1
|
Miyazaki K, Fujii M, Kawano S, Ueno M, Kitajima M, Sonohata M, Mawatari M. Functional Improvement and Patient Satisfaction Following Conversion of Fused Hip to Total Hip Arthroplasty. J Arthroplasty 2024; 39:2512-2519. [PMID: 39025276 DOI: 10.1016/j.arth.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND This study aimed to determine the clinical outcomes, predictors of suboptimal functional improvement, and factors influencing patient satisfaction following conversion of a fused hip to total hip arthroplasty (THA). METHODS A retrospective analysis of clinical and radiographic data was performed on 83 patients (83 hips) who underwent fused hip conversion to THA. Implant survival and predictors of poor functional outcome (Harris hip score < 70) were analyzed. In addition, factors associated with patient dissatisfaction (visual analog scale < 25th percentile) were analyzed in 63 patients (63 hips) who completed a patient-reported outcome measures questionnaire. RESULTS The median Harris hip score improved from 55 (range, 18 to 77) to 78 (range, 36 to 100) at a mean follow-up of 10.2 ± 4.8 years (P < .001). Implant survival was 97.4% at 10 years and 91.3% at 20 years, with any revision as the endpoint. Multivariate analysis identified preoperative reliance on mobility aids as an independent predictor of poor functional outcome (P = .021). There were 48 of 63 patients (76%) satisfied (satisfaction visual analog scale ≥80) with the operated hip. Demographics and preoperative/postoperative clinical data did not differ between satisfied and unsatisfied patients. Among the patient-reported outcome measures, the Forgotten Joint Score-12 emerged as an independent discriminator of patient satisfaction. CONCLUSIONS Conversion of a fused hip to THA provides functional improvement, favorable implant survival, and high patient satisfaction. However, patients dependent on mobility aids may experience suboptimal functional recovery, underscoring the need for careful preoperative counseling and patient selection.
Collapse
Affiliation(s)
- Kensuke Miyazaki
- Faculty of Medicine, Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - Masanori Fujii
- Faculty of Medicine, Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - Shunsuke Kawano
- Faculty of Medicine, Research Center for Arthroplasty, Saga University, Saga, Japan
| | - Masaya Ueno
- Faculty of Medicine, Department of Orthopaedic Surgery, Saga University, Saga, Japan
| | - Masaru Kitajima
- Department of Orthopaedic Surgery, Shiroishi Kyoritsu Hospital, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, JCHO Saga Central Hospital, Saga, Japan
| | - Masaaki Mawatari
- Faculty of Medicine, Department of Orthopaedic Surgery, Saga University, Saga, Japan
| |
Collapse
|
2
|
Nguyen TD, Nachtrab J, LaCour M, Jacobs A, Ta M, Komistek R. Evaluation of Two Clinical Stem Fit Philosophies within the Femoral Canal Using a Preoperative Planning Tool: Could a Hybrid Approach Be Best? J Arthroplasty 2024:S0883-5403(24)00910-0. [PMID: 39233098 DOI: 10.1016/j.arth.2024.08.047] [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: 03/08/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) has transformed patient lives, yet evolving expectations and the number of postoperative foot angle changes have underscored the need for precise component positioning. The objective of this study was to use three-dimensional (3D) preoperative planning to evaluate stem alignment and orientation for three THA systems using two different stem fit algorithms. It was hypothesized that the different stem alignments would yield similar changes in stem orientation and placement within the canal for all three systems. METHOD This study introduced a novel 3D preoperative planning tool, comparing two different surgical stem fit philosophies within the canal: "canal fit" (CF) and "anatomical fit" (AF). We virtually implanted ten subjects with three different THA implant systems using both philosophies, evaluating 60 total fits within the canals. The "canal fit" philosophy aimed to minimize cortical bone removal. In contrast, the "anatomical fit" philosophy prioritized aligning the implanted head with the anatomical head center. RESULTS Detailed analyses revealed that AF led to fixation occurring mainly on the medial aspect of the stem, while CF exhibited a more even distribution between medial and lateral sides. The AF philosophy achieved significantly closer placement of the implanted head to the anatomical center (2.0 to 2.1 mm) compared to the CF philosophy (3.0 to 6.0 mm) (P < 0.01). The AF resulted in neutral stem orientation (0°) across all stems, whereas the CF exhibited greater malrotation (2.0 to 7.0°) (P < 0.02). The AF required more bone removal (0.13 to 0.46 cm³) than the CF (0.02 to 0.06 cm³) (P < 0.01). CONCLUSION The findings underscore the importance of 3D planning, emphasizing its potential to improve stem version alignment in THA. The results from this study may advocate 3D preoperative planning with robotic surgery to plan stem placement within the canal while maintaining anatomical femoral head restoration.
Collapse
Affiliation(s)
| | | | | | | | - Manh Ta
- 2450 E J. Chapman Dr, Knoxville, TN, 37996, USA
| | | |
Collapse
|
3
|
Abrishami R, Aghili SH, Afshar C, Farhang Ranjbar M, Nasrollahizadeh A, Poursalehian M. Long-term outcomes of converting fused hips to total hip arthroplasty are satisfactory: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:3391-3399. [PMID: 38846831 PMCID: PMC11152797 DOI: 10.1097/ms9.0000000000002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/23/2024] [Indexed: 06/09/2024] Open
Abstract
Background Although conversion arthroplasty of fused hips can relieve pain and provide patient satisfaction, long-term outcomes of total hip arthroplasty (THA) after hip fusion remain a subject of debate. This meta-analysis aimed to assess the effectiveness of THA for fused hips over a long period with concerns over potential complications. Methods A systematic search of five databases from 2000 until 2023 identified English studies evaluating THA for fused hips with at least 100 months of follow-up. Meta-analyses were conducted using random-effect models via the comprehensive meta-analysis software. Sensitivity analysis, in-depth meta-regression, Egger's test, and the trim-and-fill method were performed appropriately. Results The meta-analysis assessed 790 patients and 889 hips with a mean follow-up of 11 years. At the final follow-up, the mean Harris Hip Score (HHS) and leg length discrepancy (LLD) improved by 34.755 and 2.3 cm from the baseline, respectively. Regarding survival of hip fusion conversion to THA, most studies (88.8%) reported a 5-year implant survival rate of at least 90%, and the 15-year and 20-year implant survival rates, ranged between 80-90% and 70-90%, respectively. Subjective dissatisfaction with the conversion of hip fusion to THA was only 5.3%. Composite rates of revision, instability, and aseptic loosening were 13.6%, 3.8%, and 8.8%, respectively. Conclusions Conversion of fused hips to THA results in favourable long-term outcomes regarding HHS, LLD, survival rates, and subjective satisfaction, leading to improved quality of life in properly selected patients. However, the presence of complications should be considered when evaluating the overall success of the procedure.
