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Cankaya D, Inci F, Karakuş D, Turker HB, Kahve Y, Neyisci C. Isokinetic performance and function are similar after total hip arthroplasty applied with a posterior or anterolateral approach: a randomised controlled trial. Hip Int 2023; 33:67-72. [PMID: 33896243 DOI: 10.1177/11207000211012989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are ongoing debates on the effects of surgical approach on outcome after total hip arthroplasty (THA). It was hypothesised that with the anterolateral approach, trauma to the abductor arm can occur and related detrimental effects can diminish the postoperative outcomes. In this first randomised controlled trial in the literature on this subject, isokinetic performance and patient-reported functional outcomes were evaluated in patients undergoing THA with a posterior approach (PA) and an anterolateral approach (ALA). METHODS A total of 48 patients scheduled to undergo THA were randomised to ALA or PA groups. The patients were evaluated preoperatively and at 6 and 12 months postoperatively, with flexion, extension and abduction strength measurements and the Harris Hip Score (HHS). The physiatrist performing isokinetic tests and the patients were blinded to the study groups. RESULTS Both groups were similar in respect of age, body mass index (BMI), gender and preoperative isokinetic performance and HHS. Both groups demonstrated similar isokinetic performance (p < 0.05) and there was no difference in HHS (p < 0.05) at the 6- and 12-months follow-up evaluations. CONCLUSION Although there is concern about potential abductor muscle damaging during ALA, the results of this randomised controlled study demonstrated that ALA can produce similar isokinetic performance and functional outcome to PA at 6 and 12 months, despite the close proximity to the abductor arm. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04640740 (retrospectively registered).
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Affiliation(s)
- Deniz Cankaya
- Department of Orthopaedics and Traumatology, Gulhane Teaching and Research Hospital, Ankara, Turkey
| | - Fatih Inci
- Department of Orthopaedics and Traumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dilek Karakuş
- Department of Physical Medicine and Rehabilitation, School of Medicine, Ordu University, Ankara, Turkey
| | - Hasan Bozkurt Turker
- Department of Orthopaedics and Traumatology, Gulhane Teaching and Research Hospital, Ankara, Turkey
| | - Yakup Kahve
- Department of Orthopaedics and Traumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cagri Neyisci
- Department of Orthopaedics and Traumatology, Gulhane Teaching and Research Hospital, Ankara, Turkey
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Maslaris A, Vail TP, Zhang AL, Patel R, Bini SA. Impact of fatty degeneration on the functional outcomes of 38 patients undergoing surgical repair of gluteal tendon tears. Arch Orthop Trauma Surg 2022; 142:2173-2183. [PMID: 33651145 PMCID: PMC9381454 DOI: 10.1007/s00402-021-03787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gluteal tendon tears (GTT) can cause pain and weakness of the hip. We analyze the impact of gluteal muscle fatty degeneration, atrophy and tear morphology on clinical outcomes of surgical repair. METHODS All sequential patients receiving surgical repair of GTTs via anchor sutures between 1/2015 and 11/2018 were retrospectively identified. MRIs were reviewed by a radiologist for tendon retraction, muscle atrophy and tear size. The Goutallier-Fuchs Classification (GFC) was used to quantify fatty degeneration as < 2° or ≥ 2°. Demographic and clinical variables were abstracted from the electronic records. The surveys HHS Section 1 and HOOS Jr. were obtained at last follow-up. The Pearson correlation and one-way ANOVA tests served for statistical analysis of clinical variance. RESULTS 38 patients were identified, 29 (76.3%) were female. The average age was 67. Of the 11 (28.9%) patients with a prior hip arthroplasty 87.5% of primary THAs had a direct lateral approach. 29 (76.3%) patients were treated open and 9 (23.7%) arthroscopically. At an average follow-up of 20.9 months, patients reported a significant improvement in pain (97%), analgesic use (85.7%), limp (52.6%) and abduction strength (54.2%) (all: P ≤ 0.01). GFC ≥ 2° were associated with significantly worse outcomes in terms of limp (0.19/3 vs. 1.2/3, P = 0.05), HHS-S1 (58.19 vs. 71.68, P = 0.04) and complication rates (37.5% vs. 0%, P = 0.02). There was a strong correlation between tear retraction (P = 0.005), tear size (P = 0.009) and muscle atrophy (P = 0.001) with GFC ≥ 2° but not with clinical outcomes. GFC ≥ 2° was strongly related to lateral THA exposures (P < 0.001). Surgical approach had no impact on clinical outcomes. CONCLUSION While fatty degeneration can negatively impact functional outcomes, pain relief is reliably achieved. Tear morphology and muscle atrophy did not correlate with outcomes in this patient cohort. Patients should be counseled to expect a residual limp after surgery if they have GFC ≥ 2° on MRI.
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Affiliation(s)
- Alexander Maslaris
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
- Department of Orthopaedics, Friedrich-Schiller University of Jena, Campus Eisenberg, 07607 Eisenberg, Germany
- Department of Orthopaedics and Trauma Surgery, Alfried-Krupp Hospital, Campus Rüttenscheid, 45131 Essen, Germany
| | - Thomas P. Vail
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
| | - Rina Patel
- Department of Radiology of Biomedical Imaging, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
| | - Stefano A. Bini
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
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Bertaux A, Gueugnon M, Moissenet F, Orliac B, Martz P, Maillefert JF, Ornetti P, Laroche D. Gait analysis dataset of healthy volunteers and patients before and 6 months after total hip arthroplasty. Sci Data 2022; 9:399. [PMID: 35821499 PMCID: PMC9276684 DOI: 10.1038/s41597-022-01483-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
Clinical gait analysis is a promising approach for quantifying gait deviations and assessing the impairments altering gait in patients with osteoarthritis. There is a lack of consensus on the identification of kinematic outcomes that could be used for the diagnosis and follow up in patients. The proposed dataset has been established on 80 asymptomatic participants and 106 patients with unilateral hip osteoarthritis before and 6 months after arthroplasty. All volunteers walked along a 6 meters straight line at their self-selected speed. Three dimensional trajectories of 35 reflective markers were simultaneously recorded and Plugin Gait Bones, angles, Center of Mass trajectories and ground reaction forces were computed. Gait video recordings, when available, anthropometric and demographic descriptions are also available. A minimum of 10 trials have been made available in the weka file format and C3D file to enhance the use of machine learning algorithms. We aim to share this dataset to facilitate the identification of new movement-related kinematic outcomes for improving the diagnosis and follow up in patients with hip OA.
