We investigated the detailed anatomy of the gluteus
maximus, gluteus medius and gluteus minimus and their neurovascular
supply in 22 hips in 11 embalmed adult Caucasian human cadavers.
This led to the development of a surgical technique for an extended
posterior approach to the hip and pelvis that exposes the supra-acetabular
ilium and preserves the glutei during revision hip surgery. Proximal
to distal mobilisation of the gluteus medius from the posterior
gluteal line permits exposure and mobilisation of the superior gluteal
neurovascular bundle between the sciatic notch and the entrance
to the gluteus medius, enabling a wider exposure of the supra-acetabular
ilium. This technique was subsequently used in nine patients undergoing
revision total hip replacement involving the reconstruction of nine
Paprosky 3B acetabular defects, five of which had pelvic discontinuity.
Intra-operative electromyography showed that the innervation of
the
Aims. Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. Methods. Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and
Aims. In order to release the contracture band completely without damaging normal tissues (such as the sciatic nerve) in the surgical treatment of
After total hip replacement, force generating capacity of
Introduction and Objective. The human body is designed to walk in an efficient way. As energy can be stored in elastic structures, it is no surprise that the strongest elastic structure of the human body, the iliofemoral ligament (IFL), is located in the lower limb. Numerous popular surgical hip interventions, however, affect the structural integrity of the hip capsule and there is a growing evidence that surgical repair of the capsule improves the surgical outcome. Though, the exact contribution of the iliofemoral ligament in energy efficient hip function remains unelucidated. Therefore, the objective of this study was to evaluate the influence of the IFL on energy efficient ambulation. Materials and Methods. In order to assess the potential passive contribution of the IFL to energy efficient ambulation, we simulated walking using the large public dataset (n=50) from Schreiber in a the AnyBody musculoskeletal modeling environment with and without the inclusion of the IFL. The work required from the psoas, iliacus, sartorius, quadriceps and
Aims. The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells. Methods. HIPGEN is a multicentre, multinational, randomized, double-blind, placebo-controlled trial. A total of 240 patients aged 60 to 90 years with low-energy femoral neck fractures (FNF) will be allocated to two arms and receive an intramuscular injection of either 150 × 10. 6. PLX-PAD cells or placebo into the medial
The aim of the study was to evaluate radiological and clinical outcomes of surgical treatment of developmental dysplasia of the hip (DDH) with Periacetabular Osteotomy (PAO) and to determine the values of radiological parameters allowing us to obtain an optimal clinical result. Radiological evaluation included a standardized AP digital radiograph of the hip joints. Centre edge angle (CEA), medialization, distalization, femoral head coverage (FHC) and ilioischial angle were measured. Clinical evaluation based on HHS, WOMAC, Merle d'Aubigne-Postel scales and Hip Lag Sign. Radiological and clinical evaluation was performed preoperatively and approximately 12 months after the surgery. Statistically significant (p<0.05) differences in radiological measurements and all clinical scales have been observed pre- and postoperatively for all of the parameters. The results of PAO presented decreased medialization by 3.4mm (range: 3 to 3.7), distalization by 3.5mm (range: 3.2 to 3.8) and the ilioischial angle by 2.7° (range: 2.2 to 3.7). There was also an improvement in the femoral head bone coverage: CEA increased by 16.3° (range: 12.1˚ to 20.5˚) and FHC by 15.2% (range: 10.8 to 19.8). Clinically we observed an increase in HHS by 22 points (range: 15.8 to 28.2) and M. Postel d'Aubigne by 3.5 points (range: 2.0 to 4.4) and a decrease in WOMAC by 24% (range: 22.6 to 25.8). HLS improvement of
The direct anterior approach (DAA) is a popular minimally invasive approach for total hip arthroplasty (THA). It usually involves ligation of the lateral femoral circumflex artery's ascending branch (a-LFCA), which contributes to the perfusion of the tensor fasciae latae (TFL) muscle. Periarticular muscle status and clinical outcome were assessed after DAA-THA after a-LFCA preservation versus ligation. We evaluated surgical records of 161 patients undergoing DAA-THA with tentative preservation of the a-LFCA by the senior author between May and November 2021. Among 92 eligible patients, 33 (35 hips) featured successful preservation, of which 20 (22 hips, 13 female) participated in the study. From 59 patients with ligated a-LFCA, 26 (27 hips, 15 female) were enrolled, constituting the control group. MRI and clinical examinations were performed at 17–26 months to analyze volume and fatty infiltration of the TFL, gluteus medius and gluteus minimus muscles relative to the contralateral non-THA hip (15 preserved, 18 ligated). Clinical and radiographic data was retrospectively extracted from patient files. Patient-reported outcomes (PROMs) were added from the THA registry. There was a relative difference in TFL muscle volume of -6.27 cm. 3. (−9.89%, p=0.018) after a-LFCA preservation versus -8.6 cm. 3. (=11.62%, p=0.002) after ligation, without group differences (p>0.340). a-LFCA preservation showed lower relative TFL fatty infiltration (p=0.10).