Collapse
Affiliation(s)
- Ramin Abrishami
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter
| | - Seyed Hadi Aghili
- Department of Neurosurgery, Imam Khomeini Hospital Complex
- Department of Neurosurgery, Valiasr Hospital, Tehran, Iran
| | - Cyrus Afshar
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter
| | - Mehri Farhang Ranjbar
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter
| | - Amir Nasrollahizadeh
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences
| | | |
Collapse
|
4
|
Kang SY, Ko YS, Kim HS, Yoo JJ. Outcome and complication rate of total hip arthroplasty in patients younger than twenty years: which bearing surface should be used? INTERNATIONAL ORTHOPAEDICS 2024; 48:1381-1390. [PMID: 38217722 PMCID: PMC11076316 DOI: 10.1007/s00264-023-06086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Total hip arthroplasty (THA) in younger patients remains controversial due to concerns regarding long-term implant survival and potential complications. This study aimed to evaluate long-term clinical outcomes, complications, differences in complication and revision rates by bearing surfaces, and Kaplan-Meier survival curves for THA in patients under 20 years old. METHODS A retrospective review was conducted for 65 patients (78 hips) who underwent THA between 1991 and 2018. Their mean age was 18.9 years. Their clinical outcomes were assessed using the Harris Hip Score (HHS). Radiological outcomes were evaluated based on the presence of loosening, osteolysis, and heterotopic ossification. Complications such as dislocation, periprosthetic fractures, and infections were assessed. The mean follow-up period was 13.2 years (range, 5.0-31.2 years). RESULTS The mean HHS improved from 44.6 to 90.1. There were two cases of dislocation. However, no periprosthetic fracture, deep infection, or ceramic component fracture was noted. There were 19 revisions of implants. Eighteen of 19 hips were operated with hard-on-soft bearings in the index surgery (p < 0.01). The 23-year survivorship was 97.8% for THA using ceramic-on-ceramic bearings, while the 31-year survivorship was 36.7% using hard-on-soft bearings. CONCLUSION THA in patients under 20 years old yielded promising clinical and radiological outcomes, although polyethylene-bearing-related concerns persisted. Previously operated patients with hard-on-soft bearing should be meticulously examined during the follow-up. As ceramic-on-ceramic bearing showed excellent survivorship in this particular cohort, we recommend the use of this articulation as the bearing of choice.
Collapse
Affiliation(s)
- Sang Yoon Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Seung Ko
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
5
|
Mimendia I, Barro V, Sierra M, Aliaga-Martínez A, Guerra-Farfán E, Hernández A. Fused hip conversion to total hip arthroplasty with the direct anterior approach: surgical technique on a regular surgical table under fluoroscopic guidance. INTERNATIONAL ORTHOPAEDICS 2024; 48:1165-1170. [PMID: 38438578 DOI: 10.1007/s00264-024-06131-6] [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: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE Conversion of a fused hip to a total hip arthroplasty (THA) is technically challenging due to the loss of anatomical references. Here, a reproducible technique using the direct anterior approach (DAA) with a regular surgical table under fluoroscopic guidance is described, which has several advantages over traditional such as lateral or posterior approaches. METHODS There were reported 11 cases of ankylosis hip that were converted to THA using the same surgical technique protocol. Clinical and radiographic outcomes were recorded at 3.2 years of follow-up. A detailed preoperative evaluation was performed, including a pelvis radiological evaluation and magnetic resonance image (MRI) to assess the integrity of the periarticular soft tissue and flexor muscles. RESULTS The DAA has considerable advantages, such as allowing more precise targeting during surgery, avoiding the risk of pseudoarthrosis due to the absence of a trochanteric osteotomy, preserving the abductors, and allowing an easier-to-use of intraoperative fluoroscopy due to the supine position. Besides, the use of a standard table reduces surgical time and allows assessment of limb length, hip stability, and impingement in all planes in an intraoperative dynamic range, which decreases postoperative complications. CONCLUSION Conversion from hip fusion to THA is a rare and complex procedure. The use of DAA with a standard table and fluoroscopy helps to avoid high complications since it allows a dynamic intra-operative examination of the range of motion to rule out impingements, reduces the risk of dislocation, and allows leg lengthening verification.
Collapse
Affiliation(s)
- Iñaki Mimendia
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Víctor Barro
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martin Sierra
- Instituto Nacional de Ortopedia y Traumatología, Universidad de La República, Montevideo, Uruguay
| | - Andrés Aliaga-Martínez
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Ernesto Guerra-Farfán
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Hernández
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
6
|
Villa T, Tenconi AA, Colombo M, Banci L. Hip arthrodesis conversion to dual mobility total hip arthroplasty in a young adult using a custom-made highly-porous titanium monobloc cup: A case report. Int J Surg Case Rep 2024; 116:109375. [PMID: 38350380 PMCID: PMC10943636 DOI: 10.1016/j.ijscr.2024.109375] [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: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Conversion of hip arthrodesis to total hip arthroplasty (THA) is an effective but challenging procedure to restore hip functionality and improve quality of life. Herein, a case of arthrodesis takedown to a dual mobility THA with a custom-made 3D-printed cup. PRESENTATION OF CASE Due to higher risk of instability and loosening for the altered and atrophic anatomy, a custom-made highly-porous titanium dual mobility monobloc cup has been used for a cementless conversion THA in 31-year-old patient with hip arthrodesis. At 3-year follow-up clinical and radiographic results were excellent with the custom-made implant found stable and well osseointegrated. DISCUSSION To the best of our knowledge, this is the first case of arthrodesis conversion to THA with custom-made highly-porous dual mobility cup in a young adult. The dual mobility construct helped reducing the risk of dislocation, while the highly-porous structure reduced the risk of aseptic loosening. CONCLUSION The use of cementless highly-porous dual mobility implant in complex cases young patients is supported.
