there is little consensus regarding the risks and benefits of this approach in comparison with a modern
Background: Mini-incision surgery (MIS) for total hip replacement (THR) typically uses incisions of 10cm or less and therefore may offer a better cosmetic appearance. Reported advantages of MIS include decreased blood loss, less tissue trauma and decreased pain, all of which are equivocal by six weeks post-surgery, when compared with standard incisions. The aim of this study was to compare patient scar satisfaction and identify potential long-term benefits of this incision when used in the
Introduction: Avascular necrosis of the femoral head after resurfacing hip replacement is an important complication which may lead to fracture or failure. We compared the changes in femoral head oxygenation resulting from the anterolateral approach to those resulting from the
Minimal invasive surgery (MIS) is accepted when the scar is 10 cm or less. The anterior and the antero-lateral approaches had gained recently interest in the total hip arthroplasty because they allow complete muscle sparing. The postero-lateral and lateral approaches were propsed to be less satisfactory from this point of view. The goal of this paper was to report an objective and carfull assessment of the advantages of the minimal invasive
We report eight cases of sacrococcygeal chordoma treated by high sacral resection through S2 by a
Recent National Institute for Health and Care Excellence (NICE) guidance has advised against the continued use of the Thompson implant when performing hip hemiarthroplasty and recommended surgeons consider using the anterolateral surgical approach over a
In 12 patients, we measured the oxygen concentration in the femoral head-neck junction during hip resurfacing through the anterolateral approach. This was compared with previous measurements made for the
Aims: To compare the efþcacy and possible complications of two approaches in the management of unstable burst fractures of the thoracolumbar spine. Methods: retrospective review of two consecutive series of patients with a minimum 2Y follow-up. Group 1, 22 patients operated up to 1998: isolated
The accuracy of cup position in total hip arthroplasty is essential for a satisfactory result as malpositioning increases the risk of complications including dislocation, high wear rate, loosening, squeaking, edge loading, impingement and ultimately failure. We studied 173 patients in a single surgeon series of matched cohorts of patients who underwent total hip arthroplasty. Four separate groups were identified comprising of
The ideal operative treatment of displaced sub capital femoral fractures in the elderly is controversial. Recently, randomised controlled trials have suggested a better outcome with the use of total hip arthroplasty (THA) to treat displaced intra capsular fractures of the femur for elderly patients in good health. More recently the concept of dual mobility cups is being promoted to avoid dislocations in this cohort of patients. However, overall there is limited evidence to support the choice between different types of arthroplasty. Dislocation remains a main concern with THA, especially when a
The occurrence of impingement can lead to instability, accelerated wear, and unexplained pain after THA. While implant and bony impingement were widely investigated, importance of soft tissue impingement was unclear. In the THA through
Purpose: The objective of this study was to observe the change in dislocation rate by introducing a capsular enhanced short external rotator repair during primary total hip arthroplasty. Dislocation after primary total hip arthroplasty is a relatively common complication. The incidence is usually between 1% and 4%, although 0% to 10% has been reported in the literature. The
Aims. The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening. Methods. A total of 202,511 primary total hip arthroplasties (THAs) with uncemented acetabular components were identified from the National Joint Registry (NJR) dataset between 2003 and 2017. The effect of liner geometry on the risk of revision for instability or loosening was investigated using competing risk regression analyses adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, surgeon grade, surgical approach, head size, and polyethylene crosslinking. Stratified analyses by surgical approach were performed, including pairwise comparisons of liner geometries. Results. The distribution of liner geometries were neutral (39.4%; 79,822), 10° (34.5%; 69,894), 15° (21.6%; 43,722), offset reorientating (2.8%; 5705), offset neutral (0.9%; 1,767), and 20° (0.8%; 1,601). There were 690 (0.34%) revisions for instability. Compared to neutral liners, the adjusted subhazard ratios of revision for instability were: 10°, 0.64 (p < 0.001); 15°, 0.48 (p < 0.001); and offset reorientating, 1.6 (p = 0.010). No association was found with other geometries. 10° and 15° liners had a time-dependent lower risk of revision for instability within the first 1.2 years. In
