Aims. The aim of this randomized trial was to compare the functional outcome of two different surgical approaches to the hip in patients with a femoral neck fracture treated with a hemiarthroplasty. Patients and Methods. A total of 150 patients who were treated between February 2014 and July 2017 were included. Patients were allocated to undergo hemiarthroplasty using either an anterolateral or a direct lateral approach, and were followed for 12 months. The mean age of the patients was 81 years (69 to 90), and 109 were women (73%). Functional outcome measures, assessed by a physiotherapist blinded to allocation, and patient-reported outcome measures (PROMs) were collected postoperatively at three and 12 months. Results. A total of 11 patients in the direct lateral group had a positive
Background. Greater trochanteric pain syndrome (GTPS) is a common problem affecting 10–25% of the population. Physiotherapy, anti-inflammatories, corticosteroid injections and surgery have all been described in the management of GTPS, all with limited, temporal success. Extracorporeal shockwave therapy (ESWT) has been proposed as a potential management option for this difficult presentation. Method. We ran a prospective, 2 arm, single blinded, randomised control trial comparing focused shockwave therapy to an ultrasound guided corticosteroid injection. The primary outcome measure was the visual analogue pain score. Secondary outcome measures included the Harris hip score and
Complete or nearly complete disruption of the attachment of the gluteus is seen in 10–20% of cases at the time of THA. Special attention is needed to identify the lesion at the time of surgery because the avulsion often is visible only after a thickened hypertrophic trochanteric bursa is removed. From 1/1/09 to 12/31/13, 525 primary hip replacements were performed by a single surgeon. After all total hip components were implanted, the greater trochanteric bursa was removed, and the gluteus medius and minimus attachments to the greater trochanter were visualised and palpated. Ninety-five hips (95 patients) were found to have damage to the muscle attachments to bone. Fifty-four hips had mild damage consisting of splits in the tendon, but no frank avulsion of abductor tendon from their bone attachments. None of these cases had severe atrophy of the abductor muscles, but all had partial fatty infiltration. All hips with this mild lesion had repair of the tendons with #5 Ticron sutures to repair the tendon bundles together, and drill holes through bone to anchor the repair to the greater trochanter. Forty-one hips had severe damage with complete or nearly complete avulsion of the gluteus medius and minimus muscles from their attachments to the greater trochanter. Thirty-five of these hips had partial fatty infiltration of the abductor muscles, but all responded to electrical stimulation. The surface of the greater trochanter was denuded of soft tissue with a rongeur, the muscles were repaired with five-seven #5 Ticron mattress sutures passed through drill holes in the greater trochanter, and a gluteus maximus flap was transferred to the posterior third of the greater trochanter and sutured under the vastus lateralis. Six hips had complete detachment of the gluteus medius and minimus muscles, severe atrophy of the muscles, and poor response of the muscles to electrical stimulation. The gluteus medius and minimus muscles were sutured to the greater trochanter, and gluteus maximus flap was transferred as in the group with functioning gluteus medius and minimus muscles. Postoperatively, patients were instructed to protect the hip for 8 weeks, then abductor exercises were started. The normal hips all had negative
Introduction. Complete or nearly complete disruption of the gluteus attachment is seen in 10–20% of cases at the time of total hip arthroplasty (THA). Special attention is needed to identify the lesion at the time of surgery because the avulsion often is visible only after a thickened hypertrophic trochanteric bursa is removed. The purpose of this study was to evaluate a technique designed to restore abductor function by transferring the gluteus maximus to compensate for the deficient medius and minimus muscles. Methods. From Jan 1 2009 to Dec 31 2013, 525 primary THAs were performed by the author. After the components were implanted, the greater trochanteric bursa was removed, and the gluteus medius and minimus attachments to the greater trochanter were visualized and palpated. Ninety-five hips (95 patients) were found to have damaged muscle attachments to bone. Fifty-four hips had mild damage consisting of splits in the tendon, but no frank avulsion of abductor tendon from the bone attachment. None had severe atrophy of the abductor muscles, but all had partial fatty infiltration. All hips with this mild lesion had repair of the tendons with #5 Ticron sutures to repair the tendon bundles together, anchored to the greater trochanter. Forty-one hips had severe damage with complete or nearly complete avulsion of the gluteus medius and minimus muscles from their attachments to the greater trochanter. Thirty-five of these hips had partial fatty infiltration of the abductor muscles, but all responded to