Collapse
Affiliation(s)
- Tiziano Villa
- Department of Orthopaedics and Traumatology, G.B. Mangioni Hospital, Via Leonardo Da Vinci, 49, 23900 Lecco, LC, Italy
| | - Angelo Alberto Tenconi
- Department of Orthopaedics and Traumatology, G.B. Mangioni Hospital, Via Leonardo Da Vinci, 49, 23900 Lecco, LC, Italy
| | - Marta Colombo
- Clinical Department, Permedica S.p.A., Via Como, 38, 23807 Merate, LC, Italy.
| | - Lorenzo Banci
- Clinical Department, Permedica S.p.A., Via Como, 38, 23807 Merate, LC, Italy
| |
Collapse
|
7
|
Dittman LE, Houdek MT, Rose PS, Abdel MP, Sim FH, Lewallen DG, Couch CG. Midterm outcomes of total hip arthroplasty after internal hemipelvectomy and iliofemoral arthrodesis. J Surg Oncol 2024; 129:609-616. [PMID: 37942700 DOI: 10.1002/jso.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Recent studies have reported acceptable outcomes after arthrodesis takedown and conversion to total hip arthroplasty (THA); however, there are no reports on outcomes after oncologic resection, which are inherently complex and may portend poorer outcomes. The purpose of this study was to examine the surgical and functional outcomes of patients who underwent prior hemipelvectomy for tumor resection and were later converted to THA. METHODS All patients who had prior iliofemoral arthrodesis after oncologic resection that were later converted to THA at a single institution were examined. Charts were reviewed for demographic information, operative information, functional outcomes, and complications/reoperations. RESULTS All three patients in this study were males who underwent internal hemipelvectomies for chondrosarcoma. Patients were converted to THA at a mean of 26 years after arthrodesis. Mean follow-up after conversion to THA was 7.4 years. During this follow-up period, two of the three patients required revision surgery. At last follow-up, the mean Harris Hip Score was 81 and the mean Mayo Hip Score was 67, and all patients were ambulatory without significant pain. CONCLUSIONS Overall, patients who undergo iliofemoral arthrodesis after oncologic hemipelvectomy and are later converted to THA can expect to have a reasonable outcome, despite a high rate of complications and revision surgery.
Collapse
Affiliation(s)
- Lauren E Dittman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Franklin H Sim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cory G Couch
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
8
|
Daliri M, Moallem SMH, Sadeghi M, Dehghani M, Parsa A, Moradi A, Shahpari O, Ebrahimzadeh MH. Clinical Outcomes and Complications Following Hip Fusion Conversion to Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:261-268.e36. [PMID: 37541602 DOI: 10.1016/j.arth.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Efficacy, clinical outcomes, and complications following hip fusion conversion to total hip arthroplasty (THA) surgery have been explored in several studies with controversial findings and no consensus. METHODS Comprehensive search of online databases was performed through December 2022 for prepost clinical trials using MeSH keywords. Harris hip score (HHS), leg length discrepancy (LLD), pain score, and range of motion (ROM) were considered as clinical outcomes along with implant survival and complications. The retrieved studies were assessed for methodologic quality. Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated using random effects meta-analysis taking into account for heterogeneity. Subgroup meta-analysis as well as sensitivity analysis were performed. RESULTS Findings of meta-analysis on 34 trials showed that HHS increase after THA (WMD: 42.3; 95% confidence interval (CI): 38 to 47). Subgroup analyses indicated that cementless prosthesis, length of arthrodesis <12 years, age <45 years, and studies with good quality have more HHS improvement. The LLD decreased 21 mm (95% CI: 19 to 24 mm) based on 21 trials. The range of motion (ROM) reached to 89 (95% CI: 84 to 95) for flexion, 32 (95% CI: 27 to 37) for abduction, 25 (95% CI: 21 to 29) for adduction, 29 (95% CI: 25 to 33) for external rotation, and 25 (95% CI: 20 to 31) for internal rotation after surgery. The most common complication was heterotopic ossification (14%). CONCLUSION Conversion of an ankylosed hip to THA leads to improved hip function and leg discrepancy with relatively notable rate of complications. Our findings could provide a framework to guide surgeons and decision makers.