Introduction. A high inclination angle has been linked to an increased dislocation rate, liner fracture, and increased wear. The aim of this study was to compare the operative (OI) with the radiological inclination (RI) angle and determine the influence of patient morphology on pelvic tilt and cup inclination angle. Methods. In the first cohort of 100 patients undergoing uncemented primary total hip arthroplasty, the cup was inserted freehand. In the second cohort of 100 patients, the OI was measured with the aid of a digital inclinometer. RI and pelvic tilt in lateral decubitus were measured. Results. The mean RI in the freehand group was similar to the protractor group (38.5 SD 7.0 and 38.3 SD 4.7; p=0.83) with a significantly greater variance in the freehand group (range 22°-60° versus 27°-51°; p=0.0001) and more outliers for the inclination safe zone (24 versus 10; p=0.01). The mean difference between the RI and OI (ΔRI-OI) in the protractor group was 12.3° SD 4.2 (range 3.8°-19.8°). The mean pelvic tilt was 4.0° (SD 3.5) of adduction. Linear regression analysis demonstrated that RI was positively correlated with OI (r. 2. =0.44, p<0.0001). Hip circumference was negatively correlated with pelvic tilt (r. 2. =0.20, p=0.002) and ΔRI-OI (r. 2. =0.37, p=0.0001). There was a significant reduction in the number of inclination outliers over time in the second cohort (6 versus 2 versus 1 versus 1; p=0.04). Discussion. The mean ΔRI-OI was 12.3°. In patients with a larger hip circumference there was less pelvic tilt in the frontal plane and less ΔRI-OI. Surgeons using the
Introduction: In cases of severe, rigid scoliotic curves, anterior or posterior fusion alone is inadequate and surgical treatment with a combined anterior and posterior) approach is required. The purpose of this study is to evaluate the effectiveness and the complications of these lengthy procedures. Material and Methods: Between 1993 and 2002, 125 patients with scoliosis were surgically treated in our department. A total of 18 patients with scoliosis were treated with a combined anterior and
The direct anterior approach (DAA) for total hip arthroplasty (THA) has become an extremely familiar concept over the last 8 to 10 years. There has been growing pressure to utilise this approach driven by the lay press, implant manufacturers looking for an edge, as well as from surgeons looking for a marketing advantage. This media and industry presence could leave many surgeons feeling that we delay adoption of the DAA at the risk of losing patients or at minimum must have a good explanation as to why we have chosen not to perform “that surgery where you come in from the front.”. The atmosphere of perceived superiority of DAA has occurred in spite of numerous publications identifying unique risks and complications, including steeply increased complication rates in the “learning curve”, while lacking data identifying its promised advantages when compared to the “modern posterior approach” to THA. It persists despite a recent prospective comparative study that failed to identify any clinical advantages for the anterior THA versus a “mini-posterior” THA and other evidence from state joint registries that has shown the dislocation rate of the DAA is not significantly different from
We report and discuss a combined anterior, anterolateral and
Introduction We believe minimally invasive surgery should be defined by the extent of soft tissue dissection rather than incision length. We describe a new technique that is truly soft-tissue sparing and report our early results. The surgical approach The landmarks for the incision are identified and an incision is made over the posterior aspect of the greater trochanter. Piriformis is preserved. A capsular repair is performed through drill holes into bone. There are no restrictions to mobility. No specialised instruments are required. Method The standard
We report the use of combined anterior and
Introduction and Aims: We present the results of 228 consecutive Charnley low-friction arthroplasties, inserted in 193 patients between July 1972 and December 1976. Unusually for this time, all hips were inserted by the
We present the results of 228 consecutive Charnley low friction arthroplasties, inserted in 193 patients between July 1972 and December 1976. All hips were inserted by the
Introduction We believe minimally invasive surgery should be defined by the extent of soft tissue dissection rather than incision length. We describe a new technique that is truly soft-tissue sparing and report our early results. The surgical approach The landmarks for the incision are identified and a 6–8cm oblique incision is made over the posterior aspect of the greater trochanter. Longer incisions are required in more difficult cases. Piriformis and the proximal insertion of gluteus maximus are preserved. After implant insertion, meticulous capsular repair is performed through drill holes into bone to reconstruct the posterior envelope. There are no restrictions to mobility. No specialised instruments are required. Method The standard
Neck pain can be caused by pressure on the spinal cord or nerve roots from bone or disc impingement. This can be treated by surgically decompressing the cervical spine, which involves excising the bone or disc that is impinging on the nerves or widening the spinal canal or neural foramen. Conventional practise is to fuse the adjacent intervertebral joint after surgery to prevent intervertebral motion and subsequent recompression of the spinal cord or nerve root. However fusion procedures cause physiological stress transfer to adjacent segments which may cause Adjacent Segment Degeneration (ASD), a rapid degeneration of the adjacent discs due to increased stress. ASD is more likely to occur in fusions of two or more levels than single level fusions and is more common where there is existing degeneration of the adjacent discs, which is not unusual in people over 30 years of age. Partial dynamic stabilisation, which generally involves a semi-rigid spinal fixation, allows a controlled amount of intervertebral motion (less than physiological, but more than fusion) to prevent increased stress on the adjacent segments (potentially preventing ASD) whilst still preventing neural recompression. Partial dynamic stabilisation is suitable for treating spinal instability after decompression as well as certain degenerative instabilities and chronic pain syndromes. Dynamic stabilisation and semi-rigid fixation systems for the spine are typically fixated posteriorly. However, choice of posterior surgical stabilisation techniques in the cervical spine is limited due to the size of the osseous material available for fixation and the close proximity of the neural structures and the vertebral artery. Posterior dynamic stabilisation systems for stabilisation of the lumbar spine often use the pedicle as an anchor point. Using the pedicle of the cervical spine as an anchor point is technically difficult because of its small size, angulation and proximity to neurovascular structures. Therefore, one of the main challenges to provide stabilisation in the cervical spine is the limitations of the anatomy. This presentation will introduce a novel spinal implant (patent pending) which is proposed for the cervical spine to provide partial dynamic stabilisation in the C3 to T1 region from a
Method: This study reports upon 216 patients (97 Minimally invasive and 119 Standard) enrolled into a randomised control trial comparing a standard
Generally, the sacroiliac joint is not considered accessible for arthroscopy under physiological conditions. The non-injured joint is not large enough for introduction of even the smallest arthroscope into the joint space. After traumatic injury however, or in the event of an inflammatory condition or tumour formation, it is theoretically possible to position an endoscope in the joint space. Study of the anatomy of the sacroiliac joint and knowledge of the anatomic relations, particularly the vascular and nervous relations, is a prerequisite for arthroscopic exploration of the sacroiliac joint space. The
Introduction. Although various reports analyzed “en-bloc” excision of sacral tumors, there are still technical problems to improve protection of nerve roots, preserve surrounding structures and reduce intraoperative bleeding, maintaining the oncologic result. We present a new technique for sacral resection, with short term preliminary results, derived with modification from Osaka technique. Methods. Seven patients were resected for their sacrococcygeal chordoma with the followed described technique. Two patients had previous surgery elsewhere. The sacrum is exposed by a posterior midline incision and complete soft-tissue dissection. Lateral osteotomies were performed through the sacral foramina using a threadwire saw and Kerrison rongeurs, to avoid sacral roots damage. After proximal osteotomy, the sacrum is laterally elevated and mobilized to allow dissection of presacral structures. Mean surgical time was 5 hours (range: 3 to 8). Mean blood loss was 3640 ml. Results. Level of resection was S1 in 2 pts, S2 in 4 pts, S3 in 1. Margins were wide in 6 patients and marginal in one. At a mean follow-up of 2 years, six patients were disease-free, one had a local recurrence. No complications were showed. Conclusion. This technique allows wide margins with roots preservation and reduction of complications and operative time. Indications for
