Reconstruction of the acetabulum after failed total hip arthroplasty
(THA) can be a surgical challenge in the presence of severe bone
loss. We report the long-term survival of a porous tantalum revision
acetabular component, its radiological appearance and quality of
life outcomes. We reviewed the results of 46 patients who had undergone revision
of a failed acetabular component with a Paprosky II or III bone
defect and reconstruction with a hemispherical, tantalum acetabular
component, supplementary screws and a cemented polyethylene liner.Aims
Patients and Methods
Sagittal alignment of the lumbosacral spine, and specifically pelvic incidence (PI), has been implicated in the development of spine pathology, but generally ignored with regards to diseases of the hip. We aimed to determine if increased PI is correlated with higher rates of hip osteoarthritis (HOA). The effect of PI on the development of knee osteoarthritis (KOA) was used as a negative control. We studied 400 well-preserved cadaveric skeletons ranging from 50 to 79 years of age at death. Each specimen’s OA of the hip and knee were graded using a previously described method. PI was measured from standardised lateral photographs of reconstructed pelvises. Multiple regression analysis was performed to determine the relationship between age and PI with HOA and KOA.Objectives
Methods
Compared with primary total hip arthroplasty (THA), revision
surgery can be challenging. The cement-in-cement femoral revision
technique involves removing a femoral component from a well-fixed
femoral cement mantle and cementing a new stem into the original
mantle. This technique is widely used and when carried out for the
correct indications, is fast, relatively inexpensive and carries
a reduced short-term risk for the patient compared with the alternative
of removing well-fixed cement. We report the outcomes of this procedure
when two commonly used femoral stems are used. We identified 1179 cement-in-cement stem revisions involving
an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty
Register (SHAR) between January 1999 and December 2015. Kaplan-Meier
survival analysis was performed.Aims
Patients and Methods
The purpose of this study was to evaluate whether an innovative
templating technique could predict the need for acetabular augmentation
during primary total hip arthroplasty for patients with dysplastic
hips. We developed a simple templating technique to estimate acetabular
component coverage at total hip arthroplasty, the True Cup: False
Cup (TC:FC) ratio. We reviewed all patients with dysplastic hips
who underwent primary total hip arthroplasty between 2005 and 2012.
Traditional radiological methods of assessing the degree of acetabular dysplasia
(Sharp’s angle, Tönnis angle, centre-edge angle) as well as the
TC:FC ratio were measured from the pre-operative radiographs. A
comparison of augmented and non-augmented hips was undertaken to
determine any difference in pre-operative radiological indices between
the two cohorts. The intra- and inter-observer reliability for all
radiological indices used in the study were also calculated.Aims
Patients and Methods
Advocates of debridement, antibiotics and implant retention (DAIR)
in hip periprosthetic joint infection (PJI) argue that a procedure
not disturbing a sound prosthesis-bone interface is likely to lead
to better survival and functional outcome compared with revision.
This case-control study aims were to compare outcome of DAIRs for
infected primary total hip arthroplasty (THA) with outcomes following
primary THA and two-stage revision of infected primary THAs. We retrospectively reviewed all DAIRs, performed for confirmed
infected primary hip arthropasty (n = 82) at out institution, between
1997 and 2013. Data recorded included full patient information and
type of surgery. Outcome measures included complications, mortality,
implant survivorship and functional outcome. Outcome was compared with
two control groups matched for gender and age; a cohort of primary
THAs (n = 120) and a cohort of two-stage revisions for infection
(n = 66).Aims
Patients and Methods
To evaluate the hypothesis that failed osteosynthesis of periprosthetic
Vancouver type B1 fractures can be treated successfully with stem
revision using a transfemoral approach and a cementless, modular,
tapered revision stem with reproducible rates of fracture healing,
stability of the revision stem, and clinically good results. A total of 14 patients (11 women, three men) with a mean age
of 72.4 years (65 to 90) undergoing revision hip arthroplasty after
failed osteosynthesis of periprosthetic fractures of Vancouver type
B1 were treated using a transfemoral approach to remove the well-fixed
stem before insertion of a modular, fluted titanium stem which obtained
distal fixation. These patients were clinically and radiologically
followed up for a mean 52.2 months (24 to 144).Aims
Patients and Methods
The aim of this study was to compare early functional and health
related quality of life outcomes (HRQoL) in patients who have undergone
total hip arthroplasty (THA) using a bone conserving short stem
femoral component and those in whom a conventional length uncemented
component was used. Outcome was assessed using a validated performance
based outcome instrument as well as patient reported outcome measures
(PROMs). We prospectively analysed 33 patients whose THA involved a contemporary
proximally porous coated tapered short stem femoral component and
53 patients with a standard conventional femoral component, at a
minimum follow-up of two years. The mean follow-up was 31.4 months
(24 to 39). Patients with poor proximal femoral bone quality were
excluded. The mean age of the patients was 66.6 years (59 to 77)
and the mean body mass index was 30.2 kg/m2 (24.1 to
41.0). Outcome was assessed using the Oxford Hip Score (OHS) and
the University College Hospital (UCH) hip score which is a validated
performance based instrument. HRQoL was assessed using the EuroQol
5D (EQ-5D).Aims
Patients and Methods
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
Hip resurfacing has been proposed as an alternative
to traditional total hip arthroplasty in young, active patients.
