Aims. The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous total hip arthroplasty (THA). Methods. Data were extracted from a single centre prospective database of patients with PD who were treated with a CTAC. Patients were included if they had a follow-up of two years. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance and clinical relevance. Results. A total of 18 females with 22 CTACs who had a mean age of 73.5 years (SD 7.7) were included. A significant improvement was found in HOOS (p < 0.0001), mOHS (p < 0.0001), EQ-5D-3L utility (p = 0.003), EQ-5D-3L NRS (p = 0.013), VAS pain rest (p = 0.008), and VAS pain activity (p < 0.0001) between baseline and final follow-up. Minimal clinically important improvement in mOHS and the HOOS Physical Function Short Form (HOOS-PS) was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. Conclusion. CTAC in patients with THA acetabular loosening and PD can result in stable constructs and significant improvement in functioning and health-related quality of life at two years' follow-up. Further follow-up is necessary to determine the mid- to long-term outcome. Cite this article: Bone Jt Open 2023;4(2):53–61

Pelvic discontinuity (PD) is a detrimental complication following total hip arthroplasty (THA). The aim of this study was to assess the clinical and radiological results of patients with PD who were revised using a custom-made triflange acetabular component (CTAC). This is a single centre prospective study of patients with PD following THA who were treated with a CTAC. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Clinical and radiological complications, including reasons for revisions were registered. Trends over time are described and tested for significance and clinical relevance. 18 females with 22 CTACs were included with a mean age of 73.5 years (SD 7.7). There were significant improvements between baseline and final follow-up in HOOS (p<0.01), mOHS (p<0.01), EQ-5D-3L utility (p<0.01), EQ-5D-3L NRS (p<0.01), VAS pain rest (p<0.01), and VAS pain activity (p<0.01). A minimal clinically important improvement in mOHS and the HOOS was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. This is the first prospective assessment in clinical outcome of patients with PD who were treated with a CTAC. We have demonstrated that CTAC in patients with THA acetabular loosening and PD can result in stable constructs with no mechanical failures. Moreover, clinically relevant improvements in health-related quality of life at two years’ follow-up was observed

Introduction. Ascertaining the etiology of hip pain in young patients can be challenging. Osteoid osteoma about the hip has only been described in case reports and small case series in this sub-population. This study assessed the clinical course, radiologic findings, and treatment approaches in a large series of pediatric osteoid osteoma cases about the hip. Potential diagnostic and treatment pitfalls were identified. Methods. A single-center tertiary care departmental database was queried for all cases of osteoid osteoma seen between Jan 1, 2003 and December 31, 2015. Medical records were reviewed to identify those with lesions identified within or around the hip joint. Clinical, demographic, and radiologic data were analyzed. Results. Fifty children and adolescents (56% female, mean age 12.4 years, range 3–19 years) were identified with osteoid osteoma about the hip. The femoral neck was the most common lesion location (38%), and pain in the hip was the most common presenting chief complaint (60%). Night pain (90%) and symptom relief with NSAIDs (88%) were extremely common, though not universally reported. Sclerosis and/or cortical thickening was visible in 58% of radiographs, though a lucent nidus was visible in only 42%. Thirty patients (60%) underwent MRI, 27 of which were available for review, with focal peri-lesional edema as a universal finding. Amongst intracapsular lesions (n=17, 63%), common findings included medial retinacular thickening (33%), synovitis (45%) and effusion (76%). In the 43 patients (48%) who underwent CT, a diagnostic lucent nidus was a universal finding. Initial alternative diagnoses were recorded in 46% of cases, including, in order of decreasing frequency, femoro-acetabular impingement, minor trauma, hip synovitis, ‘growing pain’, stress fracture, and infection. Abnormal hip range of motion, positive impingement signs, and global synovitis on MRI scan were found to be associated with alternative diagnosis. On multivariate regression analysis, only abnormal hip ROM was independently predictive of alternative diagnosis. Delay in diagnosis of >6 months was seen in 43% of patients. Three patients underwent preceding operative procedures for other hip diagnoses, but had persistent hip pain until the osteoid osteoma was treated. Forty-one patients (82%) ultimately underwent radiofrequency ablation (RFA), and 1 open osteoid osteoma resection was performed. Of those who underwent RFA, 93% achieved complete symptom resolution, with 2 of 3 patients without symptom resolution undergoing revision RFA procedure, 1 of which led to symptom resolution. Complications of treatment included 1 case of deep infection along an RFA track, requiring operative debridement, 1 case of transient weakness and paresthesias in the involved extremity, and 1 case of fracture at the RFA site, requiring ORIF. Conclusions. Alternative andelayed diagnoses are common in osteoid osteoma about the hip, with femoro-acetabular impingement representing the most common alternative initial diagnosis in our series. While varying presenting complaints and nonspecific MRI findings may contribute to diagnostic uncertainty, night pain was present in the vast majority of cases and CT scans provided definitive diagnosis in all patients who received them. As increasing numbers of young, active patients are being evaluated for various causes of hip pain, such as femoro-acetabular impingement, osteoid osteoma should not be overlooked in the differential diagnosis of pain about the hip

Aims

Lateral femoral cutaneous nerve (LFCN) injury is a potential complication after the direct anterior approach for total hip arthroplasty (DAA-THA). The aim of this study was to determine how the location of the fasciotomy in DAA-THA affects LFCN injury.

Aims

There is evidence that morbidly obese patients have more intra- and postoperative complications and poorer outcomes when undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA). The aim of this study was to determine the efficacy of DAA for THA, and compare the complications and outcomes of morbidly obese patients with nonobese patients.

Aims

Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ).