This pilot study aimed to evaluate prospectively the use of inlet
radiographs of the hip as an alternative method of the assessment
of reduction after the surgical treatment of developmental dysplasia
of the hip (DDH). The children in this study underwent surgery between January
2013 and January 2015. All had inlet radiographs and CT scans post-operatively.
Data were analysed by determining inter-observer reliability and
intra-observer reproducibility, using the kappa value (K). Differences
were settled by discussion between the two observers until a consensus
was reached. The sensitivity and specificity of the radiographic
and CT results were compared. A total of 26 radiographs were obtained
from 23 children, with a mean age of 2.38 years (one to five).Aims
Patients and Methods
Slipped capital femoral epiphysis (SCFE) may
lead to symptomatic femoroacetabular impingement (FAI). We report our
experience of arthroscopic treatment, including osteochondroplasty,
for the sequelae of SCFE. Data were prospectively collected on patients undergoing arthroscopy
of the hip for the sequelae of SCFE between March 2007 and February
2013, including demographic data, radiological assessment of the
deformity and other factors that may influence outcome, such as
the presence of established avascular necrosis. Patients completed
the modified Harris hip score (mHHS) and the non-arthritic hip score
(NAHS) before and after surgery. In total, 18 patients with a mean age of 19 years (13 to 42),
were included in the study. All patients presented with pain in
the hip and mechanical symptoms, and had evidence of FAI (cam or
mixed impingement) on plain radiographs. The patients underwent arthroscopic osteoplasty of the femoral
neck. The mean follow-up was 29 months (23 to 56). The mean mHHS and NAHS scores improved from 56.2 (27.5 to 100.1)
and 52.1 (12.5 to 97.5) pre-operatively to 75.1 (33.8 to 96.8, p
= 0.01) and 73.6 (18.8 to 100, p = 0.02) at final follow-up, respectively.
Linear regression analysis demonstrated a significant association
between poorer outcome scores and increased time to surgery following SCFE
(p <
0.05 for all parameters except baseline MHHS). Symptomatic FAI following (SCFE) may be addressed using arthroscopic
techniques, and should be treated promptly to minimise progressive
functional impairment and chondrolabral degeneration. Take home message: Arthroscopy of the hip can be used to treat
femoroacetabular impingement successfully following SCFE. However,
this should be performed promptly after presentation in order to
prevent irreversible progression and poorer clinical outcomes. Cite this article:
Concerns have been raised that deformation of
acetabular shells may disrupt the assembly process of modular prostheses.
In this study we aimed to examine the effect that the strength of
bone has on the amount of deformation of the acetabular shell. The
hypothesis was that stronger bone would result in greater deformation.
A total of 17 acetabular shells were inserted into the acetabula
of eight cadavers, and deformation was measured using an optical
measuring system. Cores of bone from the femoral head were taken
from each cadaver and compressed using a materials testing machine.
The highest peak modulus and yield stress for each cadaver were used
to represent the strength of the bone and compared with the values
for the deformation and the surgeon’s subjective assessment of the
hardness of the bone. The mean deformation of the shell was 129
µm (3 to 340). No correlation was found between deformation and
either the maximum peak modulus (r² = 0.011, t = 0.426, p = 0.676) or
the yield stress (r² = 0.024, t = 0.614, p = 0.549) of the bone.
Although no correlation was found between the strength of the bone
and deformation, the values for the deformation observed could be
sufficient to disrupt the assembly process of modular acetabular
components. Cite this article:
We conducted a prospective study of a delta ceramic total hip
arthroplasty (THA) to determine the rate of ceramic fracture, to
characterise post-operative noise, and to evaluate the mid-term
results and survivorship. Between March 2009 and March 2011, 274 patients (310 hips) underwent
cementless THA using a delta ceramic femoral head and liner. At
each follow-up, clinical and radiological outcomes were recorded.
