Pelvic discontinuity is a separation through the acetabulum with the ilium displacing superiorly and the ischium/pubis displacing inferiorly. This is a biomechanically challenging environment with a high rate of failure for standard acetabular components. The cup-cage reconstruction involves the use of a highly porous metal cup to achieve biological bone ingrowth on both sides of the pelvic discontinuity and an ilioischial cage to provide secure fixation across the discontinuity and bring the articulating hip center to the correct level. The purpose of this study was to report long term follow up of the use of the cup-cage to treat pelvic discontinuity. All hip revision procedures between January 2003 and January 2022 where a cup-cage was used for a hip with a pelvic discontinuity were included in this retrospective review. All patients received a Trabecular Metal Revision Shell with either a ZCA cage or TMARS cage (Zimmer-Biomet Inc.). Pelvic discontinuity was diagnosed on pre-operative radiographs and/or intraoperatively. Kaplan-Meier survival analysis was performed with failure defined as revision of the cup-cage reconstruction. Fifty-seven cup-cages in 56 patients were included with an average follow-up of 6.25 years (0.10 to 19.98 years). The average age of patients was 72.09 years (43 to 92 years) and 70.2% of patients were female. The five year Kaplan-Meier survival was 92.0% (95% CI 84.55 to 99.45) and the ten year survival was 80.5% (95% CI 58.35 to 102.65). There were 5 major complications that required revision of the cup-cage reconstruction (3 infections and 2 mechanical failures). There were 9 complications that required re-operation without revision of the cup-cage reconstruction (5 dislocations, 3 washouts for infection and one femoral revision for aseptic loosening). In our hands the cup-cage reconstruction has provided a reliable tool to address pelvic discontinuity with an acceptable complication rate.
Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed.Aims
Methods
Patients undergoing revision surgery of a primary total hip arthroplasty often exhibit bone loss and poor bone quality, which make achieving stable fixation and osseointegration challenging. Implant components coated in porous metals are used clinically to improve mechanical stability and encourage bone in-growth. We compared ultra-porous titanium coatings, known commercially as Gription and Porocoat, in an intra-articular model by press-fitting coated cylindrical implants into ovine femoral condyles and evaluating bone in-growth and fixation strength 4, 8 and 16 weeks post-operatively. Bilateral surgery using a mini-arthrotomy approach was performed on twenty-four Dorset-Rideau Arcott rams (3.4 ± 0.8 years old, 84.8 ± 9.3 kg) with Institutional Animal Care Committee approval in accordance with the Canadian Council on Animal Care. Cylindrical implants, 6.2 mm in diameter by 10 mm in length with surface radius of curvature of 35 mm, were composed of a titanium substrate coated in either Porocoat or Gription and press-fit into 6 mm diameter recipient holes in the weight-bearing regions of the medial (MFC) and lateral (LFC) femoral condyles. Each sheep received 4 implants; two Gription in one stifle (knee) and two Porocoat in the contralateral joint. Biomechanical push-out tests (Instron ElectroPuls E10000) were performed on LFCs, where implants were pushed out relative to the condyle at a rate of 2 mm/min. Force and displacement data were used to calculate force and displacement at failure, stiffness, energy, stress, strain, elastic modulus, and toughness. MFCs were fixed in 70% ethanol, processed undecalcified, and polished sections, approximately 70 µm thick (Exakt Micro Grinding system) were carbon-coated. Backscattered electron images were collected on a scanning electron microscope (Hitachi SU3500) at 5 kV and working distance of 5 mm. Bone in-growth within the porous coating was quantified using software (ImageJ). Statistical comparisons were made using a two-way ANOVA and Fisher's LSD post-hoc test (Statistica v.8). Biomechanical evaluation of the bone-implant interface revealed that by 16 weeks, Gription-coated implants exhibited higher force (2455±1362 N vs. 1002±1466 N, p=0.046) and stress (12.60±6.99 MPa vs. 5.14±7.53 MPa, p=0.046) at failure, and trended towards higher stiffness (11510±7645 N/mm vs. 5010±8374 N/mm, p=.061) and modulus of elasticity (591±392 MPa vs. 256±431 MPa, p=0.61). Similarly, by 16 weeks, bone in-growth in Gription-coated implants was approximately double that measured in Porocoat (6.73±3.86 % vs. 3.22±1.52 %, p=0.045). No statistically significant differences were detected at either 4 nor 8 weeks, however, qualitative observations of the exposed bone-implant interface, made following push-out testing, showed more bony material consistently adhered to Gription compared to Porocoat at all three time points. High variability is attributed to implant placement, resulting from the small visual window afforded during surgery, unique curvatures of the condyles, and presence of the extensor digitorum longus tendon which limited access to the LFC. Ultra-porous titanium coatings, know commercially as Gription and Porocoat, were compared for the first time in a challenging intra-articular ovine model. Gription provided superior fixation strength and bone in-growth, suggesting it may be beneficial in hip replacement surgeries where bone stock quality and quantity may be compromised.