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Affiliation(s)
- Aurélie Bertaux
- CIAD UMR 7533, Univ. Bourgogne Franche-Comté, UB, F-21000, Dijon, France
| | - Mathieu Gueugnon
- INSERM, UMR1093-CAPS, Univ. Bourgogne Franche-Comté, UB, 21000, Dijon, France.,INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, 21000, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, 21000, Dijon, France
| | | | - Baptiste Orliac
- INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, 21000, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, 21000, Dijon, France
| | - Pierre Martz
- INSERM, UMR1093-CAPS, Univ. Bourgogne Franche-Comté, UB, 21000, Dijon, France.,INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, 21000, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, 21000, Dijon, France.,Orthopaedics department, CHU Dijon-Bourgogne, 21000, Dijon, France
| | - Jean-Francis Maillefert
- INSERM, UMR1093-CAPS, Univ. Bourgogne Franche-Comté, UB, 21000, Dijon, France.,Rheumatology department, CHU Dijon-Bourgogne, 21000, Dijon, France
| | - Paul Ornetti
- INSERM, UMR1093-CAPS, Univ. Bourgogne Franche-Comté, UB, 21000, Dijon, France.,INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, 21000, Dijon, France.,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, 21000, Dijon, France.,Rheumatology department, CHU Dijon-Bourgogne, 21000, Dijon, France
| | - Davy Laroche
- INSERM, UMR1093-CAPS, Univ. Bourgogne Franche-Comté, UB, 21000, Dijon, France. .,INSERM, CIC 1432, Module Plurithematique, Plateforme d'Investigation Technologique, 21000, Dijon, France. .,CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Plurithématique, Plateforme d'Investigation Technologique, 21000, Dijon, France.
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4
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HERMANSEN LL, VIBERG B, OVERGAARD S. Patient-reported outcome after dislocation of primary total hip arthroplasties: a cross-sectional study derived from the Danish Hip Arthroplasty Register. Acta Orthop 2022; 93:29-36. [PMID: 34633915 PMCID: PMC8815764 DOI: 10.1080/17453674.2021.1983973] [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: 09/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Knowledge regarding patient-reported outcomes (PROs) after dislocation and closed reduction is lacking. We report health- and hip-related quality of life (QoL) after dislocation, following primary total hip arthroplasty (THA). Patients and methods - We conducted a crosssectional study with patients registered in the Danish Hip Arthroplasty Register from 2010 to 2014. Dislocations were captured based on diagnosis/procedure codes and patient file reviews. Patients with dislocation were matched 1:2, according to age, sex, date, and hospital of primary surgery, to patients without dislocation. 2 PRO questionnaires were applied (EQ-5D, HOOS). Results - We identified 1,010 living patients with dislocation. Mean follow-up was 7.2 years from index surgery and 4.9 years (range 0.6-9.7) from the latest dislocation. Patients without dislocation reported a higher EQ VAS score of 76 (95% CI 75-77) compared with 68 (CI 66-70) for the dislocation group. The EQ-5D-5L mean index score was 0.89 (CI 0.88-0.90) for the control group, compared with 0.78 (CI 0.76-0.80) for the cases with dislocation without revision. Patients with dislocation reported a lower HOOSQoL domain score of 63 (CI 60-65), compared with 83 (CI 82-84) for the control group. Even 5 years after the latest dislocation, the HOOS-QoL score remained low, at 66 (CI 62-69). The other HOOS domains were consistently 8-10 points worse after dislocation. Interpretation - Both health- and hip-related QoL were markedly and persistently reduced among dislocation patients compared with those in controls, for several years. Therefore, the avoidance of the initial dislocation episode is important because the THA does not appear to achieve the full relieving potential.
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Affiliation(s)
- Lars L HERMANSEN
- Department of Orthopaedics, Hospital of South West Jutland, Esbjerg, Denmark,Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense/Department of Clinical Research, University of Southern Denmark, Denmark,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Bjarke VIBERG
- Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark,Department of Regional Health Research, University of Southern Denmark
| | - Soeren OVERGAARD
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense/Department of Clinical Research, University of Southern Denmark, Denmark,The Danish Hip Arthroplasty Register
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Weber P, Harrasser N, Twardy V, Gollwitzer H, Banke IJ. [Avulsion injuries of the gluteus medius and gluteus minimus muscles]. Unfallchirurg 2021; 124:526-535. [PMID: 34170360 DOI: 10.1007/s00113-021-01034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Avulsion injuries of the gluteus medius and gluteus minimus muscles represent a diagnostic and therapeutic challenge. Such injuries are rarely to be expected in high-energy trauma. Degenerative damage or iatrogenic injuries in the context of hip surgery are more frequently identified as the cause. Clinically, in addition to lateral hip pain, limping is an important finding and depends on the extent of the tendon damage. In addition to the medical history and clinical examination, imaging by means of sonography and, above all, magnetic resonance imaging (MRI, possibly with artifact-reduced sequences in the presence of an endoprosthesis) are diagnostically groundbreaking. Therapeutically, a stepwise approach is indicated according to the extent of rupture and quality of the gluteal tendon and muscle tissues. Specific conservative training regimens, mini-open/endoscopic anatomic reconstruction techniques in cases of gluteal muscle integrity and muscle transfer techniques as salvage option with chronic mass ruptures are available. The common goal is the restoration of everyday occupational and private activities to regain the quality of life.
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Affiliation(s)
- P Weber
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland
| | - N Harrasser
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland.,Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.,MVZ ATOS, Effnerstr. 38, 81925, München, Deutschland
| | - V Twardy
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - H Gollwitzer
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland
| | - I J Banke
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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6
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Lepri AC, Villano M, Matassi F, Carulli C, Innocenti M, Civinini R. "Anterolateral" approach to the hip: a systematic review of the correct definition of terms. Hip Int 2020; 30:13-19. [PMID: 33267690 DOI: 10.1177/1120700020966800] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The Watson-Jones interval plane between tensor fascia lata (TFL) and the gluteus medius (GM) has come back into fashion in the past few years - Röttinger described the anterolateral minimal invasive approach (ALMI) for use in total hip replacement, in which the standard Watson-Jones interval was used, but with a completely intermuscular plane. However, the term anterolateral is often still utilised to describe intramuscular approaches in which the GM was violated, thus creating a potential misunderstanding in the literature. Accordingly, we have designed a study to answer the following questions: (1) are there articles in the recent literature that use the term "anterolateral" to describe different approaches; (2) which would be the correct description of the anterolateral approach? METHODS We did a systematic review of the literature based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to look for peer reviewed papers of any evidence level focusing on the definition of anterolateral approach; MEDLINE and EMBASE were searched. RESULTS 73 manuscripts met the criteria of the systematic search. 53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL. Nonetheless, in the remaining 20 papers (27.4%) the term anterolateral was used to describe intramuscular approaches in which the gluteus medius was violated. CONCLUSION In about 1 out of 4 papers in the recent literature, the term anterolateral was utilised to describe approaches that are completely different both in terms of anatomy and function.
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Affiliation(s)
- Andrea Cozzi Lepri
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Marco Villano
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Fabrizio Matassi
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Christian Carulli
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Massimo Innocenti
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Roberto Civinini
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
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7
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Aggarwal VK, Iorio R, Zuckerman JD, Long WJ. Surgical Approaches for Primary Total Hip Arthroplasty from Charnley to Now. JBJS Rev 2020; 8:e0058. [DOI: 10.2106/jbjs.rvw.19.00058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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8
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Winther SB, Foss OA, Husby OS, Wik TS, Klaksvik J, Husby VS. Muscular strength and function after total hip arthroplasty performed with three different surgical approaches: one-year follow-up study. Hip Int 2019; 29:405-411. [PMID: 30421633 DOI: 10.1177/1120700018810673] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical approach influences short-term muscular strength, and leg-strength asymmetry has been demonstrated after total hip arthroplasty (THA). We evaluated muscular strength, physical function and patient-reported outcome measures (PROMs) up to 12 months postoperatively, in patients operated on using 3 different surgical approaches. METHODS 60 patients scheduled for primary THA were allocated to the direct lateral (DLA), posterior (PA) or anterior (AA) approach. The following parameters were evaluated: leg press and abduction strength, pain, 6-minute walking test, Harris Hip Score and Hip disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS). RESULTS Abduction strength in the DLA group was significantly more reduced than the PA and AA groups 12 months postoperatively (p < 0.001). A significant interleg difference in abduction (p < 0.01) and leg press (p < 0.03) persisted in all groups up to 6 months, and up to 12 months in the DLA (p < 0.05). In the AA group, interleg difference in leg press was present up to 12 months (p = 0.01). Pain scores were higher in the DLA than the AA group at 6 months (p = 0.01). Patients in the PA group had better HOOS-PS score than those in the DLA group 3 months postoperatively (p = 0.02). No intergroup differences in pain or PROMs were found 12 months postoperatively. CONCLUSION Patients operated via the DLA had reduced muscular strength, HOOS-PS scores and higher pain scores than those who underwent PA and AA type surgery. The non-operated leg was significantly stronger than the operated leg in all groups 6 months postoperatively and this persisted up to 12 months postoperatively for the DLA and AA groups. Clinical Trial Protocol number: ClinicalTrials.gov (NCT01506024).
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Affiliation(s)
- Siri B Winther
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Olav A Foss
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Otto S Husby
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tina S Wik
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway.,2 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jomar Klaksvik
- 1 Orthopaedic Research Centre, Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olav's Hospital HF, Trondheim, Norway
| | - Vigdis S Husby
- 3 Department of Mental Health, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Cezarino L, Vieira W, Silva J, Silva-Filho E, Souza F, Scattone R. Gait and functionality following unilateral and bilateral hip replacement. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Total Hip Replacement (THR) is a surgical procedure used to minimize symptoms generated by orthopedic pathologies, such as osteoarthritis. It is emphasized that there is no agreement if gait parameters are restored after surgery. Objective: To compare gait space-time and functionality between individuals submitted to unilateral or bilateral THR in relation to healthy controls. Method: A cross-sectional study was conducted with 23 subjects, eight submitted to Bilateral THR (BG), eight submitted to Unilateral THR (UG) and seven healthy individuals (CG). For the gait analysis, the 10-meter walk test was used, with the subjects walking in their Habitual (HS) and Maximal (MS) gait Speeds. Variables of interest included average speed, number of steps, test duration, cadence and Inter-Stride Time Variability (ISTV). Functionality was assessed by the Harris Hip Score and the WOMAC questionnaire. Comparisons were made between the three groups. Results: At the HS condition, the average gait speed was significantly lower in the BG compared to the CG. Similarly, during the MS condition, the BG showed a lower gait speed compared to the CG. During MS gait, the BG performed significantly worse regarding ISTV compared to both the UG, and the CG. The functionality results showed that both the BG and UG scored significantly worse than the CG. Conclusion: Hip functionality and gait mechanics are impaired even after several years of surgery in subjects submitted to THR.
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Affiliation(s)
| | | | | | | | - Felipe Souza
- Universidade Federal do Rio Grande do Norte, Brazil
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10
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Hermansen LL, Haubro MH, Viberg BL, Overgaard S. Patient-reported outcome after hip dislocation in primary total hip arthroplasty is virtually unknown: a systematic literature review. Acta Orthop 2018; 89:595-596. [PMID: 30326750 PMCID: PMC6300721 DOI: 10.1080/17453674.2018.1518428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Lars L Hermansen
- Department of Orthopaedics, Hospital of South West Jutland, Esbjerg;; ,The Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense;; ,Department of Clinical Research, Odense University Hospital, Odense;; ,Correspondence:
| | - Martin H Haubro
- Department of Orthopaedics, Hospital of South West Jutland, Esbjerg;;
| | - Bjarke L Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital, Kolding
| | - Søren Overgaard
- The Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense;; ,Department of Clinical Research, Odense University Hospital, Odense;;
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11
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Abbas-Zadeh MR, Azizi A, Abbas-Zadeh L, Amirian F. Effect of surgical treatment on the quality of life in patients with non-traumatic avascular necrosis of the femoral head. Rev Bras Ortop 2018; 53:773-777. [PMID: 30377614 PMCID: PMC6205024 DOI: 10.1016/j.rboe.2017.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/15/2017] [Indexed: 11/28/2022] Open
Abstract
Objective Avascular necrosis of the hip is a common debilitating disease during the fourth and fifth decades of life. This study attempted to evaluate quality of life in patients with avascular necrosis of the hip joint before and after surgery. Methods In this study, 40 patients with avascular necrosis of the hip who underwent total hip arthroplasty, bipolar surgery, or cord compression were examined during 2006–2013. Harris Hip Score was used to assess the hip joint function and quality of life before and after surgery. The mean scores and standard deviation were used to describe data for quantitative variables, while frequency percentage was used to describe qualitative variables. Data were analyzed through SPSS v.19 and paired t-test. p < 0.05 was considered significant. Results This study involved 40 subjects with a mean age of 32 ± 7.38 years, ranging from 21 to 45 years old. The mean Harris Hip Score for patients before and after surgery were 20.36 and 96.15, respectively, showing a statistically significant difference (p < 0.001). The average patient activity scores before and after surgery (8.9 and 44.2, respectively), non-deformity (1.6 and 3.9), and movement (3.6 and 4.9) indicated significant differences (p < 0.001). Furthermore, 80% of patients felt no hip joint pain six months after surgery, while 92.5% patients did not use any assistive device to walk. Conclusions The results of this study demonstrated that surgery substantially contributed to relieving pain and improving hip function in patients with osteonecrosis of the hip joint in the short term.
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Affiliation(s)
| | - Ali Azizi
- Medical School, Kermanshah University of Medical Science, Kermanshah, Iran
- Corresponding author.
| | | | - Farhad Amirian
- Medical School, Kermanshah University of Medical Science, Kermanshah, Iran
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12
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Abbas‐Zadeh MR, Azizi A, Abbas‐Zadeh L, Amirian F. Efeito do tratamento cirúrgico sobre a qualidade de vida em pacientes com necrose avascular não traumática da cabeça femoral. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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13
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Tjur M, Pedersen AR, Sloth W, Søballe K, Lorenzen ND, Stilling M. Posterior or anterolateral approach in hip joint arthroplasty - Impact on frontal plane moment. Clin Biomech (Bristol, Avon) 2018; 54:143-150. [PMID: 29587148 DOI: 10.1016/j.clinbiomech.2018.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/12/2018] [Accepted: 03/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterolateral surgical approach in hip joint arthroplasty necessitates division of the hip abductor muscle complex, which may compromise postoperative gait observed in the frontal plane. The aim of the study was to compare frontal plane moment after hip joint arthroplasty by anterolateral or posterior approach and to explore which compensatory strategies patients use to decrease frontal plane moment. METHODS Twenty-eight patients were randomized by sealed envelopes to hip resurfacing arthroplasty surgery by anterolateral (ad modum Watson) or posterior (ad modum Moore) approach, performed by two senior surgeons. Gait analyses were performed using 3D motion capture before surgery, 3, and 12 months after surgery. Peak ground reaction force was extracted for early and late stance and the corresponding frontal plane moment was defined. Measures of lateral trunk inclination, pelvic drop and hip abduction were obtained for the stance phase of the affected leg. FINDINGS An effect of surgical approach on frontal plane moment for the affected leg was found during early stance phase (p = 0.006) where average frontal plane moment in the anterolateral groups was 202.42 N mm/kg in less compared to the posterior group after one year. A similar effect from baseline to 12 months for trunk inclination (p = 0.03) and an overall negative correlation between frontal plane moment and trunk inclination was found (r = -0.66, p = 0.03). INTERPRETATION Frontal plane moment during early stance was less one year after hip joint arthroplasty through anterolateral compared to posterior approach. Patients' primary strategy to reduce frontal plane moment seems to be increased lateral trunk inclination.
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Affiliation(s)
- Marianne Tjur
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark.
| | - Asger R Pedersen
- Hammel Neurorehabilitation and Research Centre, Voldbyvej 15, 8450 Hammel, Denmark
| | - William Sloth
- Hammel Neurorehabilitation and Research Centre, Voldbyvej 15, 8450 Hammel, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, bygning 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Aarhus, Denmark; Department of Orthopaedics, Aarhus University Hospital, Tage Hansens gade 2, 8000 Aarhus C, Denmark
| | - Nina D Lorenzen
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark
| | - Maiken Stilling
- Orthopaedic Research Unit, Aarhus University Hospital, Tage Hansensgade 2, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, bygning 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Aarhus, Denmark; Department of Orthopaedics, Aarhus University Hospital, Tage Hansens gade 2, 8000 Aarhus C, Denmark
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14
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Rosenlund S, Broeng L, Holsgaard-Larsen A, Jensen C, Overgaard S. Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach. Acta Orthop 2017; 88:239-247. [PMID: 28464754 PMCID: PMC5434589 DOI: 10.1080/17453674.2017.1291100] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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 - Criticism of the lateral approach (LA) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach (PA). However, there have been no controlled studies comparing patient-reported outcomes between them. In this randomized controlled trial, we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty (THA) with PA than in those who have undergone THA with LA, 12 months postoperatively. Patients and methods - 80 patients with hip osteoarthritis (mean age 61 years) were randomized to THA using PA or the modified direct LA. We recorded outcome measures preoperatively and 3, 6, and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) as the primary outcome. Secondary outcomes were HOOS-Pain, HOOS-Quality-Of-Life, EQ-5D, UCLA Activity Score, and limping. Results - We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up. All secondary outcomes showed similar results except for limping, where PA patients improved significantly more than LA patients. Interpretation - Contrary to our hypothesis, patients treated with PA did not improve more than patients treated with LA regarding physical function, pain, physical activity, and quality of life 12 months postoperatively. However, limping was more pronounced in the LA patients.
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Affiliation(s)
- Signe Rosenlund
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense; ,Department of Orthopaedic Surgery and Traumatology, Zealand University Hospital, Køge, Denmark,Correspondence:
| | - Leif Broeng
- Department of Orthopaedic Surgery and Traumatology, Zealand University Hospital, Køge, Denmark
| | - Anders Holsgaard-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense;
| | - Carsten Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense;
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense;
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15
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Jelsma J, Pijnenburg R, Boons HW, Eggen PJMG, Kleijn LLA, Lacroix H, Noten HJ. Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study. J Orthop 2016; 14:53-58. [PMID: 27822002 DOI: 10.1016/j.jor.2016.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/16/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Since years a discussion is held on the best approach to perform total hip replacement (THR). Risk of dislocation, abductor weakness and a possible difference in rehabilitation are mentioned. We performed this study to objectify that the use of the direct anterior approach (DAA) results in a faster rehabilitation after THR compared to the non-DAA (posterolateral and anterolateral) approach. METHODS A single centre prospective cohort study was conducted. Pre- and 16-weeks postoperative completed PROMs like the VAS, PSC, GPE and HOOS were analyzed. A leg press and power test were performed. Functional capacity was determined by the TUG and the 6MWT. RESULTS A total of 119 patients were included for analysis: 87 in the DAA group, 32 in the non-DAA group. There were no differences in general baseline characteristics. The length of stay was significant (p = .000) shorter in the DAA group. At 16 weeks, the DAA group showed a significant greater improvement with respect to the VAS and HOOS. Also significant differences for all strength, power and functional capacity parameters between the pre- and postoperative measurements were found. A subgroup analysis at 6-weeks postoperative showed significant improvements in the TUG (p = .009) and 6MWT (p = .009) in the DAA group, but not in the non-DAA group. CONCLUSION PROMs, strength, power and functional capacity tests show significant improvement in all approaches after THR. There seems to be a small advantage in favour of the DAA, in particular directly postoperative and the first postoperative weeks.
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Affiliation(s)
- Jetse Jelsma
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Rik Pijnenburg
- Physiotherapy Jeurissen & van Ingh, Fabriekstraat 24, 5753 AH Deurne, The Netherlands
| | - Harm W Boons
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Peter J M G Eggen
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Lucas L A Kleijn
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Herman Lacroix
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
| | - Hub J Noten
- Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands
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16
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Grano GF, Pavlidou M, Todesco A, Palermo A, Molfetta L. A new anterolateral surgical approach for total hip replacement. JOINTS 2016; 4:148-152. [PMID: 27900306 DOI: 10.11138/jts/2016.4.3.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the purpose of the present paper is to present the short-term results of a "detachment-free" (DF) anterolateral approach for primary total hip replacement (THR) performed in a large series of patients. METHODS two hundred patients submitted to primary THR were retrospectively reviewed for the present study. In all cases, the surgery was performed using a minimally invasive DF anterolateral approach, which entails no disconnection of tendons and no muscle damage. The study population consisted of 96 men (48%) and 104 women (52%), with an average age of 69.4 years (range 38-75). Clinical and radiographic follow-up was performed after 12 months. RESULTS the clinical results, evaluated using the Harris Hip Score, were excellent in 95% of the cases and good in 5%; no cases had fair or poor results. X-rays taken at 3, 6 and 12 months after surgery did not show heterotopic ossification, mobilization of the prosthetic components, or hip dislocation. No infections, deep vein thrombosis, or failure of the gluteal muscles were reported. CONCLUSIONS the DF anterolateral approach for THR proved safe and provided effective results at short-term follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Giovanni F Grano
- Orthopaedic Unit and Regional Hip Surgery Center, Hospital of Cittadella, Italy
| | - Maria Pavlidou
- Orthopaedic Unit and Regional Hip Surgery Center, Hospital of Cittadella, Italy
| | - Alberto Todesco
- Orthopaedic Unit and Regional Hip Surgery Center, Hospital of Cittadella, Italy
| | | | - Luigi Molfetta
- School of Medical and Pharmacological Sciences, Research Center of Osteoporosis and Osteoarticular Diseases, University of Genova, Genova, Italy
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17
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Amanatullah DF, Masini MA, Roger DJ, Pagnano MW. Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty. Bone Joint J 2016; 98-B:1036-42. [DOI: 10.1302/0301-620x.98b8.37178] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/08/2016] [Indexed: 11/05/2022]
Abstract
Aims We wished to quantify the extent of soft-tissue damage sustained during minimally invasive total hip arthroplasty through the direct anterior (DA) and direct superior (DS) approaches. Materials and Methods In eight cadavers, the DA approach was performed on one side, and the DS approach on the other, a single brand of uncemented hip prosthesis was implanted by two surgeons, considered expert in their surgical approaches. Subsequent reflection of the gluteus maximus allowed the extent of muscle and tendon damage to be measured and the percentage damage to each anatomical structure to be calculated. Results The DA approach caused substantially greater damage to the gluteus minimus muscle and tendon when compared with the DS approach (t-test, p = 0.049 and 0.003, respectively). The tensor fascia lata and rectus femoris muscles were damaged only in the DA approach. There was no difference in the amount of damage to the gluteus medius muscle and tendon, piriformis tendon, obturator internus tendon, obturator externus tendon or quadratus femoris muscle between approaches. The posterior soft-tissue releases of the DA approach damaged the gluteus minimus muscle and tendon, piriformis tendon and obturator internus tendon. Conclusion The DS approach caused less soft-tissue damage than the DA approach. However the clinical relevance is unknown. Further clinical outcome studies, radiographic evaluation of component position, gait analyses and serum biomarker levels are necessary to evaluate and corroborate the safety and efficacy of the DS approach. Cite this article: Bone Joint J 2016;98-B1036–42.
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Affiliation(s)
- D. F. Amanatullah
- Stanford University, 450
Broadway St, Redwood City, CA
94063-6342, USA
| | - M. A. Masini
- Ann Arbor Bone and Joint Surgery, St.
Joseph Mercy Ann Arbor Hospital, 5315 Elliott DR., Suite
304, Ypsilanti, MI 48197, USA
| | - D. J. Roger
- Institute of Clinical Orthopedics and
Neuroscience, Desert Regional Medical Center, 1180
N. Indian Canyon, Suite W-201, Palm
Springs, CA 92262, USA
| | - M. W. Pagnano
- Mayo Clinic, 200
First Street SW, Rochester MN, 55905, USA
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18
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Thirteen year follow-up of a cementless femoral stem and a threaded acetabular cup in patients younger than fifty years of age. INTERNATIONAL ORTHOPAEDICS 2016; 41:39-45. [PMID: 27241335 DOI: 10.1007/s00264-016-3226-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Compared to older patients undergoing total hip arthroplasty (THA) younger patients are considered to be more active, thereby exposing the implant to significantly higher loads over a much longer period of time. Additionally, cases of secondary osteoarthritis caused by hip dysplasia, femoral head necrosis or rheumatic diseases are much more frequent than among the average patient population. Therefore, durable implant fixation and low wear rates are extremely important to achieve good long-term implant survival in this group of patients. OBJECTIVE The aim of this retrospective study was to evaluate the mid- to long-term survival of a cementless femoral stem (Zweymüller® SL stem) and a threaded cup (Bicon SL®) in patients younger than 50 years of age. METHODS Therefore, a consecutive series of 100 patients (111 hips) aged 50 years or younger (range: 30 to 50 years) was analysed at a mean follow up of 13.5 years. Follow-up assessment included physical examination and radiographic workup. Hip disability osteoarthritis and outcome score (HOOS) and Harris hip score (HHS) were used to evaluate the pre- and post-operative functional outcome, respectively. Patient satisfaction with the surgical result was assessed by standardized questionnaires. RESULTS The overall survival rate with any revision as endpoint was 96.8 % (95 % CI: 90.5 % to 98.9 %) at ten years. Gender, operation time and the occurence of osteolyses had no influence on joint function or patient satisfaction. We recorded an overall failure rate of 7.4 % (six cases). In four cases (5 %) the prosthesis had to be revised due to aseptic loosening of the cup after 12 years, eight years, 12 years and 11 years, in one case (1.2 %) recurrent luxation led to a revision operation (acetabular cup and head) after three years of primary implantation. In one case an implant failure was recorded (acetabular cup breakage after eight years of implantation). We recorded the occurence of asymptomatic radiolucent lines of the cup in 21 % and of the stem in 35 % in our series. The HOOS was influenced by the presence or abscence of radiolucent lines of the stem. Patients with radiolucent lines of the stem had a median HOOS score of (74 points) compared to those without radiolucent lines (89 points). Other factors, such as "diagnosis led to operation" and "previous operations" had no influence on the HHS and HOOS. CONCLUSION Our study demonstrates excellent long-term survival of cementless femoral stem in combination with a threaded cup in young patients undergoing total hip arthroplasty.
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20
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Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J 2016; 98-B:291-7. [DOI: 10.1302/0301-620x.98b3.36515] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty. The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases. Take home message: There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group. Cite this article: Bone Joint J 2016;98-B:291–7.
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Affiliation(s)
- C. Rogmark
- Lund University, Skåne University Hospital,
Malmö, Sweden and, Swedish Hip Arthroplasty
Register, Registercentrum VGR, Gothenburg, Sweden
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21
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Winther SB, Husby VS, Foss OA, Wik TS, Svenningsen S, Engdal M, Haugan K, Husby OS. Muscular strength after total hip arthroplasty. A prospective comparison of 3 surgical approaches. Acta Orthop 2016; 87:22-8. [PMID: 26141371 PMCID: PMC4940587 DOI: 10.3109/17453674.2015.1068032] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. PATIENTS AND METHODs: In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up. RESULTS Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups. INTERPRETATION The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery.
