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Bus MPA, Gademan MGJ, Fiocco M, Nelissen RGHH, De Witte PB. Pediatric hip disorders are not associated with an increased 10-year revision risk after total hip arthroplasty under the age of 55: results from the Dutch Arthroplasty Register. Acta Orthop 2024; 95:472-476. [PMID: 39192775 DOI: 10.2340/17453674.2024.41342] [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: 06/07/2023] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND AND PURPOSE Developmental dysplasia (DDH) and Legg-Calvé-Perthes disease (LCPD) are common indications for total hip arthroplasty (THA) at a young age, and may be associated with increased revision risk. We aimed to investigate the 10-year cumulative aseptic cup revision and overall revision risk of THA, and investigated whether these are increased compared with THA for primary osteoarthritis (OA) in patients below 55 years. METHODS All THAs (2007-2019) in patients under the age of 55 for the indications OA, DDH, and LCPD were extracted from the Dutch Arthroplasty register. The 10-year cumulative incidences of aseptic cup failure and overall revision were assessed for the 3 groups, with death as a competing risk. Cox regression analysis was used. RESULTS 24,263 THAs were identified: 20,645 (85%) for OA, 3,032 (13%) for DDH, and 586 (2%) for LCPD. The 10-year cumulative revision risk for aseptic cup failure was 3.4% (95% confidence interval [CI] 3.0-3.8) for OA, 3.4% (CI 2.4-3.4) for DDH, and 1.7% (CI 0.2-3.1) for LCPD. The 10-year cumulative overall revision risk was 6.0% (CI 5.6-6.5) for OA, 6.0% (CI 4.9-7.2) for DDH, and 5.1% (2.7-7.5) for LCPD. The multivariable Cox regression analysis for aseptic cup failure yielded hazard ratios of 0.7 (0.5-1.2) for DDH, and 0.8 (0.3-2.1) for LCPD compared with OA. No statistically significant differences for overall revision were found. CONCLUSION THA performed for DDH or LCDP in patients under the age of 55 was not associated with a statistically significant increased risk of aseptic cup revision or overall revision, compared with THA performed for primary OA in the same age group.
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Affiliation(s)
- Michaël P A Bus
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden
| | - Maaike G J Gademan
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | - Marta Fiocco
- Department of Biomedical Data Science, section Medical Statistics, Mathematical Institute Leiden University, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden
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Vorimore C, Adamczyk A, Laboudie P, Ricard MA, Beaule PE, Grammatopoulos G. Mid to long-term survivorship of hip arthroplasty in patients 40 years and younger. Orthop Traumatol Surg Res 2024:103978. [PMID: 39197638 DOI: 10.1016/j.otsr.2024.103978] [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: 05/03/2024] [Revised: 07/16/2024] [Accepted: 08/23/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Etiology of hip osteoarthritis (OA) and survival of hip arthroplasty in the young (below 40-years-old) remains poorly described. Furthermore, joint survivorship mid to long-term and PROMs according to the etiology are unclear. The study aims were to 1) identify the indications for arthroplasty in the below 40-years-old cohort; 2) define hip arthroplasty outcomes in the young and 3) test whether patients with sequelae of pediatrics hip disease have inferior outcome compared to other patients. HYPOTHESIS Our hypothesis was that hip arthroplasty is a viable option for managing hip disease in patients under 40, with excellent survival rates and outcomes. MATERIAL AND METHODS This is an IRB approved, retrospective, consecutive, multi-surgeon, cohort study from a single academic center. Indication for hip arthroplasty of 346 patients (410 hips) below 40-years-old were studied; 239 underwent THA (58%) and 171 hip resurfacing (42%). Patient, surgical and implant factors were tested for association with implant survivorship and functional outcome for hip arthroplasty performed with a follow-up of more than two years. Pediatric hip sequelae patients were compared for survival and PROMs with the rest of the cohort. RESULTS The most common etiology of OA was FAI (47%), followed by pediatric hip sequelae (18%). The 10-year survivorship was 97.2% ± 1.2, mean OHS was 45.1 ± 6.3 and mean HHS was 93.4 ± 12.6. The pediatric hip sequelae subgroup demonstrated no differences in 10-year survivorship and better PROMs compared to rest (OHS: 46.6 ± 3.8; HHS: 96.0 ± 8.5). DISCUSSION The most common aetiologies amongst the young with hip OA is FAI and pediatric hip sequelae. Hip arthroplasty in the young presents excellent 10-year survivorship and PROMs. Excellent survival and PROMs in the young with pediatric hip sequelae provide important information for decision-making in this challenging population. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Camille Vorimore
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Adamczyk
- Department of Orthopedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Pierre Laboudie
- Service de Chirurgie Orthopédique, Traumatologique et Oncologique, Hôpital Cochin, Paris, France
| | - Marc Antoine Ricard
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaule
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Aljasim O, Yener C, Özkayın N. Comparison of dynamic compression system versus multiple cancellous screws in the treatment of femoral neck fractures in young adults. J Orthop Surg Res 2024; 19:422. [PMID: 39039508 PMCID: PMC11265074 DOI: 10.1186/s13018-024-04913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Femoral neck fractures have posed a significant global healthcare challenge and had notable impacts on the quality of life. Current treatment strategies for femoral neck fractures in young individuals have varied, emphasizing the need for optimal fixation methods. This study compared the clinical and radiological outcomes of the dynamic compression system (DCS) and multiple cancellous screws (MCS) methods. METHODS This retrospective study included a total of 275 young adults with fresh femoral neck fractures treated with DCS and MCS. A matching analysis with a 1:1 ratio based on age, gender, fracture classification, and reduction quality was conducted. Demographic data were recorded, and comparisons were made according to follow-up time (FUT), hospitalization period, operation duration, femoral neck shortening, caput-collum-diaphysis (CCD) angle, Harris Hip Score (HHS), and post-operative complications. RESULTS A total of 42 fractures were matched with a median age of 42 years (range, 22-48). In the DCS group, vertical neck shortening (median 1.92) was significantly lower than that in the MCS group (median 4.53) (P < 0.05). In the DCS group, horizontal femoral neck shortening, resultant femoral neck shortening, the amount of change in CCD angle, and HHS were 0.57 mm (0.43, 4.74 mm), 1.82 mm (0.40, 3.53 mm), 0.13° (-0.78°, 1.80°), and 91 (85-93), respectively. They were all non-significant than 1.00 mm (0.56, 6.23 mm), 2.74 mm (1.59, 6.71 mm), -0.18° (-1.11°,1.85°), and 91 (75, 93) in the MCS group, respectively (P > 0.05). There was no statistical difference in FUT, hospitalization period, operation time, and post-operative complications at the latest follow-up (P > 0.05). There were no complications such as pulmonary embolism, deep vein thrombosis, and incision infection reported. CONCLUSION DCS and MCS demonstrated effectiveness in treating femoral neck fractures in young adults. The DCS implant provides additional stability in the vertical axis. A prospective randomized controlled study with a large sample size was needed to validate these findings.
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Affiliation(s)
- Omar Aljasim
- Department of Orthopedic Surgery, Ege University Medical Faculty Hospital, İzmir, Turkey.
| | - Can Yener
- Department of Orthopedic Surgery, Hand, Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, İzmir, Turkey
| | - Nadir Özkayın
- Department of Orthopedic Surgery, Ege University Medical Faculty Hospital, İzmir, Turkey
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Grabmann C, Hussain I, Zeller A, Kirnaz S, Sullivan V, Sommer F. Early Postoperative Weight-Bearing Ability after Total Hip Arthroplasty versus Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture. J Clin Med 2024; 13:3128. [PMID: 38892839 PMCID: PMC11172539 DOI: 10.3390/jcm13113128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/29/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Femoral neck fractures are among the most common types of fractures and particularly affect elderly patients. Two of the most common treatment strategies are total hip arthroplasty (THA) and bipolar hemiarthroplasty (BA). However, the role of the different treatment strategies in the postoperative weight-bearing ability in the early postoperative phase is still not entirely clear. Methods: Patients who underwent either THA or BA were consecutively included in our prospective cohort study. Gait analysis was performed during the early postoperative period. The gait analysis consisted of a walking distance of 40 m coupled with the turning movement in between. During the gait analysis, the duration of the measurement, the maximum peak force and the average peak force were recorded. Results: A total of 39 patients were included, 25 of whom underwent BA and 14 of whom underwent THA. The maximum peak force during the gait analysis was, on average, 80.6% ± 19.5 of the body weight in the BA group and 78.9% ± 21.6 in the THA group. The additionally determined average peak force during the entire gait analysis was 66.8% ± 15.8 of the body weight in the BA group and 60.5% ± 15.6 in the THA group. Conclusions: Patients with femoral neck fractures undergoing THA and BA can achieve sufficient weight bearing on the operated leg in the early postoperative period. In our study, BA did not allow for a significantly higher average and maximum loading capacity compared with THA.
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Affiliation(s)
- Chiara Grabmann
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Ibrahim Hussain
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Anne Zeller
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Sertac Kirnaz
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Vincent Sullivan
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - Fabian Sommer
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
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5
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Barik S, Jain A, Chanakya PV, Raj V, Goyal T. What has changed in total hip arthroplasty in patients of juvenile idiopathic arthritis since 2000? A systematic review and pooled data analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2737-2748. [PMID: 36947313 DOI: 10.1007/s00590-023-03525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16-150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA. METHODS Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included. RESULTS The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10-33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8-25%) as compared to 4% (95% CI 1-6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared. CONCLUSION JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
| | - Aakash Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - P V Chanakya
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Tarun Goyal
- Department of Orthopedics, All India Institute of Medical Sciences, Bhatinda, India
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Cieremans D, Shah A, Slover J, Schwarzkopf R, Meftah M. Trends in Complications and Outcomes in Patients Aged 65 Years and Younger Undergoing Total Hip Arthroplasty: Data From the American Joint Replacement Registry. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202303000-00009. [PMID: 36930818 PMCID: PMC10027031 DOI: 10.5435/jaaosglobal-d-22-00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Abstract
This study sought to determine common complications and the rates of readmission and revision in total hip arthroplasty patients younger than 65 years. Using the American Joint Replacement Registry, we conducted a retrospective review of all THAs in patients aged 18 to 65 years from 2012 to 2020. We excluded patients aged older than 65 years, revisions, oncologic etiology, conversion from prior surgery, and nonelective cases. Primary outcomes included cumulative revision rate, 90-day readmission rate, and reason for revision. The Kaplan-Meier method and univariate analysis were used. Five thousand one hundred fifty-three patients were included. The average age was 56.7 years (SD 7.8 years), 51% were female, 85% were White, and 89% had a Charlson Comorbidity Index of 0 (1 = 7%, >2 = 4%). The mean follow-up was 39.57 months. Fifty-three patients (1.0%) underwent revision. Seventy-four patients (1.4%) were readmitted within 90 days. Revision was more common in Black patients (P = 0.023). Survivorship was 99% (95% confidence interval, 98.7 to 99.3) and 99% (95% confidence interval, 98.5 to 99.3) at 5 and 8 years, respectively. Infection (21%), instability (15%), periprosthetic fracture (15%), and aseptic loosening (9%) were the most common indications for revision. Total hip arthroplasty performed in young and presumed active patients had a 99% survivorship at 8 years. A long-term follow-up is needed to evaluate survival trends in this growing population.