A Kaplan-Meier analysis was undertaken to estimate survival.Aims
Patients and Methods
Osteosarcoma of the pelvis is a particularly difficult tumour
to treat as it often presents late, may be of considerable size
and/or associated with metastases when it presents, and is frequently
chondroid in origin and resistant to chemotherapy. The aim of this study was to review our experience of managing
this group of patients and to identify features predictive of a
poor outcome. Between 1983 and 2014, 121 patients, (74 females and 47 males)
were treated at a single hospital: 74 (61.2%) patients had a primary
osteosarcoma and 47 (38.8%) had an osteosarcoma which was secondary
either to Paget’s disease (22; 18.2%) or to previous pelvic irradiation
(25; 20.7%). The mean age of those with a primary osteosarcoma was 29.3 years
(nine to 76) and their mean follow-up 2.9 years (0 to 29). The mean
age of those with a secondary sarcoma was 61.9 years (15 to 85)
and their mean follow-up was one year (0 to 14). A total of 22 patients with a primary sarcoma (52.4%) and 20
of those with a secondary sarcoma (47.6%) had metastases at the
time of presentation. Aims
Patients and Methods
In many papers, the diagnosis of pincer-type
femoroacetabular impingement (FAI) is attributed to the presence
of coxa profunda. However, little is known about the prevalence
of coxa profunda in the general population and its clinical relevance. In order to ascertain its prevalence in asymptomatic subjects
and whether it is a reliable indicator of pincer-type FAI, we undertook
a cross-sectional study between July and December 2013. A total
of 226 subjects (452 hips) were initially screened. According to
strict inclusion criteria, 129 asymptomatic patients (257 hips)
were included in the study. The coxa profunda sign, the crossover
sign, the acetabular index (AI) and lateral centre–edge (LCE) angle were
measured on the radiographs. The median age of the patients was
36.5 years (28 to 50) and 138 (53.7%) were women. Coxa profunda was present in 199 hips (77.4%). There was a significantly
increased prevalence of coxa profunda in women (p <
0.05) and
a significant association between coxa profunda and female gender
(p <
0.001) (92% When the presence of all radiological signs in the same subject
was considered, pincer-type FAI was found in only two hips (one
subject). We therefore consider that the coxa profunda sign should
not be used as a radiological indicator of pincer-type FAI. We consider
profunda to be a benign alteration in the morphology of the hip
with low prevalence and a lack of association with other radiological
markers of FAI. We suggest that the diagnosis of pincer-type FAI
should be based on objective measures, in association with clinical
findings. Cite this article:
Femoral stems with exchangeable (modular) necks were introduced
to offer surgeons an increased choice when determining the version,
offset and length of the femoral neck during total hip arthroplasty
(THA). It was hoped that this would improve outcomes and reduce
complications, particularly dislocation. In 2010, the Australian Orthopaedic
Association National Joint Replacement Registry (AOANJRR) first
reported an increased rate of revision after primary THA using femoral
stems with an exchangeable neck. The aim of this study was to provide
a more comprehensive up-to-date analysis of primary THA using femoral
stems with exchangeable and fixed necks. The data included all primary THA procedures performed for osteoarthritis
(OA), reported to the AOANJRR between 01 September 1999 and 31 December
2014. There were 9289 femoral stems with an exchangeable neck and
253 165 femoral stems with a fixed neck. The characteristics of
the patients and prostheses including the bearing surface and stem/neck
metal combinations were examined using Cox proportional hazard ratios
(HRs) and Kaplan-Meier estimates of survivorship. Aims
Materials and Methods
This study compared the long-term results following Salter osteotomy
and Pemberton acetabuloplasty in children with developmental dysplasia
of the hip (DDH). We assessed if there was a greater increase in
pelvic height following the Salter osteotomy, and if this had a
continued effect on pelvic tilt, lumbar curvature or functional outcomes. We reviewed 42 children at more than ten years post-operatively
following a unilateral Salter osteotomy or Pemberton acetabuloplasty.
