Introduction

Secondary osteoarthritis in a dysplastic hip is a surgical challenge. Severe leg length discrepancies and torsional deformities add to the problem of inadequate bony support available for the socket. Furthermore, many of these patients are young and wish to remain active, thereby jeopardising the long-term survival of any arthroplasty device.

For such severely dysplastic hips, the Birmingham Hip Resurfacing (BHR) device provides the option of a dysplasia component, a hydroxyapatite-coated porous uncemented socket with two lugs to engage neutralisation screws for supplementary fixation into the solid bone of the ilium more medially. The gap between the superolateral surface of the socket component and the false acetabulum is filled with impacted bone graft.

There is no consensus regarding the optimum frequency of ultrasound for monitoring the response to Pavlik harness (PH) treatment in developmental dysplasia of hip (DDH). The purpose of our study was to determine if a limited-frequency hip ultrasound (USS) assessment in children undergoing PH treatment for DDH had an adverse effect on treatment outcomes when compared to traditional comprehensive ultrasound monitoring. This study was a single-center non-inferiority randomized controlled trial. Children aged less than six months of age with dislocated, dislocatable and stable dysplastic hips undergoing a standardized treatment program with a PH were randomized, once stability had been achieved, to our current standard USS monitoring protocol (every clinic visit) or to a limited-frequency ultrasound protocol (USS only until hip stability and then end of treatment). Groups were compared based on alpha angle at the end of treatment, acetabular indices (AI) and IHDI grade on follow up radiographs at one-year post harness and complication rates. The premise was that if there were no differences in these outcomes, either protocol could be deemed safe and effective. One hundred patients were recruited to the study; after exclusions, 42 patients completed the standard protocol (SP) and 36 completed the limited protocol (LP). There was no significant difference between the mean age between both groups at follow up x-ray (SP: 17.8 months; LP: 16.6 months; p=0.26). There was no difference between the groups in mean alpha angle at the end of treatment (SP: 69°; LP: 68.1°: p=0.25). There was no significant difference in the mean right AI at follow up (SP: 23.1°; LP: 22.0°; p=0.26), nor on the left (SP:23.3°; LP 22.8°; p=0.59). All hips in both groups were IHDI grade 1 at follow up. The only complication was one femoral nerve palsy in the SP group. In addition, the LP group underwent a 60% reduction in USS use once stable. We found that once dysplastic or dislocated hips were reduced and stable on USS, a limited- frequency ultrasound protocol was not associated with an inferior complication or radiographic outcome profile compared to a standardized PH treatment pathway. Our study supports reducing the frequency of ultrasound assessment during PH treatment of hip dysplasia. Minimizing the need for expensive, time-consuming and in-person health care interventions is critical to reducing health care costs, improving patient experience and assists the move to remote care. Removing the need for USS assessment at every PH check will expand care to centers where USS is not routinely available and will facilitate the establishment of virtual care clinics where clinical examination may be performed remotely

Although physical and ultrasound (US)-based screening for congenital deformities of the hip (developmental dysplasia of the hip, or DDH) is routinely performed in most countries, one of the most commonly performed manoeuvres done under ultrasound observation - dynamic assessment - has been shown to be relatively unreliable and is associated with significant misdiagnosis rates, on the order of 29%. Our overall research objective is to develop a quantitative method of assessing hip instability, which we hope will standardise diagnosis across different raters and health-centres, and may perhaps improve reliability of diagnosis. To quantify dynamic assessment, we propose to use the variability in femoral head coverage (FHC) measurements within multiple US scans collected during a dynamic assessment. In every US scan, we use our recently-developed automatic FHC measuring tool which leverages phase symmetry features to approximate vertical cortex of ilium and a random forest classifier to identify approximate location of the femoral head. Having estimated FHC in each scan, we estimate the change in FHC across all the US scans during a dynamic assessment and compare this change with variability of FHC found in previous studies. Our findings - in a dynamic assessment on an infant done by an orthopaedic surgeon, the femoral centre moved by up to 19% of its diameter during distraction, from 55% FHC to 74% FHC. This variability is similar to the variability of FHC in static US scans reported in previous studies, so the variability in FHC readings we found are not indicative of any subluxation or dislocation of the infant's femoral head. Our clinician's qualitative assessment concluded the hip to be normal and not indicative of instability. This suggests that our technique likely has sufficient resolution and repeatability to quantify differences in laxity between stable and unstable hips, although this presumption will have to be confirmed in a subsequent study with additional subjects. The long-term significance of this approach to evaluating dynamic assessments may lie in increasing early diagnostic sensitivity in order to prevent dysplasia remaining undetected prior to manifesting itself in early adulthood joint disease