Introduction:. Direct anterior approach (DAA) total hip arthroplasty (THA) has been reported to be a muscle sparing approach. The purpose of this study was to compare gait patterns over time between patients undergoing THA via DAA and
The purposes of this study were to review retrospectively the 10-year outcome of cementless total hip arthroplasty (THA) using an active robot system in the femoral canal preparation for an anatomic short stem and navigation in the cup placement through a mini incision
INTRODUCTION. Cadaveric studies have reported damage to the direct head of rectus femoris and tensor fascia lata muscles with direct anterior approach(DAA) and to the abductors, external rotators with posterior approach(PA). The aim of this prospective study was to evaluate differences in hip muscle strength recovery between DAA and
Introduction In an attempt to decrease the incidence of posterior hip dislocation following a
The Wroblewski golf ball acetabular cup was introduced by surgeons using the trochanteric osteotomy approach for revision total hip replacement (THR) in order to reduce the rate of dislocation. We have routinely used the Ogee long posterior wall (Ogee LPW) and the Wroblewski angle bore cups in THR. Although the new Wroblewski golf ball cup performed well there was a significant early rate of dislocation of 20%. Our rate of dislocation over a period of ten years using the Ogee LPW and Wroblewski angle bore cups had been 0.52%. We present our findings and an investigation as to why the new cup has such a high rate of dislocation when used with the
Purpose. According to Bipolar Hemiarthroplasty of the Hip (BHA), several reports indicated earlier acquisition of walking ability in direct anterior approach (DAA) than
Dislocation is a recognised complication following the
INTRODUCTION. Acetabular cup orientation is an important element of Total Hip arthroplasty (THA). The purpose of this retrospective case-control study was to compare variability of acetabular cup placement between THA performed via Direct Anterior Approach (DAA) with fluoroscopy in supine position and
Introduction: The minimally invasive
Introduction: We present our results of the first 413 Charnley arthroplasties performed by and under the supervision of the senior surgeon, using the
From February 1992 to December 1997, 379 total hip arthroplasties in 342 patients were performed. 13 patients were lost to follow up, with 33 unrelated deaths. All arthroplasties were performed via the
The aim of this cadaver study was to identify
the change in position of the sciatic nerve during arthroplasty
using the posterior surgical approach to the hip. We investigated
the position of the nerve during this procedure by dissecting 11
formalin-treated cadavers (22 hips: 12 male, ten female). The distance
between the sciatic nerve and the femoral neck was measured before
and after dislocation of the hip, and in positions used during the
preparation of the femur. The nerve moves closer to the femoral
neck when the hip is flexed to >
30° and internally rotated to 90° (90°
IR). The mean distance between the nerve and femoral neck was 43.1
mm (standard deviation ( This study demonstrates that the sciatic nerve becomes closer
to the operative field during hip arthroplasty using the posterior
approach with progressive flexion of the hip. Cite this article:
Introduction We conducted a prospective study to compare the early post-operative recovery following the two different incisions. Materials and Methods 40 patients with BMI ≤ 30 were prospectively randomised (20 patients in each group) by use of envelopes. Conventional incision was 12 cm postero-lateral in all cases and minimal incision was diameter of the femoral head plus 2 cm. The patients, and assessors (physiotherapists and nurses on ward) were unaware of the treatment group. Results Average age was 66.95 years for MI group and 68.55 for conventional group (p-0.51). Average BMI for MI and conventional group was 26.5 &
24.4 respectively (p-0.029). Average pre-operative Oxford hip score was 41.75 for conventional group and 42.15 for MI group (p-0.87). There was no statistically significant difference as regards the operating times (p-0.207); post-operative day the patients were mobilised with zimmer frame (p-0.71); drop in hemoglobin (p-0.197) and hematocrit (p-0.208) or the need for blood transfusion (p-0.56). However there was a statistically significant difference in the two groups as regards post-operative pain (on a 10 point visual analogue scale) and the number of postoperative days the patient was fit for discharge. Average pain score on day 1 was 4.05 for MI group and 6.25 for conventional group (p-0.0089) with similar difference on day 2 and the day of discharge. Patients in MI group were fit for discharge on an average 1.65 days earlier than those in conventional group (p-0.042). There was no superficial or deep wound infection, dislocation or per-operative fracture in either group. Transient sciatic nerve neuropraxia occurred in one patient in the minimal incision group which recovered within 6 weeks. Conclusion Minimal incision