Collapse
Affiliation(s)
- Mahla Daliri
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Masoumeh Sadeghi
- Faculty of Health, Department of Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Dehghani
- Faculty of Health, Department of Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Parsa
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; American Hip Institute, Chicago, Illinois
| | - Ali Moradi
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omid Shahpari
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad H Ebrahimzadeh
- Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
9
|
Kobayashi T, Morimoto T, Hirata H, Yoshihara T, Tsukamoto M, Sonohata M, Mawatari M. Changes of the coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty in patients with unilateral ankylosed hip. Sci Rep 2023; 13:5541. [PMID: 37016148 PMCID: PMC10073074 DOI: 10.1038/s41598-023-32672-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/31/2023] [Indexed: 04/06/2023] Open
Abstract
To elucidate the changes in coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty (THA) in patients with unilateral ankylosed hip. A retrospective radiologic study of 48 patients (48 hips) with unilateral hip arthrodesis who underwent conversion THA was conducted. Cobb's angle of lumbar scoliosis (LS), the pelvic obliquity (PO) angle, and the hip adduction angle (HAA) on standing anterior-posterior spine-pelvis-hip radiographs were measured before and after THA. The differences of LS, PO, and HAA before and after THA were defined as ΔLS, ΔPO, and ΔHAA, respectively. A paired samples t-test or the Wilcoxon signed-rank test were used to compare the absolute values of the LS, PO, and HAA between preoperative and postoperative groups. The Pearson's correlation coefficient (r) or Spearman's correlation coefficient (ρ) was calculated to assess the relationship between ΔLS, ΔPO, and ΔHAA and possible associated factors. Significant differences were found in the preoperative LS (mean, 10.8° vs. 8.2°, p = 0.004), PO (median, 6.8° vs. 2.0°, p < 0.001), and HAA (median, 10.0° vs. 6.0°, p = 0.003). ΔLS was correlated with the preoperative LS (ρ = - 0.621, p < 0.001), PO (ρ = - 0.580, p < 0.001), and HAA (ρ = - 0.467, p < 0.001). ΔPO was correlated with the preoperative LS (r = - 0.596, p < 0.001), PO (ρ = - 0.892, p < 0.001), and HAA (ρ = - 0.728, p < 0.001). ΔHAA was correlated with the preoperative LS (r = - 0.583, p < 0.001), PO (ρ = - 0.751, p < 0.001), and HAA (ρ = - 0.824, p < 0.001). LS, PO, and HAA were significantly improved after conversion THA. Greater improvement in LS, PO, and HAA can be expected in patients with larger preoperative LS, PO, and HAA values.
Collapse
Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
- Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO) Saga Central Hospital, 3-8-1 Hyogo Minami, Saga, 849-8522, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| |
Collapse
|
10
|
Safali S, Berk T, Makelov B, Acar MA, Gueorguiev B, Pape HC. The Possibilities of Personalized 3D Printed Implants-A Case Series Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020249. [PMID: 36837451 PMCID: PMC9959288 DOI: 10.3390/medicina59020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Following the most recent software and 3D printing developments, the use of personalized 3D printed orthopedic implants for treatment of complicated surgical cases has gained more popularity. Today, orthopedic problems that cannot be solved with standard implants may be effectively addressed using personalized prostheses. The aim of this study is to present the designing, modeling and production stages of four different personalized 3D printed prostheses and their application in clinical cases of patients who underwent treatment in various anatomical locations with a precisely specified indication for implantation. Materials and Methods: Based on computed tomography scanning, personalized 3D printed prostheses were designed, produced and used in four patients within a period of three to five days after injury or admission. Results: Early term follow-ups demonstrated good to excellent results. Conclusions: Personalized 3D printed prostheses offer an opportunity for a treatment of choice and provide good anatomical and functional results, shortened surgical time, less complications, and high satisfaction in patients with appropriate indications. The method should be considered primarily for patients with large bone defects, or such indicated for resection. Personalized 3D printed prostheses have the potential to become more common and beneficial in the future.
Collapse
Affiliation(s)
- Selim Safali
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Biser Makelov
- University Multiprofile Hospital for Active Treatment ‘Prof. Stoyan Kirkovitch’, Trakia University, 6003 Stara Zagora, Bulgaria
| | - Mehmet Ali Acar
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland
- Correspondence:
| | | |
Collapse
|
11
|
Banskota B, Yadav P, Rajbhandari A, Aryal R, Banskota AK. Hip arthrodesis in children : a review of 26 cases with a mean of 20 years' follow-up. Bone Joint J 2022; 104-B:1089-1094. [PMID: 36047017 DOI: 10.1302/0301-620x.104b9.bjj-2022-0123.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 To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child. METHODS A follow-up investigation was undertaken on a cohort of 28 children previously reported at a mean of 4.8 years. The present study looked at 26 patients who had an arthrodesis of the hip as a child at a mean follow-up of 20 years (15 to 29). RESULTS The mean Harris Hip Score (HHS) increased from 39.60 (SD 11.06) preoperatively to 81.02 (SD 8.86; p = 0.041) at final review. At latest follow-up, the HHS was found to be excellent in four patients (15%), good in 11 (42%), and fair in 11 (42%). A total of 16 patients (62%) reported mild low back pain, five (19%) had moderate pain, and five (19%) patients had no back pain. Mild ipsilateral knee pain was reported by 19 (73%), moderate pain by one (4%), and no pain by six (23%) patients. Mild contralateral hip pain was reported by ten patients (38%), and no pain by 16 (62%). The 36-Item Short Form Health Survey scores were very good in four patients (15%), good in 18 (70%), and poor in four (15%), with a mean score of 70.92 (SD 12.65). Of 13 female patients who had given birth, 12 did so with uncomplicated vaginal delivery. All patients had to modify their posture for toileting, putting on lower body clothes, foot care, and putting on shoes. CONCLUSION Our results show that with hip arthrodesis, most patients have relatively good function at long-term follow-up, although some pain is experienced in adjacent joints, and modification in some activities of daily living is common.Cite this article: Bone Joint J 2022;104-B(9):1089-1094.
Collapse
Affiliation(s)
- Bibek Banskota
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Prakash Yadav
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Ansul Rajbhandari
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Rajendra Aryal
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Ashok K Banskota
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| |
Collapse
|
12
|
Adil SA, Hooper M, Kocher T, Caughran A, Bullock M. Conversion of Hip Arthrodesis Using Robotic Arm Technology. Arthroplast Today 2021; 9:40-45. [PMID: 33997207 PMCID: PMC8102203 DOI: 10.1016/j.artd.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 01/13/2023] Open
Abstract
Recent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.
