This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement.Aims
Methods
In the native hip, the hip capsular ligaments tighten at the limits of range of hip motion and may provide a passive stabilizing force to protect the hip against edge loading. In this study we quantified the stabilizing force vectors generated by capsular ligaments at extreme range of motion (ROM), and examined their ability to prevent edge loading. Torque-rotation curves were obtained from nine cadaveric hips to define the rotational restraint contributions of the capsular ligaments in 36 positions. A ligament model was developed to determine the line-of-action and effective moment arms of the medial/lateral iliofemoral, ischiofemoral, and pubofemoral ligaments in all positions. The functioning ligament forces and stiffness were determined at 5 Nm rotational restraint. In each position, the contribution of engaged capsular ligaments to the joint reaction force was used to evaluate the net force vector generated by the capsule.Aims
Methods
Aims. Developmental dysplasia of the hip (DDH) is a complex musculoskeletal disease that occurs mostly in children. This study aimed to investigate the molecular changes in the
The direct anterior approach (DAA) for total hip arthroplasty (THA) has potential advantages over other approaches and is most commonly performed with the patient in the supine position. We describe a technique for DAA THA with the patient in the lateral decubitus position and report the early clinical and radiological outcomes, the characteristics of the learning curve, and perioperative complications. All primary DAA THAs performed in the lateral position by a single surgeon over a four-year period from the surgeon’s first case using the technique were identified from a prospectively collected database. Modified Harris Hip Scores (mHHS) were collected to assess clinical outcome, and routine radiological analysis was performed. Retrospective review of the medical records identified perioperative complications, the characteristics of the learning curve, and revisions.Aims
Methods
Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored.Aims
Methods
Aims. The hip’s capsular ligaments passively restrain extreme range of movement (ROM) by wrapping around the native femoral head/neck. We determined the effect of hip resurfacing arthroplasty (HRA), dual-mobility total hip arthroplasty (DM-THA), conventional THA, and surgical approach on ligament function. Materials and Methods. Eight paired cadaveric hip joints were skeletonized but retained the
This study aimed to evaluate implant survival of reverse hybrid
total hip arthroplasty (THA) at medium-term follow-up. A consecutive series of 1082 THAs in 982 patients with mean follow-up
of 7.9 years (5 to 11.3) is presented. Mean age was 69.2 years (21
to 94). Of these, 194 (17.9%) were in patients under 60 years, 663
(61.3%) in female patients and 348 (32.2%) performed by a trainee.
Head size was 28 mm in 953 hips (88.1%) or 32 mm in 129 hips (11.9%).
Survival analysis was performed and subgroups compared using log
rank tests.Aims
Patients and Methods
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. 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.Aims
Patients and Methods
We aimed to quantify the relative contributions of the medial
femoral circumflex artery (MFCA) and lateral femoral circumflex
artery (LFCA) to the arterial supply of the head and neck of the
femur. We acquired ten cadaveric pelvises. In each of these, one hip
was randomly assigned as experimental and the other as a matched
control. The MFCA and LFCA were cannulated bilaterally. The hips
were designated LFCA-experimental or MFCA-experimental and underwent
quantitative MRI using a 2 mm slice thickness before and after injection
of MRI-contrast diluted 3:1 with saline (15 ml Gd-DTPA) into either
the LFCA or MFCA. The contralateral control hips had 15 ml of contrast
solution injected into the root of each artery. Next, the MFCA and
LFCA were injected with a mixture of polyurethane and barium sulfate
(33%) and their extra-and intra-arterial course identified by CT
imaging and dissection.Aims
Materials and Methods
Objectives. The purpose of this study was to compare the thickness of the
This study aimed to characterise and qualitatively grade the severity of the corrosion particles released into the hip joint following taper corrosion. The 26 cases examined were CoC/ABG Modular (n = 13) and ASR/SROM (n = 13). Blood serum metal ion levels were collected before and after revision surgery. The haematoxylin and eosin tissue sections were graded on the presence of fibrin exudates, necrosis, inflammatory cells and corrosion products. The corrosion products were identified based on visible observation and graded on abundance. Two independent observers blinded to the clinical patient findings scored all cases. Elemental analysis was performed on corrosion products within tissue sections. X-Ray diffraction was used to identify crystalline structures present in taper debris.Objectives
Methods
The acetabular labrum is a soft-tissue structure
which lines the acetabular rim of the hip joint. Its role in hip
joint biomechanics and joint health has been of particular interest
over the past decade. In normal hip joint biomechanics, the labrum
is crucial in retaining a layer of pressurised intra-articular fluid
for joint lubrication and load support/distribution. Its seal around
the femoral head is further regarded as a contributing to hip stability through
its suction effect. The labrum itself is also important in increasing
contact area thereby reducing contact stress. Given the labrum’s
role in normal hip joint biomechanics, surgical techniques for managing
labral damage are continuously evolving as our understanding of
its anatomy and function continue to progress. The current paper
aims to review the anatomy and biomechanical function of the labrum
and how they are affected by differing surgical techniques. Take home message: The acetabular labrum plays a critical role
in hip function and maintaining and restoring its function during
surgical intervention remain an essential goal. Cite this article:
The primary aim of this study was to investigate the effect of
an enhanced recovery program (ERP) on the short-term functional