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Affiliation(s)
- David Cieremans
- From New York University Langone Orthopedic Hospital, New York, NY
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Athanasiou V, Argyropoulou E, Antzoulas P, Lakoumentas J, Diamantakis G, Gliatis J. Mosaicplasty of the Femoral Head: A Systematic Review and Meta-Analysis of the Current Literature. Cureus 2022; 14:e31874. [PMID: 36579298 PMCID: PMC9792298 DOI: 10.7759/cureus.31874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
Abstract
Osteochondral lesions of the femoral head are rare. For the treatment of these lesions, various joint-preserving procedures, particularly in young, active patients, have been developed. Mosaicplasty is a well-established surgical procedure for the knee. However, there is little evidence that this method can also be used to treat osteochondral lesions in the hip. The indication for cartilage procedures continues to evolve for the knee, and a similar strategy may be adopted for the hip joint. Due to limited evidence and a lack of experience, mosaicplasty treatment of these lesions remains challenging, especially in young patients. This study shows that open and arthroscopic management using the knee and femoral head as donor sites yielded good to excellent short- to mid-term outcomes. For osteochondral lesions of the femoral head, mosaicplasty may be a new alternative treatment option, although this needs to be proven with longer follow-ups and in a larger sample of patients.
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Affiliation(s)
- Vasileios Athanasiou
- Department of Orthopaedics and Traumatology, University General Hospital of Patra, Patras, GRC
| | - Evangelia Argyropoulou
- Department of Orthopaedics and Traumatology, University General Hospital of Patra, Patras, GRC
| | - Panagiotis Antzoulas
- Department of Orthopaedics and Traumatology, University General Hospital of Patra, Patras, GRC
| | - John Lakoumentas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, GRC
| | - George Diamantakis
- Department of Orthopaedics and Traumatology, University General Hospital of Patra, Patras, GRC
| | - John Gliatis
- Department of Orthopaedics and Traumatology, University General Hospital of Patra, Patras, GRC
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Long-Term (up to 38 Years) Failure Modes of Total Hip Arthroplasty in Adult Patients Who Had Childhood Infection of Hip. J Arthroplasty 2022; 37:1612-1617. [PMID: 35341924 DOI: 10.1016/j.arth.2022.03.064] [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: 01/23/2022] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The long-term failure modes of total hip arthroplasty (THA) in adult patients who had childhood infection have not been documented. The purpose of this study is to analyze the longer term clinical and radiographic results, prevalence of osteolysis, and survival rate of THA. METHODS We reviewed the results of 142 patients (145 hips) (mean age 41.9 years). The age of the patients at the time that the infection was contracted was an average of 7.1 years (range 1-11). The average interval between active infection and THA was 34.5 years. All but 2 hips (1 patient) had a quiescent period of infection of more than 10 years. The average duration of follow-up after THA was 31.5 years (range 25-38). RESULTS All but 2 hips with more than 10 years of quiescent infection had no recurrence of infection. The remaining 2 hips in the 1 patient with only 7 years of quiescent infection had a recurrence of infection. Seventy-eight of 145 hips (54%) underwent isolated cup revision for loosening, or osteolysis, or dislocation. Thirty (21%) femoral components were revised for aseptic loosening and/or osteolysis. The Kaplan-Meier survivorship curve at 31.5 years showed that the survival rate of the acetabular component was 46% (95% confidence interval 39-74) and that of the femoral component was 79% (95% confidence interval 73-89). CONCLUSION Contributing factors to the high failure rate of THAs were less than optimal prostheses and poor quality of polyethylene during the time period of this study.
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A Scoping Review of Total Hip Arthroplasty Survival and Reoperation Rates in Patients of 55 Years or Younger: Health Services Implications for Revision Surgeries. Arthroplast Today 2022; 16:247-258.e6. [PMID: 36092132 PMCID: PMC9458900 DOI: 10.1016/j.artd.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/03/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
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Li L, Fu J, Xu C, Ni M, Chai W, Hao L, Zhou Y, Chen J. Fourth‐Generation Ceramic‐on‐Ceramic THA
in Patients with Ankylosing Spondylitis: A Minimum
10‐Year Follow‐Up. Orthop Surg 2022; 14:860-867. [PMID: 35434922 PMCID: PMC9087442 DOI: 10.1111/os.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To report the long‐term outcomes of total hip arthroplasty (THA) with fourth‐generation ceramic‐on‐ceramic (CoC) bearing in patients with ankylosing spondylitis (AS). Methods We retrospectively identified 180 primary THAs performed in 110 patients with AS, including 100 (90.9%) men and 10 women (9.1%), from 2009 to 2011.The mean age of the patients at surgery was 33 years (range, 16 to 65 years). Cementless prostheses with fourth‐generation CoC bearings were used in all patients. Survivorship of the implants and postoperative complications were calculated. Functional improvement was assessed by the hip flexion‐extension range of motion (ROM) and Harris hip score (HHS). A special noise assessment questionnaire was performed at the last follow‐up. The cumulative incidence of noise was calculated by the Kaplan–Meier method with 95% confidence intervals (CIs). Clinical characteristics and functional outcomes were compared in the hips with noise to those without noise. Results The mean follow‐up was 11 years (range, 10 to 12 years), and survivorship of the implants was 99.4% at the most recent follow‐up. The complications included dislocation (one hip, 0.6%), periprosthetic joint infection (one hip, 0.6%), mild to moderate pain (five hips, 2.8%), heterotopic ossification (12 hips, 6.7%), and noise (52 hips, 28.9%). The flexion‐extension ROM improved significantly with a median from 10° (range, 0 ~ 130°) to 100° (30 ~ 130°) after THA (p < 0.001), and the HHS increased significantly from 41 ± 20 to 90 ± 8 (p < 0.001). The cumulative incidence of noise at 0.5, 5, and 10 years was 6.1% (95% CI, 2.6 ~ 9.6), 16.7% (95% CI, 11.2 ~ 22.1), and 28.9% (95% CI, 22.2 ~ 35.5), respectively, and that of squeaking at 0.5, 5, and 10 years was 4.4% (95% CI, 1.4 ~ 7.4), 13.3% (95% CI, 8.4 ~ 18.3), and 23.9% (95% CI, 17.6 ~ 30.1), respectively. None of the patients with noise generation in the hip reported it affecting daily activities or causing dissatisfaction. No differences in age, sex, BMI, disease duration, bilateral THA, the frequency of bony ankylosis, the proportion of using a 36‐mm‐diameter femoral head, pre/postoperative flexion‐extension ROM, or pre/postoperative HHS were found between hips with noise and those without noise (p > 0.05). Conclusion THAs with fourth‐generation CoC bearings exhibit excellent long‐term survival and clinical outcomes in patients with AS, with a very low dislocation rate. The incidence of noise associated with CoC bearings in THA performed in patients increases over time, but it does not affect postoperative hip function or daily activities.
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Affiliation(s)
- Liangliang Li
- Medical School of Chinese PLA Beijing China
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
- Department of Orthopeadics The Second Hospital of Shanxi Medical University Taiyuan China
| | - Jun Fu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Chi Xu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Ming Ni
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Wei Chai
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Libo Hao
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Yonggang Zhou
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Jiying Chen
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
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11
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Kuijpers MFL, Colo E, Schmitz MWJL, Hannink G, Rijnen WHC, Schreurs BW. The outcome of subsequent revisions after primary total hip arthroplasty in 1,049 patients aged under 50 years : a single-centre cohort study with a follow-up of more than 30 years. Bone Joint J 2022; 104-B:368-375. [PMID: 35227093 DOI: 10.1302/0301-620x.104b3.bjj-2021-0904.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to determine the outcome of all primary total hip arthroplasties (THAs) and their subsequent revision procedures in patients aged under 50 years performed at our institution. METHODS All 1,049 primary THAs which were undertaken in 860 patients aged under 50 years between 1988 and 2018 in our tertiary care institution were included. We used cemented implants in both primary and revision surgery. Impaction bone grafting was used in patients with acetabular or femoral bone defects. Kaplan-Meier analyses were used to determine the survival of primary and revision THA with the endpoint of revision for any reason, and of revision for aseptic loosening. RESULTS The mean age of the patients at the time of the initial THA was 38.6 years (SD 9.3). The mean follow-up of the THA was 8.7 years (2.0 to 31.5). The rate of survival for all primary THAs, acetabular components only, and femoral components only at 20 years' follow-up with the endpoint of revision for any reason, was 66.7% (95% confidence interval (CI) 60.5 to 72.2), 69.1% (95% CI 63.0 to 74.4), and 83.2% (95% CI 78.1 to 87.3), respectively. A total of 138 revisions were performed. The mean age at the time of revision was 48.2 years (23 to 72). Survival of all subsequent revision procedures, revised acetabular, and revised femoral components at 15 years' follow-up with the endpoint of revision for any reason was 70.3% (95% CI 56.1 to 80.7), 69.7% (95% CI 54.3 to 80.7), and 76.2% (95% CI 57.8 to 87.4), respectively. A Girdlestone excision arthroplasty was required in six of 860 patients (0.7%). CONCLUSION The long-term outcome of cemented primary and subsequent revision THA is promising in these young patients. We showed that our philosophy of using impaction bone grafting in patients with acetabular and femoral defects is a very suitable option when treating young patients. Surgeons should realize that knowledge of the outcome of subsequent revision surgery, which is inevitable in young patients, must be communicated to this group of patients prior to their initial THA. Cite this article: Bone Joint J 2022;104-B(3):368-375.