Much has been learned following the introduction of metal-on-metal resurfacing
devices in the 1990s. The triad of a well-designed device, implanted
accurately, in the correct patient has never been more critical
than with these implants. Following Food and Drug Administration approval in 2006, we studied
the safety and effectiveness of one hip resurfacing device (Birmingham
Hip Resurfacing) at our hospital in a large, single-surgeon series.
We report our early to mid–term results in 1333 cases followed for
a mean of 4.3 years (2 to 5.7) using a prospective, observational
registry. The mean patient age was 53.1 years (12 to 84); 70% were
male and 91% had osteoarthritis. Complications were few, including
no dislocations, no femoral component loosening, two femoral neck
fractures (0.15%), one socket loosening (0.08%), three deep infections
(0.23%), and three cases of metallosis (0.23%). There were no destructive
pseudotumours. Overall survivorship at up to 5.7 years was 99.2%. Aseptic survivorship
in males under the age of 50 was 100%. We believe this is the largest
United States series of a single surgeon using a single resurfacing
system. Cite this article:
Joint-preserving surgery of the hip (JPSH) has evolved considerably
and now includes a number of procedures, including arthroscopy,
surgical dislocation, and redirectional osteotomies of the femur
and acetabulum. There are a number of different factors which lead
to failure of JPSH. Consequently, it is of interest to assess the
various modes of failure in order to continue to identify best practice
and the indications for these procedures. Using a retrospective observational study design, we reviewed
1013 patients who had undergone JPSH by a single surgeon between
2005 and 2015. There were 509 men and 504 women with a mean age
of 39 years (16 to 78). Of the 1013 operations, 783 were arthroscopies,
122 surgical dislocations, and 108 peri-acetabular osteotomies (PAO).
We analysed the overall failure rates and modes of failure. Re-operations
were categorised into four groups: Mode 1 was arthritis progression
or organ failure leading to total hip arthroplasty (THA); Mode 2
was an Incorrect diagnosis/procedure; Mode 3 resulted from malcorrection
of femur (type A), acetabulum (type B), or labrum (type C) and Mode 4
resulted from an unintended consequence of the initial surgical
intervention.Aims
Patients and Methods
The October 2015 Children’s orthopaedics Roundup360 looks at: Radiographic follow-up of DDH; When the supracondylar goes wrong; Apophyseal avulsion fractures; The ‘pulled elbow’; Surgical treatment of active or aggressive aneurysmal bone cysts in children; Improving stability in supracondylar fractures; Biological reconstruction may be preferable in children’s osteosarcoma; The paediatric hip fracture
Our aim was to prepare a systematic review and meta-analysis
to compare the outcomes of cemented and cementless hemiarthroplasty
of the hip, in elderly patients with a fracture of the femoral neck,
to investigate the mortality, complications, length of stay in hospital,
blood loss, operating time and functional results. A systematic review and meta-analysis was conducted following
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines on randomised controlled trials (RCTs), studying current
generation designs of stem only. The synthesis of results was done
of pooled data, with a fixed effects or random effects model, based on
heterogeneity.Aims
Materials and Methods
To analyse the effectiveness of debridement and implant retention
(DAIR) in patients with hip periprosthetic joint infection (PJI)
and the relationship to patient characteristics. The outcome was
evaluated in hips with confirmed PJI and a follow-up of not less
than two years. Patients in whom DAIR was performed were identified from our
hip arthroplasty register (between 2004 and 2013). Adherence to
criteria for DAIR was assessed according to a previously published
algorithm.Aims
Patients and Methods
We wished to quantify the extent of soft-tissue damage sustained
during minimally invasive total hip arthroplasty through the direct
anterior (DA) and direct superior (DS) approaches. In eight cadavers, the DA approach was performed on one side,
and the DS approach on the other, a single brand of uncemented hip
prosthesis was implanted by two surgeons, considered expert in their
surgical approaches. Subsequent reflection of the gluteus maximus
allowed the extent of muscle and tendon damage to be measured and
the percentage damage to each anatomical structure to be calculated.Aims
Materials and Methods
The October 2015 Hip &
Pelvis Roundup360 looks at: Smoking and complications in arthroplasty; Smoking cessation beneficial in arthroplasty; Intermediate care and arthroplasty; Do we still need cell salvage?; Femoroacetabular impingement in the Japanese population; Trunnionosis or taperosis and geometry; Decontamination for staphylococcus aureus works!; Policeman or opportunity? Quality improvement with registries; Death rates higher in readmission to other hospitals
The pelvis rotates in the sagittal plane during daily activities.
These rotations have a direct effect on the functional orientation
of the acetabulum. The aim of this study was to quantify changes
in pelvic tilt between different functional positions. Pre-operatively, pelvic tilt was measured in 1517 patients undergoing
total hip arthroplasty (THA) in three functional positions – supine,
standing and flexed seated (the moment when patients initiate rising
from a seated position). Supine pelvic tilt was measured from CT
scans, standing and flexed seated pelvic tilts were measured from standardised
lateral radiographs. Anterior pelvic tilt was assigned a positive
value.Aims
Patients and Methods
