Hip abductor tears(AT) have long been under-recognized, under-reported and under-treated. There is a paucity of data on the prevalence, morphology and associated factors. Patients with “rotator cuff tears of the hip” that are recognized and repaired during total hip arthroplasty(THA) report comparable outcomes to patients with intact abductor tendons at THA. The study was a retrospective review of 997 primary THA done by a single surgeon from 2012–2022. Incidental findings of AT identified during the anterolateral approach to the hip were documented with patient name, gender, age and diagnosis. The extent and size of the tears of the Gluteus medius and Minimus were recorded. Xrays and MRI's were collected for the 140 patients who had AT and matched 1:1 with respect to age and gender against 140 patients that had documented good muscle quality and integrity. Radiographic measurements (Neck shaft angle, inter-teardrop distance, Pelvis width, trochanteric width and irregularities, bodyweight moment arm and abductor moment arm) were compared between the 2 groups in an effort to determine if any radiographic feature would predict AT. The prevalence of AT were 14%. Females had statistically more tears than males(18vs10%), while patients over the age of 70y had statistically more tears overall(19,7vs10,4%), but also more Gluteus Medius tears specifically(13,9vs5,3%). Radiographic measurements did not statistically differ between the tear and control group, except for the presence of trochanteric irregularities. MRI's showed that 50% of AT were missed and subsequently identified during surgery. Abductor tears are still underrecognized and undertreated during THA which can results in inferior outcomes. The surgeon should have an high index of suspicion in elderly females with trochanteric irregularities and although an MRI for every patient won't be feasible, one should always be prepared and equipped to repair the abductor tendons during THA.
The aim of this retrospective cohort study was to investigate the reasons for total knee arthroplasty (TKA) revisions at a tertiary hospital over a four-year period. The study aimed to identify the primary causes of TKA revisions and shed light on the implications for patient care and outcomes. The study included 31 patients who underwent revisions after primary knee arthroplasty between January 2017 and December 2020. A retrospective approach was employed, utilizing medical records and radiological findings to identify the reasons for TKA revisions. The study excluded oncology patients to focus on non-oncologic indications for revision surgeries. Patient demographics, including age and gender, were recorded. Data analysis involved categorizing the reasons for revision based on clinical assessments and radiological evidence. Among the 31 patients included in the study, 9 were males and 22 were females. The age of the patients ranged from 43 to 81, with a median age of 65 and an interquartile range of 18.5. The primary reasons for TKA revisions were identified as aseptic loosening (10 cases) and prosthetic joint infection (PJI) (13 cases). Additional reasons included revision from surgitech hemicap (1 case), patella osteoarthritis (1 case), stiffness (2 cases), patella maltracking (2 cases), periprosthetic fracture (1 case), and patella resurfacing (1 case). The findings of this retrospective cohort study highlight aseptic loosening and PJI as the leading causes of TKA revisions in the examined patient population. These results emphasize the importance of optimizing surgical techniques, implant selection, and infection control measures to reduce the incidence of TKA revisions. Future research efforts should focus on preventive strategies to enhance patient outcomes and mitigate the need for revision surgeries in TKA procedures.
Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Retrospective review of consecutive arthroplasty cases performed at a District Hospital (DH), and a Tertiary Hospital (TH) in Cape Town, between January 2015 and December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2±2.0 days at DH level and 7.6±7.1 days for TH (p<0.05). Readmissions within 3 months post-surgery of 1.75% (4 patients) for district and 4.40% (35) for TH (p<0.05). Reoperation rate of 1 in every 100 patients at the DH and 8.3 in every 100 patients at the TH (p<0.05). Death rate was 0.4% vs 0.6% at district and TH respectively (p>0.05). Periprosthetic joint infection rate was 0.43% at DH and 2.26% at TH. The percentage of hip dislocation requiring revision was 0% at district and 0.37% at TH. During the study period, 228 patients received arthroplasty surgery at the DH; these patients would otherwise have remained on the TH waiting list. Hip and Knee Arthroplasty at District health care level is safe and may help ease the burden on arthroplasty services at tertiary care facilities in a Southern African context. Adequately trained surgeons should be encouraged to perform these procedures in district hospitals provided there is appropriate patient selection and adherence to strict theatre operating procedures.
A longitudinal study was done assessing the latest radiographs available in a series of collarless Corail uncemented stems which have reported survival rates of 95% at 20 years. Parameters scored included the degree of “Ghosting” or delamination, the Gruen, the stem fit in the femoral canal and the degree of calcar resorption. Patient and implant demographics were noted. At 3 years the loosening rate was 23% reaching 64% at 6 years after the index procedure. It was present in all age groups, with a peak in the 24 to 49 year age group. Males and females had the same occurrence. When it was present this was always in zone 1. It was present in 6% of patients in zone 7, but then always associated with zone 1 changes. High and standard off-set stems had the same loosening rates. The looser fit of the stem the higher the incidence of loosening. There was no correlation to the type of bearing surface or the degree of calcar resorption. Those patients with a BMI of 25 – 35 had lower loosening rates compared to those with higher or lower BMI's. We postulate that cancellous bone on-growth onto the hydroxyapatite coating associated with loading flexural micro-motion leads to hydroxyapatite being pulled off the smooth stem substrate in zone 1. Progressive delamination of the hydroxyapatite then occurs. The triple-tapered design though imparts continued stability. We report high loosening rates in the Corail stem and suggest a mechanism for its development.
We have developed a technique with the underlying principle being that the difference in height between what is removed and what is inserted will determine the leg length correction (Figure 1). The height of the implant to be inserted is determined from the manufacturer's specifications. We have developed a Vertical Measurement Tool to accurately and reproducibly determine the height of the resected bone (Figure 2). Leg length correction = a−b−c+d Vertical Measurement Tool validation was performed by 4 separate surgeons on 20 resected femoral heads in the laboratory. Inter and intra-observer error was assessed. Fifty patients were assessed clinically and radiologically, to assess if desired leg length correction was achieved. Statistical analysis showed the device to be accurate with high intra and inter observer reliability. Differences between the observers were tested using a general linear model in a repeated measure design. No main effect and interaction effects were found. Intra operatively the resected head was measured and the formula was applied. The range of desired correction was 0mm to 18mm. In all cases the post-operative correction was within 4mm of the pre-operative planned correction. Statistical analysis showed that a linear Regression with ‘Actual’ as dependent and ‘Lambda’ as independent variables resulted in R= 0.889. We believe that it is consistently possible to achieve a leg length correction to within 5 mm of the pre-operative plan using the Vertical Measurement System. The system is simple and reproducible even in the hands of relatively inexperienced surgeons. For any figures or tables, please contact the authors directly by clicking on ‘Info & Metrics’ above to access author contact details.
The ASR™ Articular Surface Replacement and ASR™ XL Metal-on-Metal systems were recalled due to high revision rates at five years. A worldwide clinical follow-up of patients was initiated. This paper summarizes current findings in South Africa (SA) in comparison with those outside SA (OSA). Patients were followed annually, or until revision, from 10 clinical centers worldwide. Data collected includes demographic, surgical, radiographic, blood metal ion levels, and patient reported outcome measures (PROM).Introduction:
Methods:
To examine the performance of a novel blood plasma-based bone putty for augmenting the treatment of open tibia fractures. The putty was manufactured from pooled blood plasma and contains a concentration of both plasma and platelet-derived regenerative factors. Based on clinical reports of the use of autologous platelet-rich plasma to treat injuries, we hypothesized that the putty would accelerate healing of fractures and surrounding soft tissues. Two-arm, randomized controlled study including 20 treatment patients and 10 controls. Follow-up examinations occurred at 14, 30, 60, 90, 180, and 365 days. The product was provided in a syringe containing 3 cc of putty in a double-pouched, sterile box. The putty was placed at the fracture site during open fracture reduction and mechanical stabilization.Purpose:
Methods:
Rapid mobilisation programs, or “fast track” protocols, are aimed at shorter hospital stays. We found a limited local experience with these programs in total hip arthroplasty in South Africa, and decided to introduce a pilot study at our institution. This pilot study is aimed at the feasibility and safety of a RM program in the private sector setting, as well as a review of the pertinent literature.Background
Purpose
Dislocation is one of the most common orthopaedic complications after primary total hip replacement (THR). The reported dislocation rate in elective THR is 5–8%. This number increases up to 22% for THR done for neck of femur fractures. Due to the reported increase in dislocation for trauma, some surgeons prefer to do a hemi-arthroplasty or open reduction and internal fixation (ORIF). Hemi-arthroplasty is known to have poorer functional outcomes. Failure of ORIF is as high as 43%, and revision of failed ORIF to THR has reported dislocation rates of up to 42%. A retrospective review of all THR done for neck of femur fractures during 2006–2011 was undertaken. The patients in our institution who are considered for a THR must have an active life-style. Records were reviewed for delay to surgery, surgical approaches, articulations, bearing surfaces, follow up periods and cemented versus uncemented implants. We excluded all pathological fractures, extra-capsular fractures, failed ORIF, patients with incomplete data and patients with a follow-up period less than 3 months. Hip dislocation was the end-point of the review and we did not study other causes of revision e.g. loosening of components or infection.Introduction
Materials and methods
Unstable pelvic ring injuries usually occur in polytrauma patients and are associated with high mortality and morbidity. Percutaneous screw fixation of sacro-iliac joint dislocations, fracture-dislocations and sacral fractures is a well-recognised technique first described by Routt and is increasingly gaining popularity. This method is biomechanically comparable to open reduction and internal fixation with plates and screws but offers the advantages of minimally invasive surgical techniques. It is however a technically demanding procedure with reported complications including hardware failure, misplacement of screws, nerve injury and poor posterior reduction. The purpose of the study is to report clinical results of patients treated with closed reduction and percutaneous ilio-sacral screw fixation for unstable pelvic ring fractures by a single surgeon. A review of prospectively collected data was performed on all patients who had percutaneous sacro-iliac fixation between 2009 and 2012. Thirty five percutaneus sacro-iliac screws were inserted in 30 patients with a mean age of 25.6 years (range 17–62). Fracture types included 10 AO type B, and 20 AO type C. The mean follow-up period was 11.6 months (range 3–38). The complications assessed were screw misplacement, neurovascular complications, hardware breakage and loss of reduction.Purpose of study
Methods
To determine the onset, incidence and associated symptoms of adverse noise emissions following total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) bearing surfaces 50 Sequential CoC THA's (45 patients) performed by a single surgeon were interviewed telephonically at an average post-operative period of 12 months. The same group was re-interviewed telephonically 12 months later. Patients who reported noise emissions at either interview were assessed clinically to determine if symptoms could be reproduced.Purpose of study
Methods
The deltamotion bearing system provides a large bearing even with small acetabular components. With optimally placed components the risk of dislocation is extremely low. However the acetabular component is a monobloc system and has significant technical considerations. This is an early series of patients to determine whether a monobloc system can be reliable placed in an acceptable position 66 consecutive deltamotion cases were performed between 1/09/2010 and 31/12/2011. 52 cases were in primary operations and 14 were in revisions. In each case the surgical technique was modified and a trial reduction was performed using the pinnacle trial shell and liner. This enabled the surgeon to determine the optimum combined anteversion before insertion of the definitive component. In no case was a component sacrificed due to failure to achieve adequate press fit fixation. In each case the acetabular component was assessed to determine the angle of inclination and version. 32 cases had follow up of greater than 1 year and these patients were contacted telephonically and interviewed concerning adventitious noises.Introduction
Method
To assess the results of Revision Hip Surgery in which a less invasive technique was utilized in situations where a number of different options was available. The authors rely on an experience of 3,445 hip arthroplasties by a single surgeon over a period of 20 years, of which approximately 20% were revision cases. Of these 617 cases, we report on 175 in which a minimally invasive option was taken. This does not apply to the skin incision, as all cases were adequately exposed. We have adopted this term to describe cases in which a surgical options was taken that resulted in the least morbidity and the shortest surgical time. We postulated that would lead to the best outcomes with the least complications. Acetabular revisions: 1) Isolated polyethylene exchange. 2) Liner revision with cement technique in cases of cup malposition or poor locking mechanism. 3) Revision of cup with a primary prosthesis with significant medial bone loss. Stem revisions: 1) Cement on cement technique. 2) Strut graft and primary stem.Purpose of Study
Method
Single screw fixation for the management of slipped upper femoral epiphysis (SUFE) was introduced in 1984 and has been reported to have less chondrolysis and avascular necrosis (AVN) than previous methods using multiple pin fixation or osteotomy (Ward 1992). Two groups of patients were investigated. The first group of 55 hips (44 patients) were treated over a 27 year period (1963–1989). Forty four hips were treated with multiple pins and 11 hips with primary intra- or extracapsular osteotomy. These patients were followed up for an average of 8 years (3–27yrs). The second group of 88 hips (69 patients) were treated over a 6 year period (1999–2004). All were treated with single screw fixation and followed up for at least one year. The duration and severity of slip were found to be similar for both groups. In the second group 16 hips (20%) were unstable (unable to walk even with crutches). Instability had not been coined as a term in the first group. All serial radiographs were retrospectively reviewed for AVN and chondrolysis and correlated with clinical findings. In the first group AVN occurred in 8 hips (14.5%). Five (9%) were due to osteotomies, two (3.5%) due to manipulation and one (2%) due to pinning in the superior quadrant. Chondrolysis occurred in 14 hips (25%); eight (14%) at presentation and six (11%) due to persistent pin penetration. In the second group AVN occurred in two hips (2%). Both were unstable. Two of 16 unstable hips (12.5%) developed AVN. Chondrolysis occurred in 6 hips (7%); four (4.5%) at presentation and 2 (2.5%) due to persistent pin penetration. The authors conclude that single screw fixation is a safer technique than multiple pin fixation or osteotomy. AVN only occurred in unstable slips. Chondrolysis due to pin penetration is significantly reduced.
