The purpose of this study is to evaluate the indications and technique of hip arthroscopy for problems associated with total joint replacement. Fifteen consecutive patients underwent arthroscopy post total hip replacement. Two cases had suspected sepsis unproven by aspiration but for medical reasons were unable to undergo arthrotomy. Two cases had intraarticular migration of a broken trochanteric wire and an additional case had progressive loosening of an acetabular screw into the articulation. The remaining 10 cases had persistent and debilitating pain despite negative diagnostic studies (aspiration, arthrogram, CT, etc). Two cases of joint sepsis were lavaged and debrided arthroscopically in addition to intravenous antibiotics without recurrent sepsis at 2-year follow up. Intraarticular metal fragments and a loose acetabular screw were successfully removed via arthroscopic means in 3 different hips. Ten cases had hip arthroscopy for persistent and debilitating pain despite negative radiographs and aspiration arthrogram. Findings included a loose acetabular component; corrosion at the interface of a metal-on-metal articulation; and 8 had dense scar tissue impingement at the head cup interface and synovitis. Four of those 8 had complete resolution of their symptoms, 3 went on to open arthrotomy, and one has had some improvement and chooses to decline further surgery.Materials and Methods:
Results:
There is an increased incidence of dislocation, dysplasia, slipped epiphysis, Perthes’ disease, and avascular necrosis leading to degenerative arthritis which occurs in up to 28% of Down's syndrome patients. As the life expectancy for patients with Down's syndrome has increased, so has the presence of hip disease. Hip replacement has been shown to have good results in this population. Special considerations include a high risk of postoperative dislocation and leg length inequality which often require large head THR or dual mobility type reconstruction to reduce these risks. Numerous spine deformities including scoliosis and C1-2 subluxation need to be taken into account-anesthesia consult.
Unexplained pain after hip arthroplasty is frustrating for patients and surgeons. The purpose of this study was 1. to describe the use of hip arthroscopy in management of the painful hip arthroplasty, 2. to critically evaluate the outcomes these patients, and 3. to help define indications for hip arthroscopy in this setting. We retrospectively reviewed 14 patients (16 hips) who underwent hip arthroscopy after joint replacement. One patient had suspected septic arthritis despite negative aspiration and one had known septic arthritis but was not a candidate for open arthrotomy; two had intra-articular migration of hardware. The remaining 10 patients (11 hips) had persistent pain despite negative diagnostic studies. The two patients (two hips) with infection were successfully treated with arthroscopic lavage and debridement plus intravenous antibiotics. Intra-articular metal fragments and a loose acetabular screw were successfully removed in two patients (three hips). Findings in remaining the 11 hips included a loose acetabular component (one); corrosion at the head-neck junction of a metal-on-metal articulation (one); soft tissue-scar impingement at the head cup interface (four); synovitis with associated scar tissue (four); and capsular scarring with adhesions (one). Arthroscopy represented a successful treatment or directly led to a successful treatment in 12 of 16 hips. We observed no complications as a result of the arthroscopy. Arthroscopy may be of value in selected patients
There is continuing debate among orthopedists regarding the appropriate treatment of femoral neck fractures, open reduction internal fixation (ORIF), Total hip arthroplasty (THA) or hemiarthroplasty. In 2003 310,000 patients were hospitalized for hip fracture in the United States and about one-third were treated with total hip arthroplasty. Worldwide, the total number of hip fractures is expected to surpass 6 million by the year 2050. In a survey distributed by the American Association of Hip and Knee Surgeons, and of the 381 members who responded, 85% preferred hemiarthroplasty, 2% preferred ORIF and 13% preferred THA. The decision to perform internal fixation, hemiarthroplasty, or THA is based on comminution of the fracture activity level and independence, bone quality, presence of rheumatoid or degenerative arthritis, and mental status. Evidence based practice indicates that in a young patient with good bone stock and a fracture with relatively low comminution an ORIF is the treatment of choice. If the patient has a comminuted fracture with poor bone quality, minimal DJD, no RA, and low activity demand a hemiarthroplasty is a reasonable choice. If the patient has a comminuted fracture with poor bone quality, DJD and high activity demand a total hip replacement is a reasonable choice.
The life expectancy of patients with Down syndrome has increased significantly in recent years. Hip abnormalities occur in children with this syndrome but little is known about their natural history in later life. In 65 adults with Down syndrome we found hip abnormalities in 28%, and this was statistically correlated with walking ability. A subgroup of 18 patients was followed by serial examination; this showed that hip instability occurred in adulthood and became worse with time. In some patients, hip instability started after skeletal maturity.
