The challenges faced by hip surgeons have changed over the last decade. Historically, fixation, polyethylene wear, osteolysis, loosening and failure to osseointegrate dominated the discussions at
When removing femoral cement in revision
The challenges faced by hip surgeons have changed over the last decade. Historically, fixation, polyethylene wear, osteolysis, loosening and failure to osseointegrate dominated the discussions at
Background. Revision total hip arthroplasty is a technically demanding procedure and especially removing a well fixed femoral stem is a challenge for revision surgeons. There are various types of trochanteric osteotomies used during revision surgery; extended trochanteric osteotomy (ETO) is being more popular. Aim. The aim of this study is to look at types of trochanteric osteotomy used during the revision surgery. We looked at the success and failure of these osteotomies. Failure of the osteotomy is defined by complete pull off by the hip abductors resulting in osteotomy fragment is no contact with the femur. We sought to assess the time to healing of osteotomy and number of cables used. Methods. We retrospectively reviewed the hospital theatre database and identified 97 patients who underwent revision
Introduction. Revision hip arthroplasty with massive proximal femoral bone loss remains challenging. Whilst several surgical techniques have been described, few have reported long term supporting data. A proximal femoral allograft (PFA) may be used to reconstitute bone stock in the multiply revised femur with segmental bone loss of greater than 8 cm. This study reports the outcome of largest case series of PFA used in revision hip arthroplasty. Methods. Data was prospectively collected from a consecutive series of 69 revision hip cases incorporating PFA and retrospective analyzed. Allografts of greater than 8 cm in length (average 14cm) implanted to replace deficient bone stock during revision
Purpose. Tape blisters after
Queen Elizabeth the Queen Mother Hospital, Margate, East Kent Hospitals NHS University Trust, UK. PURPOSE. Surfaces of supports used to position patients for hip replacement are usually are in direct contact with the patient skin around the groin/buttock areas & repeated use of same supports, in trauma & elective surgeries, can be a source of cross-infection & wound contamination. MATERIALS AND RESULTS. Swab samples from 12 supports, employed interchangeably for elective & trauma surgery. Cultured & incubated at 37 0 C in Columbia Blood Agar. 2 random supports cleaned using Sani Cloth Detergent non-alcoholic wipes & 2 samples were obtained from each support, 5 min later. 71% sampled supports were contaminated, with Coagulase-negative Staphylococcus, including Staph Epidermidis, being the most commonly grown organism with average of 5.3 colony forming units (CFU) (0-38) per swab. 5 min after cleaning 2 of above supports there was a 100% reduction in their contamination with no growth from the 4 swabs. CONCLUSION. Trauma patients are not necessarily subjected to groin MRSA swabs pre-operatively in contrast to patients undergoing elective
Aim. Different perioperative strategies have been implemented to reduce the devastating burden of infection following arthroplasty. The use of iodophor-impregnated adhesive incise drapes is one such strategy. Despite its wide adoption, there is little proof that this practice leads to a reduction of bacterial colonization. The aim of this randomized, prospective study was to evaluate the efficacy of iodophor-impregnated adhesive drapes for reducing bacterial count at the incision site. Method. A total of 96 patients undergoing open joint preservation procedure of the hip were enrolled in this prospective, randomized clinical trial of iodophor-impregnated adhesive drapes. *. One half of patients (n=48) had iodophor-impregnated adhesive drapes. *. applied to the skin prior to incision and kept on throughout the procedure, while the other half (n=48) underwent the same surgery without the use of iodophor-impregnated adhesive drapes. *. Culture swabs were taken from the surgical site at five different time points during surgery (pre-skin preparation, after skin preparation, post-incision, before subcutaneous closure, and prior to dressing application) and sent for culture and colony counts. Mixed-effects and multiple logistic regression analyses were utilized. Results. Iodophor-impregnated adhesive drapes resulted in a significant reduction of bacterial colonization of the surgical incision. At the conclusion of surgery, 12.5% (6/48) of incisions with iodophor-impregnated adhesive drapes. *. and 27.0% (13/48) without adhesive drapes were positive for bacteria. When controlling for preoperative colonization and other factors, patients without adhesive drapes were significantly more likely to have bacteria present at the incision at the time of closure (odds ratio (OR) 11.88, 95% confidence interval (CI) 1.45–80.00), and at all time-points when swab cultures were taken (OR 2.48, 95% CI 1.00–6.15). Conclusions. Based on this skin sampling study, incise draping significantly reduces the rate of bacterial colonization/contamination during
Total hip replacement in Germany has been performed in 227293 cases in 2015 and tendency is increasing. Although it is a standard intervention, freehand positioning of cup protheses has frequently poor accuracy. Image-based and image-free navigation systems improve the accuracy but most of them provide target positions as alphanumeric values on large-size screens beneath the patient site. In this case the surgeon always has to move his head frequently to change his eye-focus between incision and display to capture the target values. Already published studies using e.g. IPod-based displays or LED ring displays, show the chance for improvement by alternative approaches. Therefore, we propose a novel solution for an instrument-mounted small display in order to visualise intuitive instructions for instrument guidance directly in the viewing area of the surgeon. For this purpose a solution consisting of a MicroView OLED display with integrated Arduino microcontroller, equipped with a Bluetooth interface as well as a battery has been developed. We have used an optical tracking system and our custom-designed navigation software to track surgical instruments equipped with reference bodies to acquire the input for the mini-display. The first implementation of the display is adapted to total hip replacement and focuses on assistance while reaming the acetabulum. In this case the reamer has to be centred to the middle point of the acetabular rim circle and its rotation axis must be aligned to the acetabular centre axis by Hakki. By means of these references the actual deviations between instrument and target pose are calculated and indicated. The display contains a cross-hair indicator for current position, two bubble level bars for angular deviation and a square in square indicator for depth control. All display parts are furnished with an adaptive variable scale. Highest possible resolution is 0.5 degrees angular, 1 millimeter for position and depth resolution is set to 2 mm. Compared to existing approaches for instrument-mounted displays, the small display of our solution offers high flexibility to adjust the mounting position such that it is best visible for the surgeon while not constraining instrument handling. Despite the small size, the proposed visualisation symbols provide all information for instrument positioning in an intuitive way.
Prolonged bedrest in hospitalized patients is a major risk factor for venous thromboembolism (VTE), especially in high risk patients with hip fracture. Thrombelastography (TEG) is a whole blood viscoelastic hemostatic assay with evidence that an elevated maximal amplitude (MA), a measure of clot strength, is predictive of VTE in orthopaedic trauma patients. The objective of this study was to compare the TEG MA parameter between patients with hip fracture who were more mobile post-operatively and discharged from hospital early to patients with hip fracture with reduced mobility and prolonged hospitalizations post-operatively. In this prospective cohort study, TEG analysis was performed in patients with hip fracture every 24-hours from admission until post-operative day (POD) 5, then at 2- and 6-weeks post-operatively. Hypercoagulability was defined by MA > 65. Patients were divided into an early (within 5-day) and late (after 5-day) discharge group, inpatient at 2-weeks group, and discharge to MSK rehabilitation (MSK rehab), and long term care (LTC) groups. Two-sample t-test was used to analyze differences in MA between the early discharge and less mobile groups. All statistical tests were two-sided, and p-values < 0.05 were considered statistically significant. In total, 121 patients with a median age of 81.0 were included. Patients in the early discharge group (n=15) were younger (median age 64.0) and more likely to ambulate without gait aids pre-injury (86.7%) compared to patients in the late discharge group (n=105), inpatients at 2-weeks (n=48), discharged to MSK rehab (n=30), and LTC (n=20). At two weeks post-operative, the early discharge group was significantly less hypercoagulable (MA=68.9, SD 3.0) compared to patients in the other four groups. At 6-weeks post-operative, the early discharge group was the only group to demonstrate a trend towards mean MA below the MA > 65 hypercoagulable threshold (MA=64.4, p=0.45). Symptomatic VTE events were detected in three patients (2.5%) post-operatively. All three patients had hospitalizations longer than five days after surgery. In conclusion, our analysis of hypercoagulability secondary to reduced post-operative mobility demonstrates that patients with hip fracture who were able to mobilize independently sooner after
Prolonged bedrest in hospitalized patients is a major risk factor for venous thromboembolism (VTE), especially in high risk patients with hip fracture. Thrombelastography (TEG) is a whole blood viscoelastic hemostatic assay with evidence that an elevated maximal amplitude (MA), a measure of clot strength, is predictive of VTE in orthopaedic trauma patients. The objective of this study was to compare the TEG MA parameter between patients with hip fracture who were more mobile post-operatively and discharged from hospital early to patients with hip fracture with reduced mobility and prolonged hospitalizations post-operatively. In this prospective cohort study, TEG analysis was performed in patients with hip fracture every 24-hours from admission until post-operative day (POD) 5, then at 2- and 6-weeks post-operatively. Hypercoagulability was defined by MA > 65. Patients were divided into an early (within 5-day) and late (after 5-day) discharge group, inpatient at 2-weeks group, and discharge to MSK rehabilitation (MSK rehab), and long term care (LTC) groups. Two-sample t-test was used to analyze differences in MA between the early discharge and less mobile groups. All statistical tests were two-sided, and p-values < 0.05 were considered statistically significant. In total, 121 patients with a median age of 81.0 were included. Patients in the early discharge group (n=15) were younger (median age 64.0) and more likely to ambulate without gait aids pre-injury (86.7%) compared to patients in the late discharge group (n=105), inpatients at 2-weeks (n=48), discharged to MSK rehab (n=30), and LTC (n=20). At two weeks post-operative, the early discharge group was significantly less hypercoagulable (MA=68.9, SD 3.0) compared to patients in the other four groups. At 6-weeks post-operative, the early discharge group was the only group to demonstrate a trend towards mean MA below the MA > 65 hypercoagulable threshold (MA=64.4, p=0.45). Symptomatic VTE events were detected in three patients (2.5%) post-operatively. All three patients had hospitalizations longer than five days after surgery. In conclusion, our analysis of hypercoagulability secondary to reduced post-operative mobility demonstrates that patients with hip fracture who were able to mobilize independently sooner after
This session will present a series of challenging and complex primary and revision cases to a panel of internationally respected hip arthroplasty experts. The primary cases will include challenges such as hip dysplasia, altered bony anatomy and fixation challenges. In the revision hip arthroplasty scenarios issues such as bone stock loss, leg length discrepancy, instability and infection will be discussed. This will be an interactive case-based session that at its conclusion should leave the attendee with a more thorough approach to these challenging issues.
This session will present a series of challenging and complex primary and revision cases to a panel of internationally respected hip arthroplasty experts. The primary cases will include challenges such as hip dysplasia, altered bony anatomy and fixation challenges. In the revision hip arthroplasty scenarios issues such as bone stock loss, leg length discrepancy, instability and infection will be discussed. This will be an interactive case-based session that at its conclusion should leave the attendee with a more thorough approach to these challenging issues.
This session will present a series of challenging and complex primary and revision cases to a panel of internationally respected hip arthroplasty experts. The primary cases will include challenges such as hip dysplasia, altered bony anatomy and fixation challenges. In the revision hip arthroplasty scenarios issues such as bone stock loss, leg length discrepancy, instability and infection will be discussed. This will be an interactive case-based session that at its conclusion should leave the attendee with a more thorough approach to these challenging issues.
Not all total hip arthroplasty cases are created equal is a maxim that holds true for both primary and revision scenarios. Complex cases involve patients presenting with compromised bone and/or soft tissue. For primary cases, these include hips with dysplasia, ankylosis, deformed proximal femora, protrusio acetabuli, prior hip fracture with or without failed fixation, previous bony procedures, or neuromuscular conditions. In revision surgery, complex scenarios include cases compromised by bone loss, deterioration of the soft tissues and resulting in dislocation and instability, peri-prosthetic fracture, leg length discrepancy, infection, and more recently, hypersensitivity reactions. Meticulous surgical technique including component placement is essential. In this interactive session, a moderator and team of experts will discuss strategies for evaluation and management of a variety of challenging hip case scenarios.
The use of tranexamic acid (TEA) can significantly reduce the need for allogenic blood transfusions in elective primary joint arthroplasty. Revision total hip arthroplasty requires increased utilization of post-operative blood transfusions for acute blood loss anemia compared to elective primary hip replacement. There is limited literature to support the routine use of TEA in revision THA. We performed a retrospective review of 161 consecutive patients who underwent revision total hip arthroplasty from 2012–14 at a single institution by two fellowship-trained surgeons. We compared the transfusion requirements and the post-operative hemoglobin drop of the TEA Group (109 patients, 114 hips) versus the No TEA group (52 patients, 56 hips). Our standard protocol for administering TEA is 1000mg IV at incision, and the same dose repeated two hours later. The No TEA group did not receive the medication because of previous hospital contraindication criteria.Background
Methods
This session will present a series of challenging and complex primary and revision cases to a panel of internationally respected hip arthroplasty experts. The primary cases will include challenges such as hip dysplasia, altered bony anatomy and fixation challenges. In the revision hip arthroplasty scenarios issues such as bone stock loss, leg length discrepancy, instability and infection will be discussed. This will be an interactive case based session that at its conclusion should leave the attendee with a more thorough approach to these challenging issues.
A pericapsular approach was used with capsulotomy and then correction of the lesions both in the pelvic and in the femoral aspects. The traction times and total surgery times for the conventional method and the new out-inside technique were compared. Conventional Hip Arthroscopy 61 Hips done Total surgery time was 110 minutes Traction time was 50 minutes 6 Weeks non weight bearing New out-inside technique of hip arthroscopy 24 Hips done Total surgery time was 90 minutes Traction time was 20 minutes 4 weeks non weight bearing New out-inside technique – E Margalet results 68 Hips done Total surgery time was 80.5 minutes Traction time was 18.2 minutes 3-4 weeks non weight bearingMethods
Results
Not all total hip arthroplasty cases are created equal is a maxim that holds true for both primary and revision scenarios. Complex cases involve patients presenting with compromised bone and/or soft tissue. For primary cases, these include hips with dysplasia, ankylosis, deformed proximal femora, protrusio acetabuli, prior hip fracture with or without failed fixation, previous bony procedures, or neuromuscular conditions. In revision surgery, complex scenarios include cases compromised by bone loss, deterioration of the soft tissues and resulting instability, periprosthetic fracture, leg length discrepancy, infection, and more recently, hypersensitivity reactions. In this interactive session, a moderator and team of experts will discuss strategies for evaluation and management of a variety of challenging hip case scenarios.
This session will present a series of challenging and complex primary and revision cases to a panel of internationally respected hip arthroplasty experts. The primary cases will include challenges such as hip dysplasia, altered bony anatomy and fixation challenges. In the revision hip arthroplasty scenarios issues such as bone stock loss, leg length discrepancy, instability and infection will be discussed. This will be an interactive case based session that at its conclusion should leave the attendee with a more thorough approach to these challenging issues.