Collapse
Affiliation(s)
- Syed Ali Adil
- Marshall University Department of Orthopaedics, Huntington, WV, USA
| | - Matthew Hooper
- Marshall University Department of Orthopaedics, Huntington, WV, USA
| | - Timothy Kocher
- Marshall University Department of Orthopaedics, Huntington, WV, USA
| | | | - Matthew Bullock
- Marshall University Department of Orthopaedics, Huntington, WV, USA
| |
Collapse
|
13
|
Conversion of Fused Hip to Total Hip Arthroplasty: Long-Term Clinical and Radiological Outcomes. J Arthroplasty 2021; 36:1060-1066. [PMID: 33082070 DOI: 10.1016/j.arth.2020.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/05/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite promising results at the mid-term followup, several aspects of conversion of the fused hip to total hip arthroplasty (THA) remain controversial. The aim of this study was to evaluate clinical and radiological outcomes with a minimum 5-year followup in patients who underwent conversion of the fused hip to THA. METHODS Fifty-seven patients (59 hips) were evaluated. The Harris Hip Score (HHS), range of motion (ROM), and the Visual Analogue Scale (VAS) were used to assess hip function and low back pain. Subjective satisfaction with surgery and the presence of the Trendelenburg sign was also evaluated. Radiological assessment was performed pre- and postoperatively to evaluate loosening and heterotopic ossification (HO). RESULTS After a mean followup of 13.0 ± 6.2 years, HHS and VAS significantly improved from 46.0 ± 16.7 to 80.8 ± 18.8 and from 4.4 ± 1.5 to 2.1 ± 1.4 (both P < .001), respectively. Twenty-three patients (40.4%) had a positive Trendelenburg sign, and HOs were found in 29 cases (49.1%). An overall 29.8% complication rate was noted. Smoking habits and rheumatoid arthritis were predictive of Trendelenburg sign (P = .046 and P = .038, respectively). Implant survival rate as the end point was 98.7 ± 1.3% at 5 years, 92.4 ± 3.3% at 10 years, 82.1 ± 5.7% at 15 years, and 73.4 ± 8.0% at 20 and 25 years. A worse cumulative implant survival rate was noted in patients who underwent previous hip surgery, defined as any hip operation before fusion (P = .005). CONCLUSION Conversion of the fused hip to hip arthroplasty provides high levels of hip functionality and satisfaction with surgery at long-term followup. An implant survival rate higher than 70% can be expected 25 years postoperatively.
Collapse
|
14
|
Aldhafian OR, Alenazi BR, Mohammed AM, Khairi HE, Bin Nwihadh N. Breakdown of spontaneous fused bilateral hip with heterotopic ossification to staged bilateral total hip arthroplasty through a direct lateral approach: A case report. Int J Surg Case Rep 2020; 77:467-471. [PMID: 33395827 PMCID: PMC7700997 DOI: 10.1016/j.ijscr.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/04/2022] Open
Abstract
We present a rare case of a 26-year-old male with fused bilateral hip with heterotopic ossification after traumatic head injury. The patient underwent staged surgical resection of bilateral hip heterotopic ossification and bilateral total hip arthroplasty. The surgery was performed through a direct lateral hip approach and it was challenging and highly demanding procedure. The patient was satisfied with the outcome over 18 months of follow-up.
Introduction Heterotopic ossification (HO) is the abnormal bone formation in soft tissue where bone normally does not exist. HO can occur secondary to musculoskeletal trauma, burns, spinal cord injury, or traumatic head injury. The treatment of HO ranges from simple medical treatment to advance surgical intervention; it is largely dependent on the amount of bone formation, the location, the limitation of motion, and the severity of the joint disease. Presentation of case We present the case of a 26-year-old man who presented to an orthopedic clinic with pain in the lower back and both knees, which was not relieved by conservative treatment. The clinical examination revealed a loss of motion in both hips. Radiography of the pelvis showed bilateral fused hips and Brooker type IV HO in both hips. The patient underwent HO resection and converted the fused hip to total hip arthroplasty (THA) through a direct lateral approach. The patient was satisfied with the outcome of over 18 months of follow-up. Discussion A direct lateral approach, as what we performed, is a simple approach that can expose the acetabulum and proximal femur. The presence of intraoperative fluoroscopy can help identify HO's extension with less damage to the soft tissue and blood loss. Conclusion The surgery appears to be a doable, effective, and safe procedure to treat fused bilateral hip with HO. This is the first study to report staged bilateral THA for HO through a direct lateral approach to the best of our knowledge.
Collapse
Affiliation(s)
- Osama R Aldhafian
- Department of Orthopedic Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Bashir R Alenazi
- Department of Orthopedic Surgery, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Abdulrhman M Mohammed
- Department of Orthopedic Surgery, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Hussam E Khairi
- Department of Orthopedic Surgery, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Naif Bin Nwihadh
- Department of Orthopedic Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| |
Collapse
|
15
|
Dikmen G, Ozden VE, Gulagaci F, Tozun IR. Long-term results of cementless total hip arthroplasty for the treatment of ankylosed hip. J Orthop Surg (Hong Kong) 2020; 27:2309499019858038. [PMID: 31262219 DOI: 10.1177/2309499019858038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to report the long-term results of total hip arthroplasty (THA) for the treatment of ankylosed hip. METHODS Twenty-nine consecutive THAs were performed in 26 patients. The mean age of the patients at the time of the operation was 43.3 years (range, 19-69 years). We used cementless fixation in all hips and the mean duration of follow-up was 10.1 years (range, 4.5-20 years). Radiological evaluation of components, osteolysis, radiolucent lines and loosening were assessed. The Harris Hip Score (HHS), range of motion (ROM), limb-length discrepancy and walking capacity with or without any support were used preoperatively and at final follow-up for clinical evaluation. Survivorship analysis was conducted using the Kaplan-Meier method using second revision for any reason as the endpoint. RESULTS The mean HHS was 85.6 (range, 55-98) points and mean ROM was 110.5° for flexion. The mean limb-length discrepancy improved from 4.1 cm to 1.1 cm. Positive Trendelenburg sign was recorded in 31% of the patients and 24% of patients needed any support for walking postoperatively. We observed surgical complications related to abductor arm in 25% of the patients. Radiolucency on the acetabular side was seen on one or more zones in 15 patients (16 hips). One aseptic acetabular component loosening was observed. On the femoral side, 11 patients demonstrated non-progressive radiolucent lines and osteolysis around the stem was seen in four hips but there was no aseptic stem loosening. The Kaplan-Meier survival rate considering revision for any reason as the endpoint was 81.5%, for aseptic loosening 91.3%, for a worst-case scenario of 66.4% at 10 years. CONCLUSION Cementless fixation showed good to excellent results at 10 years. Preoperative and postoperative abductor status of the patient is critical for patient satisfaction.
