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Sanz Ruiz P, Caeiro Rey JR, Martínez Pastor JC, Martín Alguacil JL, Murcia Asensio A, Moreta Suárez J. Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:97-107. [PMID: 36934806 DOI: 10.1016/j.recot.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. METHOD an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.
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Affiliation(s)
- P Sanz Ruiz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - J R Caeiro Rey
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - J C Martínez Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - J L Martín Alguacil
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas de Granada, Granada, España
| | - A Murcia Asensio
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Reina Sofía, Murcia, España
| | - J Moreta Suárez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Galdakao-Usansolo, Bizkaia, España
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Sanz Ruiz P, Caeiro Rey JR, Martínez Pastor JC, Martín Alguacil JL, Murcia Asensio A, Moreta Suárez J. [Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T97-T107. [PMID: 37992859 DOI: 10.1016/j.recot.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/11/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVE In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. MATERIAL AND METHOD An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. RESULTS A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). CONCLUSIONS There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.
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Affiliation(s)
- P Sanz Ruiz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - J R Caeiro Rey
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - J C Martínez Pastor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J L Martín Alguacil
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas de Granada, Granada, Spain
| | - A Murcia Asensio
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - J Moreta Suárez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Galdakao-Usansolo, Bizkaia, Spain
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Yassin M, Gupta V, Ramoutar D, Hunter T. Tönnis angle and acetabular depth ratio: predictors of dislocation following hemiarthroplasty for hip fracture. Hip Int 2023; 33:958-963. [PMID: 36536490 DOI: 10.1177/11207000221142298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite efforts to mitigate possible modifiable risk factors, dislocations following hemiarthroplasty for hip fracture still occur, with reported incidence rates ranging from 1.5 to 11%. The aim of this study was to investigate whether acetabular dysplasia is a significant contributing factor to dislocation, and since non-modifiable, whether it should affect patient selection for this treatment option. METHODS This is a multicentre nested case-control study of patients treated at 2 separate centres over a 10-year period from January 2011 to December 2020. All cases of hemiarthroplasty dislocation following hip fracture were identified from local databases, and 4 random controls were selected for every case. Tönnis angle (TA) and Acetabular-depth-ratio (ADR) was measured on the injured side using AP pelvis radiographs. Patients with TA > 10° and/or ADR < 250 were considered to have abnormal acetabular morphology. RESULTS 35 cases of dislocation were identified and 140 random controls were selected. Cases of dislocation had a larger mean TA (8.8° vs. 5.5°, p < 0.001) and lower mean ADR (254 vs. 289, p < 0.001) than controls. 20 out of 35 (57%) cases were considered to have abnormal acetabular morphology, compared to 19 out of 140 (14%) controls. The odds of dislocation is 8.5 times greater (odds ratio = 8.49, 95%CI = 3.73, 19.39) in patients with abnormal TA and/or ADR. CONCLUSIONS This study demonstrates that TA > 10° and ADR < 250 are useful criteria to identify patients at greater risk of hip hemiarthroplasty dislocation due to acetabular dysplasia. Special consideration to preoperative planning should be taken in these patients. Future research should focus on methods to minimise risk in this subset of patients, including evaluating total hip arthroplasty with dual mobility component vs hemiarthroplasty.
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Affiliation(s)
- Mohamed Yassin
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham, UK
| | - Vatsal Gupta
- Department of Trauma and Orthopaedics, University Hospital of Coventry & Warwickshire, Coventry, UK
| | - Darryl Ramoutar
- Department of Trauma and Orthopaedics, University Hospital of Coventry & Warwickshire, Coventry, UK
| | - Thomas Hunter
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham, UK
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Domingue G, Warren D, Koval KJ, Riehl JT. Complications of Hip Hemiarthroplasty. Orthopedics 2023; 46:e199-e209. [PMID: 36719411 DOI: 10.3928/01477447-20230125-06] [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: 02/01/2023]
Abstract
Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is frequently successful in addressing these injuries, complications can occur. Commonly seen complications include dislocation, periprosthetic fracture, acetabular erosion, and leg-length inequality. Less frequently seen complications include neurovascular injury and capsular interposition. This article presents a comprehensive review of the complications associated with the management of hip hemiarthroplasty. [Orthopedics. 2023;46(4):e199-e209.].
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Ruan C, Kouediatouka AN, Liu Q, Dong G. A sustained release lubrication method of agarose-sodium hyaluronate hydrogels for artificial joint. J Biomater Appl 2023:8853282231186680. [PMID: 37385593 DOI: 10.1177/08853282231186680] [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: 07/01/2023]
Abstract
The artificial joint prosthesis's surface is subjected to wear due to the destruction of the joint lubrication environment after surgery. In this study, an agarose-sodium hyaluronate hydrogel was used as lubricant additive in order to supply and preserve the lubricating fluid of artificial joint prostheses. A ball on disc experiment was conducted using this hydrogel to evaluate the lubrication efficiency and release rate under various frequencies. The results showed that this hydrogel could release lubricant under pressure and then absorb the released fluid after decompression. Furthermore, the agarose-sodium hyaluronate hydrogel acted as an effective transport mechanism to release sodium hyaluronate lubricant into the metal-on-polymer friction interface. Compared with pure water lubrication, the friction coefficient and wear volume were reduced by up to 62.9%, and 86.9% respectively. Moreover, the proposed lubrication method provided a long-term lubrication on artificial hip joints.
