Periacetabular osteotomy (PAO) is an established treatment for
Total hip arthroplasty (THA) for congenital hip dysplasia (CDH) presents a challenge. In high-grade CDH, key surgical targets include cup placement in the anatomical position and leg length equality. Lengthening of more than 4 cm is associated with sciatic nerve injury, therefore shortening osteotomies are necessary. We present our experience of different shortening osteotomies including advantages and disadvantages of each technique. 89 hips, in 61 pts (28 bilateral cases), for high CDH were performed by a single surgeon from 1997 to 2022. 67 patients were female and 22 were male. Age ranged from 38 to 68 yrs. In all patients 5–8cm of leg length discrepancy (LLD) was present, requiring shortening femoral osteotomy. 12 patients underwent sequential proximal femoral resection with trochanteric osteotomy, 46 subtrochanteric, 6 midshaft, and 25 distal femoral osteotomies with simultaneous valgus correction were performed. All acetabular prostheses were placed in the true anatomical position. We used uncemented high porosity cups. Patients were followed up for a minimum of 12 months. All osteotomies healed uneventfully except 3 non-unions of the greater trochanter in the proximal femur resection group. No femoral shaft fractures in proximally based osteotomies. No significant LLD compared to the unaffected or reconstructed side. 2 patients suffered 3 and 5 degrees malrotation of the femur in the oblique sub-trochanteric group. 3 patients suffered transient sciatic nerve palsies. Shortening femoral osteotomies in the treatment of DDH are necessary to avoid injury to the sciatic nerve. In our series, we found transverse subtrochanteric osteotomies to be the most technically efficient, versatile and predictable in their clinical outcome, due to the ability to correct rotation and preserve the metaphyseal bone integrity, allowing for better initial stem stability. Distal femoral osteotomies allowed for controllable correction of valgus knee deformity.
The periacetabular osteotomy(PAO) is an effective common hip-preserving procedure to treat symptomatic acetabular dysplasia of the hip (DDH). The literature regarding truly long-term patient outcomes after PAO remains limited. We sought to evaluate our patient cohort treated by PAO 25 to 33 years ago to identify factors positively and negatively associated with durable therapeutic success. 219 dysplastic hips (183 patients) underwent PAO between August 1991 and December 1999 by a single surgeon. 164 hips in 134 patients were retrospectively evaluated at minimum of 25 years and maximum of 33 years post-operatively. Hips were evaluated using the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) postoperatively. Osteotomy failure was defined as WOMAC pain score of >/=10 or the need for total hip arthroplasty (THA). 7 patients (7 hips) had died - none of whom had THR. 142/176 remaining patients were located. All patients returned questionnaires; some were seen in person with images. Of patients analyzed to date, 109 hips (63%) were asymptomatic/mildly symptomatic with a preserved hip. 58 hips (33%) had undergone THA. 7 preserved hips (5%) were symptomatic (WOMAC>10). Patients with THA were slightly older than asymptomatic patients (54 ± 8 years vs. 50 ± 11 years; p=0.08), as they had been at time of PAO. Most patients were female (83%), with 89% of hip replacement patients being female. 4/58 replaced hips had been revised - 3 for instability and 1 for acetabular loosening. Data collection is ongoing as more patients are located and reviewed. Long-term follow-up of patients is challenging. Review after minimum of 25 years of the Boston cohort treated with PAO after minimum of 25 years dysplasia reveals that most at long-term follow-up report high levels of function, whether or not they had required arthroplasty, although 33% had required interim treatment with THA.
To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia. We reviewed patients with severe hip dysplasia, defined as Severin IVb or V (lateral centre-edge angle (LCEA) < 0°), who underwent TOA with a structural bone allograft between 1998 and 2019. A medical chart review was conducted to extract demographic data, complications related to the osteotomy, and modified Harris Hip Score (mHHS). Radiological parameters of hip dysplasia were measured on pre- and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan–Meier product-limited method, and a multivariate Cox proportional hazard model was used to identify predictors for failure.Aims
Methods
We compared a modular neck system with a non-modular system in a cementless anatomical total hip replacement (THR). Each group consisted of 74 hips with
To evaluate how abnormal proximal femoral anatomy affects different femoral version measurements in young patients with hip pain. First, femoral version was measured in 50 hips of symptomatic consecutively selected patients with hip pain (mean age 20 years (SD 6), 60% (n = 25) females) on preoperative CT scans using different measurement methods: Lee et al, Reikerås et al, Tomczak et al, and Murphy et al. Neck-shaft angle (NSA) and α angle were measured on coronal and radial CT images. Second, CT scans from three patients with femoral retroversion, normal femoral version, and anteversion were used to create 3D femur models, which were manipulated to generate models with different NSAs and different cam lesions, resulting in eight models per patient. Femoral version measurements were repeated on manipulated femora.Aims
Methods
The Patient-Reported Outcomes Measurement Information System (PROMIS) has demonstrated faster administration, lower burden of data capture and reduced floor and ceiling effects compared to traditional Patient Reported Outcomes Measurements (PROMs). We investigated the suitability of PROMIS Mobility score in assessing physical function in the sequelae of childhood hip disease. In all, 266 adolscents (aged ≥ 12 years) and adults were identified with a prior diagnosis of childhood hip disease (either Perthes’ disease (n = 232 (87.2%)) or Slipped Capital Femoral Epiphysis (n = 34 (12.8%)) with a mean age of 27.73 years (SD 12.24). Participants completed the PROMIS Mobility Computer Adaptive Test, the Non-Arthritic Hip Score (NAHS), EuroQol five-dimension five-level questionnaire, and the Numeric Pain Rating Scale. We investigated the correlation between the PROMIS Mobility and other tools to assess use in this population and any clustering of outcome scores.Aims
Methods
We report on the outcome of the Synergy cementless femoral stem
with a minimum follow-up of 15 years (15 to 17). A retrospective review was undertaken of a consecutive series
of 112 routine primary cementless total hip arthroplasties (THAs)
in 102 patients (112 hips). There were 60 female and 42 male patients
with a mean age of 61 years (18 to 82) at the time of surgery. A
total of 78 hips in the 69 patients remain Aims
Patients and Methods
Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed.Objective
Methods
Increasing follow-up identifies the outcome in younger patients who have undergone total hip replacement (THR) and reveals the true potential for survival of the prosthesis. We identified 28 patients (39 THRs) who had undergone cemented Charnley low friction arthroplasty between 1969 and 2001. Their mean age at operation was 17.9 years (12 to 19) and the maximum follow-up was 34 years. Two patients (4 THRs) were lost to follow-up, 13 (16 THRs) were revised at a mean period of 19.1 years (8 to 34) and 13 (19 THRs) continue to attend regular follow-up at a mean of 12.6 years (2.3 to 29). In this surviving group one acetabular component was radiologically loose and all femoral components were secure. In all the patients the diameter of the femoral head was 22.225 mm with Charnley femoral components used in 29 hips and C-stem femoral components in ten. In young patients who require THR the acetabular bone stock is generally a limiting factor for the size of the component. Excellent long-term results can be obtained with a cemented polyethylene acetabular component and a femoral head of small diameter.
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:
It has recently been reported that the transverse
acetabular ligament (TAL) is helpful in determining the position
of the acetabular component in total hip replacement (THR). In this
study we used a computer-assisted navigation system to determine
whether the TAL is useful as a landmark in THR. The study was carried
out in 121 consecutive patients undergoing primary THR (134 hips),
including 67 dysplastic hips (50%). There were 26 men (29 hips)
and 95 women (105 hips) with a mean age of 60.2 years (17 to 82)
at the time of operation. After identification of the TAL, its anteversion
was measured intra-operatively by aligning the inferomedial rim
of the trial acetabular component with the TAL using computer-assisted
navigation. The TAL was identified in 112 hips (83.6%). Intra-observer reproducibility
in the measurement of anteversion of the TAL was high, but inter-observer
reproducibility was moderate. Each surgeon was able to align the trial component according
to the target value of the angle of anteversion of the TAL, but
it was clear that methods may differ among surgeons. Of the measurements
of the angle of anteversion of the TAL, 5.4% (6 of 112 hips) were
outliers from the safe zone. In summary, we found that the TAL is useful as a landmark when
implanting the acetabular component within the safe zone in almost
all hips, and to prevent it being implanted in retroversion in all
hips, including dysplastic hips. However, as anteversion of the
TAL may be excessive in a few hips, it is advisable to pay attention
to individual variations, particularly in those with severe posterior
pelvic tilt. Cite this article:
We report a 12- to 15-year implant survival assessment
of a prospective single-surgeon series of Birmingham Hip Resurfacings
(BHRs). The earliest 1000 consecutive BHRs including 288 women (335
hips) and 598 men (665 hips) of all ages and diagnoses with no exclusions
were prospectively followed-up with postal questionnaires, of whom
the first 402 BHRs (350 patients) also had clinical and radiological
review. Mean follow-up was 13.7 years (12.3 to 15.3). In total, 59 patients
(68 hips) died 0.7 to 12.6 years following surgery from unrelated
causes. There were 38 revisions, 0.1 to 13.9 years (median 8.7)
following operation, including 17 femoral failures (1.7%) and seven
each of infections, soft-tissue reactions and other causes. With
revision for any reason as the end-point Kaplan–Meier survival analysis
showed 97.4% (95% confidence interval (CI) 96.9 to 97.9) and 95.8%
(95% CI 95.1 to 96.5) survival at ten and 15 years, respectively.
Radiological assessment showed 11 (3.5%) femoral and 13 (4.1%) acetabular
radiolucencies which were not deemed failures and one radiological
femoral failure (0.3%). Our study shows that the performance of the BHR continues to
be good at 12- to 15-year follow-up. Men have better implant survival
(98.0%; 95% CI 97.4 to 98.6) at 15 years than women (91.5%; 95%
CI 89.8 to 93.2), and women <
60 years (90.5%; 95% CI 88.3 to
92.7) fare worse than others. Hip dysplasia and osteonecrosis are
risk factors for failure. Patients under 50 years with osteoarthritis
fare best (99.4%; 95% CI 98.8 to 100 survival at 15 years), with
no failures in men in this group. Cite this article:
Down’s syndrome is associated with a number of
musculoskeletal abnormalities, some of which predispose patients
to early symptomatic arthritis of the hip. The purpose of the present
study was to review the general and hip-specific factors potentially
compromising total hip replacement (THR) in patients with Down’s
syndrome, as well as to summarise both the surgical techniques that
may anticipate the potential adverse impact of these factors and
the clinical results reported to date. A search of the literature
was performed, and the findings further informed by the authors’
clinical experience, as well as that of the hip replacement in Down
Syndrome study group. The general factors identified include a high
incidence of ligamentous laxity, as well as associated muscle hypotonia
and gait abnormalities. Hip-specific factors include: a high incidence
of hip dysplasia, as well as a number of other acetabular, femoral
and combined femoroacetabular anatomical variations. Four studies
encompassing 42 hips, which reported the clinical outcomes of THR
in patients with Down’s syndrome, were identified. All patients
were successfully treated with standard acetabular and femoral components.
The use of supplementary acetabular screw fixation to enhance component
stability was frequently reported. The use of constrained liners
to treat intra-operative instability occurred in eight hips. Survival
rates of between 81% and 100% at a mean follow-up of 105 months
(6 to 292) are encouraging. Overall, while THR in patients with
Down’s syndrome does present some unique challenges, the overall
clinical results are good, providing these patients with reliable
pain relief and good function. Cite this article:
We surveyed 343 young women with 420 total hip arthroplasties (THAs) regarding pregnancy and childbirth after THA. The mean age at surgery was 35 years (18 to 45). The mean length of follow-up after the initial arthroplasty was 16 years (6 to 27). Of these 343 women, 47 (13.7%) had a successful pregnancy after their primary THA. The first baby after a THA was delivered vaginally in 30 patients and by Caesarean section in 17. Of the 343 patients, 138 underwent a revision. For the entire series, the risk of revision at five years was 5%, at ten years 24%, and at 20 years 50%. After adjusting for age at surgical intervention, the risk of revision was not significantly associated with childbirth. Of the 47 patients who had a successful pregnancy, 28 (60%) noted an increase in pain in the hip during pregnancy and ten of these patients had persistent pain after their pregnancy. Seven patients complained of pain in the groin in the replaced hip after childbirth. At the time of this survey, five of these patients (70%) had had revision THA. Childbirth is not affected by the presence of a THA. Pregnancy after THA is not associated with decreased survival of the prosthesis. Pain in the hip is common during pregnancy in these patients. Pain in the groin which persists after delivery commonly leads to revision of the THA.