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Panda AK, Basu B. Functionalized Fluoropolymer-Compatibilized Elastomeric Bilayer Composites for Osteochondral Repair: Unraveling the Role of Substrate Stiffness and Functionalities. ACS APPLIED BIO MATERIALS 2021; 4:8543-8558. [PMID: 35005914 DOI: 10.1021/acsabm.1c01021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The osteochondral lesions and osteoarthritis-related complications continue to be clinically relevant challenges to be addressed by the biomaterials community. Hydrogel-based scaffolds have been widely investigated to enhance osteochondral regeneration, but the inferior mechanical properties together with poor functional stability are the major constraints in their clinical translation. The development of osteochondral implants with natural tissue-mimicking mechanical properties remains largely unexplored. In this perspective, the present study demonstrates a strategy to develop a bilayer osteochondral implant with an elastically stiff composite (poly(vinylidene difluoride)-reinforced BaTiO3, PVDF/BT) and elastically compliant composite (maleic anhydride-functionalized PVDF/thermoplastic polyurethane/BaTiO3, m-PVDF/TPU/BT). The compositional variation in polymer composites allowed the elastic modulus of the hybrid bilayer construct to vary from ∼2 GPa to ∼90 MPa, which enabled a better understanding of the substrate-stiffness-dependent cellular behavior and maturation of preosteoblasts and chondrocytes. The cellular functionalities on PVDF-based polymer matrices have been benchmarked against ultrahigh-molecular-weight polyethylene (UHMWPE), which is clinically used for a wide spectrum of orthopedic applications. The increased alkaline phosphatase (ALP) activity, collagen synthesis, and matrix mineralization confirmed the early differentiation of preosteoblasts on the PVDF/BT matrix with subchondral bone-like mechanical properties. On the contrary, the upregulated chondrogenic functionalities were recorded on m-PVDF/TPU/BT with an elevated level of collagen content, glycosaminoglycans, and proteoglycans. Emphasis has been laid on probing the regulation of the osteochondral behavior using tailored substrate stiffness and functionalities using compatibilized fluoropolymer-based elastomeric composites. Taken together, the results of this work conclusively establish the efficacy of the hybrid bilayer composite with natural tissue-mimicking mechanical properties for the functional repair of osteochondral defects.
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Affiliation(s)
- Asish Kumar Panda
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, Bangalore 560012, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bangalore, Bangalore 560012, India.,Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, Bangalore 560012, India
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2
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Yaari LS, Kadar A, Shemesh S, Haviv B, Leslie MP. Medium-term outcome and classification of traumatic anterior hip dislocations. Hip Int 2021; 31:812-819. [PMID: 32468868 DOI: 10.1177/1120700020918868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Traumatic anterior hip dislocations are subdivided to obturator (inferior) and pubic (superior) dislocations by Epstein's descriptive classification. This rare injury is thought to have favourable clinical outcomes. The incidence of associated femoral head and acetabular injuries has been low in past case series. We sought to revisit this injury and classification in the era of advanced imaging and contemporary surgical techniques. MATERIALS AND METHODS A retrospective study of 15 patients treated for anterior hip dislocation was performed. Medical records were reviewed for demographic and surgical data. Imaging studies were revisited to determine direction of dislocation and associated fractures. Patients were assessed for pain, hip function using the modified Harris Hip Score (mHHS), hip range of motion and radiographic changes. Mean follow-up time was 3 years. RESULTS Anterior dislocation occurred in an obturator (inferior), pubic (superior) or central direction. 9 patients had concomitant femoral head impaction and 7 patients suffered from acetabular fractures. 8 patients with an anterior hip dislocation underwent surgical treatment. This therapy, along with early range of motion and weight bearing, produced favourable clinical outcomes with 9 patients reporting no pain and an average mHHS of 83.8. 6 patients had heterotopic ossification at latest follow-up. CONCLUSIONS Traumatic anterior hip dislocation is commonly associated with femoral head impaction and acetabular injuries which should be addressed operatively when appropriate to produce favourable results. In this paper, we propose a revision to the commonly used descriptive classification system.