Introduction. Most Japanese patients who receive total hip arthroplasty (THA) are osteoarthritic and 70% have development dysplasia of the hip. Their stature is shorter than average and their sizes (acetabular cup and femoral stem) are smaller. The Taperloc Microplasty (BIOMET) is a short femoral stem. It was launched on July 2012 in Japan (extended on January 2013). It is essentially a shortened version of the Taperloc stem (35mm shorter than the standard stem). Objectives. We aimed to evaluate the outcomes of minimally invasive anterolateral THA using a short stem. Methods. We retrospectively reviewed all 56 patients who underwent THA at our hospitals between July 2013 and April 2015. Of these 28 (50%) were performed with short stems. The surgical approach was antero-lateral in the lateral position. The patients (4 men and 24 women) had a mean age at surgery of 66.5 years (range, 46–85 years). The original diseases were osteoarthritis (25 patients) and osteonecrosis (3 patients). We investigated the system type, size (cup, femoral head, and stem), radiological findings and complications (fracture, infection, deep vein thrombosis, and dislocation). Results. There were no severe complications, such as, infection, deep vein thrombosis, or dislocation. One patient had a femur fracture during operation and was switched to a standard stem. The mean surgery duration was 102 minutes (range, 80–142 minutes) and the mean amount of bleeding during surgery was 254 g (range, 95–720 g). Mean cup size was 51.0 mm (range, 48–60 mm) and stem size is 6 (range, 4–13). Radiological findings showed 2 patients had stem subsidence (within 5mm). One of them had severe osteoporosis and the other patient had leg length discrepancy. Conclusions. Minimally invasive anterolateral THA using a short femoral stem has good clinical and radiological results in Japanese patients. Long-term results should be further observed prospectively

Introduction. Torsional deformities are increasingly recognized as an additional factor in young patients with hip pain resulting from pincer- and cam-deformities. For example decreased femoral torsion can worsen an anterior Femoroacetabular impingement (FAI) conflict while an increased torsion can be beneficial with the same configuration. It is unknown how often torsional deformities are present in young patients presenting with hip pain that are eligible for joint preserving surgery. We questioned (1) what is the prevalence of a pathological femoral torsion in hips with FAI or hip dysplasia? (2) which hip disorders are associated with an abnormal torsion?. Methods. An IRB-approved retrospective study of 463 consecutive symptomatic FAI patients (538 hips) and a MRI or CT scan on which femoral torsion could be measured was performed (‘study group'). Out of 915 MRI we excluded 377 hips. The study group was divided into 11 groups: Dysplasia (< 22° LCE), retroversion, anteverted hips, overcoverage (LCE angle 36–39°), severe overcoverage (LCE>39°), cam (>50° alpha angle), mixed FAI, varus- (<125° CCD angle), valgus- (>139° CCD), Perthes-hips and hips with no obvious pathology. The ‘control group' of normal hips consisted of 35 patients (35 hips) without radiographic signs of osteoarthritis or hip pain wich was used for a previous study. Femoral antetorsion was measured according to Tönnis et al. as the angle between the axis of the femoral neck and the posterior axis of the femoral condyles. Normal femoral torsion was defined by Tönnis et al. as angles 10–25° while decreased resp. increased torsion was defined as <5° and >25°. Statistical analysis was performed using analysis of variances (ANOVA). Results. (1) Fifty-one percent of the patients of the study group presented with abnormal values for femoral torsion. Torsional deformities (<10° or >25°) were measured in 52% of all 538 hips eligible for joint preserving surgery. (2) Torsional deformities were present in 86% of Perthes hips, in 61 % of dysplastic hips, 52.3 % of hips with overcoverage, in 51% of mixed FAI, in 50% of varus hips, in 45% of valgus hips, in 45% of retroverted hips, in 47% of anteverted hips, in 43% of cam FAI, 35% of hips with severe overcoverage. No torsional deformity was present in the control group. Analysis of Variances (ANOVA) revealed significant differences (p<0.001) of torsion between normal hips (mean 17°) and hips with dysplasia (26°), valgus hips (27°), hips with no obvious pathology (30°) and Perthes hips (32°). Mean femoral torsion was in the normal range in the other groups. Conclusion. More than half of the patients wich are eligible for joint preserving surgery of the hip present with abnormal femoral torsion. In particular dysplastic-, valgus-, Perthes hips and hips with no obvious pathology had a significantly altered femoral torsion compared to normal hips. Femoral antetorsion should be measured in every patient eligible for hip-preserving surgery