The use of total hip arthroplasty in adolescents for end-stage degenerative hip disease is controversial with few reported outcomes in the literature. The purpose of the study was to report the outcomes of total hip arthroplasty in a cohort of adolescents managed by a multidisciplinary team of paediatric and adult orthopaedic surgeons from a single centre. A multidisciplinary clinic consisting of paediatric and adult hip surgeons was established in 2013 to identify, treat and prospectively follow adolescents who would potentially beneift from a total hip arthoplasty. To date 29 consecutive adolescent patients (20 female, 9 male, 32 hips) with end stage degenerative hip disease have undergone cementless primary total hip arthroplasty. Mean age at decision to treat was 15.7 years (age 11.4–18.5). Ten different underlying paediatric specific pathologies were documented including DDH, cerebral palsy, JIA, skeletal dysplasias, SCFE and idiopathic chondrolysis. Three patients had bilateral staged procedures. Clinical baseline and outcomes were measured using Oxford Hip Score (OHS), WOMAC score and ASKp scores. Radiographic follow-up was conducted at 6 weeks, 6 months and yearly thereafter. Post-operative complications were recorded. Twenty-five hips were eligible for minimum 2-year follow-up scoring at a mean 2.7 years (2.0–3.6 years). No intraoperative complications occurred. One case of recalcitrant postoperative psoas tendonitis occured. OHS improved from 25 (7–43) to 41 (23–48). WOMAC improved from 48 (12–8) to 12 (1–44), and ASKp improved from 78% (33–98%) to 93% (73–100%). Radiographic review revealed acceptable alignment of all components with no signs of loosening or wear. No revision of components was required. One patient died at 6 months post op from an unrelated condition. The early term results of total hip arthroplasty in adolescents from our multidisciplinary program are encouraging. Improvements in quality of life to normal values were seen as were hip scores consistent with satisfactory joint function. Depite the range of complex and varied causes of arthritis seen in this population the establishment of combined paediatric and adult orthopaedic surgical teams appears to be a successful model to manage end-stage degenerative hip disease in adolescents.
Patients with longstanding hip fusion are predisposed to symptomatic degenerative changes of the lumbar spine, ipsilateral knee and contralateral hip The aim of this study was to determine the functional results and complications in patients undergoing hip fusion conversion to total hip replacement, performed or supervised by a single surgeon. Twenty-eight hip fusions were converted between 1996 and 2016. Mean follow up was 7 years (3 to 18 years). The reasons for arthrodesis were trauma 11, septic arthritis 10, and dysplasia 7. The mean age at conversion was 52.4 years (26 to 77). A trochanteric osteotomy was performed in all hips. Uncemented components were used. A constrained liner was used in 7 hips. Heterotopic ossification prophylaxis was not used in this series. HHS improved a mean of 27 points (37.4 pre-op to 64.3 post-op). A cane was used in 30% of patients before conversion and 80% after. Heterotopic ossification occurred in 12 (42.9%) hips. There was 2 peroneal nerve injuries, 1 dislocation, 1 GT non-union and 1 infection. There have been 5 revisions; 2 for aseptic loosening, 1 for infection, 1 for recurrent dislocation and 1 for leg length discrepancy. Conversion of hip fusion to hip replacement carries an increased risk of heterotopic ossification and neurological injury. We advise prophylaxis against heterotropic ossification. When there is concern about hip stability we suggest that the use of a constrained acetabular liner is considered. Despite the potential for complications, this procedure had a high success rate and was effective in restoring hip function.