outcome after total hip arthroplasty (THA). Secondary outcomes included
its effect on rates of dislocation and mortality. Data were gathered on 1161 patients undergoing primary THA which
included 611 patients treated with traditional rehabilitation and
550 treated with an ERP. Aims
Patients and Methods
The aim of this cadaver study was to identify
the change in position of the sciatic nerve during arthroplasty
using the posterior surgical approach to the hip. We investigated
the position of the nerve during this procedure by dissecting 11
formalin-treated cadavers (22 hips: 12 male, ten female). The distance
between the sciatic nerve and the femoral neck was measured before
and after dislocation of the hip, and in positions used during the
preparation of the femur. The nerve moves closer to the femoral
neck when the hip is flexed to >
30° and internally rotated to 90° (90°
IR). The mean distance between the nerve and femoral neck was 43.1
mm (standard deviation ( This study demonstrates that the sciatic nerve becomes closer
to the operative field during hip arthroplasty using the posterior
approach with progressive flexion of the hip. Cite this article:
In this paper we propose a new classification
of neurogenic peri-articular heterotopic ossification (HO) of the
hip based on three-dimensional (3D) CT, with the aim of improving
pre-operative planning for its excision. A total of 55 patients (73 hips) with clinically significant
HO after either traumatic brain or spinal cord injury were assessed
by 3D-CT scanning, and the results compared with the intra-operative
findings. At operation, the gross pathological anatomy of the HO as identified
by 3D-CT imaging was confirmed as affecting the peri-articular hip
muscles to a greater or lesser extent. We identified seven patterns
of involvement: four basic (anterior, medial, posterior and lateral)
and three mixed (anteromedial, posterolateral and circumferential).
Excellent intra- and inter-observer agreement, with kappa values
>
0.8, confirmed the reproducibility of the classification system. We describe the different surgical approaches used to excise
the HO which were guided by the 3D-CT findings. Resection was always
successful. 3D-CT imaging, complemented in some cases by angiography, allows
the surgeon to define the 3D anatomy of the HO accurately and to
plan its surgical excision with precision. Cite this article:
Only limited data are available regarding the
infiltration of local anaesthetic for total hip arthroplasty (THA),
and no studies were performed for THA using the anterior approach. In this prospective, randomised placebo-controlled study we investigated
the effect of both standard and reverse infiltration of local anaesthetic
in combination with the anterior approach for THA. The primary endpoint
was the mean numeric rating score for pain four hours post-operatively.
In addition, we recorded the length of hospital stay, the operating
time, the destination of the patient at discharge, the use of pain
medication, the occurrence of side effects and pain scores at various
times post-operatively. Between November 2012 and January 2014, 75 patients were included
in the study. They were randomised into three groups: standard infiltration
of local anaesthetic, reversed infiltration of local anaesthetic,
and placebo. There was no difference in mean numeric rating score
for pain four hours post-operatively (p = 0.87). There were significantly
more side effects at one and eight hours post-operatively in the
placebo group (p = 0.02; p = 0.03), but this did not influence the
mobilisation of the patients. There were no differences in all other
outcomes between the groups. We found no clinically relevant effect when the infiltration
of local anaesthetic with ropivacaine and epinephrine was used in
a multimodal pain protocol for THA using the anterior approach. Cite this article:
In this Cite this article:
A total of 219 hips in 192 patients aged between
18 and 65 years were randomised to 28-mm metal-on-metal uncemented
total hip replacements (THRs, 107 hips) or hybrid hip resurfacing
(HR, 112 hips). At a mean follow-up of eight years (6.6 to 9.3)
there was no significant difference between the THR and HR groups
regarding rate of revision (4.0% (4 of 99) Cite this article:
Total hip replacement (THR) after acetabular
fracture presents unique challenges to the orthopaedic surgeon.
The majority of patients can be treated with a standard THR, resulting
in a very reasonable outcome. Technical challenges however include
infection, residual pelvic deformity, acetabular bone loss with
ununited fractures, osteonecrosis of bone fragments, retained metalwork,
heterotopic ossification, dealing with the sciatic nerve, and the
difficulties of obtaining long-term acetabular component fixation.
Indications for an acute THR include young patients with both femoral
head and acetabular involvement with severe comminution that cannot
be reconstructed, and the elderly, with severe bony comminution.
The outcomes of THR for established post-traumatic arthritis include
excellent pain relief and functional improvements. The use of modern
implants and alternative bearing surfaces should improve outcomes
further. Cite this article:
Our understanding of the origin of hip pain in
degenerative disorders of the hip, including primary osteoarthritis, avascular
necrosis and femoroacetabular impingement (FAI), is limited. We
undertook a histological investigation of the nociceptive innervation
of the acetabular labrum, ligamentum teres and capsule of the hip,
in order to prove pain- and proprioceptive-associated marker expression.
These structures were isolated from 57 patients who had undergone
elective hip surgery (44 labral samples, 33 ligamentum teres specimens,
34 capsular samples; in 19 patients all three structures were harvested).
A total of
15 000 histological sections were prepared that were investigated
immunohistochemically for the presence of protein S-100, 68 kDa
neurofilament, neuropeptide Y, nociceptin and substance P. The tissues
were evaluated in six representative areas. Within the labrum, pain-associated free nerve ending expression
was located predominantly at its base, decreasing in the periphery.
In contrast, the distribution within the ligamentum teres showed
a high local concentration in the centre. The