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Affiliation(s)
- Chunbiao Ruan
- Key Laboratory of Education Ministry for Modern Design and Rotor-Bearing System, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Ange Nsilani Kouediatouka
- Key Laboratory of Education Ministry for Modern Design and Rotor-Bearing System, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Qi Liu
- Key Laboratory of Education Ministry for Modern Design and Rotor-Bearing System, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Guangneng Dong
- Key Laboratory of Education Ministry for Modern Design and Rotor-Bearing System, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China
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Fede C, Porzionato A, Petrelli L, Fan C, Pirri C, Biz C, De Caro R, Stecco C. Fascia and soft tissues innervation in the human hip and their possible role in post-surgical pain. J Orthop Res 2020; 38:1646-1654. [PMID: 32181900 DOI: 10.1002/jor.24665] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 02/04/2023]
Abstract
Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, deep fascia, muscles, capsule, capsule ligament, ligamentum teres, and tendon in the human hip from 11 patients and 2 cadavers were quantified by staining with anti-S100 antibody for myelin-forming Schwann cells, to obtain the percentage of antibody positivity, density and mean diameter of the nerve fibers. The skin was the most highly innervated (0.73% ± 0.37% of positive area in patients; 0.80% ± 0.28% in cadavers); the tendon was the least innervated (0.07% ± 0.01% in patients, 0.07% ± 0.007% in cadavers). The muscles (vasto-lateral and gluteus medius) were the second most innervated structure according the percentage (0.31% ± 0.13% in living humans, 0.30% ± 0.07% in cadavers), but with only a few nerves, with large diameters (mean diameter 36.4 ± 13.4 µm). Instead, the superficial fasciae showed 0.22% ± 0.06% and 0.26% ± 0.05% of positive areas in living humans and cadavers, respectively. Fasciae were invaded by networks of small nerve fibers, revealing a possible role in pain. The superficial fascia was the second most highly innervated tissue after the skin, with a density of 33.0 ± 2.5/cm2 , and a mean nerve sizes of 19.1 ± 7.2 µm. Lastly, the capsule turned out to be poorly innervated (0.09%), showing that its removal does not necessarily lead to painful consequences. Statement of clinical significance: Deeper knowledge about the innervation of the soft tissue in the human hip joint will enhance study and understanding of the best surgical procedures to follow during hip arthroplasty to reduce post-operative pain.
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Affiliation(s)
- Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Carlo Biz
- Department of Surgery, Oncology and Gastroenterology, Orthopedic Clinic, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
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McLawhorn AS, Christ AB, Morgenstern R, Burge AJ, Alexiades MM, Su EP. Prospective Evaluation of the Posterior Tissue Envelope and Anterior Capsule After Anterior Total Hip Arthroplasty. J Arthroplasty 2020; 35:767-773. [PMID: 31679976 DOI: 10.1016/j.arth.2019.09.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Femoral exposure for direct anterior approach (DAA) total hip arthroplasty (THA) invariably requires posterior soft tissue releases. Released posterior structures cannot be repaired. The purpose of this study is to describe the frequency and anatomic consequences of DAA THA posterior soft tissue releases and to compare the appearance of the anterior capsule between a group of patients who had capsulotomy and repair versus capsulectomy. METHODS Thirty-two DAA THA patients underwent metal artifact reduction sequence magnetic resonance imaging at discharge and 1-year follow-up. Seventeen had underwent capsulotomy and repair and 15 capsulectomy. A radiologist blinded to intraoperative data scored each metal artifact reduction sequence magnetic resonance imaging. Anterior capsular integrity, status of the piriformis and conjoint tendons, and muscle atrophy were graded. Descriptive statistics were performed to analyze results. RESULTS Immediately postoperatively, 75% of piriformis tendons were intact and 38% of conjoined tendons were intact. At 1 year, 97% had an intact piriformis and conjoined tendon, although many were in continuity through scar with the capsule. The posterior capsule directly contacted bone in all patients. At 1 year, none of the patients who underwent capsulotomy with repair had persistent anterior capsule defects, while 27% in the capsulectomy group had persistent defects. CONCLUSION Posterior capsule and conjoined tendon releases were commonly performed during DAA THA, yet continuity with bone was frequently achieved at 1 year. In this study, capsulotomy with repair resulted in no anterior capsular defects when compared with capsulectomy. These results may support improved THA stability observed after DAA with capsular repair despite posterior soft tissue releases. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Michael M Alexiades
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Edwin P Su
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Jones C, Briffa N, Jacob J, Hargrove R. The Dislocated Hip Hemiarthroplasty: Current Concepts of Etiological factors and Management. Open Orthop J 2017; 11:1200-1212. [PMID: 29290857 PMCID: PMC5721319 DOI: 10.2174/1874325001711011200] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Hip hemiarthroplasty (HA) following an intracapsular neck of femur fracture is an increasingly common procedure as a result of an ageing population. Patients are often frail and so morbidity and mortality figures are significant. As a result the National Institute for Health and Clinical Excellence (NICE) has formulated guidelines and a Best Practice Tariff (BPT) in an attempt to improve the care of such patients. Dislocation following HA is a potentially devastating complication with a reported incidence ranging from 1 to 15%. Multiple causative factors have been cited and studied in an effort to reduce the incidence of this complication which has a high rate of recurrence following the first episode and is associated with a high mortality rate and significant financial burden on the health economy. This paper reviews the available literature in an effort to identify the most pertinent factors affecting dislocation rates and thus reduce the incidence of