A variety of materials were used for early hip prostheses. The introduction of Vitallium by
Introduction. We perform PAO via a modified
The purpose of this study was to determine the complications after Bernese periacetabular osteomy (PAO) performed by one experienced surgeon using a minimally invasive modified
Periacetabular osteotomy is an effective way of treating symptomatic
hip dysplasia. We describe a new minimally invasive technique using
a modification of the Smith-Peterson approach. We performed a prospective, longitudinal cohort study to assess
for any compromise in acetabular correction when using this approach,
and to see if the procedure would have a higher complication rate
than that quoted in the literature for other approaches. We also
assessed for any improvement in functional outcome. From 168 consecutive patients (189 hips) who underwent acetabular
correction between March 2010 and March 2013 we excluded those who
had undergone previous pelvic surgery for DDH and those being treated
for acetabular retroversion. The remaining 151 patients (15 men,
136 women) (166 hips) had a mean age of 32 years (15 to 56) and the
mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90%
of cases were Tönnis grade 0 or 1. Functional outcomes were assessed
using the Non Arthritic Hip Score (NAHS), University of California,
Los Angeles (UCLA) and Tegner activity scores.Aims
Patients and Methods
The most effective surgical approach for total hip arthroplasty
(THA) remains controversial. The direct anterior approach may be
associated with a reduced risk of dislocation, faster recovery,
reduced pain and fewer surgical complications. This systematic review
aims to evaluate the current evidence for the use of this approach
in THA. Following the Cochrane collaboration, an extensive literature
search of PubMed, Medline, Embase and OvidSP was conducted. Randomised
controlled trials, comparative studies, and cohort studies were
included. Outcomes included the length of the incision, blood loss,
operating time, length of stay, complications, and gait analysis.Aims
Materials and Methods
The increasing desire to protect the periarticular structures led the need of a Tissue Sparing Surgery. The accesses most widely used are the direct-lateral approach and the postero-lateral one, both with patient in lateral decubitus. Aim: This accesses require however an incision of tendons and muscles even in their minimally invasive technique, so we looked for an approach that would wholly protect the periarticular structures and allow us not to revise our experience in patient positioning, preparation of the operating field and surgeon's position during surgery. Our intent was to leave the acquired knowledge unchanged and to preserve unaltered the anatomical landmarks that we had previously identified and consolidated for the correct positioning of the components. We have used this approach in more than 180 cases of primary hip arthroplasty. Clinical control includes: Oxford Hip Score, VAS and X-Ray.Background
Methods
This is the first time that the principle of the mouldâthe principle of guiding the repair of nature for the purpose of recreating a destroyed or damaged structure, has been applied to surgery. The evolution of the method to its present encouraging stage is the result of the co-operative, professional family spirit of the Massachusetts General Hospital. We all share in it. We share it with the general surgeon because of his contributions to surgical technique. We share it with the "medical man" because of his pre-operative and post-operative care of the patient; because of his guidance as to when, and when not, to operate; and because of the many friendly arguments which are productive of so much good. We share it with the anaesthetist because of his clinical judgment of the patient, his selection of anaesthetic agent, and his continuous, conscientious administration of the anaesthetic throughout the operation. I am going to change from "we" to "I." I owe so much to my assistants, from the first to the last: Bill Rogers, Eddie Cave, George Van Gorder, Paul Norton, Milton Thompson, Otto Aufranc, and Carroll Larson. I want to thank them all for helping to carry the load, for remembering the things that I forgot, and for making helpful suggestions which often led to improvement in surgical technique or to the construction of a useful instrument. I want to pay tribute to the staff of the Orthopaedic Service of the Massachusetts General Hospital and to thank its members for kindly scepticism, constructive criticism, and neverfailing loyal support. The subject of this lecture, "Evolution of Mould Arthroplasty of the Hip Joint," is appropriate for a Moynihan lecture. It is not the work of one man alone. It is the work of one man, supported by a co-operative, helpful, and friendly hospital staff. This is what Lord Moynihan strove so hard to bring about at a time when surgeons viewed one another as rivals. To quote Dr William Mayo: "It is to Lord Moynihan's everlasting credit that, largely as a result of his unceasing efforts, surgeons came to consider themselves as fellow-workers in a cause."
Complex spinal deformities can cause pain, neurological symptoms and imbalance (sagittal and/or coronal), severely impairing patients’ quality of life and causing disability. Their treatment has always represented a tough challenge: prior to the introduction of modern internal fixation systems, the only option was an arthrodesis to prevent worsening of the deformity. Then, the introduction of pedicle screws allowed the surgeons to perform powerful corrective manoeuvres, distributing forces over multiple levels, to which eventually associate osteotomies. In treating flexible coronal deformities, in-ternal fixation and corrective manoeuvres may be sufficient: the combination of high density pedicle screws and direct vertebral rotation revolutionized surgical treatment of scoliosis. However, spinal osteotomies are needed for correcting complex rigid deformities; the type of osteot-omy must be chosen according to the aetiology, type and apex of the deformity. When dealing with large radius deformities, spread over multiple levels and without fusion, multiple posterior column os-teotomies such as
Purpose: Fractures of the anterior acetabular wall with preservation of the pelvic inlet are rare. These lesions were not noted or classiþed by Judet and Letournel in their classiþcation system Ð Ç In fractures of the anterior wall, the anterior part of the articular horseshoe breaks off with a major portion of the middle segment of the anterior column È. The ilio-inguinal approach was recommended for the surgical treatment of these fractures. Method : We have encountered two cases involving purely the anterior wall with preservation of the pelvic inlet, rather than the anterior wall fracture described by Judet and Letournel. We have identiþed only two other cases in the international literature. The recognition that these fractures were not as that described by Judet and Letournel was essential, as an alternative surgical approach was necessary for reconstruction. The ilioinguinal approach of Judet and Letournel is the technique of choice in anterior fractures, but provides only very limited potential for intra-articular manipulation through the line of fracture. The
The Bernese periacetabular osteotomy (PAO) is a well-established procedure in the management of symptomatic hip dysplasia. The associated
Khan OH, Malviya A, Subramanian P, Agolley D, Witt JD Minimally invasive periacetabular osteotomy using a modified
Over the past years there has been considerable interest, debate and controversy over the role of surgical approaches for total hip replacements. The leading role belongs to appropriate direction and anatomical structures mobilization during surgical approach. We strictly follow the paradigm that surgical approach must enable gentle handling vessels, nerves, muscles and fascias structures create good viewing of target field with possibilities of free manipulations, give opportunity for widening at any level. This experimental study was performed to quantitatively comparesomethemostcommonlyusedsurgicalapproaches to hip joint. Kocher-Langenbeck,
Hyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and symptomatic osteoarthritis of the hip. The purpose of this study is to analyze the clinical and radiological long-term outcome of patients treated with osteochondral autograft transfer. To our knowledge, this study represents a series of osteochondral autograft transfer of the hip with the longest follow-up. We retrospectively evaluated 11 hips in 11 patients who underwent osteochondral autograft transfer in our institution between 1996 and 2012. The mean age at the time of surgery was 28.6 years (8 to 45). Outcome measurement included standardized scores and conventional radiographs. Kaplan-Meier survival curve was used to determine the failure of the procedures, with conversion to total hip arthroplasty (THA) defined as the endpoint.Aims
Methods
Improvement in coverage achieved by double or triple osteotomies is limited by the size of the acetabular fragment and the ligaments connected with the sacrum. Correction is achieved with the notable asymmetry of the pelvis. In periacetabular Ganz osteotomy (PAO) the acetabular fragment has no connection with the sacrum, which creates enormous possibilities for correction, leaving the pelvic ring untouched. The aim of the study is to present our experience and early results of using PAO in the treatment of hip dysplasia in adolescents and young adults who were previously treated operatively in childhood, and to find the technical and clinical impact of previous operations on our Results: In the years 1998–2005 262 periacetaubular osteotomies were performed in our hospital. All the patients were operated by one surgeon (JC). From this group 41 patients (43 hips) had previously been operated in childhood for the treatment of hip dysplasia. The previous treatment consisted of: open reduction in 10 hips, DVO in 14 hips, pelvic osteotomy (Salter, Dega, Chiari) in 8 hips, combined: open reduction+DVO+pelvic osteotomy in 10 hips, greater trochanter transfer in 3 hips, bone lengthening in 4 hips, acetabular cyst removal in 1 hip. The age at the primary operation ranged from 1–20.. The follow-up period ranged from 1–7,5 ys av. 2 ys. In 31 hips the
We aimed to assess the cumulative risk of total hip arthroplasty (THA) from in situ fixation for slipped capital femoral epiphysis (SCFE) after a follow-up of almost 50 years. In this study, 138 patients with 172 affected hips treated with in situ fixation were evaluated retrospectively. A total of 97 patients (70%) were male and the mean age was 13.6 years (SD 2.1); 35 patients (25%) had a bilateral disease. The median follow-up time was 49 years (interquartile range 43 to 55). Basic demographic, stability, and surgical details were obtained from patient records. Preoperative radiographs (slip angle; SA) were measured, and data on THA was gathered from the Finnish National Arthroplasty Register.Aims
Methods