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Daliri M, Moallem SMH, Sadeghi M, Dehghani M, Parsa A, Moradi A, Shahpari O, Ebrahimzadeh MH. Clinical Outcomes and Complications Following Hip Fusion Conversion to Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:261-268.e36. [PMID: 37541602 DOI: 10.1016/j.arth.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Efficacy, clinical outcomes, and complications following hip fusion conversion to total hip arthroplasty (THA) surgery have been explored in several studies with controversial findings and no consensus. METHODS Comprehensive search of online databases was performed through December 2022 for prepost clinical trials using MeSH keywords. Harris hip score (HHS), leg length discrepancy (LLD), pain score, and range of motion (ROM) were considered as clinical outcomes along with implant survival and complications. The retrieved studies were assessed for methodologic quality. Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated using random effects meta-analysis taking into account for heterogeneity. Subgroup meta-analysis as well as sensitivity analysis were performed. RESULTS Findings of meta-analysis on 34 trials showed that HHS increase after THA (WMD: 42.3; 95% confidence interval (CI): 38 to 47). Subgroup analyses indicated that cementless prosthesis, length of arthrodesis <12 years, age <45 years, and studies with good quality have more HHS improvement. The LLD decreased 21 mm (95% CI: 19 to 24 mm) based on 21 trials. The range of motion (ROM) reached to 89 (95% CI: 84 to 95) for flexion, 32 (95% CI: 27 to 37) for abduction, 25 (95% CI: 21 to 29) for adduction, 29 (95% CI: 25 to 33) for external rotation, and 25 (95% CI: 20 to 31) for internal rotation after surgery. The most common complication was heterotopic ossification (14%). CONCLUSION Conversion of an ankylosed hip to THA leads to improved hip function and leg discrepancy with relatively notable rate of complications. Our findings could provide a framework to guide surgeons and decision makers.
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Affiliation(s)
- Mahla Daliri
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Masoumeh Sadeghi
- Faculty of Health, Department of Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Dehghani
- Faculty of Health, Department of Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Parsa
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; American Hip Institute, Chicago, Illinois
| | - Ali Moradi
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omid Shahpari
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad H Ebrahimzadeh
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
INTRODUCTION This paper aims to review the indications criteria for the surgical treatment of adolescents with hip osteoarthritis and summarize the contemporary techniques that orthopaedic surgeons can apply for hip reconstruction. DISCUSSION Hip osteoarthritis remains a concerning burden to North American society. While the rate of total hip replacement (THR) in younger patients has increased in the last decades, younger patients may have a higher risk of revision hip replacement because of their increased level of activity and expected patient longevity compared with the elderly. Increased demand for multiple revision surgeries is a concern for the adolescent patient. Although in general THR has been increasingly recommended for the treatment of end-stage osteoarthritis secondary to pediatric hip disorders, hip arthrodesis remains a beneficial alternative for the treatment of severe hip disease secondary to infection and for patients who desire to engage in a very active lifestyle. Hip preservation procedures are ideally performed in the prearthritic stage or in hips with minimal degeneration to preserve the joint and achieve the most optimal outcomes. However, adolescents and young adults with moderate and rarely advanced arthritis may benefit from surgical treatment using hip preservation techniques. CONCLUSIONS Treatment of adolescents with pain and dysfunction because of end-stage hip disease is challenging and controversial. THR and arthrodesis are the 2 principal alternatives. However, in particular circumstances, hip reconstruction may be recommended.
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Cardile C, Cazzaniga C, Manzini B, Marasco R, Ragni P. Intertrochanteric hip fracture in an arthrodesed hip treated by a LCP condylar plate. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021039. [PMID: 33944846 PMCID: PMC8142761 DOI: 10.23750/abm.v92is1.9201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022]
Abstract
We report the case of an intertrochanteric hip fracture in a 73 years-old woman with a long-standing arthrodesis. The proper surgical treatment is controversial but we decided to treat the fracture with a single LCP condylar plate turned upside-down. After one year the patient achieved her preinjury levels of activities. This kind of fracture could be satisfactorily treated with locking plate.
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Affiliation(s)
| | - Carlo Cazzaniga
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, Garbagnate Milanese, Italy.
| | - Beatrice Manzini
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, Garbagnate Milanese, Italy.
| | - Roberto Marasco
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, Garbagnate Milanese, Italy.
| | - Paolo Ragni
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, Garbagnate Milanese, Italy.
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Adil SA, Hooper M, Kocher T, Caughran A, Bullock M. Conversion of Hip Arthrodesis Using Robotic Arm Technology. Arthroplast Today 2021; 9:40-45. [PMID: 33997207 PMCID: PMC8102203 DOI: 10.1016/j.artd.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 01/13/2023] Open
Abstract
Recent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.
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Affiliation(s)
- Syed Ali Adil
- Marshall University Department of Orthopaedics, Huntington, WV, USA
| | - Matthew Hooper
- Marshall University Department of Orthopaedics, Huntington, WV, USA
| | - Timothy Kocher
- Marshall University Department of Orthopaedics, Huntington, WV, USA
| | | | - Matthew Bullock
- Marshall University Department of Orthopaedics, Huntington, WV, USA
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Abstract
Hip arthrodesis is a treatment option for painful chronic hip conditions. Hip fractures through a previously arthrodesed hip are relatively uncommon as indications for hip arthrodesis are rare. The following case reports on the use of a sliding hip screw and a pelvic reconstruction plate to address arthrodesed hip fracture in an 81-year-old man. The use of a dynamic hip screw in this setting gave us a stable fixed-angle construct with compression across the fracture site, and the addition of a trochanteric side plate added to the stability. The dynamic compression plate with limited bone contact was used to neutralize the construct. This case describes the successful treatment of such an injury in a way not previously described in the literature with the intent of giving the orthopaedic traumatologist another method to approach this rare injury.
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Degeneration of the Sacroiliac Joint in Hip Osteoarthritis Patients: A Three-Dimensional Image Analysis. J Belg Soc Radiol 2019; 103:36. [PMID: 31149653 PMCID: PMC6534012 DOI: 10.5334/jbsr.1648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: The sacroiliac joint is an important source of low back pain and may be influenced by pathologies in adjoining structures such as the hip or the spine. This study aimed to investigate the influence of hip osteoarthritis on sacroiliac joint degeneration by examining the sacroiliac joints of hip osteoarthritis patients, focusing on the localization and quantity of vacuum phenomena. Materials and Methods: The preoperative computed tomography (CT) of 31 female hip replacement candidates (mean age 69.1) and pelvic CT of 34 age-matched controls (mean age 67.9) were used to reconstruct the sacroiliac joints three-dimensionally. The degeneration score of the sacroiliac joints on axial view, as well as the location and volume of vacuum phenomena in the three-dimensionally reconstructed sacroiliac joints, were analyzed. Results: The total sacroiliac joint degeneration scores were similar in hip osteoarthritis patients and controls but the breakdown of the score revealed that joint space narrowing and vacuum phenomena in the sacroiliac joint increase in hip osteoarthritis, while osteophytes decrease. Three-dimensional reconstruction revealed that the volume of vacuum phenomena in the sacroiliac joint was significantly larger in the hip osteoarthritis group and the vacuum areas were localized in the antero-superior region of the sacroiliac joint. Conclusion: Our results suggest that hip osteoarthritis and sacroiliac joint degeneration are related, and that with further investigation, the sacroiliac joint may become a new treatment target in hip osteoarthritis.
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Speirs J, Petkovic D, Herzenberg J, Nelson S. A technique for hip arthrodesis using a multiplanar external fixator and transarticular screws. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2019. [DOI: 10.4103/jllr.jllr_15_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Femoral head wedge resection for the treatment of avascular necrosis of the femoral head after pediatric femoral neck fracture: a case report. J Pediatr Orthop B 2018; 27:283-288. [PMID: 29570157 PMCID: PMC5895113 DOI: 10.1097/bpb.0000000000000507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This research focuses on femoral head wedge resection for the treatment of avascular necrosis (AVN) of the femoral head. A 9-year-old girl presented to the emergency room complaining of right hip pain that occurred after a pedestrian car accident. After 8 months of internal fixation using cannulated screws for Delbet-type 2 fracture of the femoral neck, AVN of the femoral head developed in the patient. Even though valgus-derotation-extension intertrochanteric osteotomy was performed for the treatment of AVN, it progressed further and femoral head wedge resection was performed to recover the femoral head sphericity. After 3 years of follow-up, radiograph results showed appropriate and satisfactory congruency and containment. This research shows that the treatment of AVN of the femoral head using femoral head wedge resection is an effective method that can yield excellent results.
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Celiktas M, Kose O, Turan A, Guler F, Ors C, Togrul E. Conversion of hip fusion to total hip arthroplasty: clinical, radiological outcomes and complications in 40 hips. Arch Orthop Trauma Surg 2017; 137:119-127. [PMID: 27900509 DOI: 10.1007/s00402-016-2597-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this retrospective study is to report the clinical and radiological outcome of total hip arthroplasty in patients with previous hip arthrodesis. PATIENTS AND METHODS We retrospectively reviewed 28 (40 hips) prospectively followed patients in whom ankylosed hips were converted to total hip arthroplasty (THA) between 2010 and 2014 in our institution. The average age at the time of the conversion operation was 40.8 ± 9.8 years (range 24-62). The ankylosis had lasted 20.4 ± 13.0 years (range 3-56) before conversion surgery. The etiology of the ankylosis was septic arthritis in 10 (25%), post-traumatic hip osteoarthritis in 8 (20%), developmental hip dysplasia in 6 (15%), rheumatoid arthritis in 6 (15%), primary osteoarthritis in 5 (12.5%) and ankylosing spondylitis in 5 (12.5%) hips. The indications for arthroplasty were intractable low back pain in 14 (50%), hip pain in 24 (85.7%), and ipsilateral knee pain in 19 (67.8%) patients. Harris Hip Score (HHS) was used to rate the clinical results before and after the surgery. Radiographic evaluations included component malposition and loosening. All complications during the study period were recorded. RESULTS The mean follow-up period was 39.9 ± 10.6 months (range 24-60). The mean preoperative HHS was 33.3 ± 8.6 (range 18-50) and the mean HHS at the final follow-up was 74.9 ± 8.6 (range 52-97). There was a statistically significant increase in HHS (p = 0.0001). HHS was excellent in 1, good in 6, fair in 14 and poor in 7 patients. Increase in HHS was lower than 20 points in one patient (18 points), and one patient required two-staged exchange procedure due to deep infection. Thus, according to our success criteria (increase in HHS more than 20 points, radiographically stable implant, and no further surgical reconstruction), 92.8% (26/28) of patients had benefit from the surgery. Trendelenburg sign was positive in 12 hips. There was limb length inequality in 11 patients (mean 0.5 cm, range 1-3 cm). No patients had heterotopic ossification, sciatic nerve palsy or dislocation. There were five intra-operative fractures of the greater trochanter that were treated with cable wiring. One patient had trochanteric avulsion injury and was treated with trochanteric grip and cables. One patient (2.5%) had deep infection one year after the conversion THA and was treated with two-staged exchange procedure. CONCLUSION Conversion hip arthroplasty is an effective treatment method which provides functional recovery and patient satisfaction. However, a proper surgical technique and planning is necessary to minimize the complications.
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Affiliation(s)
- Mustafa Celiktas
- Orthopedics and Traumatology Clinic, Ortopedia Private Hospital, Adana, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Soguksu Mah. Kazım Karabekir cd. Muratpaşa, Antalya, Turkey.
| | - Adil Turan
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Soguksu Mah. Kazım Karabekir cd. Muratpaşa, Antalya, Turkey
| | - Ferhat Guler
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Soguksu Mah. Kazım Karabekir cd. Muratpaşa, Antalya, Turkey
| | - Cagri Ors
- Orthopedics and Traumatology Clinic, Ortopedia Private Hospital, Adana, Turkey
| | - Emre Togrul
- Orthopedics and Traumatology Clinic, Ortopedia Private Hospital, Adana, Turkey
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Abstract
This review describes the normal healing process for bone, ligaments, and tendons, including primary and secondary healing as well as bone-to-bone fusion. It depicts the important mediators and cell types involved in the inflammatory, reparative, and remodeling stages of each healing process. It also describes the main challenges for clinicians when trying to repair bone, ligaments, and tendons with a specific emphasis on Charcot neuropathy, fifth metatarsal fractures, arthrodesis, and tendon sheath and adhesions. Current treatment options and research areas are also reviewed.
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Affiliation(s)
- Jessica A Cottrell
- Department of Biological Sciences, Seton Hall University, 400 South Orange Avenue, South Orange, NJ 07101, USA.
| | - Jessica Cardenas Turner
- Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Martin Luther King Boulevard, Newark, NJ 07102, USA
| | - Treena Livingston Arinzeh
- Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Martin Luther King Boulevard, Newark, NJ 07102, USA
| | - J Patrick O'Connor
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Medical Sciences Building, Room E-659, 185 South Orange Avenue, Newark, NJ 07103, USA
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Scemama C, Lestrat V, Combourieu B, Judet T. Anterior approach for total hip arthroplasty conversion of hip fusion. INTERNATIONAL ORTHOPAEDICS 2015; 40:1821-5. [PMID: 26711448 DOI: 10.1007/s00264-015-3084-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Hip fusion conversion has shown mixed results, in particular a higher rate of failure than primary total hip replacement. Conversion is usually carried out by a lateral approach. METHODS We reported a series of 37 hip fusion conversions performed by an anterior approach. Clinical and radiographic outcomes of this unusual approach were reported at eight years of follow up. RESULTS At eight years of follow up, survivorship was 86. 6 % (IC 95 %: 62.4-95.7 %). Sixteen patients reported good relief of the pre-operative back spine or knee pain. PMA score was significantly improved. Two implant aseptic loosenings needing revision surgery were reported. CONCLUSION The anterior approach seemed to be as good as the other hip approaches for hip fusion conversion to total hip replacement.
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Affiliation(s)
- Caroline Scemama
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France.
| | - Vincent Lestrat
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France
| | - Benoit Combourieu
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France
| | - Thierry Judet
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France
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Fang C, Fang B, Wong TM, Lau TW, Pun T, Leung F. Fixing a fractured arthrodesed hip with rapid prototype templating and minimal invasive plate osteosynthesis. Trauma Case Rep 2015; 1:79-83. [PMID: 30101181 PMCID: PMC6082500 DOI: 10.1016/j.tcr.2015.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 10/29/2022] Open
Abstract
CASE We present an elderly lady with an intertrochanteric fracture of a previously fused hip. A 3D printed model of her pelvis and femur was used for implant templating before surgery. Minimal invasive fixation was performed with a spanning reversed distal femur locking plate without the need for removal of the previous implant. Multiple long locking screws were placed in the supra-acetabular region. The patient had union in 4 months, return to function and no complication. Conclusion The technique allowed us to optimize implant selection and insert screws safely at difficult trajectories using minimal invasive surgery.
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Affiliation(s)
- Christian Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Benjamin Fang
- Department of Radiology, H1, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Tak-Man Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.,Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tak-Wing Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Terence Pun
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.,Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Hirai T, Inaba Y, Kobayashi N, Takakagawa S, Yukizawa Y, Ike H, Saito T. Late-Onset Screw Migration into Iliac Vessels 21 years after Hip Arthrodesis. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:123-5. [PMID: 25336996 PMCID: PMC4197906 DOI: 10.4137/ccrep.s16159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/25/2014] [Accepted: 08/06/2014] [Indexed: 12/02/2022]
Abstract
Iatrogenic injuries to the vascular system are a rare but serious complication of hip surgery. We report a case of an 83-year-old man who presented with intrapelvic migration of a screw into the space between the external iliac artery and vein 21 years after hip arthrodesis. The patient was treated with laparotomy, and the damaged artery was excised and sutured. This is the first case of a late vascular complication secondary to screw migration after hip arthrodesis.
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Affiliation(s)
- Taishi Hirai
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Shu Takakagawa
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
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Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol-Surgical Treatment of Neurological Hip Flexion Contracture. Case Rep Med 2014; 2014:349014. [PMID: 24707293 PMCID: PMC3965955 DOI: 10.1155/2014/349014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/11/2013] [Accepted: 12/31/2013] [Indexed: 11/17/2022] Open
Abstract
Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.
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Hoekman P, Idé G, Kassoumou AS, Hayatou MM. Hip arthrodesis with the anterolateral plate: an innovating technique for an orphaned procedure. PLoS One 2014; 9:e85868. [PMID: 24465757 PMCID: PMC3896439 DOI: 10.1371/journal.pone.0085868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 07/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In developing countries hip osteoarthritis constitutes a major public health issue as it is highly prevalent in all age ranges of population, including the young. It often remains untreated because of the low accessibility of total hip prostheses. Hip arthrodesis still represents a major treatment option, but, for several reasons which are discussed in this paper, is nowadays infrequently performed. By means of reporting the results of a new simple technique, using a self-devised plate, the relevancy of hip arthrodesis in this particular environment is emphasized. METHODS AND FINDINGS Our series included 35 patients with painful hip osteoarthritis who underwent a hip fusion with the anterolateral arthrodesis plate. Two of them had a concurrent femoral osteotomy for correction of a vicious position of the limb and another patient had a femoral diaphysis osteotomy and placement of a Wagner elongating device in order to proceed with a limb lengthening by callotasis. The follow-up period averaged 16,9 months (9 to 34). All hips, except two, achieved solid fusion between 6 and 15 months after surgery. One failure of fusion was in the oldest patient, who presented a loosening of plate and screws due to an advanced degree of osteoporosis; the other was in a young patient who admitted having walked on his leg too soon. Patient satisfaction was high. We concluded that this technique is reliable and effective. CONCLUSIONS The results of this study should convince the hesitant surgeon and patient to consider hip arthrodesis an acceptable treatment option for disabling hip arthritis, compared to no treatment at all.
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Affiliation(s)
- Patrick Hoekman
- Department of Orthopaedic Surgery, National Hospital of Niamey, Niamey, Niger, Africa
- * E-mail:
| | - Garba Idé
- Department of Orthopaedic Surgery, National Hospital of Niamey, Niamey, Niger, Africa
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16
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Abstract
Hip arthrodesis remains a viable surgical technique in well selected patients, typically the young manual labourer with isolated unilateral hip disease. Despite this, its popularity with patients and surgeons has decreased due to the evolution of hip replacement, and is seldom chosen by young adult patients today. The surgeon is more likely to encounter a patient who requests conversion to total hip replacement (THR). The most common indications are a painful pseudarthrosis, back pain, ipsilateral knee pain or contralateral hip pain. Occasionally the patient will request conversion because of difficulty with activities of daily living, body image and perceived cosmesis. The technique of conversion and a discussion of the results are presented. Cite this article: Bone Joint J 2013;95-B, Supple A:114–19.
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Affiliation(s)
- M. R. Whitehouse
- University of British Columbia, The
University of British Columbia, Department
of Orthopaedics, 3rd Floor, 910
West 10th Avenue, Vancouver, BC, V5Z
4E3, Canada
| | - C. P. Duncan
- University of British Columbia, The
University of British Columbia, Department
of Orthopaedics, 3rd Floor, 910
West 10th Avenue, Vancouver, BC, V5Z
4E3, Canada
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17
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Jain S, Giannoudis PV. Arthrodesis of the hip and conversion to total hip arthroplasty: a systematic review. J Arthroplasty 2013; 28:1596-602. [PMID: 23523503 DOI: 10.1016/j.arth.2013.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 01/18/2013] [Accepted: 01/25/2013] [Indexed: 02/01/2023] Open
Abstract
A systematic review of the literature was performed in order to evaluate the outcomes following arthrodesis of the hip and subsequent conversion to total hip arthroplasty. Eight studies regarding primary hip arthrodesis evaluating 249 hips revealed variable union rates (37.5%-100%) and patient satisfaction rates (69%-100%). Adjacent joint pain was commonly seen in the lower back (up to 75%) and ipsilateral knee (up to 57%) and complications were reported in 8.4%. Eleven studies regarding conversion arthroplasty evaluating 579 patients revealed inconsistent results regarding relief of pain. Complications were seen in up to 54%, most commonly due to mechanical failure, deep infection and nerve palsy. Whilst hip arthrodesis can provide pain relief and patient satisfaction, conversion arthroplasty is associated with an unacceptably high complication rate.
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Affiliation(s)
- Sameer Jain
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK
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Abstract
Debilitating arthritis in teenage patients is a complex problem with limited surgical options. Hip arthrodesis is unpopular amongst patients, and contemporary total hip arthroplasty (THA) may be a promising alternative. We report on the outcomes of THA in patients less than 20 years of age. All consecutive teenage patients undergoing THA at a tertiary referral centre were reviewed. Mean follow-up was 3.4 years (range 0.6-6.8) and 9 patients had at least 5 years follow-up. There were 51 THAs in 43 patients with a mean age of 17 years (range 12-19). The commonest indication was osteonecrosis (35 cases), mostly secondary to slipped upper femoral epiphysis (15 cases). Forty-six were uncemented and 5 were reverse hybrid THAs of which 7 were computer assisted design/manufacture (CADCAM) components. The commonest bearing surface used was ceramic on ceramic (40 cases). The survival rate was 96% and there were 2 complications. At latest follow-up, the mean Harris hip score was 90 (range 68-99) and UCLA activity score was 6 (range 4-9). Radiological analysis showed 2 patients with lucent lines around the acetabular component, but no signs of osteolysis or wear. We report good short to intermediate term survivorship and outcomes, and feel THA represents a valid alternative option to hip arthrodesis.
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Bartoníček J, Vávra J, Bartoška R, Havránek P. Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents. INTERNATIONAL ORTHOPAEDICS 2011; 36:149-57. [PMID: 21796335 DOI: 10.1007/s00264-011-1272-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 04/21/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Our aim was to assess operative treatment for post-traumatic avascular necrosis of the femoral head (ANFH) in adolescents. METHODS Eleven patients with an average age of 17 (range 14-26) years were operated up on for ANFH after proximal femoral fractures. The average interval between injury and reconstructive surgery was four (range two to eight) years. The average follow-up of the entire cohort was 89 (range 48-132) months. Five patients with total ANFH were treated by total hip replacement (THR). Six patients with partial ANFH were treated with valgus intertrochanteric osteotomy (VITO). RESULTS In all patients, operation improved hip function. The average preoperative Harris Hip Score (HHS) was 70 points and average postoperative HHS was 97 points. Comparison of magnetic resonance imaging (MRI) scans before and after VITO demonstrated resorption of the necrotic segment of the femoral head and its remodelling in all six patients with partial ANFH. A complication was encountered in one patient. CONCLUSION Patients treated for ANFH had good medium-term outcomes after THR for total necrosis and also after VITO for partial necrosis.
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Affiliation(s)
- Jan Bartoníček
- Department of Surgery of the 1st Faculty of Medicine, Charles Univeristy, Thomayer University Hospital, Vídeňská 800, Prague-4, Czech Republic.
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Is total hip arthroplasty after hip arthrodesis as good as primary arthroplasty? Clin Orthop Relat Res 2011; 469:1971-83. [PMID: 21116751 PMCID: PMC3111784 DOI: 10.1007/s11999-010-1704-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 11/15/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Conversion of hip arthrodesis to a THA reportedly provides a reasonable solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with a hip fusion. Patients generally are satisfied with conversion despite the fact that range of mobility, muscle strength, leg-length discrepancy (LLD), persistence of limp, and need for assistive walking aids generally are worse than those for conventional primary THA. QUESTIONS/PURPOSES We compared THA after hip arthrodesis and primary THA to determine whether these procedures would be associated with similar functional scores, maintenance of scores with time, complications and failures, survivorship of the arthroplasty, and patient satisfaction. PATIENTS AND METHODS We retrospectively matched 48 patients undergoing conversion of a fused hip to a THA between January 1980 and January 2000, with 50 patients receiving a primary THA during the same period. We prospectively followed all patients between January 2000 and January 2010. The changes in function and pain after THA were compared between the two cohorts using the Harris hip score (HHS) and the Rosser Index Matrix (RIM). The Oxford hip score (OHS) and the SF-36 also were used to assess quality of life (QOL) during followup. Complications were collected and survivorship of the THA was evaluated. Patient satisfaction was assessed using the Robertsson and Dunbar questionnaire. The minimum followup was 10 years (mean, 17 years; range, 10-29 years). RESULTS At last followup, hip function and health-related QOL were similar for patients having conversion of hip arthrodesis to THA and for patients having a routine THA. Scores diminished overall in the two groups between 2000 and 2010, but without a difference for the HHS, RIM QOL, and OHS in the study cohort. The rate of complications, THA survival, and patient satisfaction were similar in both groups. CONCLUSIONS Conversion of hip arthrodesis to a THA provides substantial improvement of hip function and health-related QOL, with an acceptable rate of complications, good expectancy of survival for the arthroplasty, and high level of patient satisfaction comparable to those of primary THA. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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