Introduction. In the evaluation of patients with pre-arthritic hip disorders, making the correct diagnosis and identifying the underlying bone pathology is of upmost importance to achieve optimal patient outcomes. 3-dimensional imaging adds information for proper preoperative planning. CT scans have become the gold standard for this, but with the associated risk of radiation exposure to this generally younger patient cohort. Purpose. To determine if 3D-MR reconstructions of the hip can be used to accurately demonstrate femoral and acetabular morphology in the setting of femoroacetabular impingement (FAI) and development dysplasia of the hip (DDH) that is comparable to CT imaging. Materials and Methods. We performed a retrospective review of 14 consecutive patients with a diagnosis of FAI or DDH that underwent both CT and MRI scans of the same hip with 3D reconstructions. 2 fellowship trained musculoskeletal radiologists reviewed all scans, and a fellowship trained hip preservation surgeon separately reviewed scans for relevant surgical parameters. All were blinded to the patients' clinical history. The 3D reconstructions were evaluated by radiologists for the presence of a CAM lesion and acetabular retroversion, while the hip preservation surgeon also evaluated CAM extent using a clock face convention of a right hip, location of femoral head blood supply, and morphological anterior inferior iliac spine (AIIS) variant. The findings on the 3D CT reconstructions were considered the reference standard. Results. Of 14 patients, there were 9 females and 5 males with a mean age 32 (range 15–42). There was no difference in the ability of MRI to detect the presence of a CAM lesion (100% agreement between 3D-MR and 3D-CT, p=1), AIIS morphology (p=1, mode=type 1 variant), or acetabular retroversion (85.7%, p=0.5). 3D-MR had a sensitivity and specificity of 100 in detecting a CAM lesion relative to 3D-CT. Four CT studies were inadequate to adequately evaluate for presence of a CAM. Five CT studies were inadequate to evaluate for location of the femoral head vessels, while MRI was able to determine location in those patients. In the 10 remaining patients for presence of CAM, and nine patients for femoral head vessel location, there was no statistically significant difference between 3D-MR and 3D-CT in determining the location of CAM lesion on a clock face (p=0.8, mean MRI = 12:54, mean CT: 12:51, SD = 66 mins MR, 81 mins CT) or in determining vessel location (p=0.4, MR mean 11:23, CT mean 11:36, SD 33 mins for both). Conclusion. 3D MRI reconstructions are as accurate as 3D CT reconstructions in evaluating osseous morphology of the hip, and may be superior to CT in determining other certain clinically relevant hip parameters. 3D-MR was equally useful in determining the presence and extent of a CAM lesion, acetabular retroversion, and AIIS morphologic variant, and more useful than 3D CT in determining location of the femoral head vessels. In evaluating FAI or hip dysplasia, a 3D-MR study is sufficient to evaluate both soft tissue and osseous anatomy, sparing the need for a 3D CT scan and its associated radiation exposure and cost

Background. In total hip arthroplasty (THA), the importance of preserving muscle is widely recognized. It is important to preserve the short external rotator muscles because they contribute to joint stability and prevent postoperative dislocation. However, despite careful capsular release and femoral rasping, damage to the short external rotator muscles may occur. The Optymis Shot Stem preserves more bone and surrounding tissue than does a traditional primary stem. We investigated the usefulness of the stem in terms of the extent of preservation of the tendon attachment on the greater trochanter. Method. In this study, we enrolled 31 consecutive patients (39 hips; 6 males, 25 females) who underwent THA. Simultaneous bilateral THA was performed in 8 patients. The patients’ mean age was 56.1 years. Diagnoses included developmental dysplasia in 35 hips (Crowe group 1: 31 hips, group 2: 4 hips), and sequel of Perthes disease in 4 hips. All THAs were performed via the direct anterior approach without traction tables. The femoral procedure was performed with the hip hyperextended, and posterior capsular release was performed if the femoral procedure became technically difficult. We compared the following among patients: the operative time, intraoperative blood loss, length of hospital stay, rate of posterior capsular release, postoperative radiographic findings, WOMAC score before and after surgery, and any complications. Results. The mean operative time was 42.0 ± 8.9 min, the mean intraoperative blood loss was 308 ± 196 g, and the mean hospital stay was 6.7 ± 1.3 days. Posterior capsular release was performed in 17 hips [44%; 10 hips (32%) in Crowe group 1, 8 hips (88%) for other diagnoses]. The total WOMAC score improved significantly from 42.4 points preoperatively to 11.2 points at 3 months preoperatively. A postoperative stem subsidence ≥3 mm was observed in 1 hip (2.6%), whereas postoperative dislocation, intra- and postoperative periprosthetic fracture, and thigh pain were not observed. Conclusions. The Optymis Short Stem could be placed without performing posterior capsular release in 68% of patients with Crowe group 1 developmental dysplasia. We therefore consider the stem as useful for preserving the tendon attachment on the greater trochanter

