The
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
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
Aims. In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the
The direct superior approach (DSA) is a modification of 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
Background. Instability is one of the most common complications after total hip arthroplasty (THA), particularly when using the
Aims. It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the
Introduction. The direct anterior approach (DAA) and 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
Objectives. Metal-on-metal hip resurfacing (MOMHR) is available as an alternative
option for younger, more active patients. There are failure modes
that are unique to MOMHR, which include loosening of the femoral
head and fractures of the femoral neck. Previous studies have speculated
that changes in the vascularity of the femoral head may contribute
to these failure modes. This study compares the survivorship between
the standard
We undertook a randomised controlled trial to
compare the piriformis-sparing approach with the standard
The aim of this cadaver study was to identify
the change in position of the sciatic nerve during arthroplasty
using the
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
Introduction. The Direct Anterior Approach (DAA) offers potential advantages of quicker rehabilitation compared to
Nerve injury is a rare complication of total hip replacement which may be related to the exposure used for the operation. The
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
In the UK, the
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