This study reports the clinical outcome of reconstruction
of deficient abductor muscles following revision total hip arthroplasty
(THA), using a fresh–frozen allograft of the extensor mechanism
of the knee. A retrospective analysis was conducted of 11 consecutive
patients with a severe limp because of abductor deficiency which
was confirmed on MRI scans. The mean age of the patients (three
men and eight women) was 66.7 years (52 to 84), with a mean follow-up
of 33 months (24 to 41). Following surgery, two patients had no limp, seven had a mild
limp, and two had a persistent severe limp (p = 0.004). The mean
power of the abductors improved on the Medical Research Council
scale from 2.15 to 3.8 (p <
0.001). Pre-operatively, all patients
required a stick or walking frame; post-operatively, four patients
were able to walk without an aid. Overall, nine patients had severe
or moderate pain pre-operatively; ten patients had no or mild pain
post-operatively. At final review, the Harris hip score was good in five patients,
fair in two and poor in four. We conclude that using an extensor mechanism allograft is relatively
effective in the treatment of chronic abductor deficiency of the
hip after THA when techniques such as local tissue transfer are
not possible. Longer-term follow-up is necessary before the technique can be
broadly applied. Cite this article:
Revision total hip replacement (THR) for young
patients is challenging because of technical complexity and the potential
need for subsequent further revisions. We have assessed the survivorship,
functional outcome and complications of this procedure in patients
aged <
50 years through a large longitudinal series with consistent treatment
algorithms. Of 132 consecutive patients (181 hips) who underwent
revision THR, 102 patients (151 hips) with a mean age of 43 years
(22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26)
post-operatively. We attempted to restore bone stock with allograft
where indicated. Using further revision for any reason as an end point,
the survival of the acetabular component was 71% ( This overall perspective on the mid- to long-term results is
valuable when advising young patients on the prospects of revision
surgery at the time of primary replacement. Cite this article:
The purpose of this study was to identify factors
that predict implant cut-out after cephalomedullary nailing of intertrochanteric
and subtrochanteric hip fractures, and to test the significance
of calcar referenced tip-apex distance (CalTAD) as a predictor for
cut-out. We retrospectively reviewed 170 consecutive fractures that had
undergone cephalomedullary nailing. Of these, 77 met the inclusion
criteria of a non-pathological fracture with a minimum of 80 days
radiological follow-up (mean 408 days; 81 days to 4.9 years). The
overall cut-out rate was 13% (10/77). The significant parameters in the univariate analysis were tip-apex
distance (TAD) (p <
0.001), CalTAD (p = 0.001), cervical angle
difference (p = 0.004), and lag screw placement in the anteroposterior
(AP) view (Parker’s ratio index) (p = 0.003). Non-significant parameters
were age (p = 0.325), gender (p = 1.000), fracture side (p = 0.507),
fracture type (AO classification) (p = 0.381), Singh Osteoporosis
Index (p = 0.575), lag screw placement in the lateral view (p =
0.123), and reduction quality (modified Baumgaertner’s method) (p = 0.575).
In the multivariate analysis, CalTAD was the only significant measurement
(p = 0.001). CalTAD had almost perfect inter-observer reliability
(interclass correlation coefficient (ICC) 0.901). Our data provide the first reported clinical evidence that CalTAD
is a predictor of cut-out. The finding of CalTAD as the only significant
parameter in the multivariate analysis, along with the univariate
significance of Parker’s ratio index in the AP view, suggest that
inferior placement of the lag screw is preferable to reduce the
rate of cut-out. Cite this article:
We retrospectively reviewed 44 consecutive patients
(50 hips) who underwent acetabular re-revision after a failed previous
revision that had been performed using structural or morcellised
allograft bone, with a cage or ring for uncontained defects. Of
the 50 previous revisions, 41 cages and nine rings were used with
allografts for 14 minor-column and 36 major-column defects. We routinely
assessed the size of the acetabular bone defect at the time of revision
and re-revision surgery. This allowed us to assess whether host
bone stock was restored. We also assessed the outcome of re-revision
surgery in these circumstances by means of radiological characteristics,
rates of failure and modes of failure. We subsequently investigated
the factors that may affect the potential for the restoration of bone
stock and the durability of the re-revision reconstruction using
multivariate analysis. At the time of re-revision, there were ten host acetabula with
no significant defects, 14 with contained defects, nine with minor-column,
seven with major-column defects and ten with pelvic discontinuity.