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Affiliation(s)
- Lee S Yaari
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Campus, Petah-Tikva, Israel.,Orthopaedic Surgery Department, Rabin Medical Center, Hasharon Campus, Petah-Tikva, Israel, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Assaf Kadar
- Orthopaedic Division, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University.,Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Shai Shemesh
- Orthopaedic Surgery Department, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Campus, Petah-Tikva, Israel.,Orthopaedic Surgery Department, Rabin Medical Center, Hasharon Campus, Petah-Tikva, Israel, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael P Leslie
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
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Steppacher SD, Sedlmayer R, Tannast M, Schmaranzer F, Siebenrock KA. Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis. Hip Int 2020; 30:398-406. [PMID: 31204506 DOI: 10.1177/1120700019856010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
QUESTIONS Does surgical hip dislocation with drilling or bone grafting, cartilage treatment and femoral osteotomy in avascular necrosis of the femoral head (AVN) result in: (1) progression of osteonecrosis or osteoarthritis; (2) pain relief and improved function; and (3) subsequent surgery and complications? METHODS We retrospectively reviewed 12 patients (13 hips, mean age 29 ± 9 years) undergoing surgical hip dislocation for AVN. Preoperative ARCO stages were: 1 hip ARCO II, 8 hips ARCO III early, 4 hips ARCO III late. Drilling was performed in 4 hips, 9 hips underwent curettage, drilling and autologous bone grafting. Cartilage was sutured in 5 hips, autologous matrix-induced chondrogenesis was performed in 3 hips, an osteochondral autograft was used in 1 hip. Femoral osteotomy was performed in 10 hips. Mean follow-up was 3 ± 2 years. Progression of AVN and osteoarthritis was assessed preoperatively and at latest follow-up using Tönnis and ARCO staging. Pain and function were assessed with the Merle d'Aubigné-Postel score. Complications were graded according to Sink et al. RESULTS 1 hip had AVN progression and converted to THA. 9 hips showed no AVN- or advanced osteoarthritis progression and 3 hips improved at least 1 ARCO stage. The Merle d'Aubigné-Postel score increased from preoperatively 14.1 ± 3.2 to 16.6 ± 1.2 (p = 0.012). Subsequent surgery were performed in 3 hips, complications occurred in 3 hips. CONCLUSION Although the first results are promising a longer follow-up with more patients is needed to draw a definite conclusion regarding the joint preserving potential in AVN.
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Affiliation(s)
- Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
| | - Raphael Sedlmayer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland
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Hanke MS, Keel MJB, Cullmann JL, Siebenrock KA, Bastian JD. Transfer of osteochondral shell autografts to salvage femoral head impaction injuries in hip trauma patients. Injury 2020; 51:711-718. [PMID: 32033805 DOI: 10.1016/j.injury.2020.01.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Femoral head impaction defects are observed with variable severity, as a result of traumatic hip dislocations which can be caused by traffic accidents or seen in professional athletes amongst other mechanisms. Compression of the articular cartilage and the subchondral bone into the femoral head results in irregular articular surfaces influencing the outcome with predisposition to osteoarthritis, and being predictive for the need for delayed total hip replacement. This study reports the outcome after a minimum follow-up (FU) of five years in a consecutive series treated with transfer of osteochondral shell autografts in hips (TOSAH) from the head-neck junction into the defect using surgical hip dislocation. PATIENTS AND METHODS Between 06/2007 and 03/2014 a series of twelve consecutive patients (mean age: 35yrs, range 18-53; median Injury Severity Score: 12, range 9-27) sustained a traumatic posterior hip dislocation in combination with acetabular and/or Pipkin fractures and were inter alia treated using TOSAH using surgical hip dislocation. Conversion to total hip replacement (THR) during FU was noted as failure. Patients were clinically (Merle d'Aubigné score) and radiographically assessed for occurrence of osteoarthritis (OA), avascular necrosis (AVN) and/or heterotopic ossification (HO) at a minimal follow-up of five years. RESULTS Mean follow-up was 6.9 years (5.0-11.6). At five-year follow-up, we found a survivorship of 57.1% (95% Confidence interval {CI}, 46.7-100%). Four patients required conversion to a total hip replacement at 11, 16, 28 and 44 months respectively after the TOSAH procedure due to osteoarthritis progression. One patient required conversion to a total hip replacement 12 months after TOSAH procedure due to AVN. One patient was lost to follow-up after 2.7 years. The remaining six patients with preserved hips presented with a median Merle-d'Aubigné score of 16 points (range: 14-18) and no AVN. Two patients showed asymptomatic grade I osteoarthritis according to Tönnis at latest follow-up and three patients showed mild asymptomatic HO according to Brooker (Grade I-II). CONCLUSION The presented technique can be used as a salvage procedure for severely injured hip joints and to preserve the hip joint at midterm with satisfying clinical and radiological outcomes.