Background. CT-based navigation system in total hip arthroplasty(THA) is widely used to achieve accurate implant placement. The purpose of this study was to evaluate the influence of initial error correction according to the differences in the shape of the acetabulum, and correction accuracy associated with operation approach after localization of registration points at anterior or posterior area of the acetabulum. Methods. We set the anterior pelvic plane(APP) as the reference plane, and defined the coordinates as follows: X-axis for external direction, Y-axis for anterior direction, and Z-axis for proximal direction. APP is defined by the anterior superior iliac spines and anterior border of the pubic symphysis. We made a bone model of bilateral acetabular dysplasia of the hip, after rotational acetabulum osteotomy(RAO) on one side, and performed registration using infrared-reflective markers. At first, we registered the initial error on navigation system, and calculated the accuracy of the error correction based on each shape of the acetabulum as we increased the surface matching points. Based on the actual operation approach, we also examined the accuracy of the error correction when concentrating the matching points in anterior or posterior areas of the acetabulum. Results. For the rotational acetabular osteotomy model, the range of possible initial error correction increased as the surface matching points increased on both X-axis and Y-axis: On the X-axis, the range increased from 6mm to 10mm as the surface matching point increased from 10 to 20; and on the Y-axis, the range increased from 2mm to 10mm as the point increased 10 to 50. The range did not increase on the Z-axis. For the acetabular dysplasia model, the range of possible initial error correction increased on the X-axis(the range increased from 2mm to 8mm as the point increased from 10 to 50); however, no increase was observed for the Y- and Z-axis. Furthermore, concentrating the surface matching points in the posterior area around the acetabulum was more effective for the correction of the initial rotational error. Discussion. Because of the different anatomical shapes of the acetabulum, the error directions that were difficult to correct tended to vary between dysplasia and post-RAO. The error correction of Z-axis was difficult on both shapes of the acetabulum. Thus, the careful initial setting on Z-axis is important to minimize the error. Surface matching point on the posterior part of the acetabulum is more effective in correcting the initial rotational error compared with the anterior part of the acetabulum. It was shown that the difference in the error correction was affected by the localization of the registration points around the acetabulum. We presumed that using surface matching points on posterior area of the acetabulum improves the accuracy of the CT-based navigation system on the anterior approach. When using the system, it is important to understand the tendency that the shape of the acetabulum and the localization of the surface matching points have influence on correction of the initial error

Incidence of Congenital talipes equino varus [CTEV] is 1 to 2 per 1000 birth, Out of all cases 20% cases are Non-idiopathic. The management of non-idiopathic CTEV, however, continues to be challenging due to Rigidity, Poor skin condition, Bony changes, Vascularity and Associated congenital abnormalities. In recent literature, short term results of Ponseti method for correction of non-idiopathic CTEV have been encouraging. As Ponseti method decreases the severity of deformity and hence decreases the need for extensive surgery. The aim of current study is to evaluate the results of Ponseti method in Non-idiopathic CTEV. Total 7 children below the age of one year with Non idiopathic clubfoot presented to us in the duration of 2013 to 2015 who were treated by us. The cases included are Streeters Dysplasia with congenital constriction rings 3, Arthrogryposis multiplex congenita with Developmental dysplasia of hip 2, Arthrogryposis multiple congenita spina Bifida 1, Pierre Robinson Syndrome with Ichthiosis 1. Initially all the patients treated with Ponseti casting technique and scoring was done using modified pirani scoring. At an average we could correct the foot from Pirani 7 to 2.5 with a relapse in 4 patients. 2 patients were treated again by Ponseti's method with success while treatment was discontinued in 2 feet. We recommended Ponseti's technique in Syndromic clubfoot as an non-surgical initial modality with good results given. The final outcome may depend more on the underlying condition than the CTEV

Revision total hip arthroplasty (THA) is a challenging scenario following complex primary THA for developmental dysplasia of hip (DDH). Our study envisages the long-term outcomes of revision DDH and the role of lateral structural support in socket fixation in these young patients who may require multiple revisions in their life-time. Hundred and eighteen consecutive cemented revision THAs with minimum follow up of 5 years following primary diagnosis of DDH operated between January 1974 and December 2012 were analysed for their clinical and radiological outcomes. The mean follow-up of 118 patients was 11.0 years (5.1–39.6 years). The Kaplan Mier survivorship at 11 years with end point as revision for any reason was 89.8% (CI 81.1–98.4). Of 118 revisions, 88 acetabular revisions were for aseptic loosening. Out of the acetabular revisions, 21 had pre-existing structural bone grafts from primary surgery, of which only 3 needed structural re-grafting during revision. Amongst the remaining 18 hips, the lateral support from the previous graft facilitated revision with no requirement of additional structural graft. Sixty-three hips did not have any form of grafting during primary operation. Amongst them, 35 had bone grafting in revision surgery (18 structural grafting). This study reports the largest number of revision THAs with primary diagnosis of DDH with the longest follow up. In our experience, the lateral support from the structural graft done in primary operation appears to have provided benefit in subsequent revision socket fixation

