This study aimed to investigate the incidence of ≥ 5 mm asymmetry in lower and whole leg lengths (LLs) in patients with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH-OA) and primary hip osteoarthritis (PHOA), and the relationship between lower and whole LL asymmetries and femoral length asymmetry. In total, 116 patients who underwent unilateral total hip arthroplasty were included in this study. Of these, 93 had DDH-OA and 23 had PHOA. Patients with DDH-OA were categorized into three groups: Crowe grade I, II/III, and IV. Anatomical femoral length, femoral length greater trochanter (GT), femoral length lesser trochanter (LT), tibial length, foot height, lower LL, and whole LL were evaluated using preoperative CT data of the whole leg in the supine position. Asymmetry was evaluated in the Crowe I, II/III, IV, and PHOA groups.Aims
Methods
Aims. This paper describes the methodology, validation and reliability
of a new computer-assisted method which uses models of the patient’s
bones and the components to measure their migration and polyethylene
wear from radiographs after total hip arthroplasty (THA). Materials and Methods. Models of the patient’s acetabular and femoral component obtained
from the manufacturer and models of the patient’s pelvis and femur
built from a single
Osteosynthesis of anterior pubic ramus fractures using one large-diameter screw can be challenging in terms of both surgical procedure and fixation stability. Small-fragment screws have the advantage of following the pelvic cortex and being more flexible. The aim of the present study was to biomechanically compare retrograde intramedullary fixation of the superior pubic ramus using either one large- or two small-diameter screws. A total of 12 human cadaveric hemipelvises were analysed in a matched pair study design. Bone mineral density of the specimens was 68 mgHA/cm3 (standard deviation (Objectives
Materials and Methods
Accurate placement of the acetabular component during total hip
arthroplasty (THA) is an important factor in the success of the
procedure. However, the reported accuracy varies greatly and is
dependent upon whether free hand or navigated techniques are used.
The aim of this study was to assess the accuracy of an instrument
system that incorporates 3D printed, patient-specific guides designed
to optimise the placement of the acetabular component. A total of 100 consecutive patients were prospectively enrolled
and the accuracy of placement of the acetabular component was measured
using post-operative CT scans.Aims
Patients and Methods
In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject–specific finite element (FE) models of pre- and post-operative femurs with stems were constructed and used to perform FE analyses (FEAs) to simulate single-leg stance. FEA predictions were compared with changes in bone mineral density (BMD) measured for each patient during the first post-operative year.Objectives
Patients and Methods
There are many guidelines that help direct the management of
patients with metal-on-metal (MOM) hip arthroplasties. We have undertaken
a study to compare the management of patients with MOM hip arthroplasties in
different countries. Six international tertiary referral orthopaedic centres were
invited to participate by organising a multi-disciplinary team (MDT)
meeting, consisting of two or more revision hip arthroplasty surgeons
and a musculoskeletal radiologist. A full clinical dataset including
history, blood tests and imaging for ten patients was sent to each
unit, for discussion and treatment planning. Differences in the
interpretation of findings, management decisions and rationale for
decisions were compared using quantitative and qualitative methods.Aims
Methods
To confirm whether developmental dysplasia of
the hip has a risk of hip impingement, we analysed maximum ranges
of movement to the point of bony impingement, and impingement location
using three-dimensional (3D) surface models of the pelvis and femur
in combination with 3D morphology of the hip joint using computer-assisted methods.
Results of
We investigated the detailed anatomy of the gluteus
maximus, gluteus medius and gluteus minimus and their neurovascular
supply in 22 hips in 11 embalmed adult Caucasian human cadavers.
This led to the development of a surgical technique for an extended
posterior approach to the hip and pelvis that exposes the supra-acetabular
ilium and preserves the glutei during revision hip surgery. Proximal
to distal mobilisation of the gluteus medius from the posterior
gluteal line permits exposure and mobilisation of the superior gluteal
neurovascular bundle between the sciatic notch and the entrance
to the gluteus medius, enabling a wider exposure of the supra-acetabular
ilium. This technique was subsequently used in nine patients undergoing
revision total hip replacement involving the reconstruction of nine
Paprosky 3B acetabular defects, five of which had pelvic discontinuity.
