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The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 11 | Pages 1494 - 1498
1 Nov 2012
Philippon MJ Pennock A Gaskill TR

Femoroacetabular impingement causes groin pain and decreased athletic performance in active adults. This bony conflict may result in femoroacetabular subluxation if of sufficient magnitude. The ligamentum teres has recently been reported to be capable of withstanding tensile loads similar to that of the anterior cruciate ligament, and patents with early subluxation of the hip may become dependent on the secondary restraint that is potentially provided by the ligamentum teres. Rupture of the ligamentum may thus cause symptomatic hip instability during athletic activities. An arthroscopic reconstruction of the ligamentum teres using iliotibial band autograft was performed in an attempt to restore this static stabiliser in a series of four such patients. Early clinical results have been promising. The indications, technique and early outcomes of this procedure are discussed


The Bone & Joint Journal
Vol. 105-B, Issue 7 | Pages 735 - 742
1 Jul 2023
Andronic O Germann C Jud L Zingg PO

Aims

This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD.

Methods

We identified 42 hips in 40 patients treated between January 2009 and January 2016 with BHD defined as a lateral centre-edge angle (LCEA) of ≥ 18° but < 25°. A minimum five-year follow-up was available. Patient-reported outcomes (PROMs) including Tegner score, subjective hip value (SHV), modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed. The following morphological parameters were evaluated: LCEA, acetabular index (AI), α angle, Tönnis staging, acetabular retroversion, femoral version, femoroepiphyseal acetabular roof index (FEAR), iliocapsularis to rectus femoris ratio (IC/RF), and labral and ligamentum teres (LT) pathology.


The Bone & Joint Journal
Vol. 98-B, Issue 1_Supple_A | Pages 44 - 49
1 Jan 2016
Sheth NP Melnic CM Paprosky WG

Given the increasing number of total hip arthroplasty procedures being performed annually, it is imperative that orthopaedic surgeons understand factors responsible for instability. In order to treat this potentially complex problem, we recommend correctly classifying the type of instability present based on component position, abductor function, impingement, and polyethylene wear. Correct classification allows the treating surgeon to choose the appropriate revision option that ultimately will allow for the best potential outcome.

Cite this article: Bone Joint J 2016;98-B(1 Suppl A):44–9.


The Bone & Joint Journal
Vol. 95-B, Issue 11_Supple_A | Pages 41 - 45
1 Nov 2013
Zywiel MG Mont MA Callaghan JJ Clohisy JC Kosashvili Y Backstein D Gross AE

Down’s syndrome is associated with a number of musculoskeletal abnormalities, some of which predispose patients to early symptomatic arthritis of the hip. The purpose of the present study was to review the general and hip-specific factors potentially compromising total hip replacement (THR) in patients with Down’s syndrome, as well as to summarise both the surgical techniques that may anticipate the potential adverse impact of these factors and the clinical results reported to date. A search of the literature was performed, and the findings further informed by the authors’ clinical experience, as well as that of the hip replacement in Down Syndrome study group. The general factors identified include a high incidence of ligamentous laxity, as well as associated muscle hypotonia and gait abnormalities. Hip-specific factors include: a high incidence of hip dysplasia, as well as a number of other acetabular, femoral and combined femoroacetabular anatomical variations. Four studies encompassing 42 hips, which reported the clinical outcomes of THR in patients with Down’s syndrome, were identified. All patients were successfully treated with standard acetabular and femoral components. The use of supplementary acetabular screw fixation to enhance component stability was frequently reported. The use of constrained liners to treat intra-operative instability occurred in eight hips. Survival rates of between 81% and 100% at a mean follow-up of 105 months (6 to 292) are encouraging. Overall, while THR in patients with Down’s syndrome does present some unique challenges, the overall clinical results are good, providing these patients with reliable pain relief and good function.

Cite this article: Bone Joint J 2013;95-B, Supple A:41–5.


The Bone & Joint Journal
Vol. 104-B, Issue 7 | Pages 820 - 825
1 Jul 2022
Dhawan R Baré JV Shimmin A

Aims. Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. Methods. A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. Results. The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). Conclusion. In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years’ follow-up. Cite this article: Bone Joint J 2022;104-B(7):820–825


The Bone & Joint Journal
Vol. 101-B, Issue 12 | Pages 1578 - 1584
1 Dec 2019
Batailler C Weidner J Wyatt M Pfluger D Beck M

Aims. A borderline dysplastic hip can behave as either stable or unstable and this makes surgical decision making challenging. While an unstable hip may be best treated by acetabular reorientation, stable hips can be treated arthroscopically. Several imaging parameters can help to identify the appropriate treatment, including the Femoro-Epiphyseal Acetabular Roof (FEAR) index, measured on plain radiographs. The aim of this study was to assess the reliability and the sensitivity of FEAR index on MRI compared with its radiological measurement. Patients and Methods. The technique of measuring the FEAR index on MRI was defined and its reliability validated. A retrospective study assessed three groups of 20 patients: an unstable group of ‘borderline dysplastic hips’ with lateral centre edge angle (LCEA) less than 25° treated successfully by periacetabular osteotomy; a stable group of ‘borderline dysplastic hips’ with LCEA less than 25° treated successfully by impingement surgery; and an asymptomatic control group with LCEA between 25° and 35°. The following measurements were performed on both standardized radiographs and on MRI: LCEA, acetabular index, femoral anteversion, and FEAR index. Results. The FEAR index showed excellent intraobserver and interobserver reliability on both MRI and radiographs. The FEAR index was more reliable on radiographs than on MRI. The FEAR index on MRI was lower in the stable borderline group (mean -4.2° (. sd. 9.1°)) compared with the unstable borderline group (mean 7.9° (. sd. 6.8°)). With a FEAR index cut-off value of 2°, 90% of patients were correctly identified as stable or unstable using the radiological FEAR index, compared with 82.5% using the FEAR index on MRI. The FEAR index was a better predictor of instability on plain radiographs than on MRI. Conclusion. The FEAR index measured on MRI is less reliable and less sensitive than the FEAR index measured on radiographs. The cut-off value of 2° for radiological FEAR index predicted hip stability with 90% probability. Cite this article: Bone Joint J 2019;101-B:1578–1584


The Bone & Joint Journal
Vol. 100-B, Issue 11 | Pages 1434 - 1441
1 Nov 2018
Blakeney WG Beaulieu Y Puliero B Lavigne M Roy A Massé V Vendittoli P

Aims. This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing. Patients and Methods. Of the 276 hips (246 patients) included in this study, 264 (96%) were reviewed at a mean of 67 months (48 to 79) postoperatively. Procedures were performed with a mini posterior approach. Clinical and radiological outcomes were recorded at regular intervals. A noise assessment questionnaire was completed at last follow-up. Results. There were four re-operations (1%) including one early revision for insufficient primary fixation (0.4%). No hip dislocation was reported. The mean University of California, Los Angeles (UCLA) activity score, 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS) score, SF-12 Physical Component Summary (PCS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Forgotten Joint Score (FJS) were 6.6 (2 to 10), 52.8 (25.5 to 65.7), 53.0 (27.2 to 66.5), 7.7 (0 to 63), and 88.5 (23 to 100), respectively. No signs of loosening or osteolysis were observed on radiological review. The incidence of squeaking was 23% (n = 51/225). Squeaking was significantly associated with larger head diameter (p < 0.001), younger age (p < 0.001), higher SF-12 PCS (p < 0.001), and UCLA scores (p < 0.001). Squeaking did not affect patient satisfaction, with 100% of the squeaking hips satisfied with the surgery. Conclusion. LDH CoC THAs have demonstrated excellent functional outcomes at medium-term follow-up, with very low revision rate and no dislocations. The high incidence of squeaking did not affect patient satisfaction or function. LDH CoC with a monoblock acetabular component has the potential to provide long term implant survivorship with unrestricted activity, while avoiding implant impingement, liner fracture at insertion, and hip instability. Cite this article: Bone Joint J 2018;100-B:1434–41


The Bone & Joint Journal
Vol. 100-B, Issue 6 | Pages 733 - 739
1 Jun 2018
DeDeugd CM Perry KI Trousdale WH Taunton MJ Lewallen DG Abdel MP

Aims. The aims of this study were to determine the clinical and radiographic outcomes, implant survivorship, and complications of patients with a history of poliomyelitis undergoing total hip arthroplasty (THA) in affected limbs and unaffected limbs of this same population. Patients and Methods. A retrospective review identified 51 patients (27 male and 24 female, 59 hips) with a mean age of 66 years (38 to 88) and with the history of poliomyelitis who underwent THA for degenerative arthritis between 1970 and 2012. Immigrant status, clinical outcomes, radiographic results, implant survival, and complications were recorded. Results. In all, 32 THAs (63%) were performed on an affected limb, while 27 (37%) were performed on an unaffected limb. The overall ten-year survivorship free from aseptic loosening, any revision, or any reoperation were 91% (95% CI 0.76 to 0.99), 91% (95% CI 0.64 to 0.97) and 87% (95% CI 0.61 to 0.95), respectively. There were no revisions for prosthetic joint infection. There were no significant differences in any of the above parameters if THA was on the affected or unaffected control limbs. Conclusion. Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed. Cite this article: Bone Joint J 2018;100-B:733–9


The Bone & Joint Journal
Vol. 104-B, Issue 7 | Pages 775 - 780
1 Jul 2022
Kołodziejczyk K Czubak-Wrzosek M Kwiatkowska M Czubak J

Aims

Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH.

Methods

Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment.


The Bone & Joint Journal
Vol. 103-B, Issue 11 | Pages 1678 - 1685
1 Nov 2021
Abdelaziz H Schröder M Shum Tien C Ibrahim K Gehrke T Salber J Citak M

Aims

One-stage revision hip arthroplasty for periprosthetic joint infection (PJI) has several advantages; however, resection of the proximal femur might be necessary to achieve higher success rates. We investigated the risk factors for resection and re-revisions, and assessed complications and subsequent re-revisions.

Methods

In this single-centre, case-control study, 57 patients who underwent one-stage revision arthroplasty for PJI of the hip and required resection of the proximal femur between 2009 and 2018 were identified. The control group consisted of 57 patients undergoing one-stage revision without bony resection. Logistic regression analysis was performed to identify any correlation with resection and the risk factors for re-revisions. Rates of all-causes re-revision, reinfection, and instability were compared between groups.


The Bone & Joint Journal
Vol. 103-B, Issue 7 Supple B | Pages 38 - 45
1 Jul 2021
Horberg JV Coobs BR Jiwanlal AK Betzle CJ Capps SG Moskal JT

Aims

Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in recent years due to proposed benefits, including a lower risk of dislocation and improved early functional recovery. This study investigates the dislocation rate in a non-selective, consecutive cohort undergoing THA via the DAA without any exclusion or bias in patient selection based on habitus, deformity, age, sex, or fixation method.

Methods

We retrospectively reviewed all patients undergoing THA via the DAA between 2011 and 2017 at our institution. Primary outcome was dislocation at minimum two-year follow-up. Patients were stratified by demographic details and risk factors for dislocation, and an in-depth analysis of dislocations was performed.


The Bone & Joint Journal
Vol. 103-B, Issue 3 | Pages 486 - 491
1 Mar 2021
Di Martino A Bordini B Ancarani C Viceconti M Faldini C

Aims

Total hip arthroplasty (THA) patients undergoing or having a prior lumbar spine fusion (LSF) have an increased risk of mechanical complications. The aim of this registry-based, retrospective comparative cohort study is to assess the longer term survival of THA in patients who have undergone a LSF during a 17-year period (2000 to 2017).

Methods

A registry-based population study was conducted on 679 patients who underwent both THA and LSF surgeries. Patients were identified from the regional arthroplasty data base and cross linked to patients with LSF from the regional hospital discharge database between 2000 and 2017. Demographic data, diagnosis leading to primary THA, primary implant survival, perioperative complications, number and causes of failure, and patients requiring revision arthroplasty were collated and compared. For comparison, data from 67,919 primary THAs performed during the same time time period were also retrieved and analyzed.


The Bone & Joint Journal
Vol. 103-B, Issue 8 | Pages 1351 - 1357
1 Aug 2021
Sun J Chhabra A Thakur U Vazquez L Xi Y Wells J

Aims

Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies.

Methods

In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD.


The Bone & Joint Journal
Vol. 102-B, Issue 7 Supple B | Pages 41 - 46
1 Jul 2020
Ransone M Fehring K Fehring T

Aims

Patients with abnormal spinopelvic mobility are at increased risk for instability. Measuring the change in sacral slope (ΔSS) can help determine spinopelvic mobility preoperatively. Sacral slope (SS) should decrease at least 10° to demonstrate adequate posterior pelvic tilt. There is potential for different ΔSS measurements in the same patient based on sitting posture. The purpose of this study was to determine the effect of sitting posture on the ΔSS in patients undergoing total hip arthroplasty (THA).

Methods

In total, 51 patients undergoing THA were reviewed to quantify the variability in preoperative spinopelvic mobility when measuring two different sitting positions using SS for planning.


The Bone & Joint Journal
Vol. 102-B, Issue 12 | Pages 1636 - 1645
1 Dec 2020
Lerch TD Liechti EF Todorski IAS Schmaranzer F Steppacher SD Siebenrock KA Tannast M Klenke FM

Aims

The prevalence of combined abnormalities of femoral torsion (FT) and tibial torsion (TT) is unknown in patients with femoroacetabular impingement (FAI) and hip dysplasia. This study aimed to determine the prevalence of combined abnormalities of FT and TT, and which subgroups are associated with combined abnormalities of FT and TT.

Methods

We retrospectively evaluated symptomatic patients with FAI or hip dysplasia with CT scans performed between September 2011 and September 2016. A total of 261 hips (174 patients) had a measurement of FT and TT. Their mean age was 31 years (SD 9), and 63% were female (165 hips). Patients were compared to an asymptomatic control group (48 hips, 27 patients) who had CT scans including femur and tibia available for analysis, which had been acquired for nonorthopaedic reasons. Comparisons were conducted using analysis of variance with Bonferroni correction.


The Bone & Joint Journal
Vol. 101-B, Issue 10 | Pages 1218 - 1229
1 Oct 2019
Lerch TD Eichelberger P Baur H Schmaranzer F Liechti EF Schwab JM Siebenrock KA Tannast M

Aims

Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT.

Patients and Methods

A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed.


The Bone & Joint Journal
Vol. 101-B, Issue 4 | Pages 403 - 414
1 Apr 2019
Lerch TD Vuilleumier S Schmaranzer F Ziebarth K Steppacher SD Tannast M Siebenrock KA

Aims

The modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE.

Patients and Methods

We performed a retrospective analysis involving 46 hips in 46 patients treated with a modified Dunn procedure for severe SCFE (slip angle > 60°) between 1999 and 2016. At nine-year-follow-up, 40 hips were available for clinical and radiological examination. Mean preoperative age was 13 years, and 14 hips (30%) presented with unstable slips. Mean preoperative slip angle was 64°. Kaplan–Meier survivorship was calculated.


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 45 - 50
1 Jun 2019
Schloemann DT Edelstein AI Barrack RL

Aims

The aims of this study were to determine the change in pelvic sagittal alignment before, during, and after total hip arthroplasty (THA) undertaken with the patient in the lateral decubitus position, and to determine the impact of these changes on acetabular component position.

Patients and Methods

We retrospectively compared the radiological pelvic ratio among 91 patients undergoing THA. In total, 41 patients (46%) were female. The mean age was 61.6 years (sd 10.7) and the mean body mass index (BMI) was 20.0 kg/m2 (sd 5.5). Anteroposterior radiographs were obtained: in the standing position preoperatively and at six weeks postoperatively; in the lateral decubitus position after trial reduction intraoperatively; and in the supine position in the post-anaesthesia care unit. Pelvic ratio was defined as the ratio between the vertical distance from the inferior aspect of the sacroiliac (SI) joints to the superior pubic symphysis and the horizontal distance between the inferior aspect of the SI joints. Changes in the apparent component position based on changes in pelvic ratio were determined, with a change of > 5° considered clinically significant. Analyses were performed using Wilcoxon’s signed-rank test, with p < 0.05 considered significant.


The Bone & Joint Journal
Vol. 101-B, Issue 7 | Pages 808 - 816
1 Jul 2019
Eftekhary N Shimmin A Lazennec JY Buckland A Schwarzkopf R Dorr LD Mayman D Padgett D Vigdorchik J

There remains confusion in the literature with regard to the spinopelvic relationship, and its contribution to ideal acetabular component position. Critical assessment of the literature has been limited by use of conflicting terminology and definitions of new concepts that further confuse the topic. In 2017, the concept of a Hip-Spine Workgroup was created with the first meeting held at the American Academy of Orthopedic Surgeons Annual Meeting in 2018. The goal of this workgroup was to first help standardize terminology across the literature so that as a topic, multiple groups could produce literature that is immediately understandable and applicable. This consensus review from the Hip-Spine Workgroup aims to simplify the spinopelvic relationship, offer hip surgeons a concise summary of available literature, and select common terminology approved by both hip surgeons and spine surgeons for future research.

Cite this article: Bone Joint J 2019;101-B:808–816.


The Bone & Joint Journal
Vol. 101-B, Issue 1_Supple_A | Pages 11 - 18
1 Jan 2019
Kayani B Konan S Thakrar RR Huq SS Haddad FS

Objectives

The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) versus robotic-arm assisted THA. Secondary objectives were to determine differences between these treatment techniques for THA in achieving the planned combined offset, component inclination, component version, and leg-length correction.

Materials and Methods

This prospective cohort study included 50 patients undergoing conventional manual THA and 25 patients receiving robotic-arm assisted THA. Patients undergoing conventional manual THA and robotic-arm assisted THA were well matched for age (mean age, 69.4 years (sd 5.2) vs 67.5 years (sd 5.8) (p = 0.25); body mass index (27.4 kg/m2 (sd 2.1) vs 26.9 kg/m2 (sd 2.2); p = 0.39); and laterality of surgery (right = 28, left = 22 vs right = 12, left = 13; p = 0.78). All operative procedures were undertaken by a single surgeon using the posterior approach. Two independent blinded observers recorded all radiological outcomes of interest using plain radiographs.