This case series highlights the use of the Ganz approach (trochanteric slide approach) and surgical dislocation for excision of fibrous dysplasia of the femoral neck, pigmented villonodular synovitis and synovial chondromatosis of the hip. The first patient was a 16-year-old girl, who presented with pain in her hip, having fallen whilst playing football. Investigations revealed a fibrous dysplasia, which was successfully excised returning her to an active lifestyle. The second patient was a 27-year-old lady, who presented having suffered left hip pain for four years. She was diagnosed with a pigmented villonodular synovitis, which was excised and the patient was able to return to the gym. The third patient was a 41-year-old lady, who presented after experiencing right hip pain both at night and at rest for a year, without any trauma. She was diagnosed with synovial chondromatosis and returned to all activities of daily living. The Ganz approach allows safe dislocation of the hip joint without the risk of osteonecrosis of the femoral head. We demonstrate that it is possible to obtain excellent exposure of the femoral neck, head and acetabulum to surgically treat these three tumours of the hip. The surgeon can thus be reassured that complete excision of the tumour has occurred. This series can recommend the Ganz approach with trochanteric slide and full surgical dislocation of the hip to excise pigmented villonodular synovitis, synovial chondromatosis and fibrous dysplasia of the hip

Introduction. Alumina-on-alumina in total hip replacement has been used for avoiding osteolysis and loosening. Published series report no ceramic wear and low rates for fractures and noises, but report poor results because of acetabular fixation failure. From 1999 to 2005, we used the “first generation” of a cementless cup, tri-radius relatively-smoothed HA coated (group 1), and from 2006 we have used a “second-generation” of this same cementless cup design with a macrotextured surface (group 2). We compare the perioperative conditions of two groups of patients using these two different cups and the clinical and radiological results. Material and Methods. We analysed 679 (612 patients) consecutive and non-selected primary cementless alumina-on-alumina prostheses. There were 342 hips in group 1 and 337 in group 2. The stem used for all patients in this series was the same and fitted with an Al2O3 liner and femoral head. The use of screws were according to the intraoperative stability of the cup (pull-out test). Patients’ mean age was 48.7+13.6 years and the average follow-up until revision or the last evaluation was 11.7 years for group 1 and 5.4 years for group 2. Results. Group 1, osteopenic and dysplastic acetabulae and women had a higher risk of screw use (p=0.004, p<0.001, p<0.001, p=0.011, respectively). Although the pre-operative clinical score was worse in group 2, the post-operative results were better (p<0.001).). No squeaking was found in any case. No alumina fractures occurred in this series. There was malseating of the liner in three hips, spontaneously resolved at six monthpostsurgery in all cases. No stem loosening, osteolysis or stress shielding were found in any case by the end of follow-up. Changes in linear femoral head penetration were not seen in any hip. There were 17 revised cups due to aseptic loosening, 15 were group 1 and two group 2. The probability of not having cup loosening was 93.3% (95% CI: 89.7 to 96.9) in group 1 and 97.5% (95% CI: 93.5 to 100) in group 2. Cup loosening was more frequent for severe congenital dysplasia of the hip (p<0.001) and in acetabular Dorr’ type C than in other types (p=0.0004). Of the hips revised for aseptic loosening, 6 were inside Lewinnek's safe zone versus 11 cups which was outside this zone (p<0.0001). Multivariate analysis showed that acetabular type C and cups outside Lewinnek´s safe zone had a higher risk for aseptic loosening (p<0.001, HR: 8.088, 95% CI 3.121–20.961; and p=0.003, HR: 5.128, 95% CI 1.773–14.829, respectively). Conclusions. Although the follow-up of this series is too short in the new Cerafit cup to allow definite conclusions, our data suggest that Cerafit alumina-on-alumina prostheses show excellent results after fifteen years. The macrotextured surface of the cup improved fixation compared to the early group Cup loosening was more frequent in severe congenital dysplasia, acetabular Dorr type C and in cups implanted outside of the Lewinnek's safe zone. Continued follow-up is required to determine if reduction in wear between the alumina-on alumina bearings results in less osteolysis, loosening, and late dislocations