We measured the increase in pelvic height and the iliac crest tilt
and sacral tilt at the most recent review and at an earlier review
point in the first decade of follow-up. We measured the lumbar Cobb angle
and the Short Form-36 (SF-36) and Harris hip scores were collected
at the most recent review.Aims
Patients and Methods
The most effective surgical approach for total hip arthroplasty
(THA) remains controversial. The direct anterior approach may be
associated with a reduced risk of dislocation, faster recovery,
reduced pain and fewer surgical complications. This systematic review
aims to evaluate the current evidence for the use of this approach
in THA. Following the Cochrane collaboration, an extensive literature
search of PubMed, Medline, Embase and OvidSP was conducted. Randomised
controlled trials, comparative studies, and cohort studies were
included. Outcomes included the length of the incision, blood loss,
operating time, length of stay, complications, and gait analysis.Aims
Materials and Methods
Successful management of late presenting hip
dislocation in childhood is judged by the outcome not just at skeletal
maturity but well beyond into adulthood and late middle age. This
review considers different methods of treatment and looks critically
at the handful of studies reporting long-term follow-up after successful
reduction. Cite this article
The aim of the study was to investigate the controversial issue
of whether the pelvic ring should be reconstructed following resection
of the sarcomas of the ilium. From our database, we identified 64 patients who underwent excision
of a tumour involving the ilium between 1976 and 2015. A total of
35 underwent complete resection, of whom 24 were reconstructed with
a non-vascularised fibula graft, and four with extracorporeal irradiation
and reimplantation. A total of 29 patients had a partial resection.
The mean follow-up was 9.2 years (1.1 to 25.6). Functional outcomes
were assessed using the Toronto Extremity Salvation Score (TESS)
at final follow-up. In all, 32 patients (50%) had a chondrosarcoma.Aims
Patients and Methods
Acetabular component orientation in total hip arthroplasty (THA)
influences results. Intra-operatively, the natural arthritic acetabulum
is often used as a reference to position the acetabular component.
Detailed information regarding its orientation is therefore essential. The
aim of this study was to identify the acetabular inclination and
anteversion in arthritic hips. Acetabular inclination and anteversion in 65 symptomatic arthritic
hips requiring THA were measured using a computer navigation system.
All patients were Caucasian with primary osteoarthritis (29 men,
36 women). The mean age was 68 years (SD 8). Mean inclination was
50.5° (SD 7.8) in men and 52.1° (SD 6.7) in women. Mean anteversion
was 8.3° (SD 8.7) in men and 14.4° (SD 11.6) in women. Objectives
Methods
We describe our experience in the reduction of
dislocation of the hip secondary to developmental dysplasia using ultrasound-guided
gradual reduction using flexion and abduction continuous traction
(FACT-R). During a period of 13 years we treated 208 Suzuki type
B or C complete dislocations of the hip in 202 children with a mean
age of four months (0 to 11). The mean follow-up was 9.1 years (five
to 16). The rate of reduction was 99.0%. There were no recurrent
dislocations, and the rate of avascular necrosis of the femoral
head was 1.0%. The rate of secondary surgery for residual acetabular
dysplasia was 19.2%, and this was significantly higher in those
children in whom the initial treatment was delayed or if other previous
treatments had failed (p = 0.00045). The duration of FACT-R was significantly
longer in severe dislocations (p = 0.001) or if previous treatments
had failed (p = 0.018). This new method of treatment is effective and safe in these difficult
cases and offers outcomes comparable to or better than those of
standard methods. Cite this article:
The purpose of this study was to determine patient-reported
outcomes of patients with mild to moderate developmental dysplasia
of the hip (DDH) and femoroacetabular impingement (FAI) undergoing
arthroscopy of the hip in the treatment of chondrolabral pathology.
