Treatment guidelines for atypical femoral fractures associated
with bisphosphonates have not been established. We conducted a systematic
review of the treatment of atypical femoral fractures first, to
evaluate the outcomes of surgical fixation of complete atypical fractures
and secondly, to assess whether prophylactic surgery is necessary
for incomplete atypical fractures. Case reports and series were identified from the PubMed database
and were included if they described the treatment of atypical femoral
fractures. In total, 77 publications met our inclusion criteria
and 733 patients with 834 atypical complete or incomplete femoral fractures
were identified.Aims
Materials and Methods
We describe our technique and rationale using
hybrid fixation for primary total hip arthroplasty (THA) at the Hospital
for Special Surgery. Modern uncemented acetabular components have
few screw holes, or no holes, polished inner surfaces, improved
locking mechanisms, and maximised thickness and shell-liner conformity. Uncemented
sockets can be combined with highly cross-linked polyethylene liners,
which have demonstrated very low wear and osteolysis rates after
ten to 15 years of implantation. The results of cement fixation
with a smooth or polished surface finished stem have been excellent,
virtually eliminating complications seen with cementless fixation
like peri-operative femoral fractures and thigh pain. Although mid-term
results of modern cementless stems are encouraging, the long-term
data do not show reduced revision rates for cementless stems compared
with cemented smooth stems. In this paper we review the conduct
of a hybrid THA, with emphasis on pre-operative planning, surgical
technique, hypotensive epidural anaesthesia, and intra-operative
physiology. Cite this article:
The December 2015 Hip &
Pelvis Roundup360 looks at: Vitamin E infusion helpful in polyethylene; Hip replacement in fracture and arthritis; Non-surgical treatment for arthritis; Cost and approach in hip surgery; Who does well in FAI surgery?; AAOS Thromboembolism guidelines; Thromboprophylaxis and periprosthetic joint infection; Fluid collections not limited to metal-on-metal THR
The high revision rates of the DePuy Articular Surface Replacement (ASR) and the DePuy ASR XL (the total hip arthroplasty (THA) version) have led to questions over the viability of metal-on-metal (MoM) hip joints. Some designs of MoM hip joint do, however, have reasonable mid-term performance when implanted in appropriate patients. Investigations into the reasons for implant failure are important to offer help with the choice of implants and direction for future implant designs. One way to assess the performance of explanted hip prostheses is to measure the wear (in terms of material loss) on the joint surfaces. In this study, a coordinate measuring machine (CMM) was used to measure the wear on five failed cementless Biomet Magnum/ReCap/ Taperloc large head MoM THAs, along with one Biomet ReCap resurfacing joint. Surface roughness measurements were also taken. The reason for revision of these implants was pain and/or adverse reaction to metal debris (ARMD) and/or elevated blood metal ion levels.Objectives
Methods
Hemiarthroplasty of the hip is usually carried out through either
a direct lateral or posterior approach. The aim of this prospective
observational study was to determine any differences in patient-reported
outcomes between the two surgical approaches. From the Swedish Hip Arthroplasty Register we identified patients
of 70 years and above who were recorded as having had a hemiarthroplasty
during 2009. Only patients who had been treated with modern prostheses
were included. A questionnaire was posted to those who remained
alive one year after surgery. A total of 2118 patients (78% of those
available) with a mean age of 85 years (70 to 102) returned the
questionnaire. Aims
Patients and Methods
To evaluate whether an ultra-low-dose CT protocol can diagnose
selected limb fractures as well as conventional CT (C-CT). We prospectively studied 40 consecutive patients with a limb
fracture in whom a CT scan was indicated. These were scanned using
an ultra-low-dose CT Reduced Effective Dose Using Computed Tomography
In Orthopaedic Injury (REDUCTION) protocol. Studies from 16 selected
cases were compared with 16 C-CT scans matched for age, gender and
type of fracture. Studies were assessed for diagnosis and image
quality. Descriptive and reliability statistics were calculated.
The total effective radiation dose for each scanned site was compared.Aims
Patients and Methods
One goal of total hip arthroplasty is to restore normal hip anatomy.
The aim of this study was to compare displacement of the centre
of rotation (COR) using a standard reaming technique with a technique
in which the acetabulum was reamed immediately peripherally and
referenced off the rim. In the first cohort the acetabulum was reamed to the floor followed
by sequentially larger reamers. In the second cohort the acetabulum
was only reamed peripherally, starting with a reamer the same size
as the native femoral head. Anteroposterior pelvic radiographs were
analysed for acetabular floor depth and vertical and horizontal position
of the COR.Aims
Patients and Methods
The goals of this study were to define the risk factors, characteristics,
and chronology of fractures in 5417 revision total hip arthroplasties
(THAs). From our hospital’s prospectively collected database we identified
all patients who had undergone a revision THA between 1969 and 2011
which involved the femoral stem. The patients’ medical records and
radiographs were examined and the relevant data extracted. Post-operative
periprosthetic fractures were classified using the Vancouver system.
