Aims. The hypothesis of this study was that
Background.
Of growing concern in arthroplasty is the emergence of atypical infections, particularly For this non-randomized non-blinded study, 101 adult patients scheduled for hip or knee surgery were recruited. For each, four 3 mm dermal punch biopsies were collected after administration of anaesthesia, but prior to antibiotics. Prebiopsy skin preparation consisted of a standardized preoperative 2% chlorhexidine skin cleansing protocol and an additional 70% isopropyl alcohol mechanical skin scrub immediately prior to biopsy collection. Two skin samples 10 cm apart were collected from a location approximating a standard direct anterior skin incision, and two samples 10 cm apart were collected from a lateral skin incision (suitable for posterior, direct-lateral, or anterolateral approaches). Samples were cultured for two weeks using a protocol optimized for Aims
Methods
Aims. This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent total hip arthroplasty (THA): are patient-reported outcome measures (PROMs) affected by the location of the maximum severity of pain?; are PROMs affected by the presence of non-groin pain?; are PROMs affected by the severity of pain?; and are PROMs affected by the number of pain locations?. Methods. We reviewed 336 hips (305 patients) treated with THA for hip OA from December 2016 to November 2019 using pain location/severity questionnaires, modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), international Hip Outcome Tool (iHOT-12) score, and radiological analysis. Descriptive statistics, analysis of covariance (ANCOVA), and Spearman partial correlation coefficients were used. Results. There was a significant difference in iHOT-12 scores between groups experiencing the most severe pain in the groin and the trochanter (p = 0.039). Additionally, more favourable mHHS scores were related to the presence of preoperative pain in trochanter (p = 0.049), lower back (p = 0.056), lateral
Few surgical techniques to reconstruct the abductor mechanism of the hip have been reported, with outcomes reported only from case reports and small case series from the centres that described the techniques. As in many of our revision THA patients the gluteus maximus was affected by previous repeat posterior approaches, we opted to reconstruct the abductor mechanism using a vastus lateralis to gluteus medius transfer. We report the results of such reconstructions in seven patients, mean age 66 (range, 53–77), five females, presenting with severe abductor deficiency (MRC grade 1–2). Five patients had previous revision THA, two with a proximal femoral replacement, one patient had a primary THA after a failed malunited trochanteric fracture, and one patient had a native hip with idiopathic fatty infiltration of glutei of >90%. All patients had instrumented gait analysis, and surface electromyography (EMG) of the glutei, TFL, and vastus muscles simultaneously before surgery and at each post-op follow-up. Postoperatively, patients were allowed to weight bear as tolerated and were requested to wear an abduction brace for the first six weeks after surgery to protect the transfer. All patients improved after surgery and reached an abductor power of 3 or more. All patients walked without support six months after surgery and were satisfied with the result. Abductor function continued to improve beyond one year of follow-up, and some patients reached an abductor power of 5. EMG demonstrated that the transferred vastus lateralis started firing synchronously with gluteus medius after three months post-surgery, suggesting adaptation to its new function. No knee extension weakness was recorded. One patient complained of lateral
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. Methods. In this trial, 134 patients were randomized into a lateral fasciotomy (n = 67) or a conventional fasciotomy (n = 67) group. This study was a dual-centre, double-blind, prospective randomized controlled two-arm trial with parallel group design and a 1:1 allocation ratio. The primary endpoint was the presence of LFCN injury, which was determined by the presence of numbness, decreased sensation, tingling, jolt-like sensation, or pain over the lateral aspect of the
We compared the clinical and radiological outcomes
of two cementless femoral stems in the treatment of patients with
a Garden III or IV fracture of the femoral neck. A total of 70 patients (70
hips) in each group were enrolled into a prospective randomised
study. One group received a short anatomical cementless stem and
the other received a conventional cementless stem. Their mean age
was 74.9 years (50 to 94) and 76.0 years (55 to 96), respectively
(p = 0.328). The mean follow-up was 4.1 years (2 to 5) and 4.8 years
(2 to 6), respectively. Perfusion lung scans and high resolution
chest CTs were performed to detect pulmonary microemboli. At final follow-up there were no statistically significant differences
between the short anatomical and the conventional stems with regard
to the mean Harris hip score (85.7 (66 to 100) versus 86.5
(55 to 100); p = 0.791), the mean Western Ontario and McMaster Universities
Osteoarthritis Index (17 (6 to 34) versus 16 (5
