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Hardwick-Morris M, Twiggs J, Miles B, Al-Dirini RMA, Taylor M, Balakumar J, Walter WL. Determination of preoperative risk factors for iliopsoas tendonitis after total hip arthroplasty: A simulation study. J Orthop Res 2024; 42:2035-2042. [PMID: 38587991 DOI: 10.1002/jor.25856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/28/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
This study aims to identify preoperative risk factors for iliopsoas tendonitis after total hip arthroplasty, a complication typically attributed to acetabular cup position and orientation, using a validated iliopsoas impingement detection simulation. Analyzing CT scans and X-rays of 448 patients using a validated preoperative planning protocol, patients were simulated for iliopsoas impingement and categorized into at-risk and not at-risk groups based on a prior validation study, with a 23% at-risk incidence. Implementing a propensity score matching algorithm to reduce covariate imbalance, we identified factors that may exacerbate risk of iliopsoas tendonitis. Parameters that were investigated included standing pelvic tilt, functional femoral rotation, and the difference between the planned acetabular cup diameter and native femoral head diameter (ΔC-NFH). Comparing pelvic tilt, we found a significant difference between the groups (at-risk: -6.0°, not at-risk: -0.7°; p << 0.01). A similar trend was noted for ΔC-NFH (at-risk: +5.7 mm, not at-risk: +5.1 mm; p = 0.01). Additional simulations of at-risk patients indicated increased anteversion of the acetabular cup reduces impingement risk more effectively than medialisation. These findings suggest that spinopelvic parameters may exacerbate iliopsoas irritation risk, underscoring their importance in preoperative planning and patient expectation management. Similar findings of a greater than 6 mm difference between cup size and native femoral head diameter being a significant risk for iliopsoas tendonitis have been observed before, underscoring its potential veracity. These results may provide surgeons with a simple threshold that can be used in determining a cup size to reduce the risk of iliopsoas tendonitis.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Joshua Twiggs
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
| | - Brad Miles
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
| | - Rami M A Al-Dirini
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Mark Taylor
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | | | - William L Walter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Chen H, Lai P, Lu H, Zhu J, Sang W, Wang C, Zhong Y, Zhu L, Ma J. Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study. J Orthop Surg Res 2024; 19:374. [PMID: 38915048 PMCID: PMC11194934 DOI: 10.1186/s13018-024-04862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19. METHODS Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay. RESULTS The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259-39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03-1.55, p = 0.027). CONCLUSION This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).
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Affiliation(s)
- Hongjie Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Peng Lai
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Haiming Lu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Jun Zhu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201620, China
| | - Weilin Sang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Cong Wang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yiming Zhong
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Libo Zhu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
| | - Jinzhong Ma
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Sterneder CM, Tüngler TL, Haralambiev L, Boettner CS, Boettner F. Pelvic Roll Back Can Trigger Functional Psoas Impingement in Total Hip Arthroplasty. Arthroplast Today 2024; 27:101375. [PMID: 38680848 PMCID: PMC11047294 DOI: 10.1016/j.artd.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 05/01/2024] Open
Abstract
In most cases, impingement of the iliopsoas tendon after total hip arthroplasty is caused by acetabular component retroversion. The present case report describes a patient with functional iliopsoas impingement following total hip arthroplasty. With increasing flexibility of the hip joint after surgery, the functional adjustment to the stiff thoracolumbar spine in this patient with diffuse idiopathic skeletal hyperostosis resulted in progressive pelvic roll back. This roll back resulted in a functional iliopsoas impingement as the psoas tendon travels over the front of the pecten ossis pubis. Since excessive roll back is usually also addressed in primary total hip arthroplasty by decreasing anteversion of the acetabular component, surgeons should be aware to avoid the combination of roll back and decreased anteversion and their potential impact on iliopsoas impingement.
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Affiliation(s)
| | - Tim Ludwig Tüngler
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Cosima S. Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Finsterwald M, Mancino F, Waters G, Ebert J, Malik SS, Jones CW, Yates PJ, D'Alessandro P. Endoscopic Tendon Release for Iliopsoas Impingement After Total Hip Arthroplasty-Excellent Clinical Outcomes and Low Failure Rates at Short-Term Follow-Up. Arthroscopy 2024; 40:790-798. [PMID: 37544336 DOI: 10.1016/j.arthro.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To investigate the clinical effectiveness of endoscopic iliopsoas tendon release (IPR) at the lesser trochanter (LT) in patients with iliopsoas impingement (IPI) after total hip arthroplasty (THA). METHODS Between November 2017 and March 2021, a consecutive series of 36 patients were treated with endoscopic IPR for diagnosed IPI. Patients included had acetabular cup position confirmed by functional imaging (OPS, Corin, Pymble, NSW), typical clinical symptoms of IPI, and a positive response to diagnostic injection. Clinical assessment included validated patient-reported outcome measures (PROMs) along with hip flexion strength and active range of motion at different time marks up to 2-year follow-up, as well as surgical complications. RESULTS Overall, 36 consecutive patients (11 males) with a mean age of 62 ± 12 years were included. All patients had failed nonoperative management. Dynamic computed tomography assessment was available in 89% of the patients, edge loading was reported in 10%, and variable cup overhang was reported in 50%. Clinically, PROMs were significantly improved at every time mark when compared with preoperative values (P < .001), showing the biggest improvement within the first 4 weeks after surgery. At the 6-month follow-up, peak isometric hip flexion strength on the operated side was 20% lower than the contralateral side (P < .001). Failure rate of the procedure was 2.8% (1 case). Linear regression showed no association between cup overhang and clinical outcomes. CONCLUSIONS Endoscopic IPR at the LT is a safe and reproducible technique associated with significant and immediate improvement in pain, functional outcomes, and high patient satisfaction. With minimal short-term weakness, no complications, and only a single revision, even in cases with cup malposition and/or edge loading, we believe that endoscopic IPR can be considered as one of the first-line operative options in patients with symptomatic IPI, irrespective of component position. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Michael Finsterwald
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia.
| | - Fabio Mancino
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Georgina Waters
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Jay Ebert
- Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia; HFRC Rehabilitation Clinic, Perth, Western Australia
| | | | - Christopher W Jones
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Curtin University, Perth, Western Australia, Australia
| | - Piers J Yates
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Medical School, Division of Surgery, University of Western Australia, Perth, Australia
| | - Peter D'Alessandro
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Medical School, Division of Surgery, University of Western Australia, Perth, Australia
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Hardwick-Morris M, Twiggs J, Miles B, Al-Dirini RMA, Taylor M, Balakumar J, Walter WL. Comparison of iliopsoas tendonitis after hip resurfacing arthroplasty and total hip arthroplasty: A case-controlled investigation using a validated simulation. J Orthop Res 2024. [PMID: 38366978 DOI: 10.1002/jor.25815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
Iliopsoas tendonitis, typically caused by impingement with the acetabular cup, occurs in up to 18% of patients after total hip arthroplasty (THA) and up to 30% of patients after hip resurfacing arthroplasty (HRA). We have developed a simulation for detecting iliopsoas impingement and validated it in a previous study of THA patients. However, due to the difference in incidence between HRA and THA, this study had two aims. First, to validate the simulation in a cohort of HRA patients and, second, to comparethe results of the HRA and THA patients to understand any differences in their etiology. We conducted a retrospective search in an experienced surgeon's database for HRA patients with iliopsoas tendonitisand control patients without iliopsoas tendonitis, resulting in two cohorts of 12 patients. Using CT scans, 3D models of the each patient's prosthetic and bony anatomy were generated, landmarked, and simulated. Regarding validation of the simulation for HRA patients, impingement significantly predicted the probability of iliopsoas tendonitis in logistic regression models and the simulation had a sensitivity of 83%, specificity of 100%, and an AUC ROC curve of 0.95. Unexpectedly, the HRA cohort exhibited less impingement than the THA cohort. Our novel simulation has now been demonstrated to detect iliopsoas impingement and differentiate between the symptomatic and asymptomatic cohorts in investigations of THA and HRA patients. This tool has the potential to be used preoperatively, to guide decisions about optimal cup placement, and postoperatively, to assist in the diagnosis of iliopsoas tendonitis.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, Australia
- Enovis ANZ, Sydney, Australia
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Joshua Twiggs
- 360 Med Care, Sydney, Australia
- Enovis ANZ, Sydney, Australia
| | - Brad Miles
- 360 Med Care, Sydney, Australia
- Enovis ANZ, Sydney, Australia
| | - Rami M A Al-Dirini
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Mark Taylor
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | | | - William L Walter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
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Verhaegen JCF, Vandeputte FJ, Van den Broecke R, Roose S, Driesen R, Timmermans A, Corten K. Risk Factors for Iliopsoas Tendinopathy After Anterior Approach Total Hip Arthroplasty. J Arthroplasty 2023; 38:511-518. [PMID: 36257506 DOI: 10.1016/j.arth.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Iliopsoas tendinopathy is a cause of groin pain following total hip arthroplasty (THA). With the anterior approach becoming increasingly popular, our aim was to determine the prevalence of iliopsoas tendinopathy following anterior approach THA, to identify risk factors and to determine an influence on patient-reported outcomes. METHODS This is a retrospective case-control study of prospectively recorded data on 2,120 primary anterior approach THA (1,815 patients). The diagnosis of iliopsoas tendinopathy was based on (1) persistent postoperative groin pain, triggered by hip flexion; (2) absence of dislocation, infection, loosening, or fracture; and (3) decrease of pain after fluoroscopy-guided iliopsoas tendon sheet injection with xylocaine and corticosteroid. Outcomes included hip reconstruction (inclination/anteversion and leg-length), complication rates, reoperation rates, and patient-reported outcomes including Hip disability and Osteoarthritis Outcome Score. RESULTS Forty four patients (46 THAs) (2.2%) were diagnosed with iliopsoas tendinopathy. They were younger than patients who did not have iliopsoas tendinopathy (51 years [range, 27-76] versus 62 years [range, 20-90]; P < .001). Logistic regression analyses demonstrated that younger age (P < .001) and presence of a spine fusion (P = .008) (odds ratio 4.6) were the significant predictors of iliopsoas tendinopathy. These patients had lower Hip disability and Osteoarthritis Outcome scores, reported more often low back pain (odds ratio 4.8), and greater trochanter pain (odds ratio 5.4). CONCLUSION We found an incidence of 2.2% of iliopsoas tendinopathy patients after anterior approach THA that compromised outcomes. Younger age and previous spine fusion were identified as most important risk factors. These patients were 5 times more likely to report low back pain and greater trochanter pain post-THA.
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Affiliation(s)
- Jeroen C F Verhaegen
- Ziekenhuis Oost-Limburg, Genk, Belgium; University of Antwerp, Antwerp, Belgium; Orthopaedic Center Antwerp, AZ Monica, Antwerp, Belgium
| | | | | | - Stijn Roose
- Heuppraktijk/European Hip Clinic, Herselt, Belgium
| | | | | | - Kristoff Corten
- Ziekenhuis Oost-Limburg, Genk, Belgium; University of Hasselt, Hasselt, Belgium; Heuppraktijk/European Hip Clinic, Herselt, Belgium
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Lenartowicz KA, Wyles CC, Carlson SW, Sierra RJ, Trousdale RT. Prevalence of groin pain after primary dual-mobility total hip arthroplasty. Hip Int 2023; 33:214-220. [PMID: 34538130 DOI: 10.1177/11207000211039168] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Instability remains a challenging problem following total hip arthroplasty (THA). Dual-mobility (DM) components are used with increasing frequency to mitigate this potential complication. As has been shown with larger metal-on-metal (MoM) THA, the larger size femoral head may pose an increased risk of groin pain. This study aims to evaluate the prevalence of groin pain following primary DM THA compared to other THA constructs. METHODS We identified 190 primary THAs (183 patients) performed with DM components at a single academic institution from 2008 to 2017. We retrospectively reviewed standardised patient questionnaires and the electronic medical record to determine the prevalence of groin pain. DM patients were compared to historical controls of 39 MoM hip resurfacing, 26 large-head MoM THA, and 217 conventional THA. Mean age was 64 years, 58% were female, mean body mass index was 30 kg/m2, and mean follow-up was 3.5 years (range 2-8 years). RESULTS The prevalence of groin pain in patients with DM components was 5%, similar to the prevalence reported by patients with conventional THA (7%). There was a decreased prevalence of groin pain in DM patients compared to hip resurfacing (18%) and MoM THA (15%). Among the 9 DM patients with groin pain, 1 was treated with iliopsoas injection, and 1 underwent radiofrequency ablation of the articular nerve. CONCLUSIONS This study documents a relatively low prevalence of groin pain among primary DM THA patients. This is comparable with historical controls of conventional THA and decreased compared to hip resurfacing and large head MoM THA.
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Affiliation(s)
| | - Cody C Wyles
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Samuel W Carlson
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rafael J Sierra
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
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Hardwick-Morris M, Twiggs J, Miles B, Al-Dirini RMA, Taylor M, Balakumar J, Walter WL. Iliopsoas tendonitis after total hip arthroplasty : an improved detection method with applications to preoperative planning. Bone Jt Open 2023; 4:3-12. [PMID: 36598093 PMCID: PMC9887341 DOI: 10.1302/2633-1462.41.bjo-2022-0147.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AIMS Iliopsoas impingement occurs in 4% to 30% of patients after undergoing total hip arthroplasty (THA). Despite a relatively high incidence, there are few attempts at modelling impingement between the iliopsoas and acetabular component, and no attempts at modelling this in a representative cohort of subjects. The purpose of this study was to develop a novel computational model for quantifying the impingement between the iliopsoas and acetabular component and validate its utility in a case-controlled investigation. METHODS This was a retrospective cohort study of patients who underwent THA surgery that included 23 symptomatic patients diagnosed with iliopsoas tendonitis, and 23 patients not diagnosed with iliopsoas tendonitis. All patients received postoperative CT imaging, postoperative standing radiography, and had minimum six months' follow-up. 3D models of each patient's prosthetic and bony anatomy were generated, landmarked, and simulated in a novel iliopsoas impingement detection model in supine and standing pelvic positions. Logistic regression models were implemented to determine if the probability of pain could be significantly predicted. Receiver operating characteristic curves were generated to determine the model's sensitivity, specificity, and area under the curve (AUC). RESULTS Highly significant differences between the symptomatic and asymptomatic cohorts were observed for iliopsoas impingement. Logistic regression models determined that the impingement values significantly predicted the probability of groin pain. The simulation had a sensitivity of 74%, specificity of 100%, and an AUC of 0.86. CONCLUSION We developed a computational model that can quantify iliopsoas impingement and verified its accuracy in a case-controlled investigation. This tool has the potential to be used preoperatively, to guide decisions about optimal cup placement, and postoperatively, to assist in the diagnosis of iliopsoas tendonitis.Cite this article: Bone Jt Open 2023;4(1):3-12.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, Australia,Flinders University, Adelaide, Australia,Correspondence should be sent to Max Hardwick-Morris. E-mail:
| | | | | | | | | | | | - William L. Walter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia,Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
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Abstract
INTRODUCTION Recent advances in polyethylene and ceramic technologies has allowed us to use larger sized heads without compromising the wear properties of a total hip arthroplasty (THA). 1 benefit of this change has been proposed to be a lower incidence of dislocation. METHODS We retrospectively evaluated the dislocation rate in 913 THAs performed using the same standardised surgical technique employed by a single team of surgeons at our institution between 1995 and 2015. Patients were assigned to 2 groups: small (⩽28 mm), large diameter heads (⩾36 mm and larger). The cup position was measured and plotted to determine its status according to the Lewinnek's safe zone (15° ± 10° for anteversion, 40° ± 10° for inclination). RESULTS 16 of the 472 small heads dislocated (3.4%) while 5 of the 441 in large head group (1.1%) (p = 0.04). In all of the large head patients that dislocated the cup position was in the safe range of Lewinnek. However, in the large head group only 64.5% of the cups were in the safe zone. CONCLUSIONS By changing the head size to 36 mm, we were able to decrease the dislocation rate significantly. Errors of cup positioning according to Lewinnek became oblivious when using large heads. In our opinion, using large heads in THA makes a difference in terms of dislocation.
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Affiliation(s)
- Erkan Sabri Ertaş
- Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Mazhar Tokgözoğlu
- Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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10
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Stavrakis AI, Khoshbin A, Joseph A, Lee LY, Bostrom MP, Westrich GH, McLawhorn AS. Dual Mobility Total Hip Arthroplasty Is Not Associated with a Greater Incidence of Groin Pain in Comparison with Conventional Total Hip Arthroplasty and Hip Resurfacing:A Retrospective Comparative Study. HSS J 2020; 16:394-399. [PMID: 33380972 PMCID: PMC7749877 DOI: 10.1007/s11420-020-09764-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Groin pain is a common long-term complication of total hip arthroplasty (THA). Femoral head size has been proposed as one of the primary causes. The implants used in dual mobility (DM) THA have large outer-bearing articulations, which could increase the risk of post-operative groin pain. Hip resurfacing (HR), too, has been shown to be associated with a risk of groin pain. QUESTIONS/PURPOSES The goals of this study were to compare the incidence of groin pain at 1 year after hip arthroplasty in patients with different femoral head diameters and in patients undergoing conventional THA, DM THA, and HR. METHODS After combing an institutional registry for all patients who had undergone THA or HR for primary hip osteoarthritis, we included 3193 patients in the analysis; 2008 underwent conventional THA, 416 underwent DM THA, and 769 underwent HR. We used logistic regression modeling to analyze the relation of groin pain at 1 year after surgery to patient demographics and clinical characteristics, including age, sex, body mass index (BMI), University of California at Los Angeles activity score at 1 year after surgery, bearing couple, and the ratio of acetabular diameter to femoral head diameter. We also measured cup inclination and anteversion in a subset of patients with and without groin pain at 1 year to assess whether pain could be related to implant position. RESULTS Overall, 8.7% of patients reported groin pain at 1 year. Patients with groin pain were younger and had lower BMIs. There were increased odds of groin pain with a greater cup-to-head ratio, although DM implants, interestingly, were not significantly associated with groin pain; this may be attributable to so much of their movement taking place inside the implant. Subgroup analysis measuring cup inclination and anteversion showed no difference in cup position between patients with and without pain. CONCLUSION In this population of hip arthroplasty patients, the incidence of groin pain 1 year after surgery did not differ among patients undergoing DM and conventional THA; DM THA in particular was not associated with a higher risk of groin pain, despite its comparatively larger femoral head sizes. HR, on the other hand, was associated with a higher risk of pain. Appropriate implant sizing and bearing couple choice may optimize the functional benefit of THA.
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Affiliation(s)
- Alexandra I. Stavrakis
- grid.19006.3e0000 0000 9632 6718Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Amir Khoshbin
- grid.17063.330000 0001 2157 2938Division of Orthopaedic Surgery, University of Toronto, Toronto, ON Canada
| | - Amethia Joseph
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Lily Y. Lee
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Mathias P. Bostrom
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Geoffrey H. Westrich
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Alexander S. McLawhorn
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
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Extra-Articular Impingement at the Anterior Inferior Iliac Spine: A Cause of Refractory Periarticular Pain After Total Hip Arthroplasty. Arthroplast Today 2020; 6:845-849. [PMID: 33088882 PMCID: PMC7567039 DOI: 10.1016/j.artd.2020.07.016] [Citation(s) in RCA: 2] [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] [Received: 09/07/2019] [Revised: 06/07/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Periarticular pain after total hip arthroplasty (THA) can significantly impair the postoperative functionality. Extra-articular impingement between the greater trochanter and the anterior inferior iliac spine is presented as a cause of refractive pain after THA. Methods Twenty patients were treated for refractive periarticular pain and limited internal rotation between January 2014 and April 2016. All patients underwent a positive chair rise test, pelvic inclination test, and Marcainisation test. Patients were treated with bone resection of the anterior part of the greater trochanter with or without component revision. Results At a mean follow-up of 20 months, all functional outcomes had improved significantly. All patients were willing to undergo the surgery again. Sixteen (80%) indicated the result as very good, 3 (15%) as good, and one (5%) as poor. Two patients developed a postoperative heterotopic ossification that required resection. Conclusions Extra-articular impingement should be considered as a possible cause of refractive groin pain after THA. Bony resection through the Hueter interval provides immediate pain relief with improved functional outcomes 1 year after surgery.
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Nam D, Nunley RM, Clohisy JC, Lombardi AV, Berend KR, Barrack RL. Does patient-reported perception of pain differ based on surgical approach in total hip arthroplasty? Bone Joint J 2019; 101-B:31-36. [DOI: 10.1302/0301-620x.101b6.bjj-2018-1575.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study’s purposes were to determine differences in pain based on surgical approach (direct anterior (DA) vs posterolateral (PL)) and PL approach incision length. Patients and Methods This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year’s follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80). Results A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, sd 12.9 vs 62.7 years, sd 9.7; p < 0.001) and had shorter follow-up (3.3 years, sd 1.3 vs 3.7 years, sd 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% vs 21%; p < 0.001) and groin pain (19% vs 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior thigh, back, or buttock pain between cohorts (p = 0.05 to 0.7). PL approach incision length did not impact the incidence or severity of pain (p = 0.3 to 0.7). Conclusion A significant proportion of patients perceive persistent pain following THA regardless of approach. DA patients reported less trochanteric and groin pain versus PL patients. PL incision length did not influence the incidence or severity of patient-reported pain. Cite this article: Bone Joint J 2019;101-B(6 Supple B):31–36.
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Affiliation(s)
- D. Nam
- Rush University Medical Center, Chicago, Illinois, USA
| | - R. M. Nunley
- Washington University Orthopedics, Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - J. C. Clohisy
- Washington University Orthopedics, Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - A. V. Lombardi
- Joint Implant Surgeons Inc., Mount Carmel Health System, New Albany, Ohio, USA
| | - K. R. Berend
- Joint Implant Surgeons Inc., Mount Carmel Health System, New Albany, Ohio, USA
| | - R. L. Barrack
- Washington University Orthopedics, Barnes Jewish Hospital, St. Louis, Missouri, USA
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Di Benedetto P, Niccoli G, Magnanelli S, Beltrame A, Gisonni R, Cainero V, Causero A. Arthroscopic treatment of iliopsoas impingement syndrome after hip arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:104-109. [PMID: 30715007 PMCID: PMC6503398 DOI: 10.23750/abm.v90i1-s.8076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Groin pain after hip arthroplasty (HA) ranges from 0.4% to 18.3%. Defining the cause of groin pain after HA can be difficult. Iliopsoas impingement (IPI) has been reported to be the underlying cause of groin pain in up to 4.4% of cases. The purpose of this study is to present arthroscopic surgical outcomes in the treatment of IPI after HA. METHODS Between September 2013 and March 2018, 13 patients, 11 total hip arthroplasty (THA), 1 hip endoprosthesis and 1 total hip resurfacing affected by groin pain due to unceasing iliopsoas tendinopathy for impingement after HA were treated arthroscopically. The patients underwent to physical examination, blood analysis, hip X-rays, bone scintigraphy and CT assessment. We performed the arthroscopic OUT-IN access to hip joint in all patients. VAS scale, Harris Hip Score (HHS) and Medical Research Council (MRC) scale were performed before surgery and during follow up at 1-3-6-12 months. RESULTS After 10 months of mean follow-up, average HHS and MRC scale improved significantly from preoperatively to postoperatively. No complications arose in our case series. CONCLUSIONS Hip arthroscopy after hip arthroplasty is supported in the literature for a variety of indications. Hip arthroscopy is a viable and reproducible technique in treatment of IPI, being less invasive than the classic open technique. This simple arthroscopic release provides satisfactory results and preserves HA function. Moreover an arthroscopic OUT-IN access proves good clinical outcomes, few complications and iatrogenic lesions.
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14
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Maeckelbergh L, Peeters T, Moskal J, Corten K. Normative Functional Outcomes as a New Outcome Assessment Tool Following Hip Procedures. Orthopedics 2018; 41:e663-e670. [PMID: 30011054 DOI: 10.3928/01477447-20180711-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/12/2018] [Indexed: 02/03/2023]
Abstract
Patient-reported outcome measures play an important role in evaluating the functional outcome of surgical and nonsurgical treatments of the hip joint. One thousand healthy volunteers completed the modified Harris hip score, the University of California, Los Angeles score, the Hip Osteoarthritis Outcome Score, and the Western Ontario and McMaster Universities Osteoarthritis Index score. Between September 2010 and December 2015, a total of 127 periacetabular osteotomies were performed in 111 patients with symptomatic developmental dysplasia of the hip. Forty-two of these patients (10 male and 32 female) met inclusion criteria. Mean follow-up was 32 months (range, 13-59 months). Pre- and postoperative radiographic analysis of the lateral center-edge angle and the acetabular index was conducted in all cases with a proper pelvic anteroposterior radiograph. The patients completed the modified Harris hip score, the University of California, Los Angeles score, the Hip Osteoarthritis Outcome Score, and the Western Ontario and McMaster Universities Osteoarthritis Index score. The authors investigated the influence of various confounding variables to (1) obtain recommendations when outcome scores are being compared between 2 cohorts and (2) define a normative reference level of "hip-healthy" functionality. This normative level of functionality was used as a target level of functionality following a hip procedure such as periacetabular osteotomy. All functional outcome scores had significantly improved 1 year after periacetabular osteotomy; thus, patients were much better than preoperatively. However, only 55% achieved the 95% functionality of the normative population based on modified Harris hip score and University of California, Los Angeles score. The results were worse for the Hip Osteoarthritis Outcome Score subscales. This approach places the results of surgical procedures in a different but potentially more realistic perspective in terms of expectations and goals. [Orthopedics. 2018; 41(5):e663-e670.].
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15
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Henawy AT, Abdel Badie A. Dual mobility total hip arthroplasty in hemiplegic patients. SICOT J 2017; 3:40. [PMID: 28573967 PMCID: PMC5454797 DOI: 10.1051/sicotj/2017024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/21/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction: The rate of cerebrovascular insults is increasing, currently leaving many patients with difficulties to maintain their balance due to muscular weakness and/or poor central control. Those patients are at risk of dislocation when total hip arthroplasty (THA) is planned. Instability remains the most significant issue after primary THA especially in such groups of patients. The risk is more pronounced when other factors are added such as, older age, femoral neck fractures, avascular necrosis and/or hip osteoarthritis. Dual mobility cup (DMC) is considered as a prosthesis with higher inherent stability that may help in such situation. In this patient series, we aimed to evaluate stability, clinical and radiological results of dual mobility THA done on the weak limb of hemiplegic patients. Methods: Twenty-four consecutive hemiplegic patients have undergone DMC with a mean age of 68 years. The indication for surgery was hip osteoarthritis in one third of the patients and femoral neck fractures in the remaining patients. Those patients were capable of walking prior to hospital admission despite weakness. Those patients were observed postoperatively for at least one year. Clinical results and complications were recorded. Results: After a minimum of one year, 91.6% of the patients have satisfactory results. No cases of hip or intraprosthetic dislocation were observed. Discussion: Dual mobility THA in the hemiplegic patients provides both efficacy and stability with good functional results.
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Affiliation(s)
- Ayman T Henawy
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, 41111 Ismailia, Egypt
| | - Ahmed Abdel Badie
- Department of Orthopedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, 41111 Ismailia, Egypt
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Homma Y, Baba T, Kobayashi H, Desroches A, Ochi H, Ozaki Y, Matsumoto M, Yuasa T, Kaneko K. Benefit and risk in short term after total hip arthroplasty by direct anterior approach combined with dual mobility cup. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:619-24. [PMID: 27311447 DOI: 10.1007/s00590-016-1808-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/12/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE No previous reports have described the benefits and risks associated with the dual mobility cup (DMC) in primary THA via direct anterior approach (DAA). The aim of this study was to compare the safety and rate of early postoperative complication of the DAA with the DMC for THA with those of the DAA with a single standard cup, and to investigate the influence of the learning curve of the use of DMC on intra- and perioperative outcomes. METHODS We retrospectively investigated 60 hips treated in the single-DAA group and 60 hips treated in the dual-DAA group. A primary/secondary outcome variable was the presence of any intra- or perioperative complication within the first 6 months/the operative time and hip function at 6 months postoperatively. We also analyzed influence of the learning curve of the use of DMC on intra- and perioperative outcomes. RESULTS No intraoperative complications were observed in either group. One anterior dislocation and one periprosthetic hip fracture were occurred in the single-DAA group. The surgical times in the single-DAA and dual-DAA groups were 112.0 ± 20.9 and 121.0 ± 26.9 min (p < 0.001). There was no significant difference in the 6-month postoperative hip function scores between the two groups. There was no influence of the learning curve of the use of DMC on intra- and perioperative outcomes. CONCLUSION We have demonstrated the short-term safety and lack of inferiority of using the DMC in the DAA compared with the standard single mobility cup.
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Affiliation(s)
- Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Asuka Desroches
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Hôpital Henri Mondor, Créteil, France
| | - Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yu Ozaki
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mikio Matsumoto
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takahito Yuasa
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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The role of arthroscopy in the treatment of groin pain after total hip arthroplasty: our experience. Hip Int 2016; 26 Suppl 1:28-33. [PMID: 27174071 DOI: 10.5301/hipint.5000405] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
AIM The purpose of the study was to present our arthroscopic surgical technique and the results in patient with pain after a hip replacement. METHODS Between November 2009 and September 2011, 35 patients with groin pain after total hip arthroplasty (THA) were treated arthroscopically. The patients underwent a preoperative examination consisting in careful history, physical examination, laboratory evaluation, diagnostic evaluation using x-rays and pelvis CT scans. In patients for whom the clinical picture suggested iliopsoas tendonitis, we also performed injection of local anaesthetic on the iliopsoas tendon sheath. All the patients were positioned in the supine decubitus position with traction applied, using 2 arthroscopic portals (AL, MID-A). An extensive debridement of adhesions, periprosthetic tissue and neocapsula were performed; when there were signs of iliopsoas impingement, a transcapsular tenotomy was performed according to Wettstein technique. RESULTS The average age was 57 (29-77) years old. The average time to onset of symptoms was 10.8 (5-15) months after THA. The average preoperative Harris Hip Score (HHS) was 44.1 (range 32-56). The average preoperative Medical Research Council (MRC) scale for muscle strenght was 3.27 (range 3-4). After 24 months of follow-up patients show an average HHS of 75.73 (range 50-91). Patients who underwent iliopsoas release show a postoperative HHS of 83.28 (range 61-91). The average postoperative MRC scale was 4.45. CONCLUSIONS Hip arthroscopy in treatment of reactive synovitis and adhesions shows good results according to literature. Hip arthroscopy in treatment of anterior iliopsoas impingement is the most useful instrument, being less invasive than the classic open technique.
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Nam D, Nunley RM, Sauber TJ, Johnson SR, Brooks PJ, Barrack RL. Incidence and Location of Pain in Young, Active Patients Following Hip Arthroplasty. J Arthroplasty 2015; 30:1971-5. [PMID: 26067707 DOI: 10.1016/j.arth.2015.05.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/03/2015] [Accepted: 05/15/2015] [Indexed: 02/01/2023] Open
Abstract
Persistent pain following hip arthroplasty remains a concern, especially in young, active patients. Four hundred twenty patients less than 60 years of age with a pre-symptomatic UCLA score ≥ 6 (196 total hip arthroplasty [THA]; 224 surface replacement arthroplasty [SRA]) completed a pain-drawing questionnaire investigating the location, severity, and frequency of pain around the hip. At a mean of 2.9 years of follow-up, 40% reported pain in at least one location around the hip. There was no difference in the incidence of groin pain between SRA and THA patients (32% vs. 29%, P=0.6), but THA patients had a greater incidence of anterior (25% vs. 8%, P<0.001) and lateral (20% vs. 10%, P=0.01) thigh pain. A high percentage of young, active patients experience persistent pain following hip arthroplasty.
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Affiliation(s)
- Denis Nam
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | - Ryan M Nunley
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | | | - Staci R Johnson
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
| | | | - Robert L Barrack
- Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri
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19
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Hernández C, Díaz-Heredia J, Berraquero ML, Crespo P, Loza E, Ruiz Ibán MÁ. Pre-operative Predictive Factors of Post-operative Pain in Patients With Hip or Knee Arthroplasty: A Systematic Review. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.reumae.2014.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Birkett N, El-Daly I, Ibraheim H, Mbubaegbu C. Metallosis following full thickness wear in total hip arthroplasty. J Surg Case Rep 2015; 2015:rjv122. [PMID: 26395872 PMCID: PMC4577831 DOI: 10.1093/jscr/rjv122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Extreme wear through the metal-backed acetabular cup following total hip arthroplasty is rare, as symptoms such as pain and disability will usually manifest earlier. We present the second reported case of extreme wear in a 78-year-old male patient, who presented 20 years following an uncemented total hip replacement with a 3-year history of hip pain, clicking on ambulation and worsening mobility. Radiographs demonstrated that the femoral head had migrated superolaterally through the polyethylene liner and the acetabular cup, and was articulating with the superior wall of the acetabulum causing bony destruction. Metallic fragments were also evident. A review of the current literature on metallosis suggests that should there be any clinical suspicion, blood metal ion levels are monitored and an MARS-MRI scan performed if indicated. If metallosis is detected, then revision surgery can be attempted at an earlier date, where the procedure is not as technically difficult.
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Affiliation(s)
- Nicholas Birkett
- Department of Trauma and Orthopaedics, Homerton University Hospital, London, UK
| | - Ibraheim El-Daly
- Department of Trauma and Orthopaedics, Homerton University Hospital, London, UK
| | - Hajir Ibraheim
- Basildon and Thurrock University Hospital, Basildon, Essex, UK
| | - Chima Mbubaegbu
- Department of Trauma and Orthopaedics, Homerton University Hospital, London, UK
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21
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Hernández C, Díaz-Heredia J, Berraquero ML, Crespo P, Loza E, Ruiz Ibán MÁ. Pre-operative Predictive Factors of Post-operative Pain in Patients With Hip or Knee Arthroplasty: A Systematic Review. ACTA ACUST UNITED AC 2015; 11:361-80. [PMID: 25840826 DOI: 10.1016/j.reuma.2014.12.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/27/2014] [Accepted: 12/01/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze pre-surgical predictive factors of post-surgical pain in patients undergoing hip or knee arthoplasty. METHODS A systematic literature review was performed. We defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undertaking knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale) in whom predictive factors of post-surgical pain were evaluated before surgery. Systematic reviews, meta-analyses, controlled trials and observational studies were selected. We excluded animals and basic science articles, reviews of prosthesis, prosthesis due to fractures, patients with rheumatic diseases or studies with mixed population in which disaggregated data was not possible to obtain. RESULTS A total 37 articles of moderate quality were selected. The articles included representative patients undergoing a knee or hip arthroplasty in our country; most of them were aged 60 years or above, with osteoarthritis, and with a high rate of obesity and comorbidities. We found great variability regarding the type of studies and predictive factors. There was a strong association between post-surgical pain and the following pre-surgical factors: female gender, low socio-economic status, higher pain, comorbidities, low back pain, poor functional status, and psychological factors (depression, anxiety or catastrophic pain). CONCLUSIONS There are pre-surgical factors that might influence post-surgical pain in patients undergoing a knee or hip arthroplasty. Therefore, they should be taken into account when considering an arthroplasty.
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Affiliation(s)
- Clara Hernández
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - Jorge Díaz-Heredia
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Luisa Berraquero
- Servicio de Anestesiología y Reanimación, Hospital Virgen de la Macarena, Sevilla, España
| | - Pablo Crespo
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Miguel Ángel Ruiz Ibán
- Unidad de Hombro y Codo. Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España.
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Nam D, Sauber TJ, Barrack T, Johnson SR, Brooks PJ, Nunley RM. Radiographic parameters associated with pain following total hip and surface arthroplasty. J Arthroplasty 2015; 30:495-501. [PMID: 25456636 DOI: 10.1016/j.arth.2014.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/01/2014] [Accepted: 10/01/2014] [Indexed: 02/01/2023] Open
Abstract
Pain following total hip arthroplasty (THA) and surface arthroplasty (SRA) remains a significant source of patient dissatisfaction. Two hundred twenty-four SRA and 196 THA patients completed a pain drawing questionnaire and postoperative radiographic measurements of component positioning were performed. In the SRA cohort, 11 of 21 patients (52%) with acetabular uncoverage of ≥5 mm versus 43 of 147 (29%) with acetabular uncoverage of ≤4.9 mm reported groin pain (P=.03). In the THA cohort, an increased distal-third canal fill ratio and a lower canal calcar ratio trended towards a higher incidence of thigh pain (P=.10 and .06), while a decreased mid-third canal fill ratio was associated with increased severity of thigh pain (P=.04). This study identifies associations between radiographic findings and pain following THA and SRA.
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Affiliation(s)
- Denis Nam
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | | | - Toby Barrack
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Staci R Johnson
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | | | - Ryan M Nunley
- Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
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Waheeb A, Zywiel MG, Palaganas M, Venkataramanan V, Davis AM. The influence of patient factors on patient-reported outcomes of orthopedic surgery involving implantable devices: A systematic review. Semin Arthritis Rheum 2015; 44:461-71. [DOI: 10.1016/j.semarthrit.2014.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 06/17/2014] [Accepted: 08/06/2014] [Indexed: 12/27/2022]
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Zylberberg AD, Nishiwaki T, Kim PR, Beaulé PE. Clinical results of the conserve plus metal on metal hip resurfacing: an independent series. J Arthroplasty 2015; 30:68-73. [PMID: 25212284 DOI: 10.1016/j.arth.2014.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 02/01/2023] Open
Abstract
The purpose of the present study was to report the clinical and radiographic results of an independent series of the Conserve Plus hip resurfacing. Five hundred forty-eight consecutive hip resurfacings were performed using the Conserve Plus prosthesis in 458 patients (350 males) with a mean age of 48.3 years (range 19 to 66). No patients were lost to follow-up. At a mean follow-up of 6.6 years (3.9 to 11.9) thirty (5.4%) hips required conversion to a total hip arthroplasty (THA) (20 males, 10 females, mean age=48.3±7.3 years). Five-year survival with as revision endpoint was 94.5% (95% CI: 93.5% to 95.5%). This study confirms the good clinical results previously reported with the Conserve Plus hip resurfacing device.
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25
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Cadossi M, Tedesco G, Savarino L, Baldini N, Mazzotti A, Greco M, Giannini S. Effect of acetabular cup design on metal ion release in two designs of metal-on-metal hip resurfacing. J Biomed Mater Res B Appl Biomater 2014; 102:1595-601. [DOI: 10.1002/jbm.b.33191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 02/14/2014] [Accepted: 04/12/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Matteo Cadossi
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
| | - Giuseppe Tedesco
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
| | - Lucia Savarino
- Complex Orthopedic-Trauma Pathology Department; Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - Nicola Baldini
- Bologna University; Bologna Italy
- Complex Orthopedic-Trauma Pathology Department; Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - Antonio Mazzotti
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
| | - Michelina Greco
- Complex Orthopedic-Trauma Pathology Department; Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine; Rizzoli Orthopaedic Institute; Bologna Italy
| | - Sandro Giannini
- Department I of Orthopaedics and Traumatology; Rizzoli Orthopaedic Institute; Bologna Italy
- Bologna University; Bologna Italy
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Correlation between groin pain and cup design of hip-resurfacing implants: a prospective study. INTERNATIONAL ORTHOPAEDICS 2013; 38:923-8. [PMID: 24323353 DOI: 10.1007/s00264-013-2226-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/22/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE Cup design has been incriminated as the source of groin pain after hip resurfacing but has not been well described; thus, it was assessed in a prospective study looking at three implant types. METHODS A group-match was done between three groups of hip resurfacing devices according to age, sex, body mass index, activity level, osteoarthritis aetiology and pre-operative scores. RESULTS The global groin pain rate was 5.7 % at six months and 2.7 % at last follow-up. Groin pain rate was significantly different between the three groups (p = 0.004) and had a strong influence on the subjective results (p = 0.04). No groin pain emerged between six months and last follow-up. No clinical differences were noted in Harris hip score and Merle d'Aubigné-Postel score at last follow-up. However, the Oxford hip score and Devane activity score were significantly lower for cups with macrostructures. CONCLUSION The low groin pain rate in this prospective cohort was probably secondary to the specific surgical technique used and seems to be correlated with cup design. Macrostructures on the external part of the cup could be significantly harmful.
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Combes A, Migaud H, Girard J, Duhamel A, Fessy MH. Low rate of dislocation of dual-mobility cups in primary total hip arthroplasty. Clin Orthop Relat Res 2013; 471:3891-900. [PMID: 23516032 PMCID: PMC3825881 DOI: 10.1007/s11999-013-2929-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dual-mobility (DM) cups were introduced to minimize the risk of THA dislocation. The overall rate of dislocation of DM cups (including both large and small articulations) is controversial and ranges from 0% to 5% in previous studies. QUESTIONS/PURPOSES We therefore recorded (1) the dislocation rate, (2) loosening and osteolysis, and (3) subsequent related revisions with DM cups. METHODS Between 1998 and 2003, 2480 primary THAs with DM cups were undertaken in 2179 patients. The mean age was 69 years (range, 19-94 years). This group underwent specific clinical and radiographic evaluation at a minimum followup of 0.17 years (mean, 7 years; range, 0.17-11 years) to assess dislocation, reoperation, osteolysis, and cup fixation. RESULTS There were 22 dislocations (0.88%): 15 dislocations of large articulations (0.6%), with two (0.08%) recurring but only one requiring revision (0.04%), and seven intraprosthetic small articulation dislocations (0.28%), all needing revision surgery. At last followup, mean Harris hip score was 91 (range, 60-100); 2439 cups (98%) showed no signs of loosening; and 141 patients (145 hips) had osteolysis (6%). Osteolysis and cup loosening were more frequent in patients younger than 50 years at the time of surgery. The 10-year survivorship considering revision for any reason was 93% (95% CI, 91%-95%). CONCLUSIONS DM cups had a low dislocation rate in primary THA, with a limited frequency of adverse effects. We recommend DM cups to minimize dislocation in populations at high risk for instability, but they should be avoided in younger, active patients at higher risk for osteolysis.
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Affiliation(s)
- Antoine Combes
- />Roger Salengro Hospital, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue, Oscar Lambret, 59037 Lille Cedex, France
| | - Henri Migaud
- />Roger Salengro Hospital, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue, Oscar Lambret, 59037 Lille Cedex, France
| | - Julien Girard
- />Roger Salengro Hospital, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue, Oscar Lambret, 59037 Lille Cedex, France
| | - Alain Duhamel
- />Centre d’Etudes et de Recherche en Informatique Médicale, Faculté Médecine, Université de Lille 2, Lille, France
| | - Michel Henri Fessy
- />Department of Orthopaedics, Traumatology and Sports Medicine, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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[Metal ion concentrations in patients with metal-metal bearings in prostheses]. DER ORTHOPADE 2013; 42:622-8. [PMID: 23842780 DOI: 10.1007/s00132-012-2035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Increased wear leads to elevated systemic and local metal ion concentrations for patients treated with metal-on-metal bearings. The local metal ion content in the close environment of the joint replacement (e.g. joint aspirate or tissue) is several times higher compared to the systemic metal content (e.g. in blood or serum). As a result of increased metal ion levels, local and systemic effects, such as osteolysis, pseudotumors, sensitization or in rare cases toxicity may occur. Although the definition of a specific threshold to define clinical problems is difficult due to a lack of sensitivity, the systemic metal concentration is frequently measured clinically. Currently a threshold for cobalt and chromium between 4 µg/l and 7 µg/l is under debate. Very high levels (≥ 20 µg/l) or a steady increase over time should be a warning sign; however, metal ion levels should not be interpreted as a single diagnostic tool but rather in the entire context of the clinical, radiological and cross-sectional imaging, metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI), ultrasound and computed tomography (CT) findings.
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Abstract
Pneumatic compression and cryotherapy have been successfully being employed in the management of acute tissue damage. The Game Ready System (GRS) combines cyclic compression and cryotherapy. No randomised controlled trial has been performed on the effects of combined cyclic compression and cryotherapy in total hip arthroplasty (THA). We observed postoperative pain, morphine usage, blood loss, wound discharge, patient and medical staff satisfaction, together with the feasibility of a cryocompression machine, total hospital admission time, infection rate, deep vein thrombosis, and short-term prosthesis related problems in this context. Thirty patients, mean age 68 yrs (range 31-83 yrs) undergoing elective hip arthroplasty for end-stage osteoarthritis were included. Control patients (n = 15) received a tricot compression bandage alone, and patients studied received a tricot compression bandage plus intermittent cryocompression therapy 15 times for 30 minutes. Haemoglobin levels on postoperative day (POD) 1 dropped 2.34 mmol/L in the control group and 1,87 mmol/L in the intervention group (p = 0,027). At POD 3 haemoglobin levels were reduced by 2,63 and 2,16 respectively (p = 0,646). A trend occurred towards lower morphine usage, shorter hospital admission time and less wound discharge in the study group. No difference was found in postoperative pain scores. One event of deep venous thrombosis occurred in the control group. Intermittent cryocompression therefore appears to reduce postoperative blood loss. A trend towards less analgesic use, shorter hospital stay, less wound discharge and less pain at 6 weeks postoperatively was also observed.
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Leclercq S, Lavigne M, Girard J, Chiron P, Vendittoli PA. Durom hip resurfacing system: retrospective study of 644 cases with an average follow-up of 34 months. Orthop Traumatol Surg Res 2013; 99:273-9. [PMID: 23562709 DOI: 10.1016/j.otsr.2012.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/25/2012] [Accepted: 10/15/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The performance of second-generation metal-on-metal bearings has led to the reintroduction of hip resurfacing. The goal of this multicentre study was to evaluate the short-term radiological and clinical outcomes with the Durom hip resurfacing system. HYPOTHESIS The Durom hip-resurfacing system will have similar results to other hip resurfacing systems and traditional hip arthroplasty implants. MATERIALS AND METHODS In the four participating centers, 580 patients (406 men, 174 women) and 644 hips were included. The average patient age was 48 years (range 16-77). A posterolateral surgical approach was used in 357 cases; a Hardinge-type approach was used in 182 cases and a Rottinger-type approach in 105. RESULTS After an average follow-up of 34 months, 31 hips (4.8%) had been revised. The reasons for revision were the following: 10 (1.6%) neck fracture (seven with Rottinger operative approach, one with Hardinge approach and one with posterolateral approach); 12 (1.9%) femoral loosening (four with lateral approach and eight with posterolateral approach); four (0.6%) acetabular cup migration; three (0.5%) unexplained pain; one (0.2%) adverse reaction to metal debris; one (0.2%) infection. Four hips (0.6%) dislocated but without recurrence - all were operated using the Hardinge approach. The 613 hips that were not operated on again had satisfactory clinical results; the Merle d'Aubigné score was 17.2 (range 12-18) and the WOMAC score was 91 (range 20-100). The five-year survival rate was 91% (95% CI: 87-94%). Based on radiographs, the average cup inclination was 44.4° (range 30 to 70°). The femoral offset was reduced by an average of 2.4mm (-31 to 23 mm) and the leg length had increased by an average of 0.8mm (-15 to 19 mm) relative to the other side, which was prosthesis-free. None of the non-revised implants showed any signs of loosening. DISCUSSION This multicentre evaluation revealed that the Durom revision rate was slightly higher than the rate with other hip resurfacing systems and traditional total hip arthroplasty. Although the Durom system displayed excellent tribological performance, the differences relative to other implants may be attributed to the challenges associated with impaction, related to the geometry and design of the cup, and to precarious primary fixation. The choice of surgical exposure and implantation technique was an important factor in the survival of the implant. LEVEL OF PROOF Level IV - Retrospective study.
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Affiliation(s)
- S Leclercq
- St Martin Hospital Center, 18, rue Rocquemonts, 14000 Caen, France
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Queen RM, Newman ET, Abbey AN, Vail TP, Bolognesi MP. Stair ascending and descending in hip resurfacing and large head total hip arthroplasty patients. J Arthroplasty 2013; 28:684-9. [PMID: 23151367 DOI: 10.1016/j.arth.2012.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 06/21/2012] [Accepted: 07/10/2012] [Indexed: 02/01/2023] Open
Abstract
Large head total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are alternatives to standard THA that generally have head sizes larger than 36mm. This study examined 20 patients (10 large head THA and 10 HRA), at an average of 18months postoperatively, and 15 healthy control subjects during stair negotiation. Hip kinetic and kinematic variables and ground reaction forces were measured. The THA and HRA groups ascended the stairs with increased peak hip flexion angles and decreased hip extension angles as compared with controls. The operative groups also descended the stairs with decreased hip flexion moments. No differences between the operative groups were observed. Eighteen months postoperatively, patients with large head THA or HRA display abnormal flexion and extension during a physically-demanding task.
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Affiliation(s)
- Robin M Queen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27705, USA
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Verhelst L, Guevara V, De Schepper J, Van Melkebeek J, Pattyn C, Audenaert EA. Extra-articular hip endoscopy: A review of the literature. Bone Joint Res 2012; 1:324-32. [PMID: 23610664 PMCID: PMC3626189 DOI: 10.1302/2046-3758.112.2000133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 10/11/2012] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- L Verhelst
- AZ Groeninge Kortrijk, Burgemeester Vercruysselaan 5, 8500 Kortrijk, Belgium
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Zhou Y, Sun C, Wang Y. New Method Addressing the Problem of Using Ceramic-on-Ceramic Bearing in Too Small Acetabulum of High-Riding DDH Patients with THA. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.sart.2012.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Large femoral heads have been used with increasing frequency over the last decade. The prime reason is likely the effect of large heads on stability. The larger head neck ratio, combined with the increased jump distance of larger heads result in a greater arc of impingement free motion, and greater resistance to dislocation in a provocative position. Multiple studies have demonstrated clear clinical efficacy in diminishing dislocation rates with the use of large femoral heads. With crosslinked polyethylene, wear has been shown to be equivalent between larger and smaller heads. However, the stability advantages of increasing diameter beyond 38 mm have not been clearly demonstrated. More importantly, recent data implicates large heads in the increasing prevalence of groin pain and psoas impingement. There are clear benefits with larger femoral head diameters, but the advantages of diameters beyond 38 mm have not yet been demonstrated clinically.
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Affiliation(s)
- J. A. Rodriguez
- Center For joint Preservation & Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th street, 11th floor, New York, NY-10075, USA
| | - P. A. Rathod
- Center For joint Preservation & Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th street, 11th floor, New York, NY-10075, USA
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Illical E, Belanger H, Kim PR, Beaulé PE. Groin pain after metal on metal hip resurfacing: mid-term follow-up of a prospective cohort of patients. HSS J 2012; 8:257-61. [PMID: 24082869 PMCID: PMC3470668 DOI: 10.1007/s11420-012-9299-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Groin pain after metal on metal hip resurfacing has been previously reported. The purpose of this study was to determine the natural history of a cohort of patients with groin pain after hip resurfacing previously reported on and incidence of revision surgery. METHODS Our group previously reported an 18% incidence of groin pain at a mean of 18 months post hip resurfacing. This cohort of groin pain patients was prospectively followed. Patients were evaluated using a visual analog pain rating score, the University of California at Los Angeles (UCLA) Physical Activity Index, and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Functional outcome scores were compared from initial to latest follow up using the paired Student's t test. Further diagnostic evaluation and/or intervention or other complication was also recorded. RESULTS The latest mean follow up from surgery was 63 ± 15 months. The mean pain rating, UCLA, and WOMAC scores all improved at latest follow up, although WOMAC score improvement was not statistically significant. Mean pain rating score improved from 5.2 ± 2.0 to 2.5 ± 1.4 (p = 0.0001). UCLA activity score improved from 6.4 ± 2.0 to 6.9 ± 1.6 (p = 0.03). Total WOMAC score improved from 75.6 ± 20.5 to 84.5 ± 14.8 (p = 0.15). Only one patient was revised for an adverse local tissue reaction. CONCLUSION Groin pain post hip resurfacing has a multifactorial etiology, and in the vast majority of cases improves over time with no significant functional limitations. However, the surgeon should be aware of the many potential causes, and help minimize the possibility with proper patient selection and surgical technique.
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Affiliation(s)
- Emmanuel Illical
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
| | - Heather Belanger
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
| | - Paul R. Kim
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
| | - Paul E. Beaulé
- Division of Orthopaedic Surgery, 501 Smyth Road, Room W1650, Ottawa, ON K1H 8L6 Canada
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Douis H, Dunlop DJ, Pearson AM, O'Hara JN, James SLJ. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol 2012; 41:1035-46. [PMID: 22426776 DOI: 10.1007/s00256-012-1390-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/09/2012] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
Hip arthroplasty is one of the most commonly performed orthopedic procedures. Clinicians can be faced with the diagnostic dilemma of the patient presenting with a painful hip following arthroplasty and satisfactory post-operative radiographs. Identifying the cause of symptoms can be challenging and ultrasound is increasingly being utilized in the evaluation of potential soft tissue complications following hip surgery. In this article, we describe the common surgical approaches used during hip arthroplasty as this can influence the nature and location of subsequent complications. A review of the literature is presented along with the imaging appearances frequently encountered when imaging this patient population.
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Affiliation(s)
- H Douis
- Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Stürup J, Dahl LB, Jensen KE, Larsen AB, Gebuhr P. Few adverse reactions to metal on metal articulation in total hip arthroplasty in a review study on 358 consecutive cases with 1 to 5 years follow-up. Open Orthop J 2012; 6:366-70. [PMID: 22930667 PMCID: PMC3428671 DOI: 10.2174/1874325001206010366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/17/2012] [Accepted: 07/22/2012] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to determine the frequency of adverse reaction to metal on metal total hip arthroplasty using a M2a-38 articulation and a Magnum articulation, (Biomet Warsaw, Indiana).All patients who had received a Metal on Metal bearing prosthesis, in two centres in Copenhagen, were asked to complete a questionnaire about groin pain. Patients with self-reported groin pain, 68/314, underwent a physical examination and had Co and Cr ion levels measured in full blood samples. Fifty patients also had a CT scan performed.The present study found one patient with bilateral arthroplasty, who had an adverse reaction on one side. In addition the study showed that females had higher values of Co and Cr, and that younger patient reported groin pain more often.The conclusion of this study is that the number of adverse reactions is low, despite the time of observation being relatively short, no high frequency of adverse reactions to this prosthesis is expected.
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Affiliation(s)
- Jens Stürup
- Orthopaedic Department U, 2162, Rigshospitalet, University of Copenhagen, Denmark
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38
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Matthies AK, Skinner JA, Osmani H, Henckel J, Hart AJ. Pseudotumors are common in well-positioned low-wearing metal-on-metal hips. Clin Orthop Relat Res 2012; 470:1895-906. [PMID: 22179978 PMCID: PMC3369086 DOI: 10.1007/s11999-011-2201-7] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pseudotumors are sterile inflammatory lesions found in the soft tissues surrounding metal-on-metal (MOM) and metal-on-polyethylene hip arthroplasties. In patients with MOM hip arthroplasties, pseudotumors are thought to represent an adverse reaction to metal wear debris. However, the pathogenesis of these lesions remains unclear. Currently, there is inconsistent evidence regarding the influence of adverse cup position and increased wear in the formation of pseudotumors. QUESTIONS/PURPOSES We therefore determined whether pseudotumor formation was associated with (1) adverse cup position, (2) raised metal ion levels, and (3) increased wear rates of the retrieved components. METHODS We retrospectively reviewed all 352 patients for whom we had retrieved specimens from revisions of a current-generation MOM hip prosthesis between February 2008 and September 2010; of these, 105 met our inclusion criteria. We used multivariate logistic regression analysis to compare acetabular orientation, metal ion levels before revision, and component wear rates between patients with (n = 72) and without (n = 33) pseudotumors, according to findings on metal artifact reduction sequence MRI. RESULTS The proportion of patients demonstrating evidence of a pseudotumor in well-positioned hips was similar to those with adverse cup positions (67% and 66%, respectively). Patients revised with pseudotumors had similar whole-blood metal ion levels and component wear rates to those who were not revised. CONCLUSIONS Pseudotumors were not associated with increased wear or metal ion levels, suggesting patient susceptibility is likely to be more important.
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Affiliation(s)
- Ashley K. Matthies
- Department of Musculoskeletal Surgery, Imperial College London, London, SW7 2AZ UK
| | - John A. Skinner
- Department of Orthopedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Humza Osmani
- Department of Musculoskeletal Surgery, Imperial College London, London, SW7 2AZ UK
| | - Johann Henckel
- Department of Musculoskeletal Surgery, Imperial College London, London, SW7 2AZ UK
| | - Alister J. Hart
- Department of Musculoskeletal Surgery, Imperial College London, London, SW7 2AZ UK
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Baumgarten KM, McKenzie MJ. Iliopsoas Tendon Impingement After Total Hip Arthroplasty with Use of a Large-Diameter Femoral Head: A Case Report. JBJS Case Connect 2012; 2:e22. [PMID: 29252423 DOI: 10.2106/jbjs.cc.k.00079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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40
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Bernthal NM, Celestre PC, Stavrakis AI, Ludington JC, Oakes DA. Disappointing short-term results with the DePuy ASR XL metal-on-metal total hip arthroplasty. J Arthroplasty 2012; 27:539-44. [PMID: 22000575 DOI: 10.1016/j.arth.2011.08.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 08/26/2011] [Indexed: 02/01/2023] Open
Abstract
Outcomes of ultralarge-diameter femoral heads used in metal-on-metal (MOM) total hip arthroplasty (THA) are relatively unknown. This study reports on early failures of the ASR XL (Depuy, Warsaw, Ind) and assesses whether a correlation with cup positioning exists. A retrospective review of 70 consecutive MOM THAs with ultralarge-diameter femoral head and monoblock acetabular component was conducted. Minimum follow-up was 24 months. Of 70 THAs, 12 (17.1%) required revision within 3 years for pain (7), loosening (3), and squeaking (2). Three additional THAs noted squeaking, 2 noted grinding, and 3 additional hips had persistent pain. In total, 20 (28.6%) of 70 demonstrated implant dysfunction. Acetabular components for all symptomatic hips were in acceptable range of cup abduction and anteversion. The failures noted with this design do not correlate to cup placement. The high rate of implant dysfunction at early follow-up suggests serious concerns with the concept of MOM THA with an ultralarge-diameter femoral head paired with a monoblock acetabular cup.
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Affiliation(s)
- Nicholas M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-6902, USA
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41
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Abstract
We compared 47 patients with groin pain following hip resurfacing to a matched control group. Functional scores and plain radiographs were assessed along with measurement of whole blood cobalt and chromium by inductively coupled mass spectrometry. Symptomatic patients underwent ultrasound scan of the affected hip. Mean functional outcomes were poor in those with pain and good in the control group. Groin pain was associated with valgus stem positioning and lower neck:head ratio (relatively narrow neck) (p=0.03, p=0.04 respectively). We classified patients with groin pain into two groups: biological and mechanical. The biological group had soft tissue abnormalities on USS and higher levels of cobalt and chromium (p=0.04, p=0.05 respectively). The mechanical group had normal USS, lower metal ion levels and more retroverted femoral components (p=0.01).
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Low incidence of groin pain and early failure with large metal articulation total hip arthroplasty. Clin Orthop Relat Res 2012; 470:388-94. [PMID: 21932102 PMCID: PMC3254765 DOI: 10.1007/s11999-011-2069-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large-diameter metal-on-metal articulations reportedly improve stability and wear in THAs. However, some reports suggest some patients have unexplained hip and early failures with these implants. Thus, the potential benefits may be offset by these concerns. However, the incidence of these problems is not clearly established. QUESTIONS/PURPOSES We therefore assessed hip pain, function, osteolysis, and complications in patients with large-diameter metal-on-metal THA. PATIENTS AND METHODS We retrospectively reviewed 611 patients who had 681 large-diameter metal-on-metal THAs with the same cup and head design. The average age at operation was 62 years, 53% of the THAs were in men, and the average body mass index was 32 kg/m(2). The diagnosis was osteoarthritis in 92% of the THAs. The minimum followup was 24 months (mean, 37 months; range, 24-60 months). RESULTS Nine of the 611 patients (1.5%) experienced moderate or severe pain in the hip region that we considered to be coming from an extraarticular source in each case. Harris hip scores for pain averaged 42 points. Total Harris hip scores averaged 93 points. Cup abduction averaged 42°, and cup anteversion averaged 26°. There were no infections. Three cups (0.4%) were considered radiographically loose. All were secondary to inadequate seating of the shell. CONCLUSION Our observations suggest with this implant the concerns of higher incidences of groin pain, early failures, and adverse tissue reactions were not confirmed. Early successes or failures with large-diameter metal-on-metal articulations may be implant specific. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Abstract
Persistent groin pain after seemingly successful total hip replacement (THR) appears to have become more common. Recent studies have indicated a high incidence after metal-on-polyethylene and metal-on-metal conventional THR and it has been documented in up to 18% of patients after metal-on-metal resurfacing. There are many causes, including acetabular loosening, stress fracture, and iliopsoas tendonitis and impingement. The evaluation of this problem requires a careful history and examination, plain radiographs and an algorithmic approach to special diagnostic imaging and tests. Non-operative treatment is not usually successful. Specific operative treatment depending on the cause of the pain usually involves revision of the acetabular component, iliopsoas tenotomy or other procedures, and is usually successful. Here, an appropriate algorithm is described.
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Affiliation(s)
- R. A. Henderson
- Duke University Medical Center, 201
Trent Drive, Durham, North
Carolina 27710, USA
| | - P. F. Lachiewicz
- Duke University Medical Center, 201
Trent Drive, Durham, North
Carolina 27710, USA
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45
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Hsu JE, Kinsella SD, Garino JP, Lee GC. Ten-Year Follow-Up of Patients Younger Than 50 Years With Modern Ceramic-on-Ceramic Total Hip Arthroplasty. ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.sart.2011.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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46
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Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. State of the art in hard-on-hard bearings: how did we get here and what have we achieved? Expert Rev Med Devices 2011; 8:187-207. [PMID: 21627555 DOI: 10.1586/erd.10.75] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings. Improvements in the manufacturing of metal-on-metal bearings over the past 50 years have resulted in implants that provide low wear rates and allow for the use of large femoral heads. However, concerns remain regarding elevated serum metal ion levels, potential teratogenic effects and potentially devastating adverse local tissue reactions, whose incidence and pathogenesis remains unclear. Modern total hip resurfacing has shown excellent outcomes over 10 years in the hands of experienced surgeons. Current ceramic-on-ceramic bearings have demonstrated excellent survival with exceptionally low wear rates and virtually no local adverse effects. Concerns remain for insertional chipping, in vivo fracture and the variable incidence of squeaking. Contemporary ceramic-on-metal interfaces are in the early stages of clinical use, with little data reported to date. Hard-on-hard bearings for total hip arthroplasty have improved dramatically over the past 50 years. As bearing designs continue to improve with new and modified materials and improved manufacturing techniques, it is likely that the use of hard-on-hard bearings will continue to increase, especially in young and active patients.
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Affiliation(s)
- Michael G Zywiel
- Division of Orthopaedic Surgery, University of Toronto, 100 College Street Room 302, Toronto, Ontario M5G 1L5, Canada
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Pattyn C, Verdonk R, Audenaert E. Hip arthroscopy in patients with painful hip following resurfacing arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:1514-20. [PMID: 21409469 DOI: 10.1007/s00167-011-1463-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 02/21/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE Determining the etiology of persistent groin pain after hip resurfacing arthroplasty (HRA) can be very challenging, even for the experienced surgeon. The purpose of the present study was to evaluate the use of hip arthroscopy as a diagnostic and therapeutic tool for the painful hip following resurfacing arthroplasty. METHODS In the present paper, the indications for arthroscopy and the arthroscopic findings in 15 patients with persistent and incapacitating groin pain following HRA are described. In all patients, nonsurgical diagnostic investigations such as ultrasound and radiography, blood sample analysis, and technetium and leukocyte-labeled scanning were inconclusive so that a definite diagnosis could not be established. RESULTS In seven patients, synovial biopsies were taken arthroscopically to rule out metal sensitivity, low-grade infection, or excessive metal wear. A definite diagnosis from histological evaluation could be made in 5 out of the 7 patients. Five patients were clinical suspicious of iliopsoas tendinitis. Diagnostic arthroscopy and histological analysis of the synovial samples provided an alternative diagnosis in 2 out of the 5 patients. Three patients underwent femoral osteoplasty for impingement due to reduced anterior femoral offset with subsequent symptom relief. CONCLUSION Hip arthroscopy after HRA is a valuable diagnostic alternative to open procedures in case of persistent groin pain, when noninvasive investigations fail to explain the symptoms. Multiple tissue samples should always be taken for histological examination and culture, as they are crucial in the final identification of the origin of the complaints.
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Affiliation(s)
- C Pattyn
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Molli RG, Lombardi AV, Berend KR, Adams JB, Sneller MA. Metal-on-metal vs metal-on-improved polyethylene bearings in total hip arthroplasty. J Arthroplasty 2011; 26:8-13. [PMID: 21723699 DOI: 10.1016/j.arth.2011.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 04/20/2011] [Indexed: 02/01/2023] Open
Abstract
Major weaknesses of total hip arthroplasty (THA) in the 20th century were polyethylene wear and dislocation. Efforts to improve THA took several directions including improvement of polyethylene and use of metal-on-metal (MoM) articulations. Metal-on-metal articulations showed excellent early results, but concerns mount over hypersensitivity and increasing failure. This study compares our experience with MoM and metal-on-improved polyethylene (MoIP) bearings in primary THA. We identified 1362 patients undergoing 1589 MoM THA and 693 patients undergoing 779 MoIP THA (all compression molded and sterilized in argon). Overall, more MoM than MoIP cups have been revised (4.0% vs 2.2%; P = .0241). Revision incidence for infection was similar; higher with MoM for loosening (P = .0020), metal complication (P = .0017), and combined aseptic causes (P = .0067); and higher for dislocation in MoIP (P = .0246). Metal-on-improved polyethylene devices had superior results compared with MoM in this study. Furthermore, 5 MoIP revisions were liner exchanges, a conservative option not available with MoM.
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Affiliation(s)
- Ryan G Molli
- Joint Implant Surgeons, Inc., New Albany, Ohio 43054, USA
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Abstract
Hip resurfacing arthroplasty is an increasingly common procedure for osteoarthritis. Conventional radiographs are used routinely for follow-up assessment, however they only provide limited information on the radiological outcome. Various complications have been reported in the scientific literature although not all are fully understood. In an effort to investigate problematic or failing hip resurfacings, various radiological methods have been utilized. These methods can be used to help make a diagnosis and guide management. This paper aims to review and illustrate the radiographic findings in the form of radiography, computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound of both normal and abnormal findings in hip resurfacing arthroplasty. However, imaging around a metal prosthesis with CT and MRI is particularly challenging and therefore the potential techniques used to overcome this are discussed.
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Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. Survival of hard-on-hard bearings in total hip arthroplasty: a systematic review. Clin Orthop Relat Res 2011; 469:1536-46. [PMID: 21057988 PMCID: PMC3094609 DOI: 10.1007/s11999-010-1658-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improvements in prosthetic materials, designs, and implant fixation for THA have led to bearing surface wear being the limitation of this technology. Hard-on-hard bearings promise decreased wear rates and increased survival. However, there may be different survival rates based on bearing materials, manufacturing technologies, and femoral component designs. Additionally, survival rate variability may be based on study design. QUESTIONS/PURPOSES We determined survival rates and study levels of evidence and quality for the following bearings: stemmed metal-on-metal THA, metal-on-metal hip resurfacing, ceramic-on-ceramic THA, and ceramic-on-metal THA. METHODS We performed a systematic review of the peer-reviewed literature addressing THA hard-on-hard bearings. Quality for Level I and II studies was assessed. RESULTS The four Level I or II second-generation stemmed metal-on-metal THA studies reported between 96% and 100% mean survival at 38 to 60 months. The two Level I hip resurfacing studies reported 94% and 98% mean survival at 56 and 33 months. The four Level I studies of ceramic-on-ceramic THA reported survival from 100% at mean 51 months to 96% at 8 years. CONCLUSIONS While hard-on-hard bearing survival rates have generally been variable with earlier designs, contemporary implants have demonstrated survival of 95% or greater at followup of between 3 and 10 years. Some variability in survival may be due to differences in surgical technique, component positioning, and implant designs. As bearing designs continue to improve with modified materials and manufacturing techniques, use will increase, especially in young and active patients, though concerns remain about the increased reports of adverse events after metal-on-metal bearings.
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Affiliation(s)
- Michael G. Zywiel
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Siraj A. Sayeed
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | - Aaron J. Johnson
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | | | - Michael A. Mont
- Center for Joint Preservation and Replacement, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
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