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Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Marius J B Keel
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland; Trauma Center Hirslanden, Klinik Hirslanden Zürich, Witellikerstrasse 40, 8032 Zürich, Switzerland
| | - Jennifer L Cullmann
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes D Bastian
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland.
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Dallich AA, Rath E, Atzmon R, Radparvar JR, Fontana A, Sharfman Z, Amar E. Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities. J Hip Preserv Surg 2019; 6:3-15. [PMID: 31069090 PMCID: PMC6501440 DOI: 10.1093/jhps/hnz002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/13/2018] [Accepted: 02/03/2019] [Indexed: 12/20/2022] Open
Abstract
The diagnosis and treatment of chondral lesions in the hip is an ongoing challenge in orthopedics. Chondral lesions are common and several classification systems exist to classify them based on severity, location, radiographic parameters, and potential treatment options. When working up a patient with a potential hip chondral lesion, a complete history, thorough physical exam, and ancillary imaging are necessary. The physical exam is performed with the patient in standing, supine, prone, and lateral positions. Plain film radiographs are indicated as the first line of imaging; however, magnetic resonance arthrogram is currently the gold standard modality for the diagnosis of chondral lesions outside of diagnostic arthroscopy. Multiple treatment modalities to address chondral lesions in the hip exist and new treatment modalities continue to be developed. Currently, chondroplasty, microfracture, cartilage transplants (osteochondral autograft transfer, mosaicplasty, Osteochondral allograft transplantation) and incorporation of orthobiologics (Autologous chondrocyte implantation, Autologous matrix-induced chondrogenesis, Mononuclear concentrate in platelet-rich plasma) are some techniques that have been successfully applied to address chondral pathology in the hip. Further refinement of these modalities and research in novel techniques continues to advance a surgeon’s ability to address chondral lesions in the hip joint.
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Affiliation(s)
- Alison A Dallich
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Atzmon
- Department of Orthopedics, Assuta Medical Center, Ashdod, Israel
| | - Joshua R Radparvar
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrea Fontana
- Orthopaedics Department, C.O.F. Lanzo Hospital, Como, Italy in association with the Orthopaedics Department, University of Pavia, Pavia, Italy
| | - Zachary Sharfman
- Department of Orthopedic Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, USA
| | - Eyal Amar
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Siebenrock KA, Keel MJB, Tannast M, Bastian JD. Surgical Hip Dislocation for Exposure of the Posterior Column. JBJS Essent Surg Tech 2019; 9:e2. [PMID: 31086720 DOI: 10.2106/jbjs.st.18.00048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Surgical hip dislocation is performed for safe and efficient management of acetabular fractures predominantly involving the posterior column. The dislocation of the femoral head allows for direct visualization of the hip joint during fracture treatment. Description The patient is placed in the lateral decubitus position with sterile preparation and draping of the ipsilateral leg to allow for dislocation. The skin incision is straight and centered over the greater trochanter. After the skin incision, the interval between the gluteus maximus and medius muscles is developed. The sciatic nerve is identified, and special attention to the course of the medial circumflex femoral artery is given during dissection of the piriformis and triceps coxae muscles (obturator internus and superior and inferior gemelli muscles). The latter are incised 2 cm posterior to their insertion on the posterior aspect of the greater trochanter. The vastus lateralis muscle belly is elevated from the lateral femoral shaft, and a trochanteric osteotomy is performed. The trochanteric medallion is rotated 90°, and the gluteus minimus muscle is released from the capsule. After complete exposure of the hip capsule, a z-shaped capsulotomy is performed whereby any injury to the posterior capsular attachments of a posterior wall fragment is avoided. The posterior column and the greater and lesser sciatic notches are exposed, with the sciatic nerve under protection. The femoral head is dislocated either anteriorly or posteriorly to obtain direct visualization of the hip. Reduction begins at the articular surface, in cases of marginal impaction, and proceeds to the posterior wall and/or posterior column and the anterior column, when involved. For fixation, 3.5-mm cortical screws acting as positioning or lag screws and reconstruction plates are used. The capsule is sutured, the trochanteric fragment is reduced anatomically and stabilized with two 3.5-mm cortical screws, the piriformis and triceps coxae muscles are sutured, and a layered closure is performed. Alternatives The Kocher-Langenbeck approach might be used instead. Rationale Surgical hip dislocation facilitates assessment of cartilage damage at the acetabulum, marginal impaction, labral tears and femoral head lesions, removal or reinsertion of free intra-articular fracture fragments, direct visualization of the accuracy of reduction, and verification of extra-articular screw placement.