to 35); p = 0.13) or the mean University of California, Los Angeles
activity score (5 (3 to 6) versus 4 (3 to 6); p
= 0.032). No patient with a short stem had
Cementless distally locked stems were introduced in revision hip arthroplasty (RTHA) in the late 1980s to deal with severe femoral bone loss. These implants have not been assessed over the long-term, particularly the influence of the design and porous coating. Therefore we performed a retrospective case-control study at a minimum 10-years' follow-up comparing the straight Ultime™ stem with 1/3 porous coating versus the anatomical Linea™ stem with 2/3 proximal coating with hydroxyapatite. We performed a single-center case-control study measuring survival, function based the Harris and Oxford-12 scores, and rate of
Aims. Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study’s purposes were to determine differences in pain based on surgical approach (direct anterior (DA) vs posterolateral (PL)) and PL approach incision length. . Patients and Methods. This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year’s follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80). Results. A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, . sd. 12.9 vs 62.7 years, . sd. 9.7; p < 0.001) and had shorter follow-up (3.3 years, . sd. 1.3 vs 3.7 years, . sd. 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% vs 21%; p < 0.001) and groin pain (19% vs 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior
Introduction. Despite well-fixed implants, persistent pain following total hip arthroplasty (THA) remains a concern. Various surgical approaches have been advocated, yet whether patient-reported pain differs amongst techniques has not been investigated. This study's purposes were to determine differences in patient-reported pain based on surgical approach (direct anterior –DA versus posterolateral-PL) or PL approach incision length. Our hypothesis was that no differences in patient-reported pain would be present. Methods. A retrospective, IRB-approved investigation from 2 centers was performed. 7 fellowship trained arthroplasty surgeons (3 DA, 3 PL, 1 both) enrolled patients undergoing primary THA for non-inflammatory arthritis. PL approach patients were categorized based on incision length (6–8cm, 8–12cm, 12–15cm). Exclusion criteria were a prior hip surgery, revision procedure, or limited postoperative mobility. All THAs were performed using a cementless titanium, proximally coated, tapered femoral stem and hemispherical acetabular component. All patients had a minimum of 1-year clinical follow-up with radiographically well-fixed components. A pain-drawing questionnaire was administered in which patients identify the location and intensity of pain on an anatomic diagram. Independent Student's t-tests and Chi-square analyses were performed (p<0.05 = significant). Power analysis indicated 800 patients in each cohort would provide adequate power to detect a 4% difference in patient-reported pain (alpha = 0.05, beta = 0.80). Results. 1848 Patients (982 DA, 866 PL) were included. PL patients were younger (59.4 + 12.9 vs. 62.7 + 9.7; p<0.001) and had shorter follow-up (3.3 + 1.3 vs. 3.7 + 1.3 years; p<0.001) versus DA patients. There was no difference in postoperative UCLA score (6.0 + 1.9 vs. 6.0 + 2.0; p>0.9). PL patients reported increased moderate to severe trochanteric (21% vs. 14%; p<0.001) and groin pain (24% vs. 19%; p=0.004) than DA patients. There were no differences in anterior or lateral
The primary aim of this trial was to compare the subsidence of two similar hydroxyapatite-coated titanium femoral components from different manufacturers. Secondary aims were to compare rotational migration (anteversion/retroversion and varus/valgus tilt) and patient-reported outcome measures between both femoral components. Patients were randomized to receive one of the two femoral components (Avenir or Corail) during their primary total hip arthroplasty between August 2018 and September 2020. Radiostereometric analysis examinations at six, 12, and 24 months were used to assess the migration of each implanted femoral component compared to a baseline assessment. Patient-reported outcome measures were also recorded for these same timepoints. Overall, 50 patients were enrolled (62% male (n = 31), with a mean age of 65.7 years (SD 7.3), and mean BMI of 30.2 kg/m2 (SD 5.2)).Aims
Methods
The purpose of this study is to report our updated results at a minimum follow-up of 30 years using a first generation uncemented tapered femoral component in primary total hip arthroplasty (THA). The original cohort consisted of 145 consecutive THAs performed by a single surgeon in 138 patients. A total of 37 patients (40 hips) survived a minimum of 30 years, and are the focus of this review. The femoral component used in all cases was a first-generation Taperloc with a non-modular 28 mm femoral head. Clinical follow-up at a minimum of 30 years was obtained on every living patient. Radiological follow-up at 30 years was obtained on all but four.Aims
Methods
