We conducted a systematic review and meta-analysis of randomised controlled trials comparing cross-linked with conventional polyethylene liners for
Aims. The classical longitudinal incision used for the direct anterior
approach (DAA) to the hip does not follow the tension lines of the
skin and can lead to impaired wound healing and poor cosmesis. The
purpose of this retrospective study was to determine the satisfaction
with the scar, and functional and radiographic outcomes comparing
the classic longitudinal incision with a modified skin crease ‘bikini’
when the DAA is used for
We undertook a randomised controlled trial to compare the outcomes of skin adhesive and staples for skin closure in
Aims. Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to
Aims. This study aims to: determine the difference in pelvic position that occurs between surgery and radiographic, supine, postoperative assessment; examine how the difference in pelvic position influences subsequent component orientation; and establish whether differences in pelvic position, and thereafter component orientation, exist between
Bone surface strains were measured in cadaver femora during loading prior to and after resurfacing of the hip and
An 81-year-old woman presented with a fracture
in the left femur. She had well-fixed bilateral hip replacements
and had received long-term bisphosphonate treatment. Prolonged bisphosphonate
use has been recently linked with atypical subtrochanteric and diaphyseal
femoral fractures. While the current definition of an atypical fracture
of the femur excludes peri-prosthetic fractures, this case suggests
that they do occur and should be considered in patients with severe
osteopenia. Union of the fracture followed cessation of bisphosphonates
and treatment with teriparatide. Thus, this case calls into question
whether prophylactic intramedullary nailing is sufficient alone
to treat early or completed atypical femoral fractures.
There are no recent studies comparing cable with
wire for the fixation of osteotomies or fractures in total hip replacement
(THR). Our objective was to evaluate the five-year clinical and
radiological outcomes and complication rates of the two techniques.
We undertook a review including all primary and revision THRs performed
in one hospital between 1996 and 2005 using cable or wire fixation.
Clinical and radiological evaluation was performed five years post-operatively.
Cables were used in 51 THRs and wires in 126, and of these, 36 THRs
with cable (71%) and 101 with wire (80%) were evaluated at follow-up.
The five-year radiographs available for 33 cable and 91 wire THRs
revealed rates of breakage of fixation of 12 of 33 (36%) and 42
of 91 (46%), respectively. With cable there was a significantly
higher risk of metal debris (68% In conclusion, we found a higher incidence of complications and
a trend towards increased infection and foreign-body reaction with
the use of cables.
We describe the results of cemented
Aims. We analyzed the acetabular morphology of Crowe type IV hips using CT data to identify a landmark for the ideal placement of the centre of the acetabular component, as assessed by morphometric geometrical analysis, and its reliability. Patients and Methods. A total of 52 Crowe IV hips (42 patients; seven male, 35 female; mean age 68.5 years (32 to 82)) and 50 normal hips (50 patients; eight male, 42 female; mean age 60.7 years (34 to 86)) undergoing
Intact abductors of the hip play a crucial role
in preventing limping and are known to be damaged through the direct lateral
approach. The extent of trauma to the abductors after revision total
hip replacement (THR) is unknown. The aim of this prospective study
was to compare the pre- and post-operative status of the gluteus
medius muscle after revision THR. We prospectively compared changes
in the muscle and limping in 30 patients who were awaiting aseptic
revision THR and 15 patients undergoing primary THR. The direct
lateral approach as described by Hardinge was used for all patients.
MRI scans of the gluteus medius and functional analyses were recorded
pre-operatively and six months post-operatively. The overall mean
fatty degeneration of the gluteus medius increased from 35.8% (1.1
to 98.8) pre-operatively to 41% (1.5 to 99.8) after multiple revision
THRs (p = 0.03). There was a similar pattern after primary THR,
but with considerably less muscle damage (p = 0.001), indicating
progressive muscle damage. Despite an increased incidence of a positive
Trendelenburg sign following revision surgery (p = 0.03) there was
no relationship between the cumulative fatty degeneration in the
gluteus medius and a positive Trendelenburg sign (p = 0.26). The
changes associated with other surgical approaches to the hip warrant
investigation. Cite this article:
We studied the effect of trochanteric osteotomy in 192
The use of short stems has become more popular
with the increased interest in less invasive approaches for total hip
arthroplasty. The curved broaches and stem can be inserted along
a curved track to avoid the abductor attachments. Short stems have
the potential of being more bone conserving by allowing for higher
neck retention, maintenance of the medial greater trochanter, and
preferential stress transfer to the proximal femur. An initial experience with 500 new short stems (Fitmore, Zimmer
Orthopedics) stems used for
In this study we hypothesised that anxiety/depression, one of five dimensions in the health-related quality of life (HRQoL) measurement tool EQ-5D, could predict outcome after
Aims. We investigated changes in the axial alignment of the ipsilateral
hip and knee after
Objectives. Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA. Methods. In this pilot study, 16 patients with primary THA were recruited (eight MoM, eight MoP). DCE-MRI of the hip was performed at 1.5 Tesla (T). For each patient, Ktrans was computed voxel-by-voxel in all tissue lateral to the bladder. The mean Ktrans for all voxels was then calculated. These values were compared with respect to implant type and gender, and further correlated with clinical parameters. Results. There was no significant difference between the two bearing types with both genders combined. However, dividing patients by THA bearing and gender, women with MoM bearings had the highest Ktrans values, exceeding those of women with MoP bearings (0.067 min. −1. versus 0.053 min. −1. ; p-value < 0.05) and men with MoM bearings (0.067 min. −1. versus 0.034 min. −1. ; p-value < 0.001). Considering only the men, patients with MoM bearings had lower Ktrans than those with MoP bearings (0.034 min. −1. versus 0.046 min. −1. ; p < 0.05). Conclusion. DCE-MRI is feasible to perform in tissues surrounding THA. Females with MoM THA show high Ktrans values in DCE-MRI, suggesting altered tissue perfusion kinematics which may reflect relatively greater inflammation. Cite this article: Dr P. E. Beaule. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene
Aims. One method of femoral head preservation following avascular necrosis
(AVN) is core decompression and insertion of a tantalum rod. However,
there may be a high failure rate associated with this procedure.
The purpose of this study was to document the clinical and radiological
outcomes following
The best treatment for the active and lucid elderly patient with a displaced intracapsular fracture of the femoral neck is still controversial. Randomised controlled trials have shown that a primary total hip replacement is superior to internal fixation as regards the need for secondary surgery, hip function and health-related quality of life. Despite good results achieved with