Intra-operative electromyography showed that the innervation of
the gluteal muscles was not affected by surgery. Clinical follow-up
demonstrated good hip abduction function in all patients. These
results were compared with those of a matched cohort treated through
a Kocher–Langenbeck approach. Our modified approach maximises the
exposure of the ilium above the sciatic notch while protecting the
gluteal muscles and their neurovascular bundle. Cite this article: Bone Joint J 2014;96-B:48–53.
Louis Pasteur once said that: “Fortune favours
the prepared mind.” As one of the great scientists who contributed
to the fight against infection, he emphasised the importance of
being prepared at all times to recognise infection and deal with
it. Despite the many scientific discoveries and technological advances,
such as the advent of antibiotics and the use of sterile techniques,
infection continues to be a problem that haunts orthopaedic surgeons
and inflicts suffering on patients. The medical community has implemented many practices with the
intention of preventing infection and treating it effectively when
it occurs. Although high-level evidence may support some of these
practices, many are based on little to no scientific foundation.
Thus, around the world, there is great variation in practices for
the prevention and management of periprosthetic joint infection. This paper summaries the instigation, conduct and findings of
a recent International Consensus Meeting on Surgical Site and Periprosthetic
Joint Infection. Cite this article:
Many tumors metastasise to bone, therefore, pathologic
fracture and impending pathologic fractures are common reasons for
orthopedic consultation. Having effective treatment strategies is
important to avoid complications, and relieve pain and preserve
function. Thorough pre-operative evaluation is recommended for medical
optimization and to ensure that the lesion is in fact a metastasis
and not a primary bone malignancy. For impending fractures, various scoring
systems have been proposed to determine the risk of fracture, and
therefore the need for prophylactic stabilisation. Lower score lesions
can often be treated with radiation, while more problematic lesions
may require internal fixation. Intramedullary fixation is generally
preferred due to favorable biomechanics. Arthroplasty may be required
for lesions with massive bony destruction where internal fixation
attempts are likely to fail. Radiation may also be useful postoperatively
to minimise construct failure due to tumor progression.
To study the vascularity and bone metabolism of the femoral head/neck
following hip resurfacing arthroplasty, and to use these results
to compare the posterior and the trochanteric-flip approaches. In our previous work, we reported changes to intra-operative
blood flow during hip resurfacing arthroplasty comparing two surgical
approaches. In this study, we report the vascularity and the metabolic
bone function in the proximal femur in these same patients at one
year after the surgery. Vascularity and bone function was assessed
using scintigraphic techniques. Of the 13 patients who agreed to
take part, eight had their arthroplasty through a posterior approach
and five through a trochanteric-flip approach.Objectives
Methods
Pseudotumours (abnormal peri-prosthetic soft-tissue reactions)
following metal-on-metal hip resurfacing arthroplasty (MoMHRA) have
been associated with elevated metal ion levels, suggesting that
excessive wear may occur due to edge-loading of these MoM implants.
This study aimed to quantify The duration and magnitude of edge-loading Objectives
Methods
The purpose of this study was to assess N-acetyl aspartate changes
in the thalamus in patients with osteoarthritis of the hip using
proton magnetic resonance spectroscopy. Nine patients with osteoarthritis of the hip (symptomatic group,
nine women; mean age 61.4 years (48 to 78)) and nine healthy volunteers
(control group, six men, three women; mean age 30.0 years (26 to
38)) underwent proton magnetic resonance spectroscopy to assess
the changes of N-acetyl aspartate in the thalamus. Objectives
Methods
We reviewed the long-term results at ten to 12 years of 118 total hip replacements in 109 patients using a second-generation hemispherical cementless acetabular component (Reflection) designed to address the problem of backside wear. Five patients (five hips) died and six patients (seven hips) were lost to follow-up. The remaining 98 patients (106 hips) had a mean age of 62.9 years (34.0 to 86.2) A rate of revision for aseptic loosening of 0.9%, and predictable results were found with respect to radiological evidence of fixation, lack of pain, walking ability, range of movement and function. One component was revised for aseptic loosening, and of the 101 hips (95.2%) that did not have a revision, minor osteolytic lesions of the pelvis were seen in six (5.9%). Kaplan-Meier survival analysis for the total cohort of 118 hips revealed a 96.4% survival at both ten (95% confidence interval 90 to 98) and 12 years (95% confidence interval 86 to 98).