The rate of arterial injury in trauma patients with pelvic ring fractures has been cited as high as 15%. Addressing this source of hemorrhage is essential in the management of these patients as mortality rates are reported as 50%. Percutaneous techniques to control arterial bleeding, such as embolization and REBOA, are being employed with increasing frequency due to their assumed lower morbidity and invasiveness than open exploration or cross clamping of the aorta. There are promising results with regards to the mortality benefits of angioembolization. However, there are concerns with regards to morbidity associated with embolization of the internal iliac vessels and its branches including surgical wound infection,
Introduction. Snapping hip syndrome is a common condition affecting 10% of the population. It is due to the advance of the iliotibial band (ITB) over the greater trochanter during lower limb movements and often associated with hip overuse, such as in athletic activities. Management is commonly conservative with physiotherapy or can be surgical to release the ITB. Here we carry out a systematic review into published surgical management and present a case report on an overlooked cause of paediatric snapping hip syndrome. Materials & Methods. A systematic review looking at published surgical management of snapping hip was performed according to PRISMA guidelines. PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Library databases were searched for “((Snapping hip OR Iliotibial band syndrome OR ITB syndrome) AND (Management OR treatment))”. Adult and paediatric published studies were included as few results were found on paediatric snapping hip alone. Results. 1548 studies were screened by 2 independent reviewers. 8 studies were included with a total of 134 cases, with an age range of 14–71 years. Surgical management ranged from arthroscopic, open or ultrasound guided release of the ITB, as well as
We report six cases of contralateral limb involvement during total hip arthroplasty including swelling of the
Minimally invasive surgery (MIS) for total hip arthroplasty and hemiarthroplasty is performed through anterior or anterolateral approach from April 2006. Appropriate stem insertion is often difficult by conventional approach. Retractor for MIS stem insertion is used from February 2007 and initial stem position is measured. Forty-four hemiarthroplasty and 20 total hip arthroplasty were performed from April 2006 until December 2007 with mean age of 79.7. Retractor for MIS stem insertion has been used for 36 hips from February 2007. Stem was cemented for more than 13mm at femoral isthmus. Stem position was measured in rentogenographs of hip after operation about adduction or abduction, extension or flexion, and anteversion of stem in proximal femur. The average abduction/adduction was 1.75 degree abduction in conventional method and 1.38 degree abduction from February 2007. The average extension/flexion was 1.10 degree flexion in conventional method and 0.25 degree flexion from February 2007. The average anteversion was 30.3 degree in conventional method and 28.4 degree from February 2007. Two cases in conventional method and one case from February 2007 complicated femoral fracture during operation. In conventional method, cement cap in one case was undersized and proximal major trochanteric fracture was happened in one case. Ectopic ossification at medial
Purpose: More and more younger patients needs primary hip replacement. Specially for these patients the so called calcar prosthesis have been enveloped; short ste ms with fixation, bone incrow and loading only in the proximal parts of the femur. Using these type of prosthesis in cases of primary operation, later on in cases of first revision the so called standard prosthesis can be used. Materials and methods: We have experience with more than 500 calcar prosthesis type MAYO in the last 4 years. The indication for operation in these group of patients is different to the older patients group; the younger patients needs hip replacement because of rheumatic diseases, dysplasia or femoral head necrosis. The mean age of these patients is below 50 years. The implantations have been done by an modified anterolateral Watson Jones approach. Especially for the use of the MAYO stem we developed a minimal invasive operation technique to provide any trauma to the