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Affiliation(s)
- Martijn F L Kuijpers
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's Hertogenbosch, The Netherlands
| | - Ena Colo
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marloes W J L Schmitz
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wim H C Rijnen
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - B Willem Schreurs
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's Hertogenbosch, The Netherlands
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Influence of shelf acetabuloplasty on the outcomes of total hip arthroplasty in hips with dysplasia: a case-control study. INTERNATIONAL ORTHOPAEDICS 2022; 46:989-997. [PMID: 35113185 DOI: 10.1007/s00264-022-05322-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Total hip arthroplasty (THA) in young adults, especially in those with hip dysplasia, is affected by wear and acetabular fixation problems. Shelf acetabuloplasty is performed to delay THA in patients with acetabular dysplasia. Thus, we conducted a retrospective, continuous case-control study at a single healthcare facility to analyze (1) the influence of prior shelf acetabuloplasty on the survival of a subsequent THA and (2) the functional outcomes. MATERIALS AND METHODS We evaluated 105 patients (124 THA) who underwent THA due to hip dysplasia: 54 patients (61 THA) were included in the THA post-shelf acetabuloplasty group (case group) and 51 patients (63 THA) in the THA for dysplasia group (control group). RESULTS At 15 years' follow-up, 89% of patients (95% CI: 84-91%) in the shelf group and 83% (95% CI: 81-90%) in the dysplasia group had not undergone surgical revision. This difference between groups was not statistically significant (p = 0.566). The functional outcomes were satisfactory in both groups; however, they were significantly better in the dysplasia group than in the shelf group based on the Merle d'Aubigne and Postel score (16.9 vs 16.0 min-max: 14-18 vs 3-18) (p = 0.01), Harris Hip score (90.0 vs 84.7, min-max: 62-100 vs 22-100) (p = 0.017), and the Oxford-12 (18/60 vs 21/60, min-max: 45-12 vs 51-12) (p = 0.04). CONCLUSION Shelf acetabuloplasty before THA does not negatively affect THA survivorship. The functional outcomes appear to be better in the hips that did not undergo shelf acetabuloplasty, although the results were good in both groups.
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13
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Hernigou J, Verdonk P, Homma Y, Verdonk R, Goodman SB, Hernigou P. Nonoperative and Operative Bone and Cartilage Regeneration and Orthopaedic Biologics of the Hip: An Orthoregeneration Network (ON) Foundation Hip Review. Arthroscopy 2022; 38:643-656. [PMID: 34506886 DOI: 10.1016/j.arthro.2021.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and, optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the hip, including osteonecrosis (aseptic necrosis) involving bone marrow, bone, and cartilage, and chondral injuries involving articular cartilage, synovium, and bone marrow. Promising and established treatment modalities for osteonecrosis include nonweightbearing; pharmacological treatments including low molecular-weight heparin, prostacyclin, statins, bisphosphonates, and denosumab, a receptor activator of nuclear factor-kB ligand inhibitor; extracorporeal shock wave therapy; pulsed electromagnetic fields; core decompression surgery; cellular therapies including bone marrow aspirate comprising mesenchymal stromal cells (MSCs aka mesenchymal stem cells) and bone marrow autologous concentrate, with or without expanded or cultured cells, and possible addition of bone morphogenetic protein-2, vascular endothelial growth factor, and basic fibroblast growth factor; and arterial perfusion of MSCs that may be combined with addition of carriers or scaffolds including autologous MSCs cultured with beta-tricalcium phosphate ceramics associated with a free vascularized fibula. Promising and established treatment modalities for chondral lesions include autologous platelet-rich plasma; hyaluronic acid; MSCs (in expanded or nonexpanded form) derived from bone marrow or other sources such as fat, placenta, umbilical cord blood, synovial membrane, and cartilage; microfracture or microfracture augmented with membrane containing MSCs, collagen, HA, or synthetic polymer; mosaicplasty; 1-stage autologous cartilage translation (ACT) or 2-stage ACT using 3-dimensional spheroids; and autologous cartilage grafting; chondral flap repair, or flap fixation with fibrin glue. Hip pain is catastrophic in young patients, and promising therapies offer an alternative to premature arthroplasty. This may address both physical and psychological components of pain; the goal is to avoid or postpone an artificial joint. LEVEL OF EVIDENCE: Level V, expert opinion.
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Affiliation(s)
| | | | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - René Verdonk
- Department of Orthopaedics & Trauma, ULB University Clinic Erasme, Brussels, Belgium
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford, California, U.S.A
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Phocas A, Holst DC, Angerame MR, Kurkis G, Dennis DA. Total Hip Revision with a Custom Acetabular Component and Femoral Allograft-Prosthetic Composite as Salvage for Failed Unstable Megaprosthesis in an Adolescent Patient: A Case Report at 19-Year Follow-up Duration. JBJS Case Connect 2021; 11:01709767-202112000-00035. [PMID: 34735375 DOI: 10.2106/jbjs.cc.21.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 13-year-old girl presented after a right proximal femur replacement after proximal femoral resection for treatment of an Ewing sarcoma. She presented after multiple episodes of recurrent instability with her hip endoprosthesis chronically dislocated. Her hip was revised to a custom, constrained metal-on-metal acetabular component with a small iliac flange. The femoral component was revised to an allograft-prosthetic composite. She has been free of malignancy recurrence, implant failure, or dislocation at 19-year follow-up duration. CONCLUSION Dislocation of the prosthetic hip can be a challenging postoperative complication, particularly when associated with a tumor megaprosthesis in a pediatric age group. This is further compounded in the presence of deficient pelvic bone stock. Restoration of bone stock is optimal, but when impossible, custom components may be necessary to establish hip stability.
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Affiliation(s)
| | - David C Holst
- Department of Orthopaedic Surgery, Durham, North Carolina
| | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado.,Adjunct Professor of Bioengineering, Department of Mechanical and Materials Engineering, Denver University, Denver, Colorado.,Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado.,Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
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15
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D'Apolito R, Bandettini G, Rossi G, Jacquot FP, Zagra L. Low Reinfection Rates But a High Rate of Complications in THA for Infection Sequelae in Childhood: A Systematic Review. Clin Orthop Relat Res 2021; 479:1094-1108. [PMID: 33617159 PMCID: PMC8116005 DOI: 10.1097/corr.0000000000001607] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Childhood hip infections can result in serious sequelae during adulthood, including persistent pain, functional limitations, and premature THA. When THA is performed in patients who had hip joint infections during childhood, surgeons surmise these arthroplasties are at an increased risk of complications and incomplete recovery. However, the degree to which this is true is not well characterized and has varied across a large number of small, retrospective studies. QUESTIONS/PURPOSES (1) What proportion of THAs performed in patients who had pediatric septic arthritis result in periprosthetic joint infection? (2) What are the Harris hip scores associated with these reconstructions? (3) What proportion of these patients develop complications after THA? (4) What proportion of patients undergo revision after these THAs? METHODS For this systematic review, we searched the MEDLINE (PubMed), Scopus, and CINAHL (EbscoHost) electronic databases. We evaluated studies published in English between 1980 and 2020 that had a minimum of 10 patients (with a minimum of 2 years of follow-up) in whom sequelae of septic arthritis of the hip were treated with single-stage THA. We also evaluated studies reporting clinical outcomes by means of the Harris hip score, along with a radiographic assessment of the prosthesis. Updates of previous studies using the same database, case reports, surgical technique reports, systematic reviews, and expert opinions were excluded. No restrictions were applied regarding study design and loss to follow-up. A total of 430 studies were identified through the initial search, and 11 studies were included after applying the inclusion and exclusion criteria. All but two studies, which included a historical control group, were retrospective case series. A total of 691 patients with a mean age of 45 years were involved. A total of 599 patients underwent cementless THAs, 84 patients underwent hybrid THA (cemented stems), and the remaining eight patients received a cemented THA. A total of 287 additional procedures were performed on the acetabulum, including autografting, allografting, and medial wall osteotomies; in three hips, tantalum augments were used. Three hundred thirty-five additional procedures were performed on the femora, including 223 shortening osteotomies and 112 greater trochanter osteotomies. The mean follow-up duration ranged from 5.5 to 15.2 years (minimum follow-up range 2-13 years). To assess the quality of the studies, we used the Methodological Index for Non-randomized Studies and the Assessment of Quality in Lower-limb Arthroplasty, for which a higher score represents a better study quality. The mean Methodological Index for Non-randomized Studies score for case series was 9 of 16 (range 6-12), and 19 and 18 of 24 for the two comparative studies. The mean reporting quality of the Assessment of Quality in Lower Limb Arthroplasty score was 6 of 8 (range 3-8). RESULTS Because of loss to follow-up, which was not consistently reported in the source studies, we caution the reader that the estimates provided here likely underestimate the risks of adverse events and overestimate the mean hip scores. The pooled proportion of patients in whom infections developed was 1% (seven of 691 THAs). Considering only studies published in the past 10 years, the proportion was 0.7% (two of 276 THAs). The Harris hip score increased from a mean of 52 ± 6 points before THA to a mean of 88 ± 2 points after THA. The pooled proportion of complications, including sciatic nerve palsy, femoral nerve palsy, intraoperative periprosthetic fracture, deep venous thrombosis, and dislocation, was 11% (76 complications among 691 THAs). The pooled proportion of patients who underwent revision was 8% (53 revisions of any components for any reason among 691 THAs) at a mean follow-up interval of 9.1 ± 3 years. CONCLUSION In THAs for sequelae of childhood septic arthritis, reinfections were uncommon, whereas generally, infection rates were slightly higher than those reported for conventional primary THAs. However, the duration of follow-up might have been insufficient to identify all patients in whom infections later developed, and the available data were not adequate to precisely detect the minimum quiescent period to avoid reinfections. Moreover, the studies in this systematic review were retrospective, and selection bias, transfer bias, and assessment bias likely influenced our findings. The general effect of these biases is to cause an underestimation of the harms of the intervention. Complications, especially intraoperative fracture and nerve palsy, were common in patients with the most-severe infections. Further data on this topic are needed, ideally from multicenter or registry studies with even longer follow-up durations. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Rocco D'Apolito
- R. D'Apolito, G. Bandettini, G. Rossi, F. P. Jacquot, L. Zagra, Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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16
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Yacovelli S, Abdelaal M, Fillingham Y, Sutton R, Madding R, Parvizi J. Prior Pelvic Osteotomy Affects the Outcome of Subsequent Total Hip Arthroplasty. J Arthroplasty 2021; 36:600-604. [PMID: 32917462 DOI: 10.1016/j.arth.2020.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although pelvic osteotomy (PO) is an important surgical procedure that can alleviate symptoms and potentially slow progression of osteoarthritis in patients with development dysplasia of the hip, some patients eventually require conversion to total hip arthroplasty (THA). This study aimed to determine the outcome of conversion THA in patients with prior PO. METHODS Forty nine patients with a history of prior PO who underwent conversion THA at a single institution were matched at a 1:3 ratio based on the date of surgery, age, gender, and body mass index with 147 developmental dysplasia of the hip patients who underwent primary THA without prior PO. A retrospective chart review was performed to compare outcomes at a minimum follow-up of 2 years. RESULTS Patients with prior PO required more supplemental screw fixation for the acetabular component (59.2% vs 38.1%, P = .016), more autologous bone grafting (24.5% vs 11.6%, P = .048), had a longer mean operative time (106.0 vs 79.8 minutes, P < .001), and greater estimated blood loss (350.0 vs 206.8 mL, P = .015). Patients with prior PO had smaller cup version angle (26.0° vs 29.0°, P = .012) and greater discrepancy in the limb length (10.3 vs 7.26 mm, P = .041). Eight hips (16.3%) with prior PO and 6 (4.1%) without osteotomy required reoperation (P = .008). There was no difference in outcome scores at the latest follow-up. CONCLUSION THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation. CONCLUSION THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.
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Affiliation(s)
- Steven Yacovelli
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Mohammad Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yale Fillingham
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Rachel Madding
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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17
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Rahm S, Hoch A, Tondelli T, Fuchs J, Zingg PO. Revision rate of THA in patients younger than 40 years depends on primary diagnosis - a retrospective analysis with a minimum follow-up of 10 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1335-1344. [PMID: 33495905 PMCID: PMC8448705 DOI: 10.1007/s00590-021-02881-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/15/2021] [Indexed: 01/12/2023]
Abstract
Background Treating osteoarthritis in elderly patients with THA is very successful. However, surgeons hesitate to recommend THA in younger patients. The spectrum of etiologies for end stage hip disease in the younger population is diverse and therefore different courses may be assumed. Our objective was to evaluate THA revision rate within a minimum follow-up period of 10 years in young patients and to analyze the difference between different primary diagnoses. Methods We included 144 consecutive hips in 127 patients younger than 40 years, who received a primary THA from 01/1996 to 12/2007. Operative reports, clinical and radiographic documentation were reviewed to determine primary diagnosis, prior hip surgery, component specifications and revision surgery. 111 hips in 97 patients were available for outcome analysis with a minimum follow-up of 10 years. Results The mean age was 33 years (range 15–40 years) at the time of the index THA, 68 patients were female and 59 were male. Ten years revision rate on the prosthetic components was 13%. The most common primary diagnosis was DDH. DDH was associated with a risk of 17% for requiring a reoperation on the prosthetic components because of mechanical fatigue and therefore, significantly higher than for any other primary diagnosis (p = 0.005). Conclusion THA in young patients is associated with a high revision rate of 13% in 10 years. 17% of patients with DDH required revision surgery for mechanical fatigue within 10 years, which was significantly higher than for any other primary diagnosis (1.2%, OR 16.8).
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Fuchs
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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18
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Verspeek J, Nijenhuis TA, Kuijpers MFL, Rijnen WHC, Schreurs BW. What Are the Long-term Results of Cemented Revision THA with Use of Both Acetabular and Femoral Impaction Bone Grafting in Patients Younger Than 55 Years? Clin Orthop Relat Res 2021; 479:84-91. [PMID: 32898047 PMCID: PMC7899485 DOI: 10.1097/corr.0000000000001462] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/29/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increasing number of THAs in younger patients will inevitably result in an increase of revision procedures. However, there is little evidence about the outcome of revision procedures in this patient group. Therefore, we updated a previous study conducted 5 years ago about the outcome of revision procedures in patients younger than 55 years. QUESTIONS/PURPOSES We sought to provide a concise update on the previously reported (1) long-term failure rate as defined by repeat revision, (2) clinical outcome as defined by the Oxford Hip score and the Harris Hip score, and (3) radiographic outcome of cemented revision THA performed with impaction bone grafting on both the acetabular and femoral sides in one surgery in patients younger than 55 years old. METHODS Between 1991 and 2007, we performed 86 complete THA revisions in patients younger than 55 years. In 38% (33 of 86) of revisions, bone impaction grafting was used on both the acetabular and femoral side because of acetabular and femoral bone stock loss. Mean age at time of revision was 46 ± 8 years. No patient was lost to follow-up, but six patients died during follow-up, including three since 2015. Still, the hips of all 33 patients were included in analysis at a mean of 17 ± 5 years. Failure was calculated using competing risk analysis. For clinical outcome, we assessed the Harris Hip score and the Oxford Hip score from our longitudinally maintained institutional database. Radiographic analysis was performed to evaluate radiographic loosening, defined as radiolucencies ≥ 2 mm in all zones or ≥ 5 mm migration for both components. The acetabular component was also considered loose with tilting ≥ 5°. RESULTS The 15-year failure rate of revision THA was 27% (95% CI 13 to 44) for re-revision of any component for any reason and 10% (95% CI 3 to 25) for re-revision of any component for aseptic loosening. The mean Harris Hip score increased from 55 ± 18 preoperatively to 74 ± 22 at latest follow-up. Eight cups were considered radiographically loose, seven of which were re-revised. No stems were considered radiographically loose. Failure rate with endpoint radiographic loosening at 15 years was 23% (95% CI 10 to 39). CONCLUSION We found that impaction bone grafting with a cemented cup and a cemented stem is a valuable biological revision technique that results in a stable and durable solution, after one or even multiple previous revision THAs. Although current implants may prove sufficient in most cases, they do not promote bone stock preservation. We believe that in young patients with bone stock loss, impaction bone grafting can be used as long as the defect can be contained adequately with a metal mesh and viable bone bed is available for revascularization. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Jason Verspeek
- J. Verspeek, T. Nijenhuis, M. F. L. Kuijpers, W. H. C. Rijnen, B. W. Schreurs, Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen, The Netherlands
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19
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Xu Y, Jiang Y, Xia C, Wang Y, Zhao Z, Li T. Stem cell therapy for osteonecrosis of femoral head: Opportunities and challenges. Regen Ther 2020; 15:295-304. [PMID: 33426232 PMCID: PMC7770428 DOI: 10.1016/j.reth.2020.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a progressive disease with a complex etiology and unclear pathogenesis, resulting in severe hip pain and dysfunction mainly observed in young patients. Although total hip arthroplasty (THA) is the most effective treatment for patients with ONFH in the terminal stage, the results of THA in young patients or active populations are often not favorable, with some complications related to the prosthesis. With the development of biotechnology, an increasing number of studies pay attention to use of stem cells for the treatment of ONFH. Stem cells are characterized by the ability to self-renew and differentiate into multiple cell types, including differentiation into osteoblasts and endothelial cells to mediate bone repair and angiogenesis. Furthermore, stem cells can offer growth factors to promote blood supply in the necrotic regions by paracrine effects. Therefore, stem cell therapy has become one of the hip-preserving alternatives for ONFH. This review summarized the current trends in stem cell therapy for ONFH, from clinical applications to related basic research, and showed that an increasing number of studies have confirmed the effectiveness of stem cell therapy in ONFH. However, many unsolved problems and challenges in practical applications of stem cell therapy still exist, such as patient selection, standardized procedures, safety assessment, and the fate of transplanted cells in the body. Additional studies are required to find ideal cell sources, appropriate transplantation methods, and the optimal number of cells for transplantation. Diversities in repair processes present a challenge in the targeted treatment of ONFH. Osteogenesis and angiogenesis are the primary mechanisms of MSCs treatment in ONFH. Systematic safety assessment and cell tracing are necessary for stem cell therapy. Optimal numbers and methods of cell transplantation need to be further confirmed.
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Key Words
- ALP, alkaline phosphatase
- AMSCs, adipose-derived MSCs
- BCP, biphasic calcium phosphate
- BMC, bone marrow concentrate
- BMMNCs, bone marrow mononuclear cells
- BMP-2, bone morphogenetic protein-2
- BMSCs, bone marrow-derived mesenchymal stem cells
- CD, Core decompression
- CPC, calcium phosphate
- CSS, cap-shaped separation
- Cell implantation
- Cell therapy
- DBM, demineralized bone matrix
- Femoral head
- HHS, Harris hip score
- IP-CHA, interconnected porous calcium hydroxyapatite
- MRI, magnetic resonance imaging
- MSCs, Mesenchymal stem cells
- MVD, microvessel density
- ONFH, Osteonecrosis of the femoral head
- Osteonecrosis
- PBMSCs, peripheral blood-derived MSCs
- PLGA, poly lactide-co-glycolide
- RCT, randomized controlled trial
- SCPP, strontium-doped calcium polyphosphate
- SVF, stromal vascular fractions
- Stem cells
- THA, total hip arthroplasty
- TMCs, transformed mesenchymal cells
- TNF, tumor necrosis factor
- Tissue engineering
- UCMSCs, umbilical cord-derived mesenchymal stem cells
- VAS, visual analogue scale
- VEGF, vascular endothelial growth factor
- WOMAC, Western Ontario and McMaster Universities Arthritis Index
- XACB, xenogeneic antigen-extracted cancellous bone
- bFGF, basic fibroblast growth factor
- β-TCP, beta-tricalcium phosphate
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Affiliation(s)
- Yingxing Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China.,Qingdao University, Qingdao, Shandong, 266071, China.,Medical Department of Qingdao University, Qingdao, Shandong, 266071, China
| | - Yaping Jiang
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China.,Qingdao University, Qingdao, Shandong, 266071, China
| | - ChangSuo Xia
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
| | - Yingzhen Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
| | - Zhiping Zhao
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China.,Qingdao University, Qingdao, Shandong, 266071, China.,Medical Department of Qingdao University, Qingdao, Shandong, 266071, China
| | - Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
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20
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Impact of Jiggling Exercise as Conservative Treatment for Hip Osteoarthritis: A Report of Two Cases. Case Rep Orthop 2020; 2020:2804193. [PMID: 32455037 PMCID: PMC7232713 DOI: 10.1155/2020/2804193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022] Open
Abstract
Total hip arthroplasty has been recognized as a feasible treatment for hip osteoarthritis, especially in advanced and terminal stages, but whether it is the best treatment for patients who are younger, have comorbidities, and/or are likely to have low compliance to medical treatment is unknown. Jiggling exercise, which involves the continuous shaking of the foot and leg in small steps, has been reported to be the easiest and a less invasive exercise for patients with hip osteoarthritis. We herein report two patients who performed jiggling exercise as conservative treatment and had successful outcomes. The first case was a 28-year-old woman with advanced-stage hip osteoarthritis that could not be treated with hip preservation surgery; furthermore, the patient refused to undergo total hip arthroplasty because of her young age. The second case was a 74-year-old woman with terminal-stage hip osteoarthritis in whom total hip arthroplasty was deemed not feasible because of possible low compliance due to mental disorder. One year after the initiation of the jiggling exercise, both patients had remarkable clinical improvement. Three years later, remarkable joint remodelling was also revealed in plain radiographs. Jiggling exercise might be a feasible conservative treatment option for joint preservation.
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21
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Kuijpers MFL, Hannink G, van Steenbergen LN, Schreurs BW. Outcome of revision hip arthroplasty in patients younger than 55 years: an analysis of 1,037 revisions in the Dutch Arthroplasty Register. Acta Orthop 2020; 91:165-170. [PMID: 31928096 PMCID: PMC7144208 DOI: 10.1080/17453674.2019.1708655] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The increasing use of hip arthroplasties in young patients will inevitably lead to more revision procedures at younger ages, especially as the outcome of their primary procedures is inferior compared with older patients. However, data on the outcome of revision hip arthroplasty in young patients are limited. We determined the failure rates of revised hip prostheses performed in patients under 55 years using Dutch Arthroplasty Register (LROI) data.Patients and methods - All 1,037 revised hip arthroplasty procedures in patients under 55 years at the moment of revision registered in the LROI during the years 2007-2018 were included. Kaplan-Meier survival analyses were used to calculate failure rates of revised hip arthroplasties with endpoint re-revision for any reason. Competing risk analyses were used to determine the probability of re-revision for the endpoints infection, dislocation, acetabular and femoral loosening, while other reasons for revisions and death were considered as competing risks.Results - Mean follow-up of revision procedures was 3.9 years (0.1-12). 214 re-revisions were registered. The most common reason for the index revision was dislocation (20%); the most common reason for re-revision was infection (35%). The 5-year failure rate of revised hip prostheses was 22% (95% CI 19-25), and the 10-year failure rate was 28% (CI 24-33). The 10-year cumulative failure rates of index revisions with endpoint re-revision for infection was 7.8% (CI 6.1-9.7), acetabular loosening 7.0% (CI 4.1-11), dislocation 3.8% (CI 2.6-5.2), and femoral loosening 2.7% (CI 1.6-4.1). The 10-year implant failure rate of index revisions for infection was 45% (CI 37-55) with endpoint re-revision for any reason.Interpretation - Failure rate of revised hip prostheses in patients under 55 years is worrisome, especially regarding index revisions due to infection. This information facilitates realistic expectations for these young patients at the time of primary THA.
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Affiliation(s)
- Martijn F L Kuijpers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen; ,Correspondence:
| | - Gerjon Hannink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms, Nijmegen;
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ‘s Hertogenbosch, the Netherlands
| | - B Willem Schreurs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Orthopaedics, Nijmegen; ,Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ‘s Hertogenbosch, the Netherlands
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Mahiques-Segura G, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles-Muñoz FA, Lopez-Prats FA. A Comparison Study of the Outcomes of Ceramic-on-Ceramic Total Hip Arthroplasty in Young vs Older Patients: A Minimum 10-Year Follow-Up Prospective Matched Study. J Arthroplasty 2019; 34:1731-1735. [PMID: 31003784 DOI: 10.1016/j.arth.2019.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to analyze the outcome and prosthesis survival in patients aged between 20 and 40 years who received a cementless total hip arthroplasty (THA) with a minimum follow-up of 10 years compared to older patients. METHODS Prospective matched comparative study was conducted between 94 young patients with mean age of 37.2 (range 22-40) years and 90 older patients with mean age of 64.7 (range 60-70) years treated with ceramic-on-ceramic THA. Clinical outcomes were assessed by the Harris Hip Score, reduced Western Ontario and MacMaster University (WOMAC), and Short-Form-12 (SF12) questionnaires. Radiological evaluation was also performed. The primary outcome was the THA survival rate. RESULTS Mean follow-up of 13.6 (range, 10-15) years. At the final follow-up, there was no significant difference between groups in Harris Hip Score (P = .356), WOMAC-pain (P = .461), SF12-physical (P = .305), or SF12-mental (P = .511), but younger group had significantly higher WOMAC-function score (P = .013). There were 7 revisions in the younger group and 4 in the older group (P = .197). The 14-year prosthesis survival for any reason was 93.2% (95% confidence interval [CI] 86.7-99.7) in the younger group and 98.3% (95% CI 95.1-100) in the older group (P = .189). For aseptic reason, the 14-year survival was 94.7% (95% CI 88.9-100) in the younger group and 98.3% (95% CI 95.1-100) in the older group (P = .332). CONCLUSION At minimum follow-up of 10 years, THA with cementless stem and ceramic-on-ceramic bearing provides successful survival and functional outcomes in young patients between 20 and 40 years old.
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Affiliation(s)
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Department of Nursing, Clinical Research Group, Faculty of Health Sciences, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | | | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
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Kenney C, Dick S, Lea J, Liu J, Ebraheim NA. A systematic review of the causes of failure of Revision Total Hip Arthroplasty. J Orthop 2019; 16:393-395. [PMID: 31110401 DOI: 10.1016/j.jor.2019.04.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/15/2019] [Indexed: 12/26/2022] Open
Abstract
This study reviewed literature published in the last 10 years to investigate the reasons for revision failure. A total of 9952 revisions were identified and it was determined that the number one cause of failure was aseptic loosening (23.19%), followed by instability (22.43%) and infection (22.13%). Further analysis of applicable revisions investigated BMI and age at the failure rates. The rate of rerevision in obese patients was markedly higher (p < 0.01) compared to non-obese patients and individuals receiving a revision THA under the age of 55 are at a higher risk of rerevision (p < 0.01).
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Affiliation(s)
- Connor Kenney
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, United States
| | - Steven Dick
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, United States
| | - Justin Lea
- University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - Jiayong Liu
- University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - Nabil A Ebraheim
- University of Toledo Medical Center, Toledo, OH, 43614, United States
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Puliero B, Blakeney WG, Beaulieu Y, Vendittoli PA. Joint Perception After Total Hip Arthroplasty and the Forgotten Joint. J Arthroplasty 2019; 34:65-70. [PMID: 30352769 DOI: 10.1016/j.arth.2018.09.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Assessing patients' functional outcomes following total hip arthroplasty with traditional scoring systems is limited by their ceiling effects. The Forgotten Joint Score (FJS) has been suggested as a more discriminating option. The actual score in the FJS which constitutes a "forgotten joint," however, has not been defined. The emerging concept of joint perception led to the development of the Patient's Joint Perception question (PJP) to assess the patient's opinion of their prosthetic joint. METHODS Two hundred fifty-seven total hip arthroplasties were assessed at a mean of 68 months of follow-up (range 57-79). Outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), FJS, and PJP. Correlation of the scores as well as the ceiling effects were analyzed. RESULTS The mean FJS was 88.5 (range 27.1-100). PJP was correlated with the FJS and WOMAC (Spearman's rho -0.510 and 0.465, respectively). Fifty-two percent of the patients felt their hip as a natural joint (FJS: 95% confidence interval [CI] 93.3-96.0), 24.1% as an artificial joint with no restriction (FJS: 95% CI 83.1-90.5), and 23.3% as an artificial joint with minor restrictions (FJS: 95% CI 73.8-82.2). Only 0.8% had major restrictions and none reported a non-functional joint. The ceiling effect was high with both the WOMAC and FJS, with 27.2% and 31.9%. In addition, 28.6% of the patients had a WOMAC >10 and 23.4% an FJS <90 while reporting having a natural hip. Furthermore, 21.5% with a perfect WOMAC or 21.9% with a perfect FJS reported having an artificial joint with or without limitation. CONCLUSION A forgotten hip perception corresponds to an FJS >93. In 20%-30% of the cases, the WOMAC and FJS failed to identify the forgotten joint, or reached the maximum score when the patients did not feel their hip was natural. The PJP is a simple and reliable tool that enables identification of patients who feel replaced hip is natural.
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Affiliation(s)
- Benjamin Puliero
- Department of Surgery, CIUSSS-de-L'Est-de-L'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - William G Blakeney
- Department of Surgery, CIUSSS-de-L'Est-de-L'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Yann Beaulieu
- Department of Surgery, CIUSSS-de-L'Est-de-L'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Pascal-André Vendittoli
- Department of Surgery, CIUSSS-de-L'Est-de-L'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
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Metcalfe D, Peterson N, Wilkinson JM, Perry DC. Temporal trends and survivorship of total hip arthroplasty in very young patients. Bone Joint J 2018; 100-B:1320-1329. [DOI: 10.1302/0301-620x.100b10.bjj-2017-1441.r2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to describe temporal trends and survivorship of total hip arthroplasty (THA) in very young patients, aged ≤ 20 years. Patients and Methods A descriptive observational study was undertaken using data from the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man between April 2003 and March 2017. All patients aged ≤ 20 years at the time of THA were included and the primary outcome was revision surgery. Descriptive statistics were used to summarize the data and Kaplan–Meier estimates calculated for the cumulative implant survival. Results A total of 769 THAs were performed in 703 patients. The median follow-up was 5.1 years (interquartile range (IQR) 2.6 to 7.8). Eight patients died and 35 THAs were revised. The use of metal-on-metal (MoM) bearings and resurfacing procedures declined after 2008. The most frequently recorded indications for revision were loosening (20%) and infection (20%), although the absolute risk of these events occurring was low (0.9%). Factors associated with lower implant survival were MoM and metal-on-polyethylene (MoP) bearings and resurfacing arthroplasty ( vs ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) bearings, p = 0.002), and operations performed by surgeons who undertook few THAs in this age group as recorded in the NJR ( vs those with five or more recorded operations, p = 0.030). Kaplan–Meier estimates showed 96% (95% confidence interval (CI) 94% to 98%) survivorship of implants at five years. Conclusion Within the NJR, the overall survival for very young patients undergoing THA exceeded 96% during the first five postoperative years. In the absence of studies that can better account for differences in the characteristics of the patients, surgeons should consider the association between early revision and the type of implant, the number of THAs performed in these patients, and the bearing surface when performing THA in very young patients. Cite this article: Bone Joint J 2018;100-B:1320–9.
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Affiliation(s)
- D. Metcalfe
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
| | - N. Peterson
- Specialty Registrar in Trauma & Orthopaedic Surgery, Alder Hey Children’s Hospital, Liverpool, UK
| | - J. M. Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sorby Wing, Northern General Hospital, Sheffield, UK
| | - D. C. Perry
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
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Abstract
INTRODUCTION Total hip arthroplasties (THAs) in younger patients are becoming increasingly popular. However, the outcome of subsequent revisions in younger patients is not well known and, therefore, their success (subsequent revision prosthesis survival) might be overestimated. We investigated available data on the outcome of primary- and subsequent revision THAs performed in the same cohort of patients who underwent primary THA under the age of 50. METHODS Medline, Embase and the Cochrane Library (CENTRAL) were searched up until April 13, 2016 for studies that reported both the survival of primary and subsequent revisions THA of single cohorts of patients younger than 50. Eligible articles had to include Kaplan Meier analysis or competing risk analysis for survival of the primary THA at a mean follow-up of 10 years, as well as for the subsequent revision THA within the same cohort. RESULTS We found 4,799 unique records; 43 of which were potentially eligible. Only 1 paper met our inclusion criteria. It reported on the survival of 69 primary prostheses at a mean of more than 10 years follow-up and 13 subsequent revisions. CONCLUSIONS There is a clear lack of evidence about the outcomes of the revision arthroplasty in younger patients. Only 1 study reported the survival-rate of subsequent revision arthroplasty with the minimum 10-year survival rate of the original THA cohort. In the future, this serious lack of knowledge could result in a large number of patients with no further reconstructive options after failed THA, and a large medical burden for society.
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Einhorn TA, Anoushiravani AA, Chen KK, Elbuluk A, Tsismenakis T, Lespasio M, Iorio R. Treatment of stage I and II osteonecrosis of the femoral head with core decompression and bone marrow aspirate concentrate injection—A 2-year follow-up study. ACTA ACUST UNITED AC 2017. [DOI: 10.1053/j.sart.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Total hip arthroplasty (THA) is a very successful and effective orthopedic operation with very good immediate as well as long-term results to alleviate pain and improve health-related quality of life. A THA is indicated in end-stage hip osteoarthritis with a high degree of persistent suffering when conservative treatment has failed and in patients who wish a THA. This statement is generally valid for patients where the medical history, clinical examination and radiographic findings are conclusive, the pressure of suffering and the expectations are realistic. The timing of THA is based on the patient's discomfort. The treatment of these patients should include an interdisciplinary approach and the main goal is to improve the quality of life. Patients will learn to have reasonable expectations and should be well informed about the risks and benefits of THA. Realistic patient expectations seem to be a predictive factor for a good subjective outcome after THA.
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Affiliation(s)
- S Rahm
- Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
| | - P O Zingg
- Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz
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Wear of XLPE liner against zirconium heads in cementless total hip arthroplasty for patients under 40 years of age. Hip Int 2017; 27:532-536. [PMID: 28574118 DOI: 10.5301/hipint.5000513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) in the young is challenging. The purpose of this study was to retrospectively determine the clinical, radiographic, and polyethylene wear rate of relatively young patients. METHODS We evaluated the outcome of consecutive patients receiving primary THA who were under 40 years of age with a minimum 10-year follow-up. Indications for THA in these patients were osteoarthritis due to developmental dysplasia of the hip joint (9 hips), osteonecrosis of the femoral head (7 hips), juvenile idiopathic arthritis (2 hips), and osteoarthritis due to Perthes disease (1 hip). All THA were performed with a cross-linked ultra-high-molecular-weight polyethylene (XLPE) liner against zirconium heads with cementless implants. RESULTS The average Japanese Orthopaedic Association hip score significantly improved from 42 to 93 points at the latest follow-up. The mean steady wear was 0.015 mm/year (maximum 0.033 mm/year), and the mean creep wear was 0.111 mm (maximum 0.4 mm). Osteolysis was observed around 1 acetabular component and 2 stems. 1 femoral component had subsidence over 5 mm. All of the femoral components achieved fixation with an optimal interface with spot welds at the latest follow-up. Stress shielding was observed in all hips. CONCLUSIONS THA using an XLPE liner against zirconium heads appeared to have improved THA longevity. However, the imaging findings in some cases were suggestive of wear debris. A rigorous continual follow-up is required for relatively young patients undergoing THA.
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Redmond JM, Gupta A, Dunne K, Humayun A, Yuen LC, Domb BG. What Factors Predict Conversion to THA After Arthroscopy? Clin Orthop Relat Res 2017; 475:2538-2545. [PMID: 28688017 PMCID: PMC5599408 DOI: 10.1007/s11999-017-5437-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 06/26/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Failure of hip preservation to alleviate symptoms potentially subjects the patient to reoperation or conversion surgery to THA, adding recovery time, risk, and cost. A risk calculator using an algorithm that can predict the likelihood that a patient who undergoes arthroscopic hip surgery will undergo THA within 2 years would be helpful, but to our knowledge, no such tool exists. QUESTIONS (1) Are there preoperative and intraoperative variables at the time of hip arthroscopy associated with subsequent conversion to THA? (2) Can these variables be used to develop a predictive tool for conversion to THA? MATERIALS AND METHODS All patients undergoing arthroscopy from January 2009 through December 2011 were registered in our longitudinal database. Inclusion criteria for the study group were patients undergoing hip arthroscopy for a labral tear, who eventually had conversion surgery to THA. Patients were compared with a control group of patients who underwent hip arthroscopy for a labral tear but who did not undergo conversion surgery to THA during the same study period. Of the 893 who underwent surgery during that time, 792 (88.7%) were available for followup at a minimum of 2 years (mean, 31.1 ± 8.1 years) and so were considered in this analysis. Multivariate regression analyses of 41 preoperative and intraoperative variables were performed. Using the results of the multivariate regression, we developed a simplified calculator that may be helpful in counseling a patient regarding the risk of conversion to THA after hip arthroscopy. RESULTS Variables simultaneously associated with conversion to THA in this model were older age (rate ratio, 1.06; 95% CI, 1.03-1.08; p < 0.0001), lower preoperative modified Harris hip score (rate ratio [RR], 0.98; 95% CI, 0.96-0.99; p = 0.0003), decreased femoral anteversion (RR, 0.97; 95% CI, 0.94-0.99; p = 0.0111), revision surgery (RR, 2.4; 95% CI, 1.15-5.01; p = 0.0193), femoral Outerbridge Grades II to IV (Grade II: RR, 2.23 [95% CI, 1.11-4.46], p = 0.023; Grade III: RR, 2.17, [95% CI, 1.11-4.23], p = 0.024; Grade IV: RR, 2.96 [95% CI, 1.34-6.52], p = 0.007), performance of acetabuloplasty (RR, 1.83; 95% CI, 1.03-3.24; p = 0.038), and lack of performance of femoral osteoplasty (RR, 0.62; 95% CI, 0.36-1.06; p = 0.081). Using the results of the multivariate regression, we developed a simplified calculator that may be helpful in counseling a patient regarding the risk of conversion surgery to THA after hip arthroscopy. CONCLUSION Multiple risk factors have been identified as possible risk factors for conversion to THA after hip arthroscopy. A weighted calculator based on our data is presented here and may be useful for predicting failure after hip arthroscopy for labral treatment. Determining the best candidates for hip preservation remains challenging; careful attention to long-term followup and identifying characteristics associated with successful outcomes should be the focus of further study. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- John M. Redmond
- American Hip Institute, Westmont, IL USA ,Southeast Orthopedic Specialists, Jacksonville, FL USA
| | | | | | - Ammar Humayun
- American Hip Institute, Westmont, IL USA ,Southeast Orthopedic Specialists, Jacksonville, FL USA
| | | | - Benjamin G. Domb
- American Hip Institute, Westmont, IL USA ,Hinsdale Orthopaedics, 1010 Executive Court, Suite 250, Westmont, IL USA
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Dugard MN, Kuiper JH, Parker J, Roberts S, Robinson E, Harrison P, Richardson JB. Development of a Tool to Predict Outcome of Autologous Chondrocyte Implantation. Cartilage 2017; 8:119-130. [PMID: 28345413 PMCID: PMC5358825 DOI: 10.1177/1947603516650002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The study had 2 objectives: first, to evaluate the success of autologous chondrocyte implantation (ACI) in terms of incidence of surgical re-intervention, including arthroplasty, and investigate predictors of successful treatment outcome. The second objective was to derive a tool predicting a patient's arthroplasty risk following ACI. Design In this Level II, prognostic study, 170 ACI-treated patients (110 males [aged 36.8 ± 9.4 years]; 60 females [aged 38.1 ± 10.2 years]) completed a questionnaire about further surgery on their knee treated with ACI 10.9 ± 3.5 years previously. Factors commonly assessed preoperatively (age, gender, defect location and number, previous surgery at this site, and the preoperative Lysholm score) were used as independent factors in regression analyses. Results At final follow-up (maximum of 19 years post-ACI), 40 patients (23.5%) had undergone surgical re-intervention following ACI. Twenty-six patients (15.3%) underwent arthroplasty, more commonly females (25%) than males (10%; P = 0.001). Cox regression analyses identified 4 factors associated with re-intervention: age at ACI, multiple operations before ACI, patellar defects, and lower pretreatment Lysholm scores (Nagelkerke's R2 = 0.20). Six predictive items associated with risk of arthroplasty following ACI (Nagelkerke's R2 = 0.34) were used to develop the Oswestry Risk of Knee Arthroplasty index with internal cross-validation. Conclusion In a single-center study, we have identified 6 factors (age, gender, location and number of defects, number of previous operations, and Lysholm score before ACI) that appear to influence the likelihood of ACI patients progressing to arthroplasty. We have used this information to propose a formula or "tool" that could aid treatment decisions and improve patient selection for ACI.
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Affiliation(s)
- M. Naomi Dugard
- Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK,Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, UK
| | - Jan Herman Kuiper
- Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK,Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, UK
| | - Jane Parker
- Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK,Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, UK
| | - Sally Roberts
- Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK,Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, UK,Sally Roberts, ARC/TORCH Building, RJAH Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK.
| | - Eric Robinson
- Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK
| | - Paul Harrison
- Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK
| | - James B. Richardson
- Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust Hospital, Oswestry, Shropshire, UK,Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, UK
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Moriya M, Fukushima K, Uchiyama K, Takahira N, Yamamoto T, Minegishi Y, Takaso M. Clinical results of arthroscopic surgery in patients over 50 years of age-what viability does it have as a joint preservative surgery? J Orthop Surg Res 2017; 12:2. [PMID: 28057012 PMCID: PMC5217539 DOI: 10.1186/s13018-016-0504-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To identify whether hip arthroscopy is a suitable option for treating hip pain in elderly patients and investigate the clinical outcomes of hip arthroscopic surgery for labrum tear and/or osteoarthritis in patients over 50 years of age. METHODS Between August 2009 and May 2014, a series of 23 patients (6 men and 17 women) with a mean age of 59 years underwent arthroscopy. We retrospectively examined the clinical records, radiographs, and outcome questionnaires from all patients. The mean follow-up period was 28 months. RESULTS The mean Japan Orthopedic Association hip score after surgery improved by a statistically significant amount. Eight patients (34.8%) were noted to have a progression of osteoarthritis (OA) diagnosed by radiograph, and one underwent THA after 13 months following arthroscopic surgery. The patients in which OA progression was noted were identified as having radiographical OA preoperatively and acetabular cartilage damage in the arthroscopic findings. CONCLUSIONS Arthroscopic surgery performed in selected patients over 50 years of age might be beneficial if classified as Tönnis grade 0 preoperatively and/or classified as Outerbridge grade II in the arthroscopic findings.
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Affiliation(s)
- Mitsutoshi Moriya
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Takeaki Yamamoto
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yojiro Minegishi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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McLaughlin JR, Lee KR. Total Hip Arthroplasty With an Uncemented Tapered Femoral Component in Patients Younger Than 50 Years of Age: A Minimum 20-Year Follow-Up Study. J Arthroplasty 2016; 31:1275-1278. [PMID: 26781396 DOI: 10.1016/j.arth.2015.12.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Previously, we reported the mean 16-year results of primary uncemented total hip arthroplasty using a tapered femoral component in patients <50 years. The purpose of this study was to update our previous report using the Taperloc femoral component in young patients who had been followed for a minimum of 20 years postoperatively. METHODS Between 1983 and 1990, 108 consecutive uncemented total hip arthroplasties were performed in 91 patients of age <50 years, with use of the Taperloc femoral component. Every patient was followed for a minimum of 20 years after surgery or until death. At a mean of 25 (range, 20-29 years) postoperatively, 76 patients (91 hips) were living. The Harris Hip Score, radiographic results, complications, and Kaplan-Meier survivorship were evaluated. RESULTS In the entire cohort of 108 hips, 9 femoral components (8%) have been revised, none for aseptic loosening. Five well-fixed stems were removed during acetabular revision, 3 stems were revised for infection, and 1 stem was exchanged because of a peroneal nerve palsy. Distal femoral osteolysis was identified around 1 hip. With failure defined as stem removal for any reason, implant survival was 90% (CI = 82-95) at 29 years. With failure defined as stem removal for aseptic loosening, implant survival was 100% at 29 years. CONCLUSION Primary total hip arthroplasty with the Taperloc femoral component in young patients was associated with a high rate of survival at 29 years.
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Affiliation(s)
| | - Kyla R Lee
- Gundersen Lutheran Medical Center, LaCrosse, Wisconsin
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te Stroet MAJ, Rijnen WHC, Gardeniers JWM, van Kampen A, Schreurs BW. Satisfying outcomes scores and survivorship achieved with impaction grafting for revision THA in young patients. Clin Orthop Relat Res 2015; 473:3867-75. [PMID: 25894808 PMCID: PMC4626523 DOI: 10.1007/s11999-015-4293-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far. QUESTIONS/PURPOSES The purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old. METHODS During the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate. RESULTS The mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%-95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%-100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised. CONCLUSIONS IBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
| | - Wim H. C. Rijnen
- Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Jean W. M. Gardeniers
- Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Albert van Kampen
- Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - B. Willem Schreurs
- Radboud University Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
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Abstract
UNLABELLED Classification systems for femoral revision of a failed THA fail to address several of the more critical determinants. The aim of the present study was to assess the reliability of a simplified algorithm for decision making during cementless reconstruction for femoral loosening with respect to stem length, stem design and the need for an extended trochanteric osteotomy. Four observers with different levels of clinical experience blindly assessed 40 X-rays of hips scheduled for a femoral revision. Intra-observer and inter-observer reliability of 4 radiographic criteria were assessed: 1) diaphyseal bone loss extension to the isthmus; 2) proximal femoral remodelling; 3) presence of cement; and 4) cortical thickness. Inter-observer agreement relating to the four criteria was good (κ = 0.66) for the extension to isthmus, moderate (κ = 0.57) for proximal femoral remodelling and very good for presence of cement (κ = 1) and cortical thickness (κ = 0.88). Intra-observer agreement was good for extension to isthmus and proximal femoral remodelling and very good for presence of cement and cortical thickness. Based on these criteria, an algorithm has been developed to describe 4 reconstruction options. The algorithm seems reliable for decision making during femoral cementless revision, but research into comparison with intraoperative findings is still required. LEVEL OF EVIDENCE Level II, Development of diagnostic criteria on consecutive patients.
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Migaud H, Putman S, Berton C, Lefèvre C, Huten D, Argenson JN, Gaucher F. Does prior conservative surgery affect survivorship and functional outcome in total hip arthroplasty for congenital dislocation of the hip? A case-control study in 159 hips. Orthop Traumatol Surg Res 2014; 100:733-7. [PMID: 25281551 DOI: 10.1016/j.otsr.2014.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 06/26/2014] [Accepted: 07/10/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The results of total hip arthroplasty (THA) in congenital dislocation of the hip (CDH) are well known, but such is not the case for the impact of prior conservative surgery on THA function and survivorship. The present study compared THA in CDH with prior conservative bone surgery (BS group) versus no prior bone surgery (NBS group), to (1) assess the impact of prior conservative surgery on function and survivorship after THA, and (2) determine whether a particular type of conservative surgery affected function or survivorship. HYPOTHESIS Prior conservative surgery for CDH does not affect function or survivorship of subsequent THA. PATIENTS AND METHODS A multicenter retrospective case-control study analyzed 430 THAs in CDH patients (332 patients: 269 female, 63 male; mean age, 56 years [range, 17-80 years]) at a mean 13.2±5.4 years' follow-up (range, 1-29 years). The BS group included 159 hips (37%) (64 pelvic, 81 femoral and 14 combined pelvic and femoral osteotomies), and the NBS group 271 (63%). Groups were comparable for gender, age at surgery, Devane activity score, preoperative Postel Merle d'Aubigné (PMA) functional score and CDH radiographic type following Crowe. RESULTS At follow-up, PMA scores were comparable: BS, 16.8±1.4 (11-18); NBS, 16.9±1.5 (7-18). Fifteen-year survivorship censored for implant revision for whatever reason did not significantly differ: BS, 87% (95% CI: 83-91%); NBS, 89% (95% CI: 86-92%). Ten-year survivorship on the same criterion did not significantly differ according to type of prior surgery: hip shelf arthroplasty, 97% (95% CI: 95-99%); Chiari osteotomy, 100%; femoral osteotomy, 95% (95% CI: 92-98%); and Milch osteotomy 96% (95% CI: 93-99%). DISCUSSION/CONCLUSION Conservative surgery for CDH does not impair the functional results or survivorship of subsequent THA. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- H Migaud
- Service d'orthopédie C, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France; Faculté de médecine, université Lille-Nord-de-France, place de Verdun, 589045 Lille, France.
| | - S Putman
- Service d'orthopédie C, département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France; Faculté de médecine, université Lille-Nord-de-France, place de Verdun, 589045 Lille, France
| | - C Berton
- Faculté de médecine, université Lille-Nord-de-France, place de Verdun, 589045 Lille, France; Service d'orthopédie-traumatologie, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes cedex, France
| | - C Lefèvre
- Service de chirurgie orthopédique et de traumatologie, hôpital Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - D Huten
- Service de chirurgie orthopédique et de traumatologie, CHU de Rennes, 16, boulevard de Bulgarie, BP 90347, 35000 Rennes, France
| | - J-N Argenson
- Institut du mouvement et de l'appareil locomoteur, service de chirurgie orthopédique, hôpital Sainte-Marguerite, université Aix-Marseille, CHU de Marseille, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - F Gaucher
- Service de chirurgie orthopédique et de traumatologie, Hôtel-Dieu, rue Roger-Signor, 29120 Pont l'Abbé, France
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Pakos EE, Paschos NK, Xenakis TA. Long Term Outcomes of Total Hip Arthroplasty in Young Patients under 30. THE ARCHIVES OF BONE AND JOINT SURGERY 2014; 2:157-162. [PMID: 25386575 PMCID: PMC4225019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND We aimed to report outcomes of total hip arthroplasty (THA) in very young patients under the year of 30. METHODS Thirty patients (45 hips) with various indications for THA were retrospectively reviewed radiologically and clinically and analyzed regarding survival, reasons of failure, factors associated with outcomes and postoperative complications. RESULTS Within a mean follow-up time of 116 months the 10-year survival rate was 90.3%. All hips were revised due to aseptic loosening. No association was found among the tested parameters with increased revision rates. Three complications associated with the THA were recorded and managed conservatively. All patients had statistically significant improved clinical scores compared to the pre-operative period, despite the underlying disorder that compromised the condition in the majority of the patients. CONCLUSIONS Our study showed excellent long term outcomes of THA in patients younger than 30 years of age, comparable with those in older patients.
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Affiliation(s)
- Emilios E Pakos
- Emilios E. Pakos MD, Nikolaos K. Paschos MD, Theodoros A. Xenakis MD, Laboratory of Orthopaedics and Biomechanics, University of Ioannina, Medical School, Ioannina, Greece
| | - Nikolaos K Paschos
- Emilios E. Pakos MD, Nikolaos K. Paschos MD, Theodoros A. Xenakis MD, Laboratory of Orthopaedics and Biomechanics, University of Ioannina, Medical School, Ioannina, Greece
| | - Theodoros A Xenakis
- Emilios E. Pakos MD, Nikolaos K. Paschos MD, Theodoros A. Xenakis MD, Laboratory of Orthopaedics and Biomechanics, University of Ioannina, Medical School, Ioannina, Greece
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Lee PTH, Lakstein DL, Lozano B, Safir O, Backstein J, Gross AE. Mid-to long-term results of revision total hip replacement in patients aged 50 years or younger. Bone Joint J 2014; 96-B:1047-51. [DOI: 10.1302/0301-620x.96b8.31587] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Revision total hip replacement (THR) for young patients is challenging because of technical complexity and the potential need for subsequent further revisions. We have assessed the survivorship, functional outcome and complications of this procedure in patients aged < 50 years through a large longitudinal series with consistent treatment algorithms. Of 132 consecutive patients (181 hips) who underwent revision THR, 102 patients (151 hips) with a mean age of 43 years (22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26) post-operatively. We attempted to restore bone stock with allograft where indicated. Using further revision for any reason as an end point, the survival of the acetabular component was 71% (sd 4) and 54% (sd 7) at ten- and 20 years. The survival of the femoral component was 80% (sd 4) and 62% (sd 6) at ten- and 20 years. Complications included 11 dislocations (6.1%), ten periprosthetic fractures (5.5%), two deep infections (1.1%), four sciatic nerve palsies (2.2%; three resolved without intervention, one improved after exploration and freeing from adhesions) and one vascular injury (0.6%). The mean modified Harris Hip Score was 41 (10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is valuable when advising young patients on the prospects of revision surgery at the time of primary replacement. Cite this article: Bone Joint J 2014;96-B:1047–51.
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Affiliation(s)
- P. T. H. Lee
- Royal London Hospital, Barts
Health NHS Trust. Whitechapel Rd, London, E1
1BB, UK
| | | | - B. Lozano
- Hospital San Felipe de Jesus, Paseo
de los Leones #2508, Col. Cumbres her Sector, Monterey, N.L.
64610, México
| | - O. Safir
- Mount Sinai Hospital, Division
of Orthopaedic Surgery, 600 University Avenue, Toronto, Ontario
M5G 1X5, Canada
| | - J. Backstein
- Mount Sinai Hospital, Division
of Orthopaedic Surgery, 600 University Avenue, Toronto, Ontario
M5G 1X5, Canada
| | - A. E. Gross
- Mount Sinai Hospital, Division
of Orthopaedic Surgery, 600 University Avenue, Toronto, Ontario
M5G 1X5, Canada
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Pauyo T, Drager J, Albers A, Harvey EJ. Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop 2014; 5:204-217. [PMID: 25035822 PMCID: PMC4095012 DOI: 10.5312/wjo.v5.i3.204] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/17/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.
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Mesnil P, Vasseur L, Wavreille G, Fontaine C, Duquennoy A, Migaud H. Is cemented metal-polyethylene 22.2mm hip arthroplasty a gold standard? Results of a series of 105 primary arthroplasties at a minimum of ten years follow-up. Orthop Traumatol Surg Res 2014; 100:369-73. [PMID: 24768433 DOI: 10.1016/j.otsr.2014.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although Charnley-Kerboull metal-on-polyethylene 22.2mm cemented total hip arthroplasty (THA) is considered to be the gold standard in France, results with this prosthesis are conflicting, in particular in relation to Scandinavian registers. The goal of this retrospective study was to confirm the validity of this prosthesis at a minimum of 10years follow-up. HYPOTHESIS Survival of this type of THA would fulfill NICE conditions (survival at 10 years of at least 90%). MATERIALS AND METHODS One hundred and five primary THA were performed in 93 patients (30 men and 63 women) mean age 72.6 years old (60-86) between January 1998 and March 2001. After a mean follow-up of 10.6 years (10-13 years), 21 patients (23 THA) were lost to follow-up and 32 (35 THA) had died leaving 40 patients (47 THA) for clinical analysis (Merle d'Aubigné and Oxford scores) and X-ray assessment. Survival was calculated with revision for any cause and radiological loosening with or without revision as end-points. RESULTS The mean Oxford score at the final follow-up was 22/60 (13-45), the PMA score was 14.2 (11-17). Eight patients underwent revision surgery after a mean 7.5 years (2-11) (1 early dislocation and 7 acetabular cup loosenings). Survival at 10 years was 89.4% (CI95%: 78-95) for all causes of revision and 78% (CI95%: 61-91) for loosening with (n=7) or without (n=3) revision. No cases of septic or femoral loosening were observed. Twelve of the 47 revised hip replacements (25.5%) presented wear≥2mm. DISCUSSION Although functional results were acceptable for this elderly population, survival did not reach the NICE value and was lower than results in the literature for this type of implant. Cup loosening and wear were the main causes of revision. LEVEL OF EVIDENCE IV retrospective.
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Affiliation(s)
- P Mesnil
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France.
| | - L Vasseur
- Université Lille-Nord de France, 59000 Lille, France; Service d'Orthopédie D, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - G Wavreille
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France; Laboratoire d'anatomie, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - C Fontaine
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France; Laboratoire d'anatomie, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - A Duquennoy
- Service d'Orthopédie B, CHRU de Lille, rue Émile-Laine, 59000 Lille, France; Université Lille-Nord de France, 59000 Lille, France
| | - H Migaud
- Université Lille-Nord de France, 59000 Lille, France; Service d'Orthopédie C, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
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Karam JA, Tokarski AT, Ciccotti M, Austin MS, Deirmengian GK. Revision total hip arthroplasty in younger patients: indications, reasons for failure, and survivorship. PHYSICIAN SPORTSMED 2012; 40:96-101. [PMID: 23306419 DOI: 10.3810/psm.2012.11.1992] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Increasing numbers of total hip arthroplasty (THA) procedures are being performed on younger patients, and the incidence of revision THA in this population is also increasing. The goals of our retrospective study were to survey the surgical indications and reasons for failure and survivorship of revision THA in patients aged < 50 years. We identified 139 cases of revision THA performed over a 6-year period in patients aged < 50 years. The most common reason for revision was aseptic loosening, followed by acetabular liner wear with or without osteolysis. We found an overall 10-year survivorship of 76%. When survivorship was stratified by the indication for revision surgery, revision for wear demonstrated the best 10-year survivorship, while revision for instability or infection exhibited poor survivorship.
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Affiliation(s)
- Joseph A Karam
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Abstract
BACKGROUND Metal-on-metal bearing with cemented femoral component and cementless acetabular fixation is the current standard in surface replacement arthroplasty (RSA) of the hip. Because of concerns about the long-term survivorship of cemented stems in conventional hip arthroplasty, it seems logical to achieve cementless fixation on the femoral side with RSA. QUESTIONS/PURPOSES The goals of this review were to evaluate clinical and radiological data reported from previously published cementless RSA series. In addition, we intend to review author's preliminary experience with Conserve Plus cementless devices specifically assessing the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels measured in follow-up. METHODS A references search was done with PubMed using the key words "cementless hip resurfacing", "cementless hip resurfacing prosthesis", and "femoral cementless hip resurfacing". Additionally, the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels were measured in 94 cementless Conserve Plus(©) devices in 90 patients (68 males and 22 females) with a mean age of 41.1 years (18-59). Mean follow-up was 13.1 months (8-16). RESULTS No revision was performed during the observed follow-up. Neither radiological signs of loosening nor neck narrowing >10% were evident. Chromium and cobalt levels in whole blood samples rose respectively from 0.53 μg/l (0.1-1.7) to 1.7 μg/l (0.6-2.9) and from 0.54 μg/l (0.1-1.4) to 1.98 μg/l (0.1-2.8). CONCLUSIONS Cementless "fit and fill" femoral-side fixation, which seems to be potentially evolved and design-related, should be considered for future hip-resurfacing device generations.
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Affiliation(s)
- Julien Girard
- Department of Orthopaedic Surgery, Roger Salengro Hospital, University of Lille, 2 avenue Oscar Lambret, Lille, France
- Department of Sports Medicine, University of Lille 2, Lille cedex, 59037 France
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Migaud H, Putman S, Combes A, Berton C, Bocquet D, Vasseur L, Girard J. Metal-on-Metal Bearing: Is This the End of the Line? We Do Not Think So. HSS J 2012; 8:262-9. [PMID: 24082870 PMCID: PMC3470659 DOI: 10.1007/s11420-012-9300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies have recommended the discontinuation of metal-on-metal (MoM) components in total hip arthroplasty (THA) because of adverse effects reported with large-diameter MoM THA. This is despite favorable long-term results observed with 28 and 32 mm MoM bearings. QUESTIONS/PURPOSES The aim of this study was to assess the value of calls for an end to MoM bearings as THA components. Specifically, we wish to address the risks associated with MoM bearings including adverse soft tissue reactions, metal ion release, and carcinogenic risk. METHODS The study evaluates the arguments in the literature reporting on MoM (adverse soft tissue reactions, metal ion release, and carcinogenic risk) and the experience of the current authors who re-introduced these bearings in 1995. They are balanced by a benefit-risk review of the literature and the authors' experience with MoM use. RESULTS Adverse reactions to metallic debris as well as metal ion release are predictable and can be prevented by adequate design (arc of coverage, clearance), metallurgy (forged instead of cast alloy, high-carbide content), and appropriate component orientation. There is no scientific evidence that carcinogenicity is increased in subjects with MoM hip prostheses. MoM articulations appear to be attractive allowing safe hip resurfacing, decreasing the risk of THA revision in active patients, and providing secure THA fixation with cement in cages in severely deformed hips. MoM bearings in women of child-bearing age are controversial, but long-term data on metallic devices in adolescents undergoing spinal surgery seem reassuring. DISCUSSION Adequate selection of MoM articulations ensures their safe use. These articulations are sensitive to orientation. Fifteen years of safe experience with 28- and 32-mm bearings of forged alloy and high-carbide content is the main reason for retaining them in primary and revision THA.
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Affiliation(s)
- Henri Migaud
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Sophie Putman
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedic Department, Lille University Hospital, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Antoine Combes
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Charles Berton
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Donatien Bocquet
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Laurent Vasseur
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Julien Girard
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Department of Sport and Medicine, University of Lille 2, Lille, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
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Abstract
Young adults with osteochondral lesions of the femoral head are at risk of rapid progression to symptomatic arthritis of the hip joint. Between January 2008 and July 2009, 10 patients were treated for femoral cartilage damage by a osteochondral mosaicplasty of the femoral head through a trochanteric flap with dislocation of the hip. The consecutive series had the following exclusion criteria: acetabular chondropathy, age above 25 years, and femoral head osteonecrosis. Patients were followed up after surgery using the Oxford-12 score, Harris hip score and the Merle d'Aubigné score, and activity assessed by the UCLA and Devane scores. Radiological evaluation by computed tomographic (CT) arthrography was undertaken in all patients at 6 months and plain radiographs. Mean follow-up was 29.2 months (20-39 months). The Postel Merle d'Aubigné score improved from the pre-operative period to the latest follow-up, from 10.5 points (8-13) to 15.5 points (12-17). Global range of motion increased from 175.4° (140-215) to 210.7° (175-240). All radiological investigations at latest follow-up showed that the autograft plugs were well-incorporated at the site of osteochondroplasty in the femoral head with intact cartilage over them and smooth interfaces between articulating bony surfaces. Osteochondral autograft transplantation may be a new alternative option for osteochondral lesions of the femoral head, but this has to be confirmed with longer follow-up and in a larger number of patients. The results of similar surgery in the knee have been mixed, and in the hip the technique is demanding, requiring familiarity with surgical hip dislocation.
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Jungmann PM, Salzmann GM, Schmal H, Pestka JM, Südkamp NP, Niemeyer P. Autologous chondrocyte implantation for treatment of cartilage defects of the knee: what predicts the need for reintervention? Am J Sports Med 2012; 40:58-67. [PMID: 21969180 DOI: 10.1177/0363546511423522] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is a well-established treatment option for isolated cartilage defects of the knee joint, providing satisfying outcome. However, cases of treatment failure with the need for surgical reintervention are reported; typical patient's individual and environmental risk factors have previously not been described. HYPOTHESIS The need for reintervention after ACI is associated with specific preoperative detectable individual risk factors. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 413 patients following ACI (first, second, and third generation) were filtered for those who required revision surgery during their follow-up time (2-11.8 years). Factors were analyzed that might have significant effects on increased revision rate. Using preoperatively collected data, all patients were grouped according to 12 standard prognostic factors. Apart from odds ratio and Pearson χ(2) test, statistical analysis of risk factors was performed with multivariate binary logistic regression models and Cox regression, the method of choice for survival time data. RESULTS After a follow-up of 4.4 ± 0.9 years (limited to 5 years), a total of 88 patients (21.3%) had undergone surgical revision. The time to revision surgery was 1.8 ± 1.1 years. Four prognostic factors associated with a significantly higher risk for reintervention were detected: (1) female gender (Cox survival fit: P = .033), (2) previous surgeries of the affected joint (P = .002), (3) previous bone marrow stimulation (P = .041), and (4) periosteum patch-covered ACI (P = .028). An influence of patient age, body mass index (BMI), defect number, defect size, lesion origin, lesion location, parallel treatment, or smoking on the risk for reintervention could not be observed. CONCLUSION The study identifies clear facts that significantly increase the risk of revision surgery. These facts can be easily obtained preoperatively and may be taken into consideration when indicating ACI.
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Affiliation(s)
- Pia M Jungmann
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
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