A total of 28 patients with a centre-edge angle between 15° and
19° were identified from an institutional database. Their mean age
was 34 years (18 to 53), with 12 female and 16 male patients. All
underwent labral treatment and concomitant correction of FAI. There
were nine reoperations, with two patients requiring revision arthroscopy,
two requiring periacetabular osteotomy and five needing total hip arthroplasty. Patients who required further major surgery were more likely
to be older, male, and to have more severe DDH with a larger alpha
angle and decreased joint space. At a mean follow-up of 42 months (24 to 89), the mean modified
Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p
<
0.001). The mean Western Ontario and McMaster Universities
Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to
43; p <
0.001). Median patient satisfaction was 9.0/10 (1 to
10). Patients reported excellent improvement in function following
arthroscopy of the hip. This study shows that with proper patient selection, arthroscopy
of the hip can be successful in the young patient with mild to moderate
DDH and FAI. Cite this article:
The Unified Classification System (UCS) emphasises
the key principles in the assessment and management of peri-prosthetic
fractures complicating partial or total joint replacement. We tested the inter- and intra-observer agreement for the UCS
as applied to the pelvis and femur using 20 examples of peri-prosthetic
fracture in 17 patients. Each subtype of the UCS was represented
by at least one case. Specialist orthopaedic surgeons (experts)
and orthopaedic residents (pre-experts) assessed reliability on
two separate occasions. For the pelvis, the UCS showed inter-observer agreement of 0.837
(95% confidence intervals (CI) 0.798 to 0.876) for the experts and
0.728 (95% CI 0.689 to 0.767) for the pre-experts. The intra-observer
agreement for the experts was 0.861 (95% CI 0.760 to 0.963) and
0.803 (95% 0.688 to 0.918) for the pre-experts. For the femur, the
UCS showed an inter-observer kappa value of 0.805 (95% CI 0.765
to 0.845) for the experts and a value of 0.732 (95% CI 0.690 to 0.773)
for the pre-experts. The intra-observer agreement was 0.920 (95%
CI 0.867 to 0.973) for the experts, and 0.772 (95% CI 0.652 to 0.892)
for the pre-experts. This corresponds to a substantial and ‘almost
perfect’ inter- and intra-observer agreement for the UCS for peri-prosthetic
fractures of the pelvis and femur. We hope that unifying the terminology of these injuries will
assist in their assessment, treatment and outcome. Cite this article:
Few studies dealing with chondrosarcoma of the pelvis are currently
available. Different data about the overall survival and prognostic
factors have been published but without a detailed analysis of surgery-related complications.
We aimed to analyse the outcome of a series of pelvic chondrosarcomas
treated at a single institution, with particular attention to the
prognostic factors. Based on a competing risk model, our objective
was to identify risk factors for the development of complications. In a retrospective single-centre study, 58 chondrosarcomas (26
patients alive, 32 patients dead) of the pelvis were reviewed. The
mean follow-up was 13 years (one week to 23.1 years).Aims
Patients and Methods
The aims of this study were to report functional
outcomes of salvage procedures for patients with cerebral palsy (CP)
who have chronic dislocation of the hip using validated scoring
systems, and to compare the results of three surgical techniques. We reviewed 37 patients retrospectively. The mean age at the
time of surgery was 12.2 years (8 to 22) and the mean follow-up
was 56 months (24 to 114). Patients were divided into three groups:
14 who underwent proximal femoral resection arthroplasty (PFRA group
1), ten who underwent subtrochanteric valgus osteotomy (SVO group 2),
and 13 who underwent subtrochanteric valgus osteotomy with resection
of the femoral head (SVO with FHR group 3). All patients were evaluated
using the Caregiver Priorities and Child Health Index of Life with
Disabilities (CPCHILD) and the Pediatric Quality of Life Inventory
(PedsQL). Significant improvements occurred in most CPCHILD and PedsQL
subsection scores following surgery in all patients, without significant
differences between the groups. There were 12 post-operative complications.
Less severe complications were seen in group 1 than in groups 2
and 3. Salvage surgery appears to provide pain relief in patients with
CP who have painful chronic dislocation of the hip. The three salvage
procedures produced similar results, however, we recommend the use
of PFRA as the complications are less severe. Take home message: Salvage surgery can be of benefit to patients
with CP with chronic painful hip dislocation, but should be limited
to selected patients considering complications. Cite this article:
The aim of this study was to examine the real time A total of 50 patients (83 hips) underwent 4D dynamic CT scanning
of the hip, producing real time osseous models of the pelvis and
femur being moved through flexion, adduction, and internal rotation.
The location and size of the cam deformity and its relationship
to the angle of flexion of the hip and pelvic tilt, and the position
of impingement were recorded.Aims
Patients and Methods