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Affiliation(s)
- Siri B Winther
- Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital, Trondheim,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim,Correspondence:
| | - Vigdis S Husby
- Faculty of Nursing, Sør-Trøndelag University College, Trondheim
| | - Olav A Foss
- Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital, Trondheim
| | - Tina S Wik
- Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital, Trondheim
| | | | - Monika Engdal
- Department of Physiotherapy, Trondheim University Hospital, Trondheim, Norway
| | - Kristin Haugan
- Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital, Trondheim
| | - Otto S Husby
- Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital, Trondheim
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22
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Zhang L, Ge S, Liu H, Wang Q, Wang L, Xian CJ. Contact damage failure analyses of fretting wear behavior of the metal stem titanium alloy–bone cement interface. J Mech Behav Biomed Mater 2015; 51:132-46. [DOI: 10.1016/j.jmbbm.2015.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/20/2015] [Accepted: 06/23/2015] [Indexed: 11/26/2022]
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23
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Sheth D, Cafri G, Inacio MCS, Paxton EW, Namba RS. Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk. Clin Orthop Relat Res 2015; 473:3401-8. [PMID: 25762014 PMCID: PMC4586236 DOI: 10.1007/s11999-015-4230-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization. QUESTIONS/PURPOSES (1) What is the incidence of aseptic revision, septic revision, and dislocation for primary THA in a large community-based healthcare organization? (2) Does the risk of aseptic revision, septic revision, and dislocation vary by THA surgical approach? METHODS The Kaiser Permanente Total Joint Replacement Registry was used to identify primary THAs performed between April 1, 2001 and December 31, 2011. Endpoints were septic revisions, aseptic revisions, and dislocations. The exposure of interest was surgical approach (posterior, anterolateral, direct lateral, direct anterior). Patient, implant, surgeon, and hospital factors were evaluated as possible confounders. Survival analysis was performed with marginal multivariate Cox models. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. A total of 42,438 primary THAs were available for analysis of revision outcomes and 22,237 for dislocation. Median followup was 3 years (interquartile range, 1-5 years). The registry's voluntary participation is 95%. The most commonly used approach was posterior (75%, N = 31,747) followed by anterolateral (10%, N = 4226), direct anterior (4%, N = 1851), and direct lateral (2%, N = 667). RESULTS During the study period 785 hips (2%) were revised for aseptic reasons, 213 (0.5%) for septic reasons, and 276 (1%) experienced a dislocation. The revision rate per 100 years of observation was 0.54 for aseptic revisions, 0.15 for septic revisions, and 0.58 for dislocations. There were no differences in adjusted risk of revision (either septic or aseptic) across the different THA approaches. However, the anterolateral approach (adjusted HR, 0.29; 95% CI, 0.13-0.63, p = 0.002) and direct anterior approach (adjusted HR, 0.44; 95% CI, 0.22-0.87, p = 0.017) had a lower risk of dislocation relative to the posterior approach. There were no differences in any of the outcomes when comparing the direct anterior approach with the anterolateral approach. CONCLUSIONS Anterior and anterolateral surgical approaches had the advantage of a lower risk of dislocation without increasing the risk of early revision. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Dhiren Sheth
- Department of Orthopaedic Surgery, Orange County, Southern California Permanente Medical Group, Irvine, CA, USA
| | - Guy Cafri
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA
| | - Maria C S Inacio
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA.
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA
| | - Robert S Namba
- Department of Orthopaedic Surgery, Orange County, Southern California Permanente Medical Group, Irvine, CA, USA
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Rosenlund S, Broeng L, Jensen C, Holsgaard-Larsen A, Overgaard S. The effect of posterior and lateral approach on patient-reported outcome measures and physical function in patients with osteoarthritis, undergoing total hip replacement: a randomised controlled trial protocol. BMC Musculoskelet Disord 2014; 15:354. [PMID: 25345483 PMCID: PMC4216831 DOI: 10.1186/1471-2474-15-354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/09/2014] [Indexed: 01/26/2023] Open
Abstract
Background Total hip replacement provides pain relief and improves physical function and quality of life in patients with end-stage hip osteoarthritis. The incidence of hip replacement operations is expected to increase due to the growing elderly population. Overall, the posterior approach and lateral approach are the two most commonly used approaches for hip replacement operations. The posterior approach is associated with an increased risk of revision due to dislocations, and some studies have shown that the lateral approach is associated with reduced patient-reported outcomes, including physical function and pain; however, this has not been investigated in a randomised controlled trial with a twelve-month follow-up. We hypothesized that the lateral approach has an inferior outcome in patient-reported outcome compared with the posterior approach after one year. Methods/Design The trial is a prospective, double blinded, parallel-group controlled trial with balanced randomisation [1: 1]. Patients with hip osteoarthritis scheduled for hip replacement surgery, aged 45–70 years, will be consecutively recruited and randomised into two groups. Group A will receive hip replacement using the posterior approach, and Group B will receive hip replacement using the lateral approach. The primary end-point for assessing the outcome of the two interventions will be twelve months after surgery. Follow-up will also be performed after three and six months. The primary outcome is Hip Disability and Osteoarthritis Outcome Score, subscale of "Physical function Short form" (HOOS-PS) Secondary outcome measures include two other subscales of HOOS ("Pain" and "Hip related Quality of Life"), physical activity level (UCLA activity score), limping (HHS) and general health status (EQ-5D-3L). Explorative outcomes include physical function test, 3D-gait-analysis and muscle strength. Discussion To our knowledge, this is the first randomised controlled trial comparing the posterior approach with the lateral approach with patient reported outcome as the primary outcome and with a twelve-month follow-up. Trial registration Clinicaltrial.gov:NCT01616667. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-354) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Signe Rosenlund
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
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25
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Hendrickx C, De Hertogh W, Van Daele U, Mertens P, Stassijns G. Effect of percutaneous assisted approach on functional rehabilitation for total hip replacement compared to anterolateral approach: study protocol for a randomized controlled trial. Trials 2014; 15:392. [PMID: 25298243 PMCID: PMC4197322 DOI: 10.1186/1745-6215-15-392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The anterolateral approach is a commonly used technique for total hip replacement. It requires the detachment of a large part of the gluteus medius muscle. However, it is known that this muscle has a great impact on hip stability. Using the percutaneous assisted approach the damage to the gluteus medius can be limited. The purpose of this study is to compare the effect of the percutaneous assisted approach with the anterolateral approach on postoperative functional outcome. METHODS/DESIGN This study uses a prospective, randomized, parallel-group design with blinded assessment and unblinded treatment to compare the percutaneous assisted approach with the anterolateral approach in total hip replacement surgery. The postoperative results of patients operated on using the percutaneous assisted approach will be compared with those of patients operated on using the anterolateral approach. Prior to surgery patients will undergo baseline measurements. These will consist of gluteus medius measurements (surface-electromyography, strength measurements of abductors and quadriceps and the Trendelenburg test), questionnaires (Oxford Hip Score and 36-item Short Form Health Survey) and functional measures (the Timed Get-Up-and-Go test, Five times Sit-to-Stand test and Six-Minute Walk test). These measurements will be repeated four and 12 weeks after surgery. After surgery both groups will receive usual care. DISCUSSION The gluteus medius is the main stabilizer of the hip joint. Therefore, we assume that functional outcome and gluteus medius function of patients after the percutaneous assisted approach will be better than after the anterolateral approach. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov on 8 January 2014, registration number: NCT02032017.
