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Chaudhry F, Daud A, Greenberg A, Braunstein D, Safir OA, Gross AE, Kuzyk PR. Cup-cage constructs in revision total hip arthroplasty for pelvic discontinuity. Bone Joint J 2024; 106-B:66-73. [PMID: 38688477 DOI: 10.1302/0301-620x.106b5.bjj-2023-0842.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Pelvic discontinuity is a challenging acetabular defect without a consensus on surgical management. Cup-cage reconstruction is an increasingly used treatment strategy. The present study evaluated implant survival, clinical and radiological outcomes, and complications associated with the cup-cage construct. Methods We included 53 cup-cage construct (51 patients) implants used for hip revision procedures for pelvic discontinuity between January 2003 and January 2022 in this retrospective review. Mean age at surgery was 71.8 years (50.0 to 92.0; SD 10.3), 43/53 (81.1%) were female, and mean follow-up was 6.4 years (0.02 to 20.0; SD 4.6). Patients were implanted with a Trabecular Metal Revision Shell with either a ZCA cage (n = 12) or a TMARS cage (n = 40, all Zimmer Biomet). Pelvic discontinuity was diagnosed on preoperative radiographs and/or intraoperatively. Kaplan-Meier survival analysis was performed, with failure defined as revision of the cup-cage reconstruction. Results The five-year all-cause survival for cup-cage reconstruction was 73.4% (95% confidence interval (CI) 61.4 to 85.4), while the ten- and 15-year survival was 63.7% (95% CI 46.8 to 80.6). Survival due to aseptic loosening was 93.4% (95% CI 86.2 to 100.0) at five, ten, and 15 years. The rate of revision for aseptic loosening, infection, and dislocation was 3/53 (5.7%), 7/53 (13.2%), and 6/53 (11.3%), respectively. The mean leg length discrepancy improved (p < 0.001) preoperatively from a mean of 18.2 mm (0 to 80; SD 15.8) to 7.0 mm (0 to 35; SD 9.8) at latest follow-up. The horizontal and vertical hip centres improved (p < 0.001) preoperatively from a mean of 9.2 cm (5.6 to 17.5; SD 2.3) to 10.1 cm (6.2 to 13.4; SD 2.1) and 9.3 cm (4.7 to 15.8; SD 2.5) to 8.0 cm (3.7 to 12.3; SD 1.7), respectively. Conclusion Cup-cage reconstruction provides acceptable outcomes in the management of pelvic discontinuity. One in four constructs undergo revision within five years, most commonly for periprosthetic joint infection, dislocation, or aseptic loosening.
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Affiliation(s)
- Faran Chaudhry
- University of Toronto Temerty Faculty of Medicine, Toronto, Canada
| | - Anser Daud
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | - Arieh Greenberg
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | | | - Oleg A Safir
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | - Allan E Gross
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | - Paul R Kuzyk
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
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Ahmed A, Hameed I. Artificial intelligence in academic cardiothoracic surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:177-178. [PMID: 38300166 DOI: 10.23736/s0021-9509.24.12962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Adham Ahmed
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Irbaz Hameed
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA -
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Goh GS, Parvizi J. Nerve Injuries Following Total Hip Arthroplasty: The Influence of Surgical Approach. Orthop Clin North Am 2022; 53:129-137. [PMID: 35365257 DOI: 10.1016/j.ocl.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Nerve injuries following total hip arthroplasty are rare but devastating complications. The most important modifiable risk factor remains the choice of hip approach and surgical technique applied. The risk of nerve injuries is related to technical complexity of the procedure and anatomic variability of the nerves. Surgeons should remain cognizant of inherent risk factors, variations in the course and branching patterns of different nerves, and technical considerations of the surgical approach to mitigate risks. This article reviews the literature on postsurgical nerve injuries following total hip arthroplasty and characterizes the influence of surgical approach on the risk of this complication.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
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Devlieger BK, Drees P, Mattyasovszky S, Özalp C, Rommens PM. Impingement of the Sciatic Nerve due to a Protruding Acetabular Cage Rim. Arthroplast Today 2020; 6:825-829. [PMID: 33024805 PMCID: PMC7529594 DOI: 10.1016/j.artd.2020.08.005] [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: 06/09/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Sciatic nerve damage is a well-known complication that occurs in 1.5% of patients after primary total hip arthroplasty and in 8% after revision total hip arthroplasty. Yet when considering re-revision arthroplasty and acetabular cage implantation, incidence and management remain unclear. This case report describes a young female patient with sciatic nerve impingement after acetabular cage implantation. Her primary complaint was shooting sciatic left leg pain, worsening on ambulation and when seated. A complete workup was negative for spinal impingement or infection, and axonal nerve damage was confirmed through nerve conduction studies. The intraoperative findings showed that it was the acetabular cage rim that stretched the sciatic nerve. The rim was adjusted using a diamond burr to provide a specific solution without sacrificing the acetabular anchorage. Postoperative findings showed an excellent return to previous mobility and resolution of pain. This case provides a rare example of sciatic nerve impingement, showing that nerve palsies in the revision total hip arthroplasty setting may require patient-specific solutions.
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Affiliation(s)
- Benjamin Karel Devlieger
- Corresponding author. Department of Orthopedics and Traumatology, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany. Tel.: +491613117 7292.
