It has recently been reported that the transverse
acetabular ligament (TAL) is helpful in determining the position
of the acetabular component in total hip replacement (THR). In this
study we used a computer-assisted navigation system to determine
whether the TAL is useful as a landmark in THR. The study was carried
out in 121 consecutive patients undergoing primary THR (134 hips),
including 67 dysplastic hips (50%). There were 26 men (29 hips)
and 95 women (105 hips) with a mean age of 60.2 years (17 to 82)
at the time of operation. After identification of the TAL, its anteversion
was measured intra-operatively by aligning the inferomedial rim
of the trial acetabular component with the TAL using computer-assisted
navigation. The TAL was identified in 112 hips (83.6%). Intra-observer reproducibility
in the measurement of anteversion of the TAL was high, but inter-observer
reproducibility was moderate. Each surgeon was able to align the trial component according
to the target value of the angle of anteversion of the TAL, but
it was clear that methods may differ among surgeons. Of the measurements
of the angle of anteversion of the TAL, 5.4% (6 of 112 hips) were
outliers from the safe zone. In summary, we found that the TAL is useful as a landmark when
implanting the acetabular component within the safe zone in almost
all hips, and to prevent it being implanted in retroversion in all
hips, including dysplastic hips. However, as anteversion of the
TAL may be excessive in a few hips, it is advisable to pay attention
to individual variations, particularly in those with severe posterior
pelvic tilt. Cite this article:
The October 2013 Children’s orthopaedics Roundup360 looks at: Half a century of Pavlik treatment; Step away from the child!: trends in fracture management; Posterolateral rotatory elbow instability in children; Osteochondral lesions undiagnosed in patellar dislocations; Oral bisphosphonates in osteogenesis imperfecta; Crossed or parallel pins in supracondylar fractures?; Not too late nor too early: getting epiphysiodesis right; Fixation of supramalleolar osteotomies.
We report a 12- to 15-year implant survival assessment
of a prospective single-surgeon series of Birmingham Hip Resurfacings
(BHRs). The earliest 1000 consecutive BHRs including 288 women (335
hips) and 598 men (665 hips) of all ages and diagnoses with no exclusions
were prospectively followed-up with postal questionnaires, of whom
the first 402 BHRs (350 patients) also had clinical and radiological
review. Mean follow-up was 13.7 years (12.3 to 15.3). In total, 59 patients
(68 hips) died 0.7 to 12.6 years following surgery from unrelated
causes. There were 38 revisions, 0.1 to 13.9 years (median 8.7)
following operation, including 17 femoral failures (1.7%) and seven
each of infections, soft-tissue reactions and other causes. With
revision for any reason as the end-point Kaplan–Meier survival analysis
showed 97.4% (95% confidence interval (CI) 96.9 to 97.9) and 95.8%
(95% CI 95.1 to 96.5) survival at ten and 15 years, respectively.
Radiological assessment showed 11 (3.5%) femoral and 13 (4.1%) acetabular
radiolucencies which were not deemed failures and one radiological
femoral failure (0.3%). Our study shows that the performance of the BHR continues to
be good at 12- to 15-year follow-up. Men have better implant survival
(98.0%; 95% CI 97.4 to 98.6) at 15 years than women (91.5%; 95%
CI 89.8 to 93.2), and women <
60 years (90.5%; 95% CI 88.3 to
92.7) fare worse than others. Hip dysplasia and osteonecrosis are
risk factors for failure. Patients under 50 years with osteoarthritis
fare best (99.4%; 95% CI 98.8 to 100 survival at 15 years), with
no failures in men in this group. Cite this article:
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:
Perthes’ disease is an osteonecrosis of the juvenile
hip, the aetiology of which is unknown. A number of comorbid associations
have been suggested that may offer insights into aetiology, yet
the strength and validity of these are unclear. This study explored
such associations through a case control study using the United
Kingdom General Practice Research database. Associations investigated
were those previously suggested within the literature. Perthes’ disease has a significant association with congenital
genitourinary and inguinal anomalies, suggesting that intra-uterine
factors may be critical to causation. Other comorbid associations
may offer insight to support or refute theories of pathogenesis.
We surveyed 343 young women with 420 total hip arthroplasties (THAs) regarding pregnancy and childbirth after THA. The mean age at surgery was 35 years (18 to 45). The mean length of follow-up after the initial arthroplasty was 16 years (6 to 27). Of these 343 women, 47 (13.7%) had a successful pregnancy after their primary THA. The first baby after a THA was delivered vaginally in 30 patients and by Caesarean section in 17. Of the 343 patients, 138 underwent a revision. For the entire series, the risk of revision at five years was 5%, at ten years 24%, and at 20 years 50%. After adjusting for age at surgical intervention, the risk of revision was not significantly associated with childbirth. Of the 47 patients who had a successful pregnancy, 28 (60%) noted an increase in pain in the hip during pregnancy and ten of these patients had persistent pain after their pregnancy. Seven patients complained of pain in the groin in the replaced hip after childbirth. At the time of this survey, five of these patients (70%) had had revision THA. Childbirth is not affected by the presence of a THA. Pregnancy after THA is not associated with decreased survival of the prosthesis. Pain in the hip is common during pregnancy in these patients. Pain in the groin which persists after delivery commonly leads to revision of the THA.
