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The Bone & Joint Journal
Vol. 104-B, Issue 7 | Pages 786 - 791
1 Jul 2022
Jenkinson MRJ Peeters W Hutt JRB Witt JD

Aims

Acetabular retroversion is a recognized cause of hip impingement and can be influenced by pelvic tilt (PT), which changes in different functional positions. Positional changes in PT have not previously been studied in patients with acetabular retroversion.

Methods

Supine and standing anteroposterior (AP) pelvic radiographs were retrospectively analyzed in 69 patients treated for symptomatic acetabular retroversion. Measurements were made for acetabular index (AI), lateral centre-edge angle (LCEA), crossover index, ischial spine sign, and posterior wall sign. The change in the angle of PT was measured both by the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac (PS-SI) index.


The Bone & Joint Journal
Vol. 99-B, Issue 1 | Pages 22 - 28
1 Jan 2017
Khan OH Malviya A Subramanian P Agolley D Witt JD

Aims

Periacetabular osteotomy is an effective way of treating symptomatic hip dysplasia. We describe a new minimally invasive technique using a modification of the Smith-Peterson approach.

We performed a prospective, longitudinal cohort study to assess for any compromise in acetabular correction when using this approach, and to see if the procedure would have a higher complication rate than that quoted in the literature for other approaches. We also assessed for any improvement in functional outcome.

Patients and Methods

From 168 consecutive patients (189 hips) who underwent acetabular correction between March 2010 and March 2013 we excluded those who had undergone previous pelvic surgery for DDH and those being treated for acetabular retroversion. The remaining 151 patients (15 men, 136 women) (166 hips) had a mean age of 32 years (15 to 56) and the mean duration of follow-up was 2.8 years (1.2 to 4.5). In all 90% of cases were Tönnis grade 0 or 1. Functional outcomes were assessed using the Non Arthritic Hip Score (NAHS), University of California, Los Angeles (UCLA) and Tegner activity scores.


The Bone & Joint Journal
Vol. 97-B, Issue 1 | Pages 24 - 28
1 Jan 2015
Malviya A Dandachli W Beech Z Bankes MJ Witt JD

Stress fractures occurring in the pubis and ischium after peri-acetabular osteotomy (PAO) are not well recognised, with a reported incidence of 2% to 3%. The purpose of this study was to analyse the incidence of stress fracture after Bernese PAO under the care of two high-volume surgeons. The study included 359 patients (48 men, 311 women) operated on at a mean age of 31.1 years (15 to 56), with a mean follow-up of 26 months (6 to 64). Complete follow-up radiographs were available for 348 patients, 64 of whom (18.4%) developed a stress fracture of the inferior pubic ramus, which was noted at a mean of 9.1 weeks (5 to 55) after surgery. Most (58; 91%) healed. In 40 of the patients with a stress fracture (62.5%), pubic nonunion also occurred. Those with a stress fracture were significantly older (mean 33.9 years (16 to 50) vs 30.5 years (15 to 56), p = 0.002) and had significantly more mean pre-operative deformity: mean centre–edge angle (9.8° (-9.5 to 35) vs 12.4° (-33 to 28), p = 0.04) and mean Tönnis angle (22.8° (0 to 45) vs 18.7° (-2 to 38), p < 0.001). The pubic nonunion rate was significantly higher in those with a stress fracture (62.5% vs 7%, p < 0.001), with regression analysis revealing that these patients had 11.8 times higher risk than those without nonunion.

Cite this article: Bone Joint J 2015; 97-B:24–8.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 12 | Pages 1618 - 1624
1 Dec 2012
Daurka JS Malik AK Robin DA Witt JD

The inherent challenges of total hip replacement (THR) in children include the choice of implant for the often atypical anatomical morphology, its fixation to an immature growing skeleton and the bearing surface employed to achieve a successful long-term result. We report the medium-term results of 52 consecutive uncemented THRs undertaken in 35 paediatric patients with juvenile idiopathic arthritis. The mean age at the time of surgery was 14.4 years (10 to 16). The median follow-up was 10.5 years (6 to 15). During the study period 13 THRs underwent revision surgery. With revision as an endpoint, subgroup analysis revealed 100% survival of the 23 ceramic-on-ceramic THRs and 55% (16 of 29) of the metal- or ceramic-on-polyethylene. This resulted in 94% (95% CI 77.8 to 98.4) survivorship of the femoral component and 62% (95% CI 41.0 to 78.0) of the acetabular component. Revision of the acetabular component for wear and osteolysis were the most common reasons for failure accounting for 11 of the 13 revisions.

The success seen in patients with a ceramic-on-ceramic articulation seems to indicate that this implant strategy has the potential to make a major difference to the long-term outcome in this difficult group of patients.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 8 | Pages 1017 - 1020
1 Aug 2011
Stafford GH Islam SU Witt JD

Ceramic-on-ceramic bearings in hip replacement have low rates of wear and are increasingly being used in young adults. Our aim was to determine the incidence of audible phenomena or other bearing-related complications.

We retrospectively analysed 250 ceramic-on-ceramic hip replacements in 224 patients which had been implanted between April 2000 and December 2007. The mean age of the patients at operation was 44 years (14 to 83) and all the operations were performed using the same surgical technique at a single centre.

At a mean follow-up of 59 months (24 to 94), the mean Oxford hip score was 40.89 (11 to 48). There were six revisions, three of which were for impingement-related complications. No patient reported squeaking, but six described grinding or clicking, which was usually associated with deep flexion. No radiological evidence of osteolysis or migration of the components was observed in any hip.

The early to mid-term results of contemporary ceramic-on-ceramic hip replacement show promising results with few concerns in terms of noise and squeaking. Positioning of the acetabular component remains critical in regard to the reduction of other impingement-related complications.