The orientation of the acetabular component is influenced by the orientation at which the surgeon implants the component and the orientation of the pelvis at the time of implantation. When operating with the patient in the lateral decubitus position, pelvic orientation can be highly variable. The goal of this study was to examine the effect of two different pelvic supports on cup orientation. In this prospective study, 200 consecutive patients undergoing uncemented primary THA in the lateral decubitus position were included. In the control group a single support over the pubic symphysis (PS) was used. In the study group, a single support over the ipsilateral anterior superior iliac spine (ASIS) was used. In every patient, the cup was inserted and the angle of the cup introducer relative to the floor (apparent operative inclination; OIa) was measured with the aid of a digital inclinometer. The radiographic inclination (RI) was measured on anteroposterior pelvic radiographs at 6 weeks postoperatively. The target zone for cup inclination was 35–45°. In both cohorts the cups were implanted close to the target OIa with an absolute difference with the OIa of 0.86° SD 0.82 in the PS cohort and 1.03° SD 0.99 in the ASIS cohort (p=0.18). The difference between the RI and OIa was higher in the PS cohort 12.2° SD 4.1 compared with 7.5° SD 3.7 in the ASIS cohort (p<0.0001) with also a bigger variance (p=0.04) in the PS cohort. The mean RI was 38.5° SD 4.4 compared with 39.2° SD 4.1 (p=0.26) respectively. There were more cups outside the RI target zone in the PS cohort compared with the ASIS cohort (respectively 26 versus 15; p<0.05). In this study the mean difference between the RI and OIa (the angle of the cup introducer during surgery) was significantly less when using a support over the ASIS compared with a support over the pubic symphysis. Apparently using a support over the ASIS causes less pelvic motion during surgery compared with a support over the pubic symphysis. This resulted in less variance and inclination outliers when using a tight target zone of 35–45°.
Introduction There has been increasing interest and enthusiasm among both surgeons and patients for small incision for total hip joint replacement (THR). We conducted a prospective study to compare the early postoperative recovery following the two different incisions. Materials and Methods 40 patients were prospectively randomised (20 patients in each group) by use of envelopes to undergo either conventional or minimal incision (MI) approach for THR between Sept. 2003 and Aug. 2004. Patients with BMI (body mass index) ≤ 30 were considered suitable for randomisation. Conventional incision was 12 cm standard posterolateral in all cases and minimal incision was defined as within 2 cm of the diameter of the contralateral uninvolved femoral head. Minimal incision was made over the posterior aspect of the greater trochanter. All procedures were performed by the senior author. The patients were assessed for operative time, blood loss, haematological parameters, wound healing, ease of mobilisation, post-operative pain, hospital stay and complications. The patients, and assessors (physiotherapists and nurses on ward) were unaware of the treatment group. Results Average age was 66.95 years for MI group and 68.55 for conventional group (p-0.501). Average BMI for MI and conventional group was 26.5 &
24.4 respectively (p-0.029). Average pre-operative Oxford hip score was 41.75 for conventional group and 42.15 for MI group (p-0.87). There was no statistically significant difference as regards the operating times (p-0.207); post-operative day the patients were mobilised with zimmer frame (p-0.71); drop in hemoglobin (p-0.197) and hematocrit (p-0.208) or the need for blood transfusion (p-0.56). However there was a statistically significant difference in the two groups as regards post-operative pain (on a 10 point visual analogue scale) and the number of postoperative days the patient was fit for discharge. Average pain score on day 1 was 4.05 for MI group and 6.25 for conventional group (p-0.0089) with similar difference on day 2 and the day of discharge. Patients in MI group were fit for discharge on an average 1.65 days earlier than those in conventional group (p-0.042). There was no superficial or deep wound infection, dislocation or per-operative fracture in either group. Transient sciatic nerve neuropraxia occurred in one patient in the minimal incision group which recovered within 6 weeks. Conclusion Minimal incision
Patients were scored pre-operatively and followed up prospectively. The only special instruments required are two large curved Hohmann retractors and an angled cup introducer.