When bone defects at re-revision were compared with those at the
previous revision, there was restoration of bone stock in 31 hips, deterioration
of bone stock in nine and remained unchanged in ten. This was a
significant improvement (p <
0.001). Morselised allografting
at the index revision was not associated with the restoration of
bone stock. In 17 hips (34%), re-revision was possible using a simple acetabular
component without allograft, augments, rings or cages. There were
47 patients with a mean follow-up of 70 months (6 to 146) available
for survival analysis. Within this group, the successful cases had
a minimum follow-up of two years after re-revision. There were 22 clinical
or radiological failures (46.7%), 18 of which were due to aseptic
loosening. The five and ten year Kaplan–Meier survival rate was
75% (95% CI, 60 to 86) and 56% (95% CI, 40 to 70) respectively with
aseptic loosening as the endpoint. The rate of aseptic loosening
was higher for hips with pelvic discontinuity (p = 0.049) and less
when the allograft had been in place for longer periods (p = 0.040). The use of a cage or ring over structural allograft bone for
massive uncontained defects in acetabular revision can restore host
bone stock and facilitate subsequent re-revision surgery to a certain
extent. Cite this article:
The use of ilioischial cage reconstruction for
pelvic discontinuity has been replaced by the Trabecular Metal (Zimmer,
Warsaw, Indiana) cup-cage technique in our institution, due to the
unsatisfactory outcome of using a cage alone in this situation.
We report the outcome of 26 pelvic discontinuities in 24 patients
(20 women and four men, mean age 65 years (44 to 84)) treated by
the cup-cage technique at a mean follow-up of 82 months (12 to 113)
and compared them with a series of 19 pelvic discontinuities in
19 patients (18 women and one man, mean age 70 years (42 to 86))
treated with a cage at a mean follow-up of 69 months (1 to 170).
The clinical and radiological outcomes as well as the survivorship
of the groups were compared. In all, four of the cup-cage group
(15%) and 13 (68%) of the cage group failed due to septic or aseptic
loosening. The seven-year survivorship was 87.2% (95% confidence interval
(CI) 71 to 103) for the cup-cage group and 49.9% (95% CI 15 to 84)
for the cage-alone group (p = 0.009). There were four major complications
in the cup-cage group and nine in the cage group. Radiological union
of the discontinuity was found in all successful cases in the cup-cage
group and three of the successful cage cases. Three hips in the
cup-cage group developed early radiological migration of the components,
which stabilised with a successful outcome. Cup-cage reconstruction is a reliable technique for treating
pelvic discontinuity in mid-term follow-up and is preferred to ilioischial
cage reconstruction. If the continuity of the bone graft at the
discontinuity site is not disrupted, early migration of the components
does not necessarily result in failure. Cite this article:
Valid and reliable techniques for assessing performance
are essential to surgical education, especially with the emergence
of competency-based frameworks. Despite this, there is a paucity
of adequate tools for the evaluation of skills required during joint
replacement surgery. In this scoping review, we examine current
methods for assessing surgeons’ competency in joint replacement
procedures in both simulated and clinical environments. The ability
of many of the tools currently in use to make valid, reliable and
comprehensive assessments of performance is unclear. Furthermore,
many simulation-based assessments have been criticised for a lack
of transferability to the clinical setting. It is imperative that
more effective methods of assessment are developed and implemented
in order to improve our ability to evaluate the performance of skills
relating to total joint replacement. This will enable educators
to provide formative feedback to learners throughout the training
process to ensure that they have attained core competencies upon
completion of their training. This should help ensure positive patient
outcomes as the surgical trainees enter independent practice. Cite this article:
In this retrospective study we evaluated the
proficiency of shelf autograft in the restoration of bone stock
as part of primary total hip replacement (THR) for hip dysplasia,
and in the results of revision arthroplasty after failure of the primary
arthroplasty. Of 146 dysplastic hips treated by THR and a shelf
graft, 43 were revised at an average of 156 months, 34 of which
were suitable for this study (seven hips were excluded because of
insufficient bone-stock data and two hips were excluded because
allograft was used in the primary THR). The acetabular bone stock
of the hips was assessed during revision surgery. The mean implant–bone
contact was 58% (50% to 70%) at primary THR and 78% (40% to 100%)
at the time of the revision, which was a significant improvement
(p <
0.001). At primary THR all hips had had a segmental acetabular
defect >
30%, whereas only five (15%) had significant segmental
bone defects requiring structural support at the time of revision.
In 15 hips (44%) no bone graft or metal augments were used during
revision. A total of 30 hips were eligible for the survival study. At a
mean follow-up of 103 months (27 to 228), two aseptic and two septic
failures had occurred. Kaplan-Meier survival analysis of the revision
procedures demonstrated a ten-year survival rate of 93.3% (95% confidence
interval (CI) 78 to 107) with clinical or radiological failure as
the endpoint. The mean Oxford hip score was 38.7 (26 to 46) for
non-revised cases at final follow-up. Our results indicate that the use of shelf autografts during
THR for dysplastic hips restores bone stock, contributing to the
favourable survival of the revision arthroplasty should the primary
procedure fail. Cite this article:
Trabecular metal (TM) augments are a relatively
new option for reconstructing segmental bone loss during acetabular
revision. We studied 34 failed hip replacements in 34 patients that
were revised between October 2003 and March 2010 using a TM acetabular
shell and one or two augments. The mean age of the patients at the
time of surgery was 69.3 years (46 to 86) and the mean follow-up
was 64.5 months (27 to 107). In all, 18 patients had a minor column
defect, 14 had a major column defect, and two were associated with
pelvic discontinuity. The hip centre of rotation was restored in
27 patients (79.4%). The Oxford hip score increased from a mean
of 15.4 points (6 to 25) before revision to a mean of 37.7 (29 to
47) at the final follow-up. There were three aseptic loosenings
of the construct, two of them in the patients with pelvic discontinuity.
One septic loosening also occurred in a patient who had previously
had an infected hip replacement. The augments remained stable in
two of the failed hips. Whenever there was a loose acetabular component
in contact with a stable augment, progressive metal debris shedding
was evident on the serial radiographs. Complications included another
deep infection treated without revision surgery. Good clinical and
radiological results can be expected for bone-deficient acetabula
treated by a TM cup and augment, but for pelvic discontinuities
this might not be a reliable option. Cite this article:
Eighteen hip fusions were converted to total
hip replacements. A constrained acetabular liner was used in three hips.
Mean follow up was five years (two to 15). Two (11%) hips failed,
requiring revision surgery and two patients (11%) had injury to
the peroneal nerve. Heterotopic ossification developed in seven
(39%) hips, in one case resulting in joint ankylosis. No hips dislocated. Conversion of hip fusion to hip replacement carries an increased
risk of heterotopic ossification and neurological injury. We advise
prophylaxis against heterotropic ossification. When there is concern
about hip stability we suggest that the use of a constrained acetabular
liner is considered. Despite the potential for complications, this procedure
had a high success rate and was effective in restoring hip function.
Two-stage re-implantation after infection of Total Knee Arthroplasty (TKA), remains the gold standard to which other forms of treatment should be compared. The primary purpose of this study was to determine the rates of failure and functional outcome of two stage revision TKA for treatment of infection comparing cemented posterior stabilized compared to constrained condylar implants. The study group included 25 consecutive patients who had two stage revision TKA to treat infection with an average follow up of 3.25 1.5 years (range 2–6). In all patients the diagnosis of infection was made using standard serum parameters as well as aspiration for joint fluid analysis. Eight patients had posterior stabilized TKAs and 17 patients with had constrained condylar TKAs. Clinical evaluation included the Knee Society Knee Scores (KSKS) at each follow-up visit as well as a detailed record of any difficulties or complications.Purpose
Method
Infection following total knee arthroplasty is a devastating complication, requiring considerable effort on the part of the surgeon to eradicate the infection and restore joint function. Two-stage revision is the standard of care in the treatment of peri-prosthetic infection, using a temporary antibiotic-impregnated spacer between procedures. However, controversy remains concerning the use of static versus dynamic spacers, as well as the spacer material. The purpose of this study was to evaluate the clinical outcomes and complications of two-stage revision total knee arthroplasty in patients treated with a metal-on-polyethylene articulating spacer, as compared to those treated with a static antibiotic-impregnated cement spacer at the same centre. Twenty-seven knees in patients with a mean age of 65 years (range, 40 to 80 years) were treated with two-stage revision of an infected total knee arthroplasty using a metal-on-polyethylene dynamic prosthetic spacer fixed with antibiotic-impregnated cement. Clinical outcomes were evaluated using maximum active knee range of motion, as well as modified Knee Society knee scores and incidence of re-infection at a minimum one-year follow-up. The results were compared to those achieved at similar follow-up in 10 patients treated with a static cement spacer. Demographic profile as measured by age and gender, and pre-operative Knee Society scores and range of motion were similar between the two groups.Purpose
Method