electrical stimulation. The surface of the greater trochanter was denuded of soft tissue with a rongeur, the muscles were repaired with five-seven #5 Ticron mattress sutures passed through drill holes in the greater trochanter, and a gluteus maximus flap was transferred to the posterior third of the greater trochanter and sutured under the vastus lateralis. Six hips had complete detachment of the gluteus medius and minimus muscles, severe atrophy of the muscles, and poor response of the muscles to electrical stimulation. The gluteus medius and minimus muscles were sutured to the greater trochanter, and the gluteus maximus flap was transferred. Postoperatively, patients were instructed to protect the hip for 8 weeks, then abductor exercises were started. Results. The normal hips all had negative
Purpose: Kotz osteotomy (polygonal pelvic osteotomy) is performed for hip dysplasia especially with deficient acetabular coverage . One of the important problems of this osteotomy is Trendelenburg limping due to detachment of abductor muscles from their origin at the iliac bone during the surgical approach. In order to solve this problem, the surgical approach of Kotz osteotomy was modified and iliac osteotomy was made from the medial side of iliac bone instead of lateral side without detaching the abductor muscles and two skin incision were used instead of three skin incisions. We present the results of nine hips in seven patients who were operated using this modified surgical approach. Materials and Methods: In this study, CE angle, VCE angle, Sharp angle, Harris hip score,
We studied prospectively 81 consecutive patients undergoing hip surgery using the Hardinge (1982) approach. The abductor muscles of the hip in these patients were assessed electrophysiologically and clinically by the modified
Traditional risk factors for post-operative neuropathy include learning curve of surgical approach, DDH, and significant leg lengthening (>1 inch). Despite these risk factors, the most common scenario of a neuropathy is in a routine THA, by an experienced surgeon, for osteoarthritis, with no leg lengthening. Post-operative hematoma can lead to nerve compression, albeit rarely. The usual clinical presentation is of an acute event, with a previously intact nerve, sometime within the first days of surgery. Once diagnosed, immediate surgical decompression should be performed. Sciatic neuropathy is the most common, regardless of surgical approach, but the posterior approach poses the highest risk. Routine gluteus maximus tendon release may help to reduce the risk. When seen in the PACU, our approach is to immediately perform CT imaging to evaluate nerve integrity or to check on acetabular screw position. If no underlying cause is identified, the patient will be managed conservatively with foot orthotics and monitored for recovery. Femoral nerve palsy (FNP) can result in significant initial disability. Fortunately most patients recover function (although it can take over 18 months). In the early post-operative period it is often diagnosed after a patient complains of the leg giving away while attempting to walk. A knee brace will assist the patient with mobilization while the nerve recovers. The highest incidence of FNP is described for the direct lateral approach. Superior gluteal nerve (SGN) palsy is related to the direct lateral approach and may be avoided if the gluteus medius split is made within the safe zone (<5 centimeters from the tip of the greater trochanter). While early post-operative limp is common after the direct lateral approach, the true reported incidence of SGN palsy is low. Few studies showed that the persistent positive
Electromyographic and clinical studies were performed on patients undergoing total hip replacement by the modified direct lateral (29 hips), the direct lateral (29 hips) and the posterior approaches (21 hips). Assessments were made three months after operation. The
Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient’s functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Eligible studies of THA patients that conducted at least one type of objective functional assessment both pre- and postoperatively were identified through Embase, Medline/PubMed, and Cochrane Central database-searching from inception to 15 September 2023. The assessments included were subgrouped for analysis: gait analysis, motion analysis, wearables, and strength tests.Aims
Methods
Introduction. 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. Methods. 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. Results. Allograft reconstruction was performed in 15 patients over 18 months. One patient had an abductor deficiency after a primary total hip. All patients had an abductor lurch gait and positive
Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphism who undergo orthopaedic interventions involving the lower limbs. A PROSPERO-registered systematic literature review was performed following PRISMA guidelines. All relevant studies published until January 2023 were identified. Individual outcomes and outcome measurement tools were extracted verbatim. The measurement tools were assessed for reliability and validity, and all outcomes were grouped according to the Outcome Measures Recommended for use in Randomized Clinical Trials (OMERACT) filters.Aims