Forty-two percent of patients were male. Mean age was 68.9 years (42–90) and BMI 26 (14–39). Average operation time was 64.1 minutes and anaesthetic time 92.5 minutes. Mean fall in haemoglobin in the first 24 hours was 2.3g/dl. Mean incision length was 7.4cm. Follow-up was a minimum of one year (range 12–29 months). There was a highly statistically significant improvement in WOMAC and SF-36 scores at three and 12 months post-operatively (p<
0.0001). Early medical complications occurred in 12 patients, including two superficial infections, all of which resolved. There were no peri-prosthetic fractures and importantly, no dislocations. There were two re-operations: one revision for cup displacement and one washout for deep infection.
Total Hip Arthroplaty (THA) using posterior approach(PA) that resect muscle have done from September, 2005 to August, 2006, but, for the purpose of a lower invasive surgery, we changed to THA using direct anterior approach(DAA) that preserve muscle from September, 2006. The purpose of this study was to compare the inflammation degree and clinical results of MIS-THA using PA with that of MIS-THA using DAA. From September 2005 to May 2008,73 hips in 69 patients were treated with consecutive primary cement-less MIS THA. The breakdown of the patients was DAA, 51 hips, and PA, 22. The average age at operation was 66 years and 58 years. The average followup after primary THA was 1.5 years and 2.8 years. The sex ratio (M/F) was DAA 2/44, and PL 6/15. For the inflammation degree, CRP at the seventh day and 14 day after surgery of DAA was significantly lower than those of PA (p<
0.01). WBC of the seventh day of DAA was significantly lower than that of PA.CPK on DAA at the first was significantly lower than that of PL (p<
0.01), and CPK of PL took time for a long time to decrease to the level before the operation compared with DAA. For clinical results, there were no significant difference operative time, blood loss volume and complication in DAA and PA. No significant differences in the HHS at the final follow up were observed between DAA and PA. In the radiographic assessment, there was no significant difference in neutral position of stem of DAA(46hips) and PA (18hips), and there was no significant difference in abduction angle of socket in DAA(average 45°) and PA (47°). The day of SLR possibility was significantly earlier DAA (average 4 day) than PA (7). No significant differences in hospital stay were observed between DAA (average 21 days) and PA (26). In the current study, there was thought that DAA was lower inflammation degree than PA, because normalization of CRP after surgery in DAA was significantly early in comparison with PA, and CPK of the first day after surgery was significantly lower in DAA than in PA. In the clinical assessment, the day of SLR possibility only was significantly earlier in DAA than in PA. This may imply muscle recovery of DAA is more rapid than that of PA. In the future, DAA will help to the further early rehabilitation and the early hospital discharge.
The documentation of the results of combined anterior -posterior approach in the treatment of spinal tumors in our department. A total of 28 patients (16 men – 12 women) aged 15 to 75 year old (mean age = 54 years) were treated. Of those 7 presented with a benign primary tumor and 21 with malignancies of which 15 were metastatic. 16 patients had a neurologic deficit but met the international criteria for surgical intervention. The staging of the tumors and their postoperative care was undertaken by a tumor centre. All patients underwent posterior decompression with laminectomy, resection of all posterior elements including part of the pedicle, excision of the tumor and posterior stabilization. This was followed at the same operative session by an anterior approach (transthoracic, transperitoneal or anterior cervical) corpectomy of the affected vertebrae and implantation of interbody cages secured with an anterior plate and screws in the healthy vertebrae. 7 patients improved neurologically following the operation while 9 had no change of their clinical condition. Perioperative complications were recorded in 5 patients. In 3 cases a dural tear was dealt with direct closure and 3 infections had to have surgical debridement at another stage and antimicrobial therapy. The treatment of spinal tumors with combined anterior-posterior approach in one session for a radical excision of the tumor is a demanding procedure
We investigated the detailed anatomy of the gluteus
maximus, gluteus medius and gluteus minimus and their neurovascular
supply in 22 hips in 11 embalmed adult Caucasian human cadavers.
This led to the development of a surgical technique for an extended
posterior approach to the hip and pelvis that exposes the supra-acetabular
ilium and preserves the glutei during revision hip surgery. Proximal
to distal mobilisation of the gluteus medius from the posterior
gluteal line permits exposure and mobilisation of the superior gluteal
neurovascular bundle between the sciatic notch and the entrance
to the gluteus medius, enabling a wider exposure of the supra-acetabular
ilium. This technique was subsequently used in nine patients undergoing
revision total hip replacement involving the reconstruction of nine
Paprosky 3B acetabular defects, five of which had pelvic discontinuity.
Intra-operative electromyography showed that the innervation of
the gluteal muscles was not affected by surgery. Clinical follow-up
demonstrated good hip abduction function in all patients. These
results were compared with those of a matched cohort treated through
a Kocher–Langenbeck approach. Our modified approach maximises the
exposure of the ilium above the sciatic notch while protecting the
gluteal muscles and their neurovascular bundle. Cite this article: Bone Joint J 2014;96-B:48–53.
This study demonstrates the utility of a modified postero-medial surgical approach to the knee in treating a series of patients with complex tibial plateau injuries with associated postero-medial shear fractures. Postero-medial shear fractures are under-appreciated and their clinical relevance have recently been characterised. Less invasive surgery and indirect reduction techniques are inadequate for treating these postero-medial coronal plane fractures. The approach includes an inverted ‘L’ shaped incision and reflection of the medial head of gastrocnemius, while protecting the neurovascular structures. This is a more extensile exposure than described by Trickey (1968). Our case series includes 8 females and 8 males. The average age is 53.1 years. The mechanism of injury included 7 RTAs, 5 fall from height, 1 industrial accident and 3 valgus injuries. All patients' schatzker grade 4, or above, fractures with a posteromedial split depression. Two were open, two had vascular compromise and one had neurological injury.Hypothesis
Methods
A systematic review of the current literature to address the debate of the optimal surgical approach for the treatment of adolescent idiopathic scoliosis (AIS). All studies comparing anterior open instrumented surgery with posterior instrumented surgery in patients with AIS, written in English and published up until February 2010 were included. Electronic databases searched included Medline, PubMed and the Cochrane database using “AIS” and “surgery” as key words. Outcome measures considered to be important were specifically identified in each paper included: Blood loss (ml); operation time (mins); hospital stay (days); curve correction (sagittal and coronal); number of fused levels; pulmonary function, and complications.Study Purpose
Method
Fractured neck of femur is a significant health concern within the UK. NICE guidance on the management of displaced intracapsular fractures states that total hip arthroplasty should be offered when patients can; walk independently out of doors with no more than a stick, not cognitively impaired, medically fit for anaesthesia and the procedure. We previously managed this subgroup using THA with standard sockets. Following an audit of this practice a dislocation rate of 9% was identified and practice was changed to using dual mobility (THA-DM) with the theoretical advantage of reducing dislocation. We reviewed all patients who underwent THA for fracture using Bluespier from 2013–2017. Operative notes and radiographs were reviewed to ensure the patients had undergone THA for displaced intracapsular fracture. Basic patient demographics were collected. Our primary outcome was dislocation rates at one year. Our secondary outcomes were length of time to surgery, length of stay, operative time, mortality, return to theatre rates and one year Oxford hip scores We found a control group of 45 THA procedures and a dual mobility group of 143 procedures. The one year dislocation rate from the THA-SS group was 9% and the THA-DM group was 1.4%(CI±1.9%)(p=<0.05%). There were also non-significant reductions in time to surgery, length of stay, operative time, mortality, return to theatre rates. The one year Oxford hip score was comparable at 42.2 to 41.8. This study demonstrates a significant reduction in one year dislocation rates with comparable oxford hip scores. Use of THA-DM should be considered in those patients who meet NICE criteria. Further research is needed into long term dislocation rates.