Purpose. The purpose of the present study is to assess 5–10 years' follow-up results after acetabular impaction bone grafting (IBG) in primary cemented total hip arthroplasty (THA) for cases with acetabular bone defect. Patients and methods. We performed 36 primary cemented THA with acetabular IBG in 33 patients between November 2004 and May 2009. As one patient died due to unrelated disease at 6 months after the surgery, 35 hips of 32 patients were included in this study. The average age at the surgery was 62.4 years, and the average follow-up period was 7.9 years (5–10 years). Diagnoses were osteoarthritis due to acetabular dysplasia in 28 hips (26 patients), Rheumatoid arthritis (RA) in 4 hips (3 patients), rapidly destructive coxopathy (RDC) in 1 hip (1 patient), idiopathic acetabular protrusion in 1 hip (1 patient), and acromegaly in 1 hip (1 patient). For clinical assessment, the Merle d'Aubigné and Postel hip score was assessed and degree of post-operative improvement was classified according to their method as very great improvement, great improvement, fair improvement, and failure. Perioperative complications were also recorded. Acetabular bone defects were assessed at the surgery and categorized using AAOS acetabular bone defect classification system. For radiological assessment, anteroposterior radiographs of the bilateral hip joints were analyzed preoperatively and post-operatively. Radiolucent lines (RLL) of more than 2 mm around the acetabular components were assessed using the DeLee and Charnley zone classification. Acetabular component loosening was assessed according to the Hodgkinson et al. classification system, and type 3 (complete demarcation line) and type 4 (migration) were classified as “loosening”. Results. The mean Merle d'Aubigné and Postel hip score improved from 9.8 points before the operation to 15.9 points at the final follow-up. Degree of post-operative improvement was assessed as “very great” in 11 hips, “great” in 23 hips and “fair” in 1 hip. Dislocation, DVT, and infection were recorded in 1 hip, 1 hip, and 1 hip, respectively. Re-operation was performed for the acute infection (without loosening) case at 5.3 years after the primary THA. Acetabular bone defects were classified as segmental defect (AAOS type I) in 29 hips, cavitary defect (AAOS type II) in 3 hips and combined segmental and cavitary defect (AAOS type III) in 3 hips. Metal meshes were used for segmental defects of 29 AAOS type I hips and 2 AAOS type III hips, and for medial wall defect of 1 AAOS III hip. On radiographic assessment, no metal device breakage was detected during the follow-up period. There were no clear lines around the cup and all cups were assessed as stable at the final follow-up. Conclusion. Acetabular impaction bone grafting in primary cemented THA is technically demanding procedure. However, postoperative functional improvement is remarkable and stable radiographic findings were achievable independent from original diagnoses. This procedure is one of useful options to restore acetabular bone deficiency in cemented primary THA for cases with acetabular bone defect

Purpose. To evaluate the clinical and radiologic midterm results of rotational acetabular osteotomy (RAO) in incongruent hip joints. Material and Methods. A consecutive series of 15 hips in 14 patients who underwent RAO in incongruent hip joint were evaluated at an average follow-up of 52.3 months (range from 36 to 101 months). The average age at operation was 27 years (range from 12 to 38 years) old. The preoperative diagnoses were developmental dysplasia in 4 hips, sequelae of Legg-Calvé-Perthes disease in 8 hips, and multiple epiphyseal dysplasia in 3 hips. The RAO procedures were combined with a femoral valgus oseotomy in 10 hips, advance osteotomy of greater trochanter in 4 hips, derotational osteotomy in 2 hips. Clinically, Harris hip score, range of motion, leg length discrepancy(LLD) and hip joint pain were evaluated. Radiological changes of anterior and lateral center-edge(CE) angle, acetabular roof angle, acetabular head index(AHI), ratio of body weight moment arm to abductor moment arm, and a progression of osteoarthritis were analyzed. Results. The Harris hip score ha been improved from average from 67.5 points preoperatively to 97.6 points postoperatively. There have been no significant changes in the range of motion. The anterior CE angle increased from an average of 9.0°(-19.7□18.6°) to 32.5°(22.6□39.1°), the lateral CE angle from 7.6°(-12.1□14.1)° to 31.7°(26.5□37.8°) and the AHI from 61%(33□73%) to 86%(65□100%). The average ratio of body weight moment arm to abductor moment arm was changed 1.88 to 1.49. There was no case showing progression of osteoarthritis. None of the patients experienced revision surgery. Conclusion. The conventional salvage operation, such as Chiari osteotomy, has been recommended in incongruent hip. However, if we can expect to have a congruency after RAO with/without any femoral osteotomies, it would be a hopeful procedure for the incongruent joints by enhancing acetabular coverage, taking joint surface with normal articular cartilage, increasing abductor moment arm with additional improvement in LLD

Introduction. Acetabular dysplasia cause hip joint osteoarthritis(OA) by change hip mechanism. However, to our best knowledge, no studies have been published using prospectively collected data from asymptomatic young age volunteers, precise radiographic method. The purpose of this study is to evaluate the prevalence of hip dysplasia in asymptomatic Korean population as one of the most important risk factor of hip OA. Materials & Methods. From December 2014 to March 2015, we investigated prospectively collected retrospectively reviewed data of 200 asymptomatic volunteers 400 hips in age between 18 and 50 years recruited from our institution. Pelvic radiographs were taken and all radiographs were reviewed by 2 experienced orthopedic surgeons. Lateral center-edge angle(LCEA), Sharp angle, Tonnis angle and acetabular width-depth ratio were measured. We analyzed the statistical differences of these values between sex by Mann-Whitney U test and independent t-test. Pearson's correlation coefficient was used to measure the relationship between dysplasia parameters. Results. On the Pelvic AP view, 60 of the 400 hips (15%) were dysplastic hip as LCEA <20°. In 146 male hips, 17 hips (11.6%) were LCEA <20°. In 254 female hips, 43 hips(16.9%) were LCEA <20°. There was no strong correlation of LCEA with other measurements. Conclusion. There are large number of asymptomatic dysplastic hips in Asian population compared previously investigated

