Known risk factors for early periprosthetic femur fracture (PFF) following total hip arthroplasty (THA) include poor bone quality, surgical approach and cementless implants. The association between femoral component size and alignment and the risk of early PFF is not well described. We evaluated radiographic parameters of femoral component sizing and alignment as risk factors for early PFF. From 16,065 primary cementless THA, we identified 66 cases (0.41%) of early PFF (<90 days from index THA) at a single institution between 2016–2020. The stem was unstable and revised in all cases. We matched 60 cases of early PFFs (2:1) to 120 controls based on femoral component model, offset, surgical approach, age, BMI, and sex. Mean age was 67 years; 60% were female. Radiographic assessment of preoperative bone morphology and postoperative femoral component parameters including stem alignment, metaphyseal fill, and medial
Aims. The aim of this study was to report the long-term results of rotational acetabular osteotomy (RAO) for symptomatic hip dysplasia in patients aged younger than 21 years at the time of surgery. Patients and Methods. We evaluated 31 patients (37 hips) aged younger than 21 years at the time of surgery retrospectively. There were 29 female and two male patients. Their mean age at the time of surgery was 17.4 years (12 to 21). The mean follow-up was 17.9 years (7 to 30). The RAO was combined with a varus or valgus femoral osteotomy or a greater trochanteric displacement in eight hips, as instability or
The goal of periacetabular osteotomy (PAO) is to delay or prevent osteoarthritic development in dysplastic hips. However, it is unclear whether the surgical goals are achieved and if so in which patients. This information is essential to select appropriate patients for a durable PAO that achieves its goals. We therefore (1) determined hip survival rates; (2) determined how many preserved hips were functionally successful after PAO; and (3) identified demographic, clinical, and radiographic factors predicting failure after PAO. We reviewed 316 patients (401 hips) who had PAO. We evaluated radiographic parameters and obtained WOMAC scores. Through inquiry to the National Registry of Patients, we identified conversions to THA. Risk factors for conversion to THA were assessed. Mean followup was 8 years (range, 4–12 years). We conclude that PAO can be performed with a good outcome at medium to long term follow-up, suggesting that it may be applied by experienced surgeons with satisfactory results. To further improve the outcome, focus should be on the potential negative influence of parameters that are easily assessed, such as the patients age (>45) preoperative grade of osteoarthritis, incongruency, and severe acetabular dysplasia. Perioperatively, the surgeon should attempt to achieve hip
Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment.Aims
Methods
The hip’s capsular ligaments passively restrain extreme range of movement (ROM) by wrapping around the native femoral head/neck. We determined the effect of hip resurfacing arthroplasty (HRA), dual-mobility total hip arthroplasty (DM-THA), conventional THA, and surgical approach on ligament function. Eight paired cadaveric hip joints were skeletonized but retained the hip capsule. Capsular ROM restraint during controlled internal rotation (IR) and external rotation (ER) was measured before and after HRA, DM-THA, and conventional THA, with a posterior (right hips) and anterior capsulotomy (left hips).Aims
Materials and Methods
In many papers, the diagnosis of pincer-type
femoroacetabular impingement (FAI) is attributed to the presence
of coxa profunda. However, little is known about the prevalence
of coxa profunda in the general population and its clinical relevance. In order to ascertain its prevalence in asymptomatic subjects
and whether it is a reliable indicator of pincer-type FAI, we undertook
a cross-sectional study between July and December 2013. A total
of 226 subjects (452 hips) were initially screened. According to
strict inclusion criteria, 129 asymptomatic patients (257 hips)
were included in the study. The coxa profunda sign, the crossover
sign, the acetabular index (AI) and lateral centre–edge (LCE) angle were
measured on the radiographs. The median age of the patients was
36.5 years (28 to 50) and 138 (53.7%) were women. Coxa profunda was present in 199 hips (77.4%). There was a significantly
increased prevalence of coxa profunda in women (p <
0.05) and