The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate. This retrospective analysis identified 267 hips from 224 patients who underwent an hip resurfacing arthroplasty (HRA) from a single fellowship-trained surgeon using the direct lateral approach between 2007 and 2019. Inclusion criteria was minimum two-year follow-up, and age younger than 40 years. Patients were followed using a prospectively maintained institutional database.Aims
Methods
This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018.Aims
Methods
Although the Fitmore Hip Stem has been on the market for almost 15 years, it is still not well documented in randomized controlled trials. This study compares the Fitmore stem with the CementLeSs (CLS) in several different clinical and radiological aspects. The hypothesis is that there will be no difference in outcome between stems. In total, 44 patients with bilateral hip osteoarthritis were recruited from the outpatient clinic at a single tertiary orthopaedic centre. The patients were operated with bilateral one-stage total hip arthroplasty. The most painful hip was randomized to either Fitmore or CLS femoral component; the second hip was operated with the femoral component not used on the first side. Patients were evaluated at three and six months and at one, two, and five years postoperatively with patient-reported outcome measures, radiostereometric analysis, dual-energy X-ray absorptiometry, and conventional radiography. A total of 39 patients attended the follow-up visit at two years (primary outcome) and 35 patients at five years. The primary outcome was which hip the patient considered to have the best function at two years.Aims
Methods
The modified Smith–Petersen and Kocher–Langenbeck
approaches were used to expose the lateral cutaneous nerve of the
thigh and the femoral, obturator and sciatic nerves in order to
study the risk of injury to these structures during the dissection,
osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular
osteotomy. Injury of the lateral cutaneous nerve of
Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels.Aims
Methods
In order to release the contracture band completely without damaging normal tissues (such as the sciatic nerve) in the surgical treatment of gluteal muscle contracture (GMC), we tried to display the relationship between normal tissue and contracture bands by magnetic resonance neurography (MRN) images, and to predesign a minimally invasive surgery based on the MRN images in advance. A total of 30 patients (60 hips) were included in this study. MRN scans of the pelvis were performed before surgery. The contracture band shape and external rotation angle (ERA) of the proximal femur were also analyzed. Then, the minimally invasive GMC releasing surgery was performed based on the images and measurements, and during the operation, incision lengths, surgery duration, intraoperative bleeding, and complications were recorded; the time of the first postoperative off-bed activity was also recorded. Furthermore, the patients’ clinical functions were evaluated by means of Hip Outcome Score (HOS) and Ye et al’s objective assessments, respectively.Aims
Methods
Introduction. Dual-mobility (DM) articulations may be useful for patients at increased risk for instability in primary and revision THA. While DM articulations are becoming increasingly popular, its routine use in primary THA is more uncertain. Even less is known about femoral head penetration in DM designs manufactured with highly cross-linked polyethylene infused with Vitamin E (E-HXLPE). The purpose of this study was to evaluate the early clinical results and femoral head penetration rates of primary THA implanted with DM E-HXLPE. Methods. Between 2012 and 2017, 105 primary DM THAs were performed using a one-piece acetabular shell, 28mm ceramic head, coupled with an E-HXLPE outer bearing via a standard posterior approach. Three patients refused follow-up after six months. 102 hips (92 patients) were available for review. The diagnosis was 99% OA. Average age was 65.7 years (33–90 years). 56% of patients were female. The most common femoral head size was 50mm (range, 44–60mm). The average thickness of the E-HXLPE outer bearing was 22.7mm (range, 16–32mm). Patients were followed at two months (baseline radiograph), six months, one, three, five, and seven years. Harris hip scores (HHS), UCLA activity score, and femoral head penetration (Martell method) were obtained at each visit beyond two months. Follow-up averaged 3 years (range, 1–7 years). Results. Average HHS improved from 43 to 95 points (50–100) at final follow-up. Similarly, average Harris pain scores improved from 10 to 42 points (20–44) with 78% of patients pain free and one patient, each, reporting groin and
Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA. This prospective randomized controlled trial (RCT) included 60 patients with symptomatic hip osteoarthritis undergoing conventional THA (CO THA) versus robotic arm-assisted THA (RO THA). Patients in both arms underwent pre- and postoperative CT scans, and a patient-specific plan was created using the robotic software. The COR, combined offset, acetabular orientation, and leg length discrepancy were measured on the pre- and postoperative CT scanogram at six weeks following surgery.Aims
Methods