When a hip is replaced using a posterior surgical approach, some of the external rotator muscles are divided. The aim of this study was to assess if this surgery has a long term affect on hip rotation during activities of daily living. An electromagnetic tracking system was used to assess hip movements during the following activities:- Activity 1. Picking an object of the floor in a straight leg stance. Activity 2. Picking an object of the floor when knees are flexed. Activity 3. Sitting on a chair. Activity 4. Putting on socks, seated, with the trunk flexed forward. Activity 5. Putting on socks, seated, with the legs crossed. Activity 6. Climbing stairs. Measurements were taken from 10 subjects with bilaterally normal hips, 10 patients with a large head hip replacement, 10 patients with a resurfacing head and 10 patients with a small head hip replacement. All the hip replacement patients were at least 6 months post-op, with an asymptomatic contra-lateral native hip for comparison. Sensors were attached over the iliac crest and the mid-shaft of the lateral thigh. Data was collected as each activity was repeated 3 times. The tracker recorded hip rotation at 10 hertz, with an accuracy of 0.15 degree.AIM
METHODS
These patients continue to be monitored to evaluate long term outcomes with this approach. (301 words)
Primary hip arthroplasty performed through a mini incision ( less than 10 cm) should provide more comfortable postoperative period and faster rehabilitation. After a long period of learning curve ( more than one hundred cases) and development of specific instruments, a prospective comparison between the standard approach technique (38 cases) and mini incision technique (41 cases) was performed. In all cases, the ABG II stem was implanted. It was uncemented in 76% of cases. As it is not randomised, there is a slight difference between the two groups in age (p = 0,03) and body mass index (p = 0,01). The fonctional status was evaluated at the third and seventh post operative days and at the first and second post operative months. Pain relief (EVA score), total peri operative blood loss (OSTHEO study criteria) and radiologic implants positioning are mesured. In this study, there was no major complication. There was one case of phlebitis in both groups. During the evaluation, there was no significant difference in the functional result. The post operative EVA pain score was not different. The mean total peri operative blood loss was 1025 ml in the standard approach group and 1164 ml in the mini incision approach group (p = 0,405). The radiologic evaluation showed no difference in the cup positioning. In the mini incision group, there was few cases of varus positioning of the ABG II stem (21% cases) but it was not significant. Those results demonstrate the safety and the efficacy of the posterior mini incision approach. There is a need for a technical learning curve and a resonably incision sizing adapted for each patient. Under those conditions, we are able to achieve the same quality of implant positioning, which should provide the same long term result.
All types of cervical laminoplasties for cervical spondylotic myelopathy (CSM) gave the same degree of postoperative neurological recoveries. However, postoperative neck functions differed according to degrees of intervention with posterior supporting elements of the neck (spinoligamentous complex, SLC). To obtain optimal postoperative neck function, SLC should be preserved. Laminar enlargement destroying SLC resulted in anterior tilt of neck, loss of cervical lordosis and loss of cervical range of motion (ROM) by 40–60% of preoperative ROM, whereas, tension-band laminoplasty ( To obtain optimal postoperative neurological recovery, the timing of decompression was a key issue. Japanese Orthopaedic Association (JOA) score for cervical myelopathy (normal = 17 points) was used for neurological evaluation. One hundred and nine patients who underwent tension-band laminoplasty, were grouped into 3 groups according to preoperative JOA scores: group A with JOA score above 14 (10 patients), group B with JOA score between 11 and 13 (48 patients), and group C with JOA score below 10 (51 patients). Mean pre-/post- JOA scores and ratios of patients with postoperative JOA score above 16 for each group were as follows: 1 0.4/14.1, 34% for total patients, 14.6/16.5, 80% for group A, 11.9/14.8, 40% for group B, and 8.2/12.9, 20% for group C. There was a statistical difference among three groups. It was concluded that decompression at the early stage with JOA score above 14 using tension-band laminoplasty might provide the best outcome to CSM-patients regarding neurological improvement and postoperative neck function.
The study was conducted to review the outcome in cases of anterior expandable interbody cages inserted through a
Purpose: Insertional calcific Achilles tendinosis is a painful, frequently disabling, condition. The longitudinal and radial alignment of the angiosomes of the posterior region of the leg makes a straight
1. An operation is described for ischio-femoral extra-articular arthrodesis of the hip joint by
Purpose of the study: The
The August 2024 Hip & Pelvis Roundup. 360. looks at: Understanding perceived leg length discrepancy post-total hip arthroplasty: the role of pelvic obliquity; Influence of femoral stem design on revision rates in total hip arthroplasty; Outcomes of arthroscopic labral treatment of femoroacetabular impingement in adolescents; Characteristics and quality of online searches for direct anterior versus