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Weynandt CL, Kowski A, Perka C, Rakow A. [Nerve Injuries in Hip and Knee Arthroplasty - Risk Factors, Diagnostic and Therapeutic Approaches]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 158:535-555. [PMID: 32645744 DOI: 10.1055/a-0915-9272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Iatrogenic nerve injuries are rare complications of total hip and knee arthroplasty, which may cause chronic pain and loss of function, severely affecting the patient's daily activities and quality of life. Nerves "at risk" include the sciatic nerve, the femoral nerve, the lateral femoral cutaneous nerve and the superior gluteal nerve during total hip arthroplasty, and the infrapatellar branch of the saphenous nerve as well as the peroneal nerve during total knee arthroplasty. Multiple procedure-related and patient-related factors have been identified to modify the risk of nerve injury in the course of lower limb joint replacement surgery. These include the surgeon's skills, the surgical approach, the type of implant fixation, the intraoperative positioning of the patient, as well as pre-existing scars, the patient's sex, age and comorbidities. Diagnostic and therapeutic approaches should be based on the aetiology of the lesion: iatrogenic nerve lesions can result from direct (compression or transection) and/or indirect (traction, ischemia) trauma. The majority of nerve injuries encountered in hip or knee arthroplasty has been referred to as "minor" nerve lesions, which generally respond very well to non-operative treatment. "Major" nerve lesions, such as complete motor nerve transection, may result in lifelong impairment. Any perioperatively encountered neurological deficit requires a meticulous diagnostic work-up and an individually tailored treatment strategy, respecting aetiology and anatomic site of the nerve lesion as well as the individual patient's needs and comorbidities.
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Vajapey SP, Morris J, Lynch D, Spitzer A, Li M, Glassman AH. Nerve Injuries with the Direct Anterior Approach to Total Hip Arthroplasty. JBJS Rev 2020; 8:e0109. [DOI: 10.2106/jbjs.rvw.19.00109] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Yoon SJ, Park MS, Matsuda DK, Choi YH. Endoscopic resection of acetabular screw tip to decompress sciatic nerve following total hip arthroplasty. BMC Musculoskelet Disord 2018; 19:184. [PMID: 29866097 PMCID: PMC5987599 DOI: 10.1186/s12891-018-2091-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/15/2018] [Indexed: 12/26/2022] Open
Abstract
Background Sciatic nerve injuries following total hip arthroplasty are disabling complications. Although degrees of injury are variable from neuropraxia to neurotmesis, mechanical irritation of sciatic nerve might be occurred by protruding hardware. This case shows endoscopic decompression for protruded acetabular screw irritating sciatic nerve, the techniques described herein may permit broader arthroscopic/endoscopic applications for management of complications after reconstructive hip surgery. Case presentation An 80-year-old man complained of severe pain and paresthesias following acetabular component revision surgery. Physical findings included right buttock pain with radiating pain to lower extremity. Radiographs and computed tomography imaging showed that the sharp end of protruded screw invaded greater sciatic foramen anterior to posterior and distal to proximal direction at sciatic notch level. A protruding tip of the acetabular screw at the sciatic notch was decompressed by use of techniques gained from experience performing endoscopic sciatic nerve decompression. The pre-operative pain and paresthesias resolved post-operatively after recovering from anesthesia. Conclusions This case report describes the first documented endoscopic resection of the tip of the acetabular screw irritating sciatic nerve after total hip arthroplasty. If endoscopic resection of an offending acetabular screw can be performed in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in several complications management after total hip arthroplasty. Electronic supplementary material The online version of this article (10.1186/s12891-018-2091-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sun-Jung Yoon
- Department of Orthopedic Surgery, Research Institute of clinical medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, 54907 Gunji-Ro 20, Dukjin-Gu, Chonbuk, Jeonju, South Korea.
| | - Myung-Sik Park
- Department of Orthopedic Surgery, Research Institute of clinical medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, 54907 Gunji-Ro 20, Dukjin-Gu, Chonbuk, Jeonju, South Korea
| | | | - Yun Ho Choi
- Department of Anatomy, Medical School, Institute for Medical Sciences, Chonbuk National University, Jeonju, 561-180, South Korea
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Hasija R, Kelly JJ, Shah NV, Newman JM, Chan JJ, Robinson J, Maheshwari AV. Nerve injuries associated with total hip arthroplasty. J Clin Orthop Trauma 2018; 9:81-86. [PMID: 29628688 PMCID: PMC5884042 DOI: 10.1016/j.jcot.2017.10.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 10/21/2017] [Accepted: 10/26/2017] [Indexed: 02/01/2023] Open
Abstract
Nerve injury is a relatively rare, yet potentially devastating complication of total hip arthroplasty (THA). Incidence of this ranges from 0.6 to 3.7%, and is highest in patients with developmental hip dysplasia and previous hip surgery. Apart from patient and surgeon dissatisfaction, this complication can have medico-legal consequences. Therefore, the purpose of this study was to review the risk factors, etiology, diagnostic options, management strategies, prognosis, and prevention measures of nerve injuries associated with THA. We specifically evaluated the: 1) sciatic nerve; 2) femoral nerve; 3) obturator nerve; 4) superior gluteal nerve; and 5) the lateral femoral cutaneous nerve.
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Affiliation(s)
- Rohit Hasija
- Department of Orthopaedic Surgery, Elmhurst Hospital, New York, United States
| | - John J. Kelly
- St. George’s University School of Medicine, West Indies, Grenada
| | - Neil V. Shah
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, United States
| | - Jared M. Newman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, United States
| | - Jimmy J. Chan
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Jonathan Robinson
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Aditya V. Maheshwari
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, United States,Corresponding author at: Adult Reconstruction and Musculoskeletal Oncology Divisions, SUNY Downstate Medical Center, 450 Clarkson Ave Box 30, Brooklyn, New York 11203, United States.
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