Methods
Introduction: The anterior and anterolateral approach to the hip traditionally are well described exposures in primary hip arthroplasty with fewer dislocations than the posterior approach. A very debilitating complication associated with the anterolateral approach however is the persistent limp and positive Trendelenburg sign. We discuss our results with respect to abductor function and morphological integrity seen on MRI when using an approach in which we preserve the majority of gluteus medius. Methods: We carried out a prospective study of thirty-nine consecutive total hip replacements performed through a gluteus medius sparing anterolateral approach. The same hip surgeon performed all these between April and October 2004. Gait analysis and
Introduction: To ascertain the optimal functional abductor moment arm of the hip for THA, we focused on the Trendelenburg sign. We investigate the various conditions associated with abductor moment arm to achieve a negative Trendelenburg sign postoperatively. Methods: We reviewed 30 patients (34 uncemented primary THAs; mean age, 56 years) at a minimum of two years postoperatively. The tilting angle of the pelvis while performing the
Purpose: To evaluate the benefits of standardization on the reliability of the physical examination of the hip by rheumatologists and orthopaedic surgeons. Methods: Six subjects with mild to severe hip osteoarthritis (OA) were examined by 6 examiners (4 rheumatologists, 2 orthopedic surgeons) experienced in the assessment of hip OA using a 6x6 Latin square design. Subjects were examined, followed by a standardization meeting and, a day later, by post-standardization examinations. 33 hip examination maneuvers were evaluated, including range of motion, pain, tenderness, muscle strength, leg length and gait. The order of examinations was randomized for each examiner. For dichotomous signs, agreement was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK). Ordinal and continuous variables were analyzed by ANOVA, using the proportion of variance due to rheumatologists to calculate a reliability coefficient (Rc). Results: Subjects’ mean age was 61 years (range 49–65), mean BMI was 24 (range 21–30), mean WOMAC pain on walking was 52 mm (range 21–81mm). 23/33 (70%) hip examinations were reliable after standardization. Two new items resulted from the standardization meeting. Pre-/post-standardization reliability for select hip examinations using PABAK were as follows: Gait 0.06/0.52; pain on internal rotation 0.60/0.52; pain on external rotation 0.24/0.72; pain on flexion 0.46/0.82; Patrick test for hip pain 0.78/0.80; Thomas test 0.60/0.88;
Instability is a common indication for revision total hip arthroplasty (THA). However, even after the initial revision, some patients continue to have recurrent dislocation. The aim of this study was to assess the risk for recurrent dislocation after revision THA for instability. Between 2009 and 2019, 163 patients underwent revision THA for instability at Stanford University Medical Center. Of these, 33 (20.2%) required re-revision due to recurrent dislocation. Cox proportional hazard models, with death and re-revision surgery for periprosthetic infection as competing events, were used to analyze the risk factors, including the size and alignment of the components. Paired Aims
Methods
The gluteus minimus (GMin) and gluteus medius (GMed) have unique structural and functional segments that may be affected to varying degrees, by end-stage osteoarthritis (OA) and normal ageing. We used data from patients with end-stage OA and matched healthy controls to 1) quantify the atrophy of the GMin and GMed in the two groups and 2) describe the distinct patterns of the fatty infiltration in the different segments of the GMin and GMed in the two groups. A total of 39 patients with end-stage OA and 12 age- and sex frequency-matched healthy controls were prospectively enrolled in the study. Fatty infiltration within the different segments of the GMin and the GMed was assessed on MRI according to the semiquantitative classification system of Goutallier and normalized cross-sectional areas were measured.Aims
Methods
The aims of this study were to assess the exposure and preservation of the abductor mechanism during primary total hip arthroplasty (THA) using the posterior approach, and to evaluate gluteus maximus transfer to restore abductor function of chronically avulsed gluteus medius and minimus. A total of 519 patients (525 hips) underwent primary THA using the posterior approach, between 2009 and 2013. The patients were reviewed preoperatively and at two and five years postoperatively. Three patients had mild acute laceration of the gluteus medius caused by retraction. A total of 54 patients had mild chronic damage to the tendon (not caused by exposure), which was repaired with sutures through drill holes in the greater trochanter. A total of 41 patients had severe damage with major avulsion of the gluteus medius and minimus muscles, which was repaired with sutures through bone and a gluteus maximus flap transfer to the greater trochanter.Aims
Patients and Methods