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Affiliation(s)
- Klaus-Arno Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marius J B Keel
- Department of Orthopaedic and Trauma Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Trauma Center Hirslanden, Clinic Hirslanden, Zürich, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic and Trauma Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes D Bastian
- Department of Orthopaedic and Trauma Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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7
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Arora V, Navarre P, Russ M, Esser M. Use of the HemiCAP partial hip resurfacing technique for traumatic femoral head osteochondral defects following obturator hip dislocations. SICOT J 2018; 4:3. [PMID: 29469803 PMCID: PMC5822937 DOI: 10.1051/sicotj/2017059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/28/2017] [Indexed: 11/14/2022] Open
Abstract
Fracture of the femoral head (OTA 31-C1.3) following anterior obturator dislocations are a challenging problem as the fractures are often communited, impacted and with loose osteochondral fragments, making surgical fixation difficult. This can result in residual articular defects if the fragments cannot be internally fixed and need be excised, predisposing to secondary osteoarthritis. Treatment options for these defects are limited, have variable results and with limited literature to guide us on outcomes due to the rarity of these injuries. Here, we describe the first use of the technique of partial femoral head resurfacing in two patients with such fractures and report on their long term outcomes.
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Affiliation(s)
- Varun Arora
- Department of Orthopaedics, Alfred Hospital, Victoria, Australia
| | - Pierre Navarre
- Department of Orthopaedics, Alfred Hospital, Victoria, Australia
| | - Mathias Russ
- Department of Orthopaedics, Alfred Hospital, Victoria, Australia
| | - Max Esser
- Department of Orthopaedics, Alfred Hospital, Victoria, Australia
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8
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Johnson JD, Desy NM, Sierra RJ. Ipsilateral femoral head osteochondral transfers for osteochondral defects of the femoral head. J Hip Preserv Surg 2017; 4:231-239. [PMID: 28948035 PMCID: PMC5604093 DOI: 10.1093/jhps/hnx022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/03/2022] Open
Abstract
Osteochondral defects of the femoral head are rare. Several treatment options have been described, though there is currently no consensus on the appropriate management of these lesions. Five patients underwent femoral head osteochondral autograft transfer for treatment of ipsilateral femoral head osteochondral defects via surgical hip dislocation between 2011 and 2014 at our institution. The mean age of the patients was 24.8 (16–37) years. There were four females and one male. Mean follow-up was 53.8 (30–64) months. Four patients reported complete resolution of preoperative pain, return to baseline activities and were satisfied with their results. Harris hip scores improved from a mean 60.8 (30–87) to 86.6 (44–100). There was no radiographic evidence of progression of the femoral head defects. There were no operative complications. Osteochondral autograft transfer from the ipsilateral femoral head using a surgical hip dislocation demonstrated good clinical and radiographic outcomes at midterm follow-up in our cohort and may be considered a suitable option for management of these lesions in select patients. Further research and follow-up is warranted to more clearly define the indications and outcomes of this procedure.