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Affiliation(s)
| | - Willem De Hertogh
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
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Xie ZG, Dong QR, Xie Y. Biological prosthesis for total hip arthroplasty in treatment of adult developmental dysplasia of the hip. Orthop Surg 2014; 6:255-6. [PMID: 25179363 DOI: 10.1111/os.12126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Zong-gang Xie
- Department of Orthopaedic Surgery, Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
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Lindgren JV, Wretenberg P, Kärrholm J, Garellick G, Rolfson O. Patient-reported outcome is influenced by surgical approach in total hip replacement. Bone Joint J 2014; 96-B:590-6. [DOI: 10.1302/0301-620x.96b5.32341] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effects of surgical approach in total hip replacement on health-related quality of life and long-term pain and satisfaction are unknown. From the Swedish Hip Arthroplasty Register, we extracted data on all patients that had received a total hip replacement for osteoarthritis through either the posterior or the direct lateral approach, with complete pre- and one-year post-operative Patient Reported Outcome Measures (PROMs). A total of 42 233 patients met the inclusion criteria and of these 4962 also had complete six-year PROM data. The posterior approach resulted in an increased mean satisfaction score of 15 (sd 19) vs 18 (sd 22) (p < 0.001) compared with the direct lateral approach. The mean pain score was 13 (sd 17) vs 15 (sd 19) (p < 0.001) and the proportion of patients with no or minimal pain was 78% vs 74% (p < 0.001) favouring the posterior approach. The patients in the posterior approach group reported a superior mean EQ-5D index of 0.79 (sd 0.23) vs 0.77 (sd 0.24) (p < 0.001) and mean EQ score of 76 (sd 20) vs 75 (sd 20) (p < 0.001). All observed differences between the groups persisted after six years follow-up. Although PROMs after THR in general are very good regardless of surgical approach, the results indicate that some patients operated by the direct lateral approach report an inferior outcome compared with the posterior approach. The large number of procedures and the seemingly sustained differences make it likely these findings are clinically relevant. Cite this article: Bone Joint J 2014;96-B:590–6.
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Affiliation(s)
- J. V. Lindgren
- Karolinska Institutet, Department
of Molecular Medicine and Surgery, Section
of Orthopaedics, SE-171 77 Stockholm, Sweden
and the Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - P. Wretenberg
- Karolinska Institutet, Department
of Molecular Medicine and Surgery, Section
of Orthopaedics, SE-171 77 Stockholm, Sweden
| | - J. Kärrholm
- Institute of Clinical Sciences, Department
of Orthopaedics, The Sahlgrenska Academy, University
of Gothenburg,
SE-413 45 Gothenburg, Sweden and Swedish Hip
Arthroplasty Register, Gothenburg, Sweden
| | - G. Garellick
- Institute of Clinical Sciences, Department
of Orthopaedics, The Sahlgrenska Academy, University
of Gothenburg,
SE-413 45 Gothenburg, Sweden and Swedish Hip
Arthroplasty Register, Gothenburg, Sweden
| | - O. Rolfson
- Institute of Clinical Sciences, Department
of Orthopaedics, The Sahlgrenska Academy, University
of Gothenburg,
SE-413 45 Gothenburg, Sweden and Swedish Hip
Arthroplasty Register, Gothenburg, Sweden
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Effect of preoperative limb-length discrepancy on abductor strength after total hip arthroplasty in patients with developmental dysplasia of the hip. Arch Orthop Trauma Surg 2014; 134:113-9. [PMID: 24297213 DOI: 10.1007/s00402-013-1899-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND Limb-length discrepancy (LLD) arising from hip subluxation or dislocation and accompanied by insufficiency of hip abductor in patients with developmental dysplasia of the hip (DDH) can be corrected partially or completely with total hip arthroplasty (THA). However, information about post-THA changes in abductor strength related to preoperative LLD in patients with DDH is lacking. We aimed to explore the post-THA recovery course of abductor muscle strength and its related factors in patients with DDH. METHODS A cohort of 45 patients with unilateral DDH was divided into two groups according to their Crowe classification: patients with class I or II DDH formed Group M, and patients in class III and IV DDH formed Group S. The following parameters were measured on standardized antero-posterior hip radiographs taken in the supine position pre- and post-THA: abductor muscle length, abductor lever arm, LLD, and femoral offset (FO). Abductor strength was evaluated quantitatively with the Isomed 2000 isokinetic test system (1 week before the operation and 1, 3, 6, and 12 months after the operation). The contralateral normal hip joint served as a within-patient control. The affected side:healthy side ratios of the parameters above were calculated. RESULTS Abductor strength ratio evaluated at the five follow-up time points was larger in Group M than that in Group S (p < 0.001). The average abductor strength ratio reached 78.5, 85.4, and 89.2% at the 3, 6, and 12 months postoperative exams, respectively, in Group M, and reached 50.3, 63.2, and 72.9% in Group S. The abductor muscle length ratio, the abductor muscle level arm ratio, and the FO ratio were significantly increased postoperatively, relative to preoperative assessment, in the two groups. LLD was reduced significantly postoperatively, relative to preoperative values, in both groups. Both preoperative LLD (r = -0.791, p < 0.001) and the change in abductor muscle length ratio (r = -0.659, p < 0.001) correlated with abductor strength recovery. CONCLUSION Patients showed the greatest improvement in abductor strength within the first 6 months after THA, especially during the first 3 months. Abductor strength was consistently greater in patients with mild dysplasia than in patients with severe dysplasia. The extent of preoperative LLD and the increase in abductor length were related with post-THA abductor strength recovery in patients with DDH.
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