Introduction. Preoperative planning is an essential procedure for successful total hip arthroplasty. Many studies reported lower accuracy of two-dimensional analogue or digital templating for developmentally dysplastic hips (DDH). There have been few studies regarding the utility of three-dimensional (3D) templating for DDH. The aim of the present study is to assess the accuracy and reliability of 3D templating of cementless THA for hip dysplasia. Methods. We used 86 sets of 3D-CT data of 84 patients who underwent consecutive cementless THA using an anatomical stem and a rim-enlarged cup. There were six men and 78 women with the mean age of 58 years. The diagnosis was developmental dysplasia in 70 hips and osteonecrosis in 14 hips and primary osteoarthritis in 2 hips. There were 53 hips in Crowe group I, 11 hips in Crowe group II and 6 hips in Crowe group III. Each operator performed 3D templating prior surgery using a planning workstation of CT-based navigation system. Planned-versus-achieved accuracy was evaluated. The templating results were categorized as either exact size or +/− 1 size of implanted size. To assess the intra- and inter-planner reliabilities, 3D templating was performed by two authors blinded to surgery twice at an interval of one month. Kappa values were calculated. The accuracy and the intra- and inter-planner reliabilities were compared between the DDH group (70 hips) and the non DDH group (16 hips). Results. There was no significant difference in accuracy of component sizes between the DDH group and the non-DDH group. The accuracy of templating for cup sizes was 76 % for DDH and 75 % for non-DDH group (p=0.95). If accuracy was expanded to include all cups within one size of the implanted size, the accuracy was 97 % and 94 %, respectively (p=0.51). The accuracy of templating for stem sizes was 60 % for the DDH group and 75 % for the non-DDH group (p=0.27). The accuracy within 1 size was 99 % and 94 %, respectively (p=0.25). Regarding intra-planner reliability, mean kappa value for the cup size was 0.67 in the DDH group and 0.81 for the non-DDH group (p=0.18). Mean kappa value for the stem size was 0.64 in the DDH group and 0.79 for the non-DDH group (p=0.18). There were no significant differences in intra-planner reliability between the DDH and non-DDH group. Regarding inter-planner reliability for the cup size, mean kappa value was 0.33 in the DDH group and 0.37 in the non-DDH group (p=0.14). Mean kappa value for the stem size was 0.46 in the DDH group and 0.69 in the non-DDH group (p=0.07). There were no significant differences in inter-planner reliability between the DDH and non-DDH group. Conclusion. The 3D templating for cementless THA was accurate for hip dysplasia. Intra- and inter-planner reliabilities of the 3D templating were comparable with those of other primary diagnosis, while intra-planner reliability of cup sizes was fair regardless of diagnosis

Over the past fifteen years hip preservation surgery has rapidly evolved. Improved understanding of the pathomechanics and associated intra-articular degeneration of both hip instability and femoroacetabular impingement have led to improved surgical indications, refined surgical techniques and more effective joint preservation surgical procedures. The periacetabular osteotomy (PAO) was initially introduced by Ganz and colleagues and has become the preferred treatment in North America for pre-arthritic, symptomatic acetabular dysplasia. Both hip arthroscopy and safe surgical dislocation of the hip have been popularised for the treatment of symptomatic femoroacetabular impingement disorders. Hip arthroscopy is effective for focal and\or accessible impingement lesions while the surgical dislocation approach is reserved for nonfocal disease patterns as seen in complex FAI, and residual Perthes and SCFE deformities. Femoroacetabular impingement from major acetabular retroversion can be managed with the PAO if there is coexistent posterosuperior acetabular insufficiency. Short- to mid-term results of these procedures are generally good to excellent for most patients and the complication rates associated with these procedures are very acceptable. Long-term outcomes are best known for the PAO. Several recent studies have documented survivorship rates of 65–90% at 10–20-year follow-up. Certain factors are associated with long-term success including minimal pre-operative radiographic OA, early symptoms, accurate acetabular correction, and younger age. These data strongly suggest that the PAO can defer THA to an older age for most patients while completely avoiding arthroplasty may only be possible in select patients with excellent congruency, no secondary OA and an ideal surgical correction

