Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain. Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar disc herniation with myelopathy. This survey was sent to 110 members of The Hip Society and 101 members of the Scoliosis Research Society. The choices of the surgeons were compared among scenarios and between surgical specialties using the chi-squared test. The free-text comments were analyzed using text-mining.Aims
Materials and Methods
Many case reports and small studies have suggested that cobalt
ions are a potential cause of cardiac complications, specifically
cardiomyopathy, after metal-on-metal (MoM) total hip arthroplasty
(THA). The impact of metal ions on the incidence of cardiac disease
after MoM THA has not been evaluated in large studies. The aim of
this study was to compare the rate of onset of new cardiac symptoms
in patients who have undergone MoM THA with those who have undergone
metal-on-polyethylene (MoP) THA. Data were extracted from the Standard Analytics Files database
for patients who underwent MoM THA between 2005 and 2012. Bearing
surface was selected using International Classification of Diseases
ninth revision codes. Patients with a minimum five-year follow-up
were selected. An age and gender-matched cohort of patients who underwent
MoP THA served as a comparison group. New diagnoses of cardiac disease
were collected during the follow-up period. Comorbidities and demographics
were identified and routine descriptive statistics were used.Aims
Patients and Methods
The stability of cementless acetabular components is an important
factor for surgical planning in the treatment of patients with pelvic
osteolysis after total hip arthroplasty (THA). However, the methods
for determining the stability of the acetabular component from pre-operative
radiographs remain controversial. Our aim was to develop a scoring
system to help in the assessment of the stability of the acetabular
component under these circumstances. The new scoring system is based on the mechanism of failure of
these components and the location of the osteolytic lesion, according
to the DeLee and Charnley classification. Each zone is evaluated
and scored separately. The sum of the individual scores from the
three zones is reported as a total score with a maximum of 10 points.
The study involved 96 revision procedures which were undertaken
for wear or osteolysis in 91 patients between July 2002 and December
2012. Pre-operative anteroposterior pelvic radiographs and Judet
views were reviewed. The stability of the acetabular component was
confirmed intra-operatively.Aims
Patients and Methods
Modular or custom-made femoral components have been preferred
for total hip arthroplasty (THA) in patients with a history of Perthes’
disease because of the distortion in the anatomy of the proximal
femur. However, it has not been established whether a monobloc cementless
stem will fit the distorted proximal femur or whether the results
of the procedure are satisfactory in this group of patients. We reviewed 68 consecutive patients who had undergone THA for
childhood Perthes’ disease between June 2003 and December 2008.
There were 35 men and 33 women with a mean age of 48 years (16 to
73) at the time of index arthroplasty. Their mean body mass index
was 24.4 (18.3 to 32.9). Of the 68 hips, 32 were classified as Stulberg
class III and 36 as class IV. The mean pre-operative shortening
of the affected leg was 17.2 mm (5 to 34). The minimum follow-up
was five years (mean 8.5 years; 5.2 to 10).Aims
Patients and Methods
