As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells.

Cite this article: Bone Joint Res 2020;9(12):857–869.

Introduction

Cemented femoral fixation has been shown to carry a lower risk of peri-prosthetic fracture (PPF). The aim of this study was to determine whether adequate (1) stem position and (2) cement mantle (i.e. factors associated with outcome of cemented stems) can be achieved with the anterior approach as compared to the posterior approach.

Introduction

Acetabular and spino-pelvic (SP) morphological parameters are important determinants of hip joint dynamics. This study aims to determine whether acetabular and SP morphological differences exist between hips with and without cam morphology and between symptomatic and asymptomatic hips with cam morphology.

Objectives

The purpose of this study was to compare the thickness of the hip capsule in patients with surgical hip disease, either with cam-femoroacetabular impingement (FAI) or non-FAI hip pathology, with that of asymptomatic control hips.

Objectives

Alarm over the reported high failure rates for metal-on-metal (MoM) hip implants as well as their potential for locally aggressive Adverse Reactions to Metal Debris (ARMDs) has prompted government agencies, internationally, to recommend the monitoring of patients with MoM hip implants. Some have advised that a blood ion level >7 µg/L indicates potential for ARMDs. We report a systematic review and meta-analysis of the performance of metal ion testing for ARMDs.

Objectives

Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA.

Objectives

Patient function after arthroplasty should ideally quickly improve. It is not known which peri-operative function assessments predict length of stay (LOS) and short-term functional recovery. The objective of this study was to identify peri-operative functions assessments predictive of hospital LOS and short-term function after hospital discharge in hip or knee arthroplasty patients.

Objectives

The purpose of this study was to investigate whether the femoral head–neck contour, characterised by the alpha angle, varies with the stage of physeal maturation using MRI evaluation of an asymptomatic paediatric population.

Purpose: The prevalence of groin pain following total hip resurfacing is unknown. Based on recent literature, 4.3% of total hip replacement patients will complain of groin pain/iliopsoas tendonitis. This study aims to determine the prevalence of groin pain after metal on metal hip resurfacing.

Method: Out of 163 patients that underwent hip resurfacing at the Ottawa General Hospital by two orthopedic surgeons with a minimum follow up of 6 months, 93 patients were evaluated in this study. Patients were questioned about post-operative groin pain in detail. A physical exam was completed by an independent orthopaedic surgeon to measure range of motion, assess for a positive impingement sign, and assess pain with straight leg raise. Radiographic evaluation included anterior femoral head/neck offset ratio, presence of acetabular component uncoverage and component loosening.

Results: A total of 98 hips, in 93 patients were evaluated. Mean age was 50 years, with a mean follow up of 21.7 months (range 6–48 months), 21% had ongoing groin pain, 8% reported taking analgesics and 10% reported limitation of activities due to pain. 5 patients received a cortisone injection with a variable response. There were no statistically significant differences detected between groin pain and the radiological parameters inspected. There was no evidence of component loosening. Decreased range of motion was slightly correlated with groin pain. Patients with groin pain had lower RAND and WOMAC scores. Patients reporting a pain score of 5 or above on a visual pain score were found to have lower functional scores than those who scored less, though not statistically significant. Neither the surgeon nor the approach were associated significantly to pain, Pain distribution did not change over the course of the post operative period from 6 months to four years.

Conclusion: Groin pain after hip resurfacing appears more common than that after total hip replacement. The origin is most likely multi-factorial: surgical approach, implant positioning and reaction to wear debris. Further research is required in determining predisposing factors as well as its natural course.

Purpose: Multi-modal therapy remains the cornerstone of post-operative pain management following knee replacement surgery. Femoral nerve catheters and blocks have been used with success in the management of post-operative pain yet most practicing arthroplasty surgeons and anaesthesiologists are unaware of the potential complications and risks of the procedure. The purpose of this study is to report on the complications associated with these techniques following knee replacement surgery.

Method: One thousand one hundred and ninety patients underwent knee replacement surgery between January 2004 and July 1, 2007 and received an indwelling continuous infusion femoral catheter for post-operative marcaine pump infusion. For the initial 469 patients (Group 1), the continuous infusion ran for 2 to 3 days. In 721 patients, the continuous infusion was discontinued 12 hours following surgery (Group 2).

Results: There were 15 major complications observed in 1190 patients: 7 femoral nerve palsies (2 in Group 1, 5 in Group 2) and 8 falls (4 in each group). For the patients who had fallen in hospital, the injuries sustained were: traumatic hemarthrosis, hemarthrosis requiring arthrotomy, major wound dehiscence with exposed implants, complete medial collateral ligament rupture requiring repair, quadriceps tendon rupture requiring delayed repair, minor wound dehiscence with suture, and displaced ankle fracture.

Conclusion: Femoral nerve catheters and blocks are effective tools for post-operative pain relief following knee arthroplasty surgery. However, it is important for the surgeon and anaesthesiologist to provide information regarding the potential complications of the treatment as part of an informed consent. Although the complication rate is relatively low at 1.3%, the occurrence of femoral nerve palsies as well as re-operations significantly delayed patient recovery. We did not observe a benefit in terms relative risk reduction with discontinuation of the continuous infusion 12 hours following surgery. The femoral palsies reported in our series have led our institution to adopt ultrasound guidance for catheter placement rather than tradition nerve stimulation technique, although the safety of this newer technique is currently under evaluation.

The purpose of the present study was to analyze the-clinical and radiographic factors which determine the enduring fixation of metal on metal hybrid surface arthroplasty.

The first 500 hips (in 436 patients) of a consecutive series of over 700 Conserve® plus were reviewed clinically and radiographically. The patients were 48.6 years-old in average, 74% were male and the dominant etiology was idiopathic osteoarthritis (64.6%). All femoral components were cemented but the femoral metaphyseal stem was cemented in 112 hips and press-fit in the remaining 388.

Average follow-up was 4.8 years (range, 2.7 to 7.8 years). Eighteen hips were converted to a THR, 11 of them for aseptic loosening of the femoral component at an average follow-up of 40.5 months. Put in positives mention fx and loose incidence, survor ship details of loose and fx for other At last review, 14 hips presented metaphyseal stem radiolucencies and 16 hips (3.2%) showed a narrowing of the neck of 10% or more at the interface with the femoral component. None of the components with cemented stems showed femoral radiolucencies, neck narrowing, or were revised for aseptic loosening. Cementing the femoral stem significantly (p = 0.013) reduces the chances of early femoral failure or appearance of a metaphyseal stem radiolucency.

Risk factors for loosening or radioluciences included cysts > 1 cm, small femoral head size, female gender, early cases (before improved acrylic fixation including femoral suctioning measures were instituted) and reduced stem shaft angle. Metal-on-metal surface arthroplasty provides a stable, bone conserving, low morbidity and wear resistant prosthetic solution well suited for young and highly active patients.