A deficient abductor mechanism leads to significant morbidity and few studies have been published describing methods for reconstruction or repair. This study reports the reconstruction of hip abductor deficiency using human allograft. All patients were identified as having deficient abductor mechanisms following total hip arthroplasty through radiographic assessment, MRI, clinical examination and intra-operative exploration. All patients underwent hip abductor reconstruction using a variety of human allografts including proximal humeral, tensor fascia lata, quadriceps and patellar tendon. The type of allograft reconstruction used was customized to each patient, all being attached to proximal femur, allograft bone adjacent to host bone, with cerclage wires. If a mid-substance muscle rupture was identified an allograft tendon to host tendon reconstruction was performed.Introduction
Methods
Revision hip arthroplasty with massive proximal femoral bone loss remains challenging. Whilst several surgical techniques have been described, few have reported long term supporting data. A proximal femoral allograft (PFA) may be used to reconstitute bone stock in the multiply revised femur with segmental bone loss of greater than 8 cm. This study reports the outcome of largest case series of PFA used in revision hip arthroplasty. Data was prospectively collected from a consecutive series of 69 revision hip cases incorporating PFA and retrospective analyzed. Allografts of greater than 8 cm in length (average 14cm) implanted to replace deficient bone stock during revision hip surgery between 1984 and 2000 were included. The average age at surgery was 56 years (range 32–84) with a minimum follow up of 10 years and a mean of 15.8 years (range).Introduction
Methods
The literature indicates that the tibial component in total knee arthroplasty (TKA) should be placed in internal rotation not exceeding 18 to the line connecting the geometrical center of the proximal tibia and the middle of the tibial tuberosity. These landmarks may not be easily identifiable intraoperatively. Moreover, an angle of 18 is difficult to measure with the naked eye. The angle at the intersection of lines from the middle of the tibial tuberosity and from its medial border to the tibial geometric center was measured in 50 patients with normal tibia. The geometric center was determined on an axial CT slice at 10mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity. Similar measurements were performed in 25 patients after TKA in order to simulate the intra operative appearance of the tibia after making its proximal resection.Purpose
Method
We report the use of porous metal acetabular
revision shells in the treatment of contained bone loss. The outcomes of
53 patients with
Pelvic discontinuity with associated bone loss is a complex challenge in acetabular revision surgery. Reconstruction using ilio-ischial cages combined with trabecular metal acetabular components and morsellised bone (the component-cage technique) is a relatively new method of treatment. We reviewed a consecutive series of 26 cases of acetabular revision reconstructions in 24 patients with pelvic discontinuity who had been treated by the component-cage technique. The mean follow-up was 44.6 months (24 to 68). Failure was defined as migration of a component of >
5 mm. In 23 hips (88.5%) there was no clinical or radiological evidence of loosening at the last follow-up. The mean Harris hip score improved significantly from 46.6 points (29.5 to 68.5) to 76.6 points (55.5 to 92.0) at two years (p <
0.001). In three hips (11.5%) the construct had migrated at one year after operation. The complications included two dislocations, one infection and one partial palsy of the peroneal nerve. Our findings indicate that treatment of pelvic discontinuity using the component-cage construct is a reliable option.
The purpose of this study was to ascertain the radiographic results of the modified extended trochanteric sliding osteotomy (ETSO), performed by the senior author. The main feature of the ETSO is preservation of the posterior 1cm of greater trochanter and its attached external rotators. Results with this particular osteotomy for revision hip arthroplasty have not been previously reported. We reviewed forty-eight ETSOs in forty-six patients that underwent revision hip arthroplasty from March 2000 to March 2006. Nineteen osteotomies were for femoral revision alone, and twenty-nine osteotomies were performed for femoral and acetabular revision. All but six (12.5%) had cortical strut augmentation of the osteotomy. The length of the osteotomy, the length of distal fit, the number of wires used were recorded and their relation to union of the osteotomy and femoral stem loosening were investigated. The rate of ETSO union in this study was 91.3%. Four osteotomies were not united and this was associated with femoral stem subsidence and loosening requiring femoral stem revision in three cases. The rate of femoral stem loosening requiring revision was 8.3%. The length of the osteotomy did not correlate with femoral stem loosening, but a distal fit of less than 9cm was highly significant(p=0.001) with regards to loosening. The use of cortical struts was not protective against osteotomy non-union or femoral stem loosening. Osteotomy union was shown to be dependant on a well fixed (p<
0.0001) and stable stem (p<
0.0001). Three patients dislocated postoperatively (6.5%), and only one of these required revision surgery. The modified extended trochanteric osteotomy has a low rate of dislocation and a reliable rate of union. We have shown that a well fixed and stable stem is critical to successfully obtaining union of the osteotomy.