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Affiliation(s)
- Joshua D Johnson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Nicholas M Desy
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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9
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Surgical hip dislocation for removal of retained intra-articular bullets. Injury 2016; 47:2218-2222. [PMID: 27375011 DOI: 10.1016/j.injury.2016.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/17/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical hip dislocation with trochanteric osteotomy was introduced for the treatment of femoroacetabular impingement and other intra-articular pathologies of the hip. We expanded the indications to include removal of retained bullets in the hip joint as an alternative to hip arthroscopy. PATIENTS AND METHODS We present a prospective case series of ten patients that were treated with a surgical hip dislocation for removal of retained bullets in the hip joint between January 2014 and October 2015 in a Level 1 trauma centre. The main outcome measurements were successful bullet removal, blood loss, surgical time and intraoperative complications. RESULTS There were 8 males and 2 females with a mean age of mean age 27.3 years (range 20-32). All patients had one whole retained bullet for removal (right side: 8; left side: 2). In all cases the bullet could be removed in its entirety. The average surgical time was 73min (range 55-125) and the average blood loss 255ml (range 200-420). CONCLUSIONS Surgical hip dislocation provides an unlimited view of the acetabulum and femoral head and neck and it therefore allows for easy removal of retained bullets. Osteocartilaginous lesions and concomitant fractures of the femoral head can be simultaneously evaluated and treated.
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10
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Horner NS, Ekhtiari S, Simunovic N, Bedi A, Glyn-Jones S, Ayeni OR. Early evidence reports positive outcomes after osteochondral grafts and chondrocyte transplantation in the hip: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Church DJ, Merrill HM, Kotwal S, Dubin JR. Novel Technique for Femoral Head Reconstruction using Allograft following Obturator Hip Dislocation. J Orthop Case Rep 2016; 6:48-51. [PMID: 27299126 PMCID: PMC4845411 DOI: 10.13107/jocr.2250-0685.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Obturator hip dislocations with an associated osteochondral fracture of the femoral head are uncommon. The treatment of these injuries is challenging and the functional outcomes are poor. Though the injury pattern has been described previously in literature, there are few published reports regarding treatment options. This case report illustrates a novel technique for fixation and stabilization for an unusual injury involving an obturator hip dislocation and an osteochondral impaction fracture of the femoral head. Case Presentation: A 30-years old African American male, involved in a motor vehicle collision, sustained an obturator dislocation of the left hip with a large posterior osteochondral fracture of the femoral head. An emergency closed reduction procedure was performed followed by a computed tomography (CT) scan of the hip joint which demonstrated a large osteochondral defect (25 x 10 mm, depth: 5 mm) of the femoral head, visualized within the weight-bearing area. Surgical intervention was planned as a fracture of the femoral head with a defect deeper than four millimeters has been shown to be a risk factor for the development of post-traumatic arthritis, often with onset of symptoms within 5 years of the date of injury. Following surgical hip dislocation, the defect of the femoral head was reconstructed with implantation of a femoral head allograft and internal fixation. At the six months follow-up, the patient could ambulate with minimal pain and without assistive devices. Radiographs demonstrated maintenance of articular congruity with no evidence of implant failure, post-traumatic arthritis or avascular necrosis. Conclusion: Surgical hip dislocation and reconstruction using femoral head allograft used to treat obturator hip dislocations with concomitant femoral head impaction fractures can lead to satisfactory short term functional outcomes.
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Affiliation(s)
- Dane J Church
- Department of Orthopaedics, University of Missouri-Kansas City. United States
| | - Haley M Merrill
- Department of Orthopaedics, University of Missouri-Kansas City. United States
| | - Suhel Kotwal
- Department of Orthopaedics, University of Missouri-Kansas City. United States
| | - Jonathan R Dubin
- Department of Orthopaedics, University of Missouri-Kansas City. United States
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13
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Fotopoulos VC, Mouzopoulos G, Floros T, Tzurbakis M. Steroid-induced femoral head osteonecrosis in immune thrombocytopenia treatment with osteochondral autograft transplantation. Knee Surg Sports Traumatol Arthrosc 2015; 23:2605-10. [PMID: 25173503 DOI: 10.1007/s00167-014-3239-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/11/2014] [Indexed: 01/17/2023]
Abstract
Osteonecrosis of the femoral head is a devastating complication of steroid administration and has rarely been observed in the treatment of immune thrombocytopenia. The treatment of osteochondral defects in advanced stages of avascular necrosis (AVN), characterized by collapse of the subchondral bone, remains an unsolved burden in orthopedic surgery. In this report, we present a case of a 19-year-old female that was admitted in the Emergency Department with walking disability and painful hip joint movement due to steroid-induced femoral head osteonecrosis. Two years before she was diagnosed with immune thrombocytopenia, for which she received pulse steroid therapy with high dose of dexamethasone and underwent a splenectomy. This case report is the first to describe the use of osteochondral autograft transplantation as a treatment of steroid-induced AVN of the femoral head due to immune thrombocytopenia at the age of 19 years with very good clinical and radiological results 3 years postoperatively.
