[Avoidance, diagnostics and therapy of nerve lesions after total hip arthroplasty]

[Arthroplasty for osteoarthritis secondary to hip dysplasia: Problem-oriented treatment strategies]

BACKGROUND

Because of anatomical variations total hip arthroplasty (THA) can be demanding in patients with osteoarthritis secondary to hip dysplasia.

OBJECTIVES

Depending on the degree of bony deformation, hip dislocation and soft tissue alteration numerous treatment strategies are available. This review describes current approaches that address frequent deformities.

MATERIALS AND METHODS

Review of relevant clinical studies, meta-analyses, and presentation of our own approach.

RESULTS

Pre-operative planning (based on a thorough clinical and radiographic examination) is essential. Acetabular reconstruction close to the primary acetabulum should always be intended. Roof augmentation and/or cup medialization can support stable bony implant fixation. Subtrochanteric shortening osteotomy of the femur is a demanding but reliable technique that avoids nerve damage in cases where inappropriate lengthening would be necessary (i.e., high riding dislocation).

CONCLUSIONS

Although the post-operative complication rate is elevated after THA for dysplastic hips compared with primary osteoarthritis, the overall functional results and implant survival are comparable.

[Joint replacement quality index: the perspective of resident physicians]

BACKGROUND AND AIM

Joint replacement is an established therapy for arthrosis. The quality index for joint replacement (knee and hip) should include screening for quality of patient-centred care in hospitals providing replacements, on the basis of administrative data. The quality index summarizes 16 inpatient and posthospital complications (indicators). The aim of the study was to evaluate this quality index from the medical practitioner's viewpoint.

METHODS

Four semistructured focus groups with 11 family physicians and 8 orthopaedic/trauma surgeons were conducted. The discussions were recorded, transcribed and analysed qualitatively according to Mayring.

RESULTS

Infections and the revision of a total joint arthroplasty have been weighted as the most important indicators from the existing quality indicators. Between the participants some differences regarding the relevance of the indicators thrombosis and pulmonary embolism occurred. These indicators were weighted as more important by family physicians than orthopedic/trauma surgeons. For eight of the indicators, imprecision in words/meaning was criticized. In an open-ended second section, 20 new indicators within the areas complications, management and overall sector communication were identified.

CONCLUSION

Major amendments of the quality index for the joint replacement are necessary. The knowledge gained from this study may serve as a basis for this development.

Long-term prognosis of nerve palsy after total hip arthroplasty: results of two-year-follow-ups and long-term results after a mean time of 8 years

INTRODUCTION

Nerve damage is a rare but serious complication after THA. There exist only little data about the outcome of these patients particularly regarding the long-term results later than 2 years postoperatively. Aim of this study is to answer the following questions: Is the recovery to be expected for light nerve lesions different from the severe ones? Is there a possibility of nerve recovery more than 2 years after THA? Is the potential of nerve recovery depending on the affected nerve?

MATERIALS AND METHODS

This study investigates 2,255 primary THA as well as revision surgeries performed from 1988 to 2003 relating to iatrogenic nerve lesion. We classified the nerve lesion according to the core muscle strength in severe (M0-M2) and light (M3-M4) nerve damage and differentiated between femoral, sciatic and superior gluteal nerve, according to the electromyography.

RESULTS

We found 34 cases of iatrogenic nerve damage representing an incidence of 1.5 %. 17 of 34 (50 %) patients showed a complete recovery after 2 years. Out of the remaining 17 patients, six out of seven patients with a final examination after a median time of 93 months achieved further improvement. The different nerves showed no significant different potential of recovery.

CONCLUSIONS

In contrast to the literature, an improvement beyond the limit of 2 years is probable and independent of the nerve affected.

[Lower limb paresis after total hip arthroplasty. A rare differential diagnosis]

We report on a case of complex nerve damage during total hip arthroplasty. The most severe clinical symptom was proximal leg paresis with diffuse sensory loss. There was an extensive causal Iliopsoas hematoma which developed during the postoperative rehabilitation under therapeutic anticoagulation for atrial fibrillation. An iliopsoas hematoma with subsequent neurological deficits are rare events in the field of hip arthroplasty and a literature review is provided. The treatment of retroperitoneal hemorrhage is controversial but in most instances a conservative approach is favored. The prognosis of neurological damage is sobering as only 20 % of victims are expected to achieve complete restitution.

[Femoral nerve palsy as delayed complication after total hip replacement: delayed hematoma formation in unexpected screw malpositioning]

Nerve injury after total hip replacement is a rare but severe complication. If the nerve lesion becomes evident in the early postoperative phase the lesion is often due to an incorrect implant position, direct nerve injury or vascular injury with manifestation of a hematoma which results in nerve compression. Secondary nerve lesions are more often due to a chronic hematoma with nerve compression. Secondary nerve lesions in particular are often a diagnostic challenge and should lead to an early revision after comprehensive imaging diagnostics.