Collapse
Affiliation(s)
- Goksel Dikmen
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
| | - Vahit Emre Ozden
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
| | - Fırat Gulagaci
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
| | - I Remzi Tozun
- Department of Orthopaedic Surgery and Traumatology, Acibadem School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
| |
Collapse
|
16
|
Desartrodese de anca – relato de três casos. Rev Bras Ortop 2019; 54:83-86. [PMID: 31363249 PMCID: PMC6415593 DOI: 10.1016/j.rbo.2017.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 06/06/2017] [Indexed: 11/20/2022] Open
Abstract
Hip desarthrodesis, which is the conversion of an arthrodesis or of a surgical bone fusion into a hip replacement arthroplasty, is a difficult and challenging operation because of the need of a joint reconstruction in cases with bone fusion and an often long-term immobilization between the femur and the acetabulum, with important anatomic changes, retractions of adjacent soft tissues, and an associated limb shortening. Hip arthrodesis is an operation performed less and less; consequently, its desarthrodesis is even rarer. The present report details three rare cases of patients with long-term hip arthrodesis who were submitted to hip replacement conversion arthroplasty; it describes the applied surgical techniques and their clinical and functional outcomes.
Collapse
|
17
|
McLawhorn AS, Schairer WW, Schwarzkopf R, Halsey DA, Iorio R, Padgett DE. Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study. J Arthroplasty 2018; 33:2025-2030. [PMID: 29275113 DOI: 10.1016/j.arth.2017.11.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 11/19/2017] [Accepted: 11/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. METHODS All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database. Conversion and primary THA patients were matched 1:1 using propensity scores, based on preoperative covariates. Multivariable logistic regressions evaluated associations between conversion THA and 30-day outcomes. RESULTS A total of 2018 conversions were matched to 2018 primaries. There were no differences in preoperative covariates. Conversions had longer operative times (148 vs 95 minutes, P < .001), more transfusions (37% vs 17%, P < .001), and longer length of stay (4.4 vs 3.1 days, P < .001). Conversion THA had increased odds of complications (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.37-2.24), deep infection (OR 4.21; 95% CI 1.72-10.28), discharge to inpatient care (OR 1.52; 95% CI 1.34-1.72), and death (OR 2.39; 95% CI 1.04-5.47). Readmission odds were similar. CONCLUSION Compared with primary THA, conversion THA is associated with more complications, longer length of stay, and increased discharge to continued inpatient care, implying greater resource utilization for conversion patients. As reimbursement models shift toward bundled payment paradigms, conversion THA appears to be a procedure for which risk adjustment is appropriate.
Collapse
Affiliation(s)
- Alexander S McLawhorn
- Department of Orthopaedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - William W Schairer
- Department of Orthopaedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - David A Halsey
- Department of Orthopaedic Surgery, University of Vermont Medical College, South Burlington, Vermont
| | - Richard Iorio
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Douglas E Padgett
- Department of Orthopaedic Surgery, Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York
| |
Collapse
|
18
|
Çalbıyık M. Total hip arthroplasty following arthrodesis: a single-center experience of 17 patients. Ther Clin Risk Manag 2018; 14:659-664. [PMID: 29695910 PMCID: PMC5905525 DOI: 10.2147/tcrm.s163569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose We aimed to present our experience with total hip arthroplasty in patients with previous hip arthrodesis. Patients and methods This was a retrospective study, in which clinical and radiological outcomes of total hip arthroplasty performed in 17 patients (mean age 54.2±8.5 years; age range 33–68 years; female to male ratio 10/7) with previous arthrodesis in our clinic between 2001 and 2014 were reviewed. Patients were followed up for 6.7±2.8 years (range 3–12 years) after the operation and evaluated for ipsilateral knee pain, range of motion, walking capacity, and leg-length discrepancy. The clinical outcome was assessed by the Harris Hip Score. Results The outcome of arthroplasty was good or excellent in 14 of 17 patients (82.3%), fair in two patients (11.8%), and failure in one patient (5.9%). The Harris Hip Score increased to 79.8±9.8 postoperatively from a preoperative score of 40.9±10.1 (p<0.01). Pain-free hip was obtained in 15 patients (88.2%), and range of motion was 88°. Fourteen patients (82.4%) reported a significant decrease in back pain, and 11 patients (64.7%) in ipsilateral knee pain. Ten patients (58.8%) were able to walk normally, five patients (29.4%) walked with slight Trendelenburg gait without support, and two patients (11.8%) with severe Trendelenburg gait using arm rests. The mean leg-length discrepancy was 1.1 cm (range 0–3 cm). The complications were peroneal nerve palsy (n=3), superficial wound infection (n=3), hip dislocation (n=2), and heterotopic ossification (n=3). Conclusion If it is well planned, conversion of hip arthrodesis to total hip arthroplasty is a successful and safe procedure, which increases patients’ functionality.
Collapse
Affiliation(s)
- Murat Çalbıyık
- Department of Orthopedics and Traumatology, Hitit University, Faculty of Medicine, Corum, Turkey
| |
Collapse
|
19
|
Long-term results of custom cementless-stem total hip arthroplasty performed in hip fusion. INTERNATIONAL ORTHOPAEDICS 2018; 42:1259-1264. [PMID: 29352333 DOI: 10.1007/s00264-018-3762-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/02/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Due to complex anatomical considerations, results of cementless-stem total hip arthroplasty (THA) in hip fusion remain controversial compared with conventional THA. We therefore aimed to analyse 3D anatomy of the fused hip based on pre-operative computed tomography (CT) scans, functional outcomes based on the Harris Hip Score (HHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS), modifications of hip anatomy based on post-operative standardised radiography, and determine complication rate and long-term survival based on Kaplan-Meier analysis. METHODS We retrospectively studied 23 hips that underwent conversion of a fused hip to THA using a 3D CT scan-based custom titanium (Ti alloy hypoxyapetite (HA)-coated stem. The mean follow-up was 15 (9-22) years. Femur anteversion ranged from -29° to 80°. RESULTS HHS improved from 59 to 89 points and average range of motion (ROM) was 88° for flexion. Back pain decreased in 62%, and knee pain decreased in 42%. The mean post-operative leg-length discrepancy was 7.8 mm. No intra-operative complications occurred. One aseptic stem loosening for mechanical failure was observed. The Kaplan-Meier survivorship considering revision for any reasons as the end point was 95.6% [95% confidence interval (CI) 92.4-98.8] at 15 years. CONCLUSION Custom cementless stems may be an interesting solution to address the particular anatomical features of hip fusion at the time of THA, with an excellent survival rate at 15 years.
Collapse
|
20
|
|
21
|
Jauregui JJ, Kim JK, Shield WP, Harb M, Illical EM, Adib F, Maheshwari AV. Hip fusion takedown to a total hip arthroplasty-is it worth it? A systematic review. INTERNATIONAL ORTHOPAEDICS 2017; 41:1535-1542. [PMID: 28349181 DOI: 10.1007/s00264-017-3436-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with surgically or spontaneously fused hips are often dissatisfied with their overall function and the debilitating effect on adjacent joints. Therefore, in properly selected patients, hip fusion-takedown and conversion to total hip arthroplasty (THA) can result in improved function and decreased pain. We aimed to (1) evaluate the indications for conversion, (2) evaluate the clinical outcomes, (3) analyze the overall complications, and (4) identify the overall satisfaction following the procedure. METHODS A systematic and comprehensive literature search was performed to analyze studies evaluating conversion of hip fusion to THA. After reviewing 3,882 studies, 27 total studies (1,104 hips) met our inclusion/exclusion criteria and were included in our final analysis. A weighted mean of rates was determined for each complication, including infection, instability, loosening, nerve-related, abductor-related, venous thrombotic event, and revision. RESULTS The study population consisted of 53.2% male and 46.8% female subjects. The mean age at time of conversion was 52 years (range 36-65 years), the mean time until follow-up was 9.2 years (range 2.5-17.3), and the mean duration of arthrodesis was 27.7 years (range 11-40.2). As measured by Harris Hip Score, overall clinical outcomes improved from 58.1 points (range 42.4-70 points) pre-operatively to 80.0 (range 62-93.5) post-operatively. The specific complication rates were 5.3% (range 0-43.6%) for infection, 2.6% (range 0-15.4%) for instability, 6.2% (range 0-17.2%) for loosening, 4.7% (range 0-13%) for nerve-related complications, 13.1% (range 0-87%) for abductor-related complications, and 1.2% (range 0-13%) for venous thrombotic events. The revision rate was 12.0% (range 0-43.6%). CONCLUSION Takedown of a fused-hip can be a challenging procedure. Although patients can benefit functionally, both patients and surgeons need to be aware of the complications and increased risk of further revision procedures, which should be an important part of the pre-operative discussion.
Collapse
Affiliation(s)
- Julio J Jauregui
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Joseph K Kim
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA
| | - William P Shield
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Matthew Harb
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA
| | - Emmanuel M Illical
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA
| | - Farshad Adib
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA.
| |
Collapse
|
22
|
Mahmoud SSS, Sukeik M, Alazzawi S, Shaath M, Sabri O. Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements. Open Orthop J 2016; 10:600-614. [PMID: 28144373 PMCID: PMC5226968 DOI: 10.2174/1874325001610010600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/24/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions.
Collapse
Affiliation(s)
- Samer S S Mahmoud
- Department of Trauma and Orthopaedics, South Tees NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3 BW, United Kingdom
| | - Mohamed Sukeik
- Department of Trauma and Orthopaedics, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - Sulaiman Alazzawi
- Department of Trauma and Orthopaedics, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - Mohammed Shaath
- Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunay's Road, Crumpsall, M8 5RB, United Kingdom
| | - Omar Sabri
- Department of Trauma and Orthopaedics, St Georges NHS Foundation Trust, Tooting, London, SW17 0QT, United Kingdom
| |
Collapse
|
23
|
Abstract
The historical mid-term results of conversion total hip arthroplasty (THA) are acceptable; however, the complication rates are high. In total, 39 patients (45 hips) from 2 institutions underwent conversion THA from 1993-2006 and were retrospectively evaluated. The mean age was 48.3 years, the mean follow-up time was 8.7 years, and the mean duration arthrodesis prior to conversion THA was 18.2 years. The outcomes included operative time, blood loss, leg-length discrepancy (LLD), thigh circumference, Harris Hip Score (HHS), complications, and radiographic evaluation. A total of 34 THAs were cemented, and 11 were uncemented. The mean operative time was 102 minutes, and the mean blood loss was 1019 ml. The mean HHS improved from 32.4 to 82.5 (p<0.01). The mean LLD decreased from 4.2 to 1.1 cm, while the thigh circumference increased by a mean of 1.6 cm. Complications included: a positive Trendelenburg gait (6), early haematoma that required surgical evacuation (5), dislocation (2), deep infection (1), and early aseptic loosening of the components (2). In conclusion, the functional results of the conversion THA using predominantly cemented components are good at mid-term follow-up; although the complication rates remain higher than a standard primary THA, aseptic loosening rates of the cemented components is low at mid-term follow-up.
Collapse
|
24
|
Uncemented total hip arthroplasty in patients younger than 20 years. J Orthop Sci 2016; 21:500-506. [PMID: 27075587 DOI: 10.1016/j.jos.2016.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/22/2016] [Accepted: 03/16/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Several diseases may lead to advanced hip disease and cause disabling symptoms in adolescents. In literature there is no consensus which is the optimal surgical treatment for young adults with end-stage osteoarthritis. The purpose of this study was to assess the clinical and radiological outcomes of uncemented total hip arthroplasty for the treatment of end-stage hip arthritis in patients younger than 20 years at a minimum follow-up of ten years. METHODS We have retrospectively evaluated 24 patients who were 20 years or younger and underwent uncemented total hip arthroplasty. Minimum follow-up was 10 years. Clinical outcome was measured using the Harris Hip Score, Western Ontario McMaster, and the Short-Form 36. Hip calcification was evaluated using Brooker classification, while osteolysis was examined at the final follow-up according to the subdivision of Gruen. RESULTS The mean preoperative Harris Hip Score was 36.94 points and improved to 92.3, and the mean preoperative WOMAC score improved from 84.72 to 28.45 The Mental Component score-SF-36 improved from a preoperative mean of 26.23 points to 58.96, while the Physical Component score-SF-36 improved from a preoperative mean of 26.38-49.95. All components were stable and osseo-integrated. Radiolucent lines were not present in any hips. We noted the presence of 4 calcifications. No patient needed implant revision. The only complication was an intraoperative femoral fracture. CONCLUSION Total hip arthroplasty is a safe and reliable procedure for the treatment of end-stage arthritis in the young that provides good to excellent mid-term results.
Collapse
|
25
|
Kliushin NM, Ababkov YV, Ermakov AM, Malkova TA. Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement. Indian J Orthop 2016; 50:16-24. [PMID: 26955173 PMCID: PMC4759869 DOI: 10.4103/0019-5413.173513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates. MATERIALS AND METHODS We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally. RESULTS Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed. CONCLUSION The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.
Collapse
Affiliation(s)
- Nikolai M Kliushin
- Bone Infection Clinic, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia
| | - Yuri V Ababkov
- Department of Bone Infection, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia
| | - Artem M Ermakov
- Department of Bone Infection, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia
| | - Tatiana A Malkova
- Department of Scientific Medical Information, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan 640014, Russian Federation, Russia,Address for correspondence: Dr. Tatiana A Malkova, Scientific Researcher, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopedics, 6, M. Ulianova Street, Kurgan 640014, Russian Federation. E-mail:
| |
Collapse
|
26
|
Scemama C, Lestrat V, Combourieu B, Judet T. Anterior approach for total hip arthroplasty conversion of hip fusion. INTERNATIONAL ORTHOPAEDICS 2015; 40:1821-5. [PMID: 26711448 DOI: 10.1007/s00264-015-3084-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Hip fusion conversion has shown mixed results, in particular a higher rate of failure than primary total hip replacement. Conversion is usually carried out by a lateral approach. METHODS We reported a series of 37 hip fusion conversions performed by an anterior approach. Clinical and radiographic outcomes of this unusual approach were reported at eight years of follow up. RESULTS At eight years of follow up, survivorship was 86. 6 % (IC 95 %: 62.4-95.7 %). Sixteen patients reported good relief of the pre-operative back spine or knee pain. PMA score was significantly improved. Two implant aseptic loosenings needing revision surgery were reported. CONCLUSION The anterior approach seemed to be as good as the other hip approaches for hip fusion conversion to total hip replacement.
Collapse
Affiliation(s)
- Caroline Scemama
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France.
| | - Vincent Lestrat
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France
| | - Benoit Combourieu
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France
| | - Thierry Judet
- Department of Reconstructive and Orthopaedic Surgery, Raymond Poincaré Hospital (AP-HP), Garches, France
| |
Collapse
|
27
|
Fang C, Fang B, Wong TM, Lau TW, Pun T, Leung F. Fixing a fractured arthrodesed hip with rapid prototype templating and minimal invasive plate osteosynthesis. Trauma Case Rep 2015; 1:79-83. [PMID: 30101181 PMCID: PMC6082500 DOI: 10.1016/j.tcr.2015.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 10/29/2022] Open
Abstract
CASE We present an elderly lady with an intertrochanteric fracture of a previously fused hip. A 3D printed model of her pelvis and femur was used for implant templating before surgery. Minimal invasive fixation was performed with a spanning reversed distal femur locking plate without the need for removal of the previous implant. Multiple long locking screws were placed in the supra-acetabular region. The patient had union in 4 months, return to function and no complication. Conclusion The technique allowed us to optimize implant selection and insert screws safely at difficult trajectories using minimal invasive surgery.
Collapse
Affiliation(s)
- Christian Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Benjamin Fang
- Department of Radiology, H1, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Tak-Man Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.,Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tak-Wing Lau
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Terence Pun
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, China.,Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
28
|
Hirai T, Inaba Y, Kobayashi N, Takakagawa S, Yukizawa Y, Ike H, Saito T. Late-Onset Screw Migration into Iliac Vessels 21 years after Hip Arthrodesis. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:123-5. [PMID: 25336996 PMCID: PMC4197906 DOI: 10.4137/ccrep.s16159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/25/2014] [Accepted: 08/06/2014] [Indexed: 12/02/2022]
Abstract
Iatrogenic injuries to the vascular system are a rare but serious complication of hip surgery. We report a case of an 83-year-old man who presented with intrapelvic migration of a screw into the space between the external iliac artery and vein 21 years after hip arthrodesis. The patient was treated with laparotomy, and the damaged artery was excised and sutured. This is the first case of a late vascular complication secondary to screw migration after hip arthrodesis.
Collapse
Affiliation(s)
- Taishi Hirai
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Shu Takakagawa
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Tomoyuki Saito
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan
| |
Collapse
|