A total of 5417 revision THAs were identified.Aims
Patients and Methods
We present an audit comparing our level I major trauma centre’s
data for a cohort of patients with hip fractures in the National
Hip Fracture Database (NHFD) with locally held data on these patients. A total of 2036 records for episodes between July 2009 and June
2014 were reviewed. Aims
Patients and Methods
Reported rates of dislocation in hip hemiarthroplasty
(HA) for the treatment of intra-capsular fractures of the hip, range
between 1% and 10%. HA is frequently performed through a direct
lateral surgical approach. The aim of this study is to determine
the contribution of the anterior capsule to the stability of a cemented
HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature,
providing ten hip joints for investigation. A Thompson HA was cemented
in place via a direct lateral approach. The cadavers were then positioned
supine, both knee joints were disarticulated and a digital torque
wrench was attached to the femur using a circular frame with three
half pins. The wrench applied an external rotation force with the
hip in extension to allow the hip to dislocate anteriorly. Each
hip was dislocated twice; once with a capsular repair and once without
repairing the capsule. Stratified sampling ensured the order in
which this was performed was alternated for the paired hips on each
cadaver. Comparing peak torque force in hips with the capsule repaired
and peak torque force in hips without repair of the capsule, revealed
a significant difference between the ‘capsule repaired’ (mean 22.96
Nm, standard deviation ( Cite this article:
A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery.Aims
Patients and Methods
Fractures of the hip are common, often occurring
in frail elderly patients, but also in younger fit healthy patients following
trauma. They have a significant associated mortality and major social
and financial implications to patients and health care providers.
Many guidelines are available for the management of these patients,
mostly recommending early surgery for the best outcomes. As a result,
healthcare authorities now put pressure on surgical teams to ‘fast
track’ patients with a fracture of the hip, often misquoting the
available literature, which in itself can be confusing and even
conflicting. This paper has been written following an extensive review of
the available literature. An attempt is made to clarify what is
meant by early surgery (expeditious Cite this article:
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:
We investigated whether blood metal ion levels could effectively
identify patients with bilateral Birmingham Hip Resurfacing (BHR)
implants who have adverse reactions to metal debris (ARMD). Metal ion levels in whole blood were measured in 185 patients
with bilateral BHRs. Patients were divided into those with ARMD
who either had undergone a revision for ARMD or had ARMD on imaging
(n = 30), and those without ARMD (n = 155). Receiver operating characteristic
analysis was used to determine the optimal thresholds of blood metal
ion levels for identifying patients with ARMD.Aims
Patients and Methods
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:
Revision of a cemented hemiarthroplasty of the
hip may be a hazardous procedure with high rates of intra-operative complications.
Removing well-fixed cement is time consuming and risks damaging
already weak bone or perforating the femoral shaft. The cement-in-cement
method avoids removal of intact cement and has shown good results
when used for revision total hip arthroplasty (THA). The use of
this technique for the revision of a hemiarthroplasty to THA has
not been previously reported. A total of 28 consecutive hemiarthroplasties (in 28 patients)
were revised to a THA using an Exeter stem and the cement-in-cement
technique. There were four men and 24 women; their mean age was
80 years (35 to 93). Clinical and radiographic data, as well as
operative notes, were collected prospectively and no patient was
lost to follow-up. Four patients died within two years of surgery. The mean follow
up of the remainder was 70 months (25 to 124). Intra-operatively
there was one proximal perforation, one crack of the
femoral calcar and one acetabular fracture. No femoral components
have required subsequent revision for aseptic loosening or are radiologically loose. Four patients with late complications (14%) have since undergone
surgery (two for a peri-prosthetic fracture, and one each for deep
infection and recurrent dislocation) resulting in an overall major
rate of complication of 35.7%. The cement-in-cement technique provides reliable femoral fixation
in this elderly population and may reduce operating time and rates
of complication. Cite this article:
This study describes the Osseointegration Group of Australia’s
Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated
reconstruction of amputated limbs. We report clinical outcomes in 50 unilateral trans-femoral amputees
with a mean age of 49.4 years (24 to 73), with a minimum one-year
follow-up. Outcome measures included the Questionnaire for persons
with a Trans-Femoral Amputation, the health assessment questionnaire
Short-Form-36 Health Survey, the Amputation Mobility Predictor scores
presented as K-levels, 6 Minute Walk Test and timed up and go tests.
Adverse events included soft-tissue problems, infection, fractures
and failure of the implant.Aims
Patients and Methods