Purpose: Among 80 surgical treatments for acetabular fracture, the Dana Mears approach was used in 15. The purpose of this study was to analyse functional and radiological outcome of these fractures at a mean follow-up of 41 months. Material and methods: The AO classification was used for fractures of the acetabulum : 12 class B (80%) with five B1a2 five B2a1 and two B1a1, and three class C (20%). There was one deformed callus (B1a2) at 120 days Two patients had associated pelvic injuries, eight a hip dislocation, and two an initial sciatic palsy. There were also two osteochondral fractures of the femoral head. The Dana Mears approach was modified slightly in the anterior part passing in front of the tensor muscle to preserve innervation. The
The direct lateral (or anterolateral) approaches to the hip for revision THA involve detachment of the anterior aspect of the gluteus medius from the trochanter along with a contiguous sleeve of the vastus lateralis. Anterior retraction of this flap of gluteus medius and vastus lateralis and simultaneous posterior retraction of the femur creates an interval for division of gluteus minimus and deeper capsular tissues and exposure of the joint. To enhance reattachment of this flap of the anterior portion of the gluteus medius and vastus lateralis back to the trochanter, an oblique wafer of bone can be elevated along with the muscle off of the anterolateral portion of the trochanter. This bony wafer prevents suture pull out when large nonabsorbable sutures are used around or through the fragment and passed into the bone of the trochanteric bed for reattachment during closure. To prevent excessive splitting proximally into the gluteus medius muscle (and resulting damage to the superior gluteal nerve), it is often helpful to extend the muscle split further distally down into the vastus lateralis. This combined with careful elevation of the
Anterior surgical approaches for total hip arthroplasty (THA) have increased popularity due to expected faster recovery and less pain. However, the direct anterior approach (Heuter approach which has been popularised by Matta) has been associated with a higher rate of early revisions than other approaches due to femoral component loosening and fractures. It is also noted to have a long learning curve and other unique complications like anterior femoral cutaneous and femoral nerve injuries. Most surgeons performing this approach will require the use of an expensive special operating table. An alternative to the direct anterior approach is the anterior-based muscle-sparing approach. It is also known as the modified Watson-Jones approach, anterolateral muscle-sparing approach, minimally invasive anterolateral approach and the Röttinger approach. With this technique, the hip joint is approached through the muscle interval between the tensor fascia lata and the
My goal for every patient undergoing THA is to achieve a perfect result. At the very least this includes no pain at any time, normal range of motion, normal functionality and a minimal chance of a second operation. Both the Posterolateral Approach (PLA) and the Direct Anterior Approach (DAA) have the capability of achieving these important goals. However, when you dive deeper into the goal of a “perfect” THA, some differences between the approaches become apparent. These include less muscle damage, faster recovery, and no restrictions at any time with the DAA as opposed to the PLA. Also there is some evidence of better wound healing (Poehling) and less chance of thromboembolic disease with the DAA (Stryker). The PLA violates all posterior structures of the hip joint, and specifically also goes through the gluteus maximus muscle. Done properly, the DAA spares all the
1. The indications for and technique of posterior iliopsoas transplantation are described with particular reference to paralytic dislocation and subluxation of the hip in children. 2. Experience of 150 operations in ninety-five patients and of the long-term results of forty-one operations are given. 3. Reduction of the dislocation has been maintained in every case even when there was complete paralysis of all
Introduction. Recently, oxidative stress has been implicated in the development of osteonecrosis. Here we focused on vitamins with marked antioxidant potency to see whether their use might prevent the development of osteonecrosis associated with corticosteroid administration. Methods. Fifteen male Japanese white rabbits weighing about 3.5 kg were injected once into the right
Massive proximal femoral bone loss can be a complex problem, despite various modern technical and implant solutions. Due to inadequate bone stock and missing proximal fixation possibilities, including larger segmental osseous defects, the use of a mega prosthesis might become necessary. Coverage of the segmental bone loss in combination with distal fixation, can be achieved in either cemented or non-cemented techniques. Some implant types allow for additional fixation of the