a significant association between coxa profunda and female gender
(p <
0.001) (92% When the presence of all radiological signs in the same subject
was considered, pincer-type FAI was found in only two hips (one
subject). We therefore consider that the coxa profunda sign should
not be used as a radiological indicator of pincer-type FAI. We consider
profunda to be a benign alteration in the morphology of the hip
with low prevalence and a lack of association with other radiological
markers of FAI. We suggest that the diagnosis of pincer-type FAI
should be based on objective measures, in association with clinical
findings. Cite this article:
Several studies have reported the safety and efficacy of subcapital
re-alignment for patients with slipped capital femoral epiphysis
(SCFE) using surgical dislocation of the hip and an extended retinacular
flap. Instability of the hip and dislocation as a consequence of
this surgery has only recently gained attention. We discuss this
problem with some illustrative cases. We explored the literature on the possible pathophysiological
causes and surgical steps associated with the risk of post-operative
instability and articular damage. In addition, we describe supplementary
steps that could be used to avoid these problems.Aims
Materials and Methods
The aim of this study was to investigate the
incidence of dysplasia in the ‘normal’ contralateral hip in patients
with unilateral developmental dislocation of the hip (DDH) and to
evaluate the long-term prognosis of such hips. A total of 48 patients
(40 girls and eight boys) were treated for late-detected unilateral
DDH between 1958 and 1962. After preliminary skin traction, closed
reduction was achieved at a mean age of 17.8 months (4 to 65) in
all except one patient who needed open reduction. In 25 patients
early derotation femoral osteotomy of the contralateral hip had been
undertaken within three years of reduction, and later surgery in
ten patients. Radiographs taken during childhood and adulthood were
reviewed. The mean age of the patients was 50.9 years (43 to 55)
at the time of the latest radiological review. In all, eight patients (17%) developed dysplasia of the contralateral
hip, defined as a centre-edge (CE) angle <
20° during childhood
or at skeletal maturity. Six of these patients underwent surgery
to improve cover of the femoral head; the dysplasia improved in
two after varus femoral osteotomy and in two after an acetabular
shelf operation. During long-term follow-up the dysplasia deteriorated
to subluxation in two patients (CE angles 4° and 5°, respectively)
who both developed osteoarthritis (OA), and one of these underwent
total hip replacement at the age of 49 years. In conclusion, the long-term prognosis for the contralateral
hip was relatively good, as OA occurred in only two hips (4%) at
a mean follow-up of 50 years. Regular review of the ‘normal’ side
is indicated, and corrective surgery should be undertaken in those
who develop subluxation. Cite this article:
The term developmental dysplasia of the hip (DDH)
describes a spectrum of disorders that results in abnormal development
of the hip joint. If not treated successfully in childhood, these
patients may go on to develop hip symptoms and/or secondary osteoarthritis
in adulthood. In this review we describe the altered anatomy encountered
in adults with DDH along with the management options, and the challenges
associated with hip arthroscopy, osteotomies and arthroplasty for
the treatment of DDH in young adults. Cite this article:
The use of joint-preserving surgery of the hip
has been largely abandoned since the introduction of total hip replacement.
However, with the modification of such techniques as pelvic osteotomy,
and the introduction of intracapsular procedures such as surgical
hip dislocation and arthroscopy, previously unexpected options for
the surgical treatment of sequelae of childhood conditions, including
developmental dysplasia of the hip, slipped upper femoral epiphysis
and Perthes’ disease, have become available. Moreover, femoroacetabular
impingement has been identified as a significant aetiological factor
in the development of osteoarthritis in many hips previously considered to
suffer from primary osteoarthritis. As mechanical causes of degenerative joint disease are now recognised
earlier in the disease process, these techniques may be used to
decelerate or even prevent progression to osteoarthritis. We review
the recent development of these concepts and the associated surgical
techniques. Cite this article:
