Manual impaction, with a mallet and introducer, remains the standard method of installing cementless acetabular cups during total hip arthroplasty (THA). This study aims to quantify the accuracy and precision of manual impaction strikes during the seating of an acetabular component. This understanding aims to help improve impaction surgical techniques and inform the development of future technologies. Posterior approach THAs were carried out on three cadavers by an expert orthopaedic surgeon. An instrumented mallet and introducer were used to insert cementless acetabular cups. The motion of the mallet, relative to the introducer, was analyzed for a total of 110 strikes split into low-, medium-, and high-effort strikes. Three parameters were extracted from these data: strike vector, strike offset, and mallet face alignment.Aims
Methods
Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.
Osteosynthesis of anterior pubic ramus fractures using one large-diameter screw can be challenging in terms of both surgical procedure and fixation stability. Small-fragment screws have the advantage of following the pelvic cortex and being more flexible. The aim of the present study was to biomechanically compare retrograde intramedullary fixation of the superior pubic ramus using either one large- or two small-diameter screws. A total of 12 human cadaveric hemipelvises were analysed in a matched pair study design. Bone mineral density of the specimens was 68 mgHA/cm3 (standard deviation (Objectives
Materials and Methods
Over recent years hip arthroscopic surgery has
evolved into one of the most rapidly expanding fields in orthopaedic surgery.
Complications are largely transient and incidences between 0.5%
and 6.4% have been reported. However, major complications can and
do occur. This article analyses the reported complications and makes recommendations
based on the literature review and personal experience on how to
minimise them.
There are several reports clarifying successful results following
open reduction using Ludloff’s medial approach for congenital (CDH)
or developmental dislocation of the hip (DDH). This study aimed
to reveal the long-term post-operative course until the period of
hip-joint maturity after the conventional surgical treatments. A long-term follow-up beyond the age of hip-joint maturity was
performed for 115 hips in 103 patients who underwent open reduction
using Ludloff’s medial approach in our hospital. The mean age at
surgery was 8.5 months (2 to 26) and the mean follow-up was 20.3
years (15 to 28). The radiological condition at full growth of the hip
joint was evaluated by Severin’s classification.Objectives
Methods
The aim of this review is to evaluate the current
available literature evidencing on peri-articular hip endoscopy
(the third compartment). A comprehensive approach has been set on
reports dealing with endoscopic surgery for recalcitrant trochanteric
bursitis, snapping hip (or coxa-saltans; external and internal),
gluteus medius and minimus tears and endoscopy (or arthroscopy)
after total hip arthroplasty. This information can be used to trigger
further research, innovation and education in extra-articular hip
endoscopy.
Femoroacetabular impingement (FAI) causes pain
and chondrolabral damage via mechanical overload during movement
of the hip. It is caused by many different types of pathoanatomy,
including the cam ‘bump’, decreased head–neck offset, acetabular
retroversion, global acetabular overcoverage, prominent anterior–inferior
iliac spine, slipped capital femoral epiphysis, and the sequelae
of childhood Perthes’ disease. Both evolutionary and developmental factors may cause FAI. Prevalence
studies show that anatomic variations that cause FAI are common
in the asymptomatic population. Young athletes may be predisposed
to FAI because of the stress on the physis during development. Other
factors, including the soft tissues, may also influence symptoms and
chondrolabral damage. FAI and the resultant chondrolabral pathology are often treated
arthroscopically. Although the results are favourable, morphologies
can be complex, patient expectations are high and the surgery is
challenging. The long-term outcomes of hip arthroscopy are still
forthcoming and it is unknown if treatment of FAI will prevent arthrosis.