We reviewed and discussed the results of one hundred and fifty-five proximal femoral allografts for revision total hip replacement at an average of eleven years (range , five to twenty years).We looked at graft survivorship, functional results, radiographic assessment and complications. We concluded that this is an excellent technique for restoration of bone stock in the multiplied revised hip. To review the results of revision hip replacement with use of a proximal femoral allograft (PFA) to restore femoral bone stock. Between 1983 and 1998 a PFA – prosthetic composite was used to revise two hundred and twenty-seven hips in two hundred and ten patients. Of these two hundred and ten revisions involved an allograft longer than 8 cm. The average age of the patients at the time of revision was sixty-six years. The average number of previous total hip replacements was 2.2. Each patient was assigned a SF-12 score and a Short WOMAC Score. Radiographic assessment for trochanteric union, allograft-host union, component stability, graft fracture and resorption was performed. At an average of 11.2 years ( range, five to twenty years) after the revision, one hundred and eighty-five patients were alive, twenty-five patients had died and thirty were unavailable for follow-up. SF-12 and short WOMAC scores are still being calculated at the time of abstract submission. 4.4% of hips failed due to infection with 50% being successfully revised. Aseptic loosening of the construct occurred in 3.9% and 78% of these were revised at the time of follow-up. Nonunion of the allograft-host junction occurred in 4.8% and dislocation in 8.4%. Success was defined as a stable implant and no need for additional surgery at the time of follow-up. Success was noted in 84% of available cases. At an average of eleven years revision hip arthroplasties with a PFA are performing very well. This technique remains an excellent alternative when confronted with femoral bone loss in the revision hip setting.
This is a retrospective study of fifty nine hips in fourty nine patients with a previous total hip replacement for developmental dysplasia of the hip who underwent a revision arthroplasty of the hip. Fifty three patients were available for follow up. Radiographs and charts were reviewed and functional outcome scores were obtained in order to determine if a correlation existed between cup position and functional outcome and survivorship. Cup height was found to be a statistically significant predictor for functional outcome and cup survivorship. To determine if cup height, lateralization or angle are correlated with functional outcome or survivorship in revision total hip replacement (THR) in patients with a previous THR for developmental dysplasia of the hip (DDH). There is a paucity of literature correlating functional outcome with cup position in revision THR. Cup height was found to have a statistically significant (p<
0.05) correlation with Harris Hip, SF36, and WOMAC functional scores. High hip centers correlated with worse scores. In addition, patients with hip centers less than 3.5 cm above the radiographic tear drop had a statistically significant improvement in cup survivorship compared to those with higher hip centers. A retrospective investigation of forty-nine sequential patients (fifty-nine hips) previously diagnosed with DDH who underwent revision THR at our center between 1984 and 2000 was performed. Forty-three patients (fifty-three hips) were available for survivorship analysis and thirty-five patients (forty-five hips) were available for functional analysis. The mean follow up was one hundred and eighteen months (range 36–230). Three independent variables identified apriori as possible correlates were cup height, lateralization and angle as measured on the AP radiographs. Functional outcome measurement consisted of the Harris Hip, SF36 and WOMAC questionnaires. Linear regression analysis and Kaplan-Meier curves were used to determine if any of the variables correlated with functional outcome or survivorship. Restoration of hip center height to as close to the radiographic tear drop as possible improves functional outcome. Placement of the cup to within 3.5 cm of the tear drop improves cup survivorship.
Our aim was to determine if the height of the cup, lateralisation or the abduction angle correlated with functional outcome or survivorship in revision total hip replacement in patients with a previous diagnosis of developmental dysplasia of the hip. A retrospective investigation of 51 patients (63 hips) who had undergone revision total hip replacement was performed. The mean duration of follow-up was 119 months. Forty-one patients (52 hips) were available for both determination of functional outcome and survivorship analysis. Ten patients (11 hips) were only available for survivorship analysis. The height of the cup was found to have a statistically significant correlation with functional outcome and a high hip centre correlated with a worse outcome score. Patients with a hip centre of less than 3.5 cm above the anatomical level had a statistically better survivorship of the cup than those with centres higher than this. Restoration of the height of the centre of the hip to as near the anatomical position as possible improved functional outcome and survivorship of the cup.