Introduction. Dysplastic hip has not only deficiency of acetabulum but also femoral deformity. Therefore, selection of stem is important in cementless THA for dysplasia. Especially using of short stem should be challenge for deformed femur. We studied clinical performance and radiological findings after THA with triple tapered short stem (Optimys hip) for dysplastic hip. Materials and method. From May 2013, we performed cementless THA for osteoarthritis with dysplasia. Seventy-one hips of 67 patients were examined including four males and 63 females. Age at surgery was from 36 to 88 years old (61.7 in average). Surgical approach was used modified Watson-Jones in all hips. Clinical evaluation was used modified Harris hip score (MHSS), incidence of complications and thig pain. Radiological findings were evaluated according Engh's classification and grade of stress shielding. Follow-up period was minimum one year and was 21.3 months in average. Results. MHHS before surgery was 41 points and that at follow-up was 88 points in average and pain score was significantly improved. Calcar fracture during surgery occurred in two hips and circular wiring was performed. Deep infection, DVT and dislocation were not observed. Incidence of thigh pain was 1.4% of one hip. Radiological findings were assessed as bone in-grown in all of the hips and grade of stress-shielding was very low. There were no aseptic loosening and no revision for any reasons. Conclusions. Cementless THA with triple tapered short stem was useful for treatment of dysplastic hips. Radiological findings of all hip were assessed as bone in-grown

Management of the young adult hip pathologies is a special entity in orthopaedic surgical practice that needs special emphasis and consideration. A wide range of pathological and traumatic conditions occur in the young adult hip that lead to functional disability and the development of premature osteoarthritis. Proper surgical interference when the hip is still in the pre-arthritic stage restores function to the young hip and protects it from early degenerative changes, and hence the anticipated need for future joint replacement surgery is prevented. Accurate estimation of the biomechanical error combined with careful understanding of the hip joint biology is the cornerstone of success of any hip preservation surgery ever performed to save the young adult hip. Safe surgical hip dislocation approach was adopted as one of the tools in the hands of the hip preservation surgeon to treat a broad spectrum of intra-articular hip pathologies like Perthes disease and severe forms of slipped capital femoral epiphysis (SCFE). Osteo-chondroplasty at the head-neck junction with relative femoral neck lengthening for Perthes disease, and Subcapital re-orientation of severe SCFE based on its retinacular vascular pedicle are often performed via the surgical hip dislocation approach. The approach is also useful with certain types of acetabular fractures that enables fixation of dual-column fractures via single approach with intra-articular visualization for the accuracy of reduction and hardware placement. The 4 cm mini-open direct anterior approach is ideal for the surgical treatment of cases with cam and/or pincer types of femoro-acetabular impingement. Peri-articular osteotomies performed either on the acetabular or the femoral sides of the hip joint are extremely useful in the correction of the biomechanical error that led to an existing hip pathology. Periacetabular osteotomies are commonly performed to treat dysplasia of the young hip. Proximal femoral osteotomies are commonly performed to treat a wide range of hip pathologies including non-unions of femoral neck fractures in the young adult. Correction of the biomechanical error at the proper timing ensures normalization of the hip joint loading conditions and range of motion that leads to reversal of the pathologic process and prevention of osteoarthritis. A hip joint replacement would have an unknown but certainly a finite life, whereas a young hip that has healed after hip preservation surgery would definitely last for a lifetime

Introduction. Most metal-on-metal hip resurfacing implants currently being used worldwide utilize bone ingrowth fixation on the acetabular side, but cement fixation remains the standard method of fixation on the femoral side. Our hypothesis is that bone ingrowth fixation of a fully porous-coated component is superior to cement fixation of the femoral hip resurfacing component. Methods. From March 2007 to Jan 2009, 429 consecutive metal-on-metal hip resurfacing arthroplasties were performed by a single surgeon in 396 unselected patients using Biomet uncemented femoral and acetabular components. All of these were at least 5-years postop. Three patients died with causes unrelated to their hip arthroplasty. The three most common primary diagnoses were osteoarthritis in 318 (74%) cases, dysplasia in 66 (15%) hips, and osteonecrosis in 19 (4%) hips. The average size of the femoral component was 50 ± 4 cm. All pre-operative, intra-operative, and post-operative data were prospectively collected and entered into our database for review. All patients are allowed unrestricted activity including impact sports after 6 months. Results. Metal ion test results were available for 78% of patients. There were 14 (3.2%) failures identified at the time of this study. There were six (1.4%) early femoral failures (4 femoral neck fractures, 2 head collapses prior to 2 years), four loose acetabular components (one failed at 2 months postoperatively; three after 2 years), two (0.5%) adverse wear related failures (AWRF; metal ion levels ≥10 ug/L, AIA> 50. 0. , metalosis), one intertrochanteric fracture; and one failure due to subluxation. There were no cases of failure of femoral ingrowth or late femoral loosening. For the non-failed group, the average post-operative HHS score was 97±9 at their latest follow-up; the average UCLA Activity Score was 7±2. Survivorship was 96.7% at 5 years (all failures). Femoral survivorship was 98.4%. The AWRF rate was 0.5% at 5 years. No femoral failures occurred after one year postop up to 7 years. Conclusions. Bone ingrowth fixation with a fully porous femoral component in hip resurfacing remains highly durable beyond 5 years. Femoral ingrowth is more reliable than acetabular ingrowth. No cases of femoral loosening have been encountered up to 7 years post implantation. AWRF is rare (0.5% at 5 years) and is caused by acetabular component malposition