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14
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Abstract
Surgical hip dislocation (SHD) is a versatile approach used to address both intra-articular and extra-articular pathology around the hip joint in both pediatric and adult patients. It allows anterior dislocation of the femoral head for direct visualization of the hip joint while preserving femoral head vascularity and minimizing trauma to the abductor musculature. Previously described indications for SHD include femoroacetabular impingement, deformity resulting from Legg-Calve-Perthes disease, slipped capital femoral epiphysis, periarticular trauma, benign lesions of the hip joint, and osteochondral lesions. In this review, we will describe current surgical techniques, indications, and clinical outcomes for SHD.
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Affiliation(s)
- Benjamin F Ricciardi
- Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, NY
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15
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Glynn AA, Barattiero FY, Albers CE, Hanke MS, Steppacher SD, Tannast M. Surgical hip dislocation does not result in atrophy or fatty infiltration of periarticular hip muscles. J Hip Preserv Surg 2014; 1:82-95. [PMID: 27011807 PMCID: PMC4765291 DOI: 10.1093/jhps/hnu008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/14/2014] [Accepted: 08/02/2014] [Indexed: 11/17/2022] Open
Abstract
Surgical hip dislocation is the gold standard for treatment of femoroacetabular impingement (FAI). It utilizes an intermuscular and internervous approach to the hip. Concerns have been expressed that this approach causes soft tissue trauma resulting in post-operative muscle weakness of patients undergoing this procedure. We therefore asked whether surgical hip dislocation leads to (i) atrophy (decreased muscle diameter or cross-sectional area [CSA]) and (ii) degeneration (fatty infiltration) of 18 evaluated periarticular hip muscles. We retrospectively evaluated 32 patients (34 hips) following surgical hip dislocation for the treatment of FAI using pre and post-operative magnetic resonance (MR) arthrography of the hip. We evaluated muscle diameter, CSA and degree of fatty infiltration according to Goutallier for 18 periarticular hip muscles on axial and sagittal views. The mean interval between pre and post-operative MR was 1.9 ± 1.5 years (range, 0.4–6.1 years). Pre and post-operative muscle diameter and CSA of all 18 evaluated hip muscles did not differ. There was no post-operative change in the Goutallier classification for any of the evaluated 18 muscles. No muscle had post-operative degeneration higher than Grade 1 according to Goutallier. No atrophy or degeneration of periarticular hip muscles could be found following surgical hip dislocation for treatment of FAI. Any raised concerns about the invasiveness and potential muscle trauma for this type of surgery are unfounded. Level III, retrospective comparative study. See guidelines for authors for a complete description of levels of evidence.
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Affiliation(s)
- Aaron A Glynn
- Department of Orthopaedic Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland and Department of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland
| | - Fabio Y Barattiero
- Department of Orthopaedic Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland and Department of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland
| | - Christoph E Albers
- Department of Orthopaedic Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland and Department of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland and Department of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland and Department of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, 3010 Bern, Switzerland and Department of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland
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Abstract
Posterior fracture dislocation of the femoral head is a rare entity usually requiring open reduction and internal fixation. Results of different fixation methods have been reported, including countersinking screws, headless screws, and bioabsorbable implants. Osteochondral autologous transfer (mosaicplasty) is an established method of treatment of full thickness cartilage defects of the knee, ankle, and elbow. At our institution, posterior fracture-dislocations of the femoral head were treated with femoral head fragment fixation using osteochondral autografts through surgical hip dislocation. Osteochondral plugs were harvested from the non-weight-bearing area of the lateral femoral condyle of the knee and used for fixation of the reduced fragment. This article details the technique and its application.
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Cetinkaya S, Toker B, Taser O. Arthroscopic retrograde osteochondral autologous transplantation to chondral lesion in femoral head. Orthopedics 2014; 37:e600-4. [PMID: 24972445 DOI: 10.3928/01477447-20140528-64] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/03/2013] [Indexed: 02/03/2023]
Abstract
This report describes the treatment of 2 cases of full-thickness cartilage defect of the femoral head. The authors performed osteochondral autologous transplantation with a different technique that has not been reported to date. One patient was 37 years old, and the other was 42 years old. Both presented with hip pain. In both patients, radiograph and magnetic resonance imaging scan showed a focal chondral defect on the weight-bearing area of the femoral head and acetabular impingement. A retrograde osteochondral autologous transplantation technique combined with hip arthroscopy and arthroscopic impingement treatment was performed. After a 2-month recovery period, the symptoms were resolved. In the first year of follow-up, Harris Hip scores improved significantly (case 1, 56.6 to 87.6; case 2, 58.6 to 90). The technique described yielded good short- and midterm clinical and radiologic outcomes. To the authors' knowledge, this report is the first to describe a retrograde osteochondral transplantation technique performed with hip arthroscopy in the femoral head.
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Leunig M, Tibor LM, Naal FD, Ganz R, Steinwachs MR. Surgical technique: Second-generation bone marrow stimulation via surgical dislocation to treat hip cartilage lesions. Clin Orthop Relat Res 2012; 470:3421-31. [PMID: 22773396 PMCID: PMC3492623 DOI: 10.1007/s11999-012-2466-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to knees, hips have more bony constraint and soft tissue coverage. Thus, repair of focal cartilage defects in hips requires more invasive and technically complex surgeries than simple arthroscopy or arthrotomy. Autologous matrix-induced chondrogenesis (AMIC) is a second-generation bone marrow stimulation technique. Improvement in Tegner, Lysholm, International Cartilage Repair Society (ICRS), and Cincinnati scores has been reported at 1 and 2 years after AMIC in knees. AMIC is potentially useful to repair defects in hips, but it is unknown whether it relieves symptoms or results in a durable construct. DESCRIPTION OF TECHNIQUE A surgical hip dislocation is used to access the defect. This is débrided to stable cartilage shoulders, necrotic bone is removed, and the lesion base is drilled. Autogenous bone graft is used for lesions with bony defects to create a level surface. Fibrin gel and a collagen membrane are placed to stabilize the superclot for fibrocartilage formation. METHODS We treated six patients with AMIC in the hip between 2009 and 2010. We obtained Oxford Hip and UCLA Activity Scores. Repair quality was assessed on 6-month postoperative MRI using the modified magnetic resonance observation of cartilage repair tissue (MOCART) system. Minimum 1-year followup data were available for four patients (range, 1-2.5 years). RESULTS Postoperative Oxford Hip Scores ranged from 13 to 17, UCLA Activity Scores ranged from 5 to 10, and MOCART scores ranged from 55 to 75. No complications occurred. CONCLUSIONS We describe AMIC in the hip. Although these patients had pain relief and improved function, long-term followup is necessary to assess the duration of improvement, durability of repair, and potential for arthrosis. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland ,University of Bern, Bern, Switzerland
| | - Lisa M. Tibor
- Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland
| | - Florian D. Naal
- Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland
| | | | - Matthias R. Steinwachs
- Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland ,University of Freiburg, Freiburg, Germany
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Keel MJB, Ecker TM, Siebenrock KA, Bastian JD. Rationales for the Bernese approaches in acetabular surgery. Eur J Trauma Emerg Surg 2012; 38:489-98. [PMID: 23162669 PMCID: PMC3495274 DOI: 10.1007/s00068-012-0229-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 09/11/2012] [Indexed: 11/30/2022]
Abstract
Purpose To present two new approaches to acetabular surgery that were established in Berne, and which aim at enhanced visualization and anatomical reconstruction of acetabular fractures. Method The trochanteric flip osteotomy allows for surgical hip dislocation, and was introduced as a posterior approach for acetabular fracture management involving the posterior column and wall. For acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach is described. Results Full exposure of the hip joint, as provided by the trochanteric flip osteotomy, facilitates anatomical reduction of acetabular or femoral head fractures and safe positioning of the anterior column screw in transverse or T-shaped fractures. Additionally, the approach enables osteochondral transplantation as a salvage procedure for severe chondral femoral head damage and osteoplasty of an associated inadequate offset at the femoral head–neck junction. The Pararectus approach allows anatomical restoration with minimal access morbidity, and combines advantages of the ilioinguinal and modified Stoppa approaches. Conclusions Utilization of the trochanteric flip osteotomy eases visualization of the superior aspect of the acetabulum, and enables the evaluation and treatment of chondral lesions of the femoral head or acetabulum and labral tears. Displaced fractures of the anterior column with a medialized quadrilateral plate can be addressed successfully through the Pararectus approach, in which surgical access is associated with minimal morbidity. However, long-term results following the two presented Bernese approaches are needed to confirm that in the treatment of complex acetabular fractures the rate of poor results in almost one-third of all cases (as currently yielded using traditional approaches) might be reduced by the utilization of the presented novel approaches.
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Affiliation(s)
- M J B Keel
- Department of Orthopedic and Trauma Surgery, University Hospital Bern Inselspital, Freiburgstrasse 3, Bern, Switzerland
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Bastian JD, Turina M, Siebenrock KA, Keel MJB. Long-term outcome after traumatic anterior dislocation of the hip. Arch Orthop Trauma Surg 2011; 131:1273-8. [PMID: 21424612 DOI: 10.1007/s00402-011-1299-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Traumatic anterior dislocation of the hip joint is rare. Additional injuries to the hip due to dislocation are even more infrequent. Outcome is limited by osteoarthritic joint degeneration or the occurrence of avascular necrosis of the femoral head. METHOD Anterior hip dislocation occurred in ten of 100 patients with traumatic hip dislocations (8 men, mean age: 43, 22-62years) at two major trauma centres, between January 2001 and December 2008. Four patients had impaction fractures of the femoral head and three patients had fractures of the anterior acetabular wall. One patient presented with an open dislocation. In three of the ten patients surgical treatment was necessary. RESULTS Nine patients were evaluated retrospectively at a follow-up of 4.8 ± 2.3 years (mean ± SD). The mean scores were 88 ± 19 (Harris Hip-Score), 15 ± 23 (WOMAC-Score), level 6 (UCLA-Score). Four cases presented with only fair clinical or radiological results according to Epstein. AVN with collapse of the femoral head was observed in one. CONCLUSION Traumatic anterior hip dislocations presented in six of the ten cases with additional injuries to the hip. Surgical treatment in cases with deep impaction fractures of the femoral head or with large fragments of the acetabulum may improve the outcome.
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Krych AJ, Lorich DG, Kelly BT. Treatment of focal osteochondral defects of the acetabulum with osteochondral allograft transplantation. Orthopedics 2011; 34:e307-11. [PMID: 21717995 DOI: 10.3928/01477447-20110526-24] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To our knowledge, treatment of focal osteochondral defects of the acetabulum with osteochondral allograft transplantation has not been described. As with osteochondral lesions of other weight-bearing surfaces, these defects may lead to disabling pain and early degenerative changes. In older patients who fail nonoperative treatment, hip arthroplasty is a reliable option to obtain pain relief and restore function. However, in young and active patients, it may be advantageous to restore joint congruity biologically. The clinical success of osteochondral allograft transplantation in the femoral condyles has been well-documented, with over 25 years of experience. We propose similar treatment principles in the hip joint.This article presents the cases of a 24-year-old woman (patient 1) and a 32-year-old man (patient 2) with hip pain and dysfunction secondary to a focal osteochondral defect of the acetabulum. Both were treated with osteochondral allograft transplantation to the defect using a dowel technique. A magnetic resonance image at 18 months in both cases demonstrated incorporation of the allograft bone into the host acetabulum. At 24 months in patient 1 and 42 months in patient 2, radiographs showed no progressive osteoarthritis. Both patients' Hip Outcome Scores were 100 points each.Osteochondral allografts allow large areas to be resurfaced without donor site morbidity, and these grafts provide an immediate functional joint surface. Although it has not been proven in terms of long-term follow-up, we believe that osteochondral allograft transplantation for focal osteochondral defects of the acetabulum in young, active patients is a feasible option to restore joint congruity.
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Affiliation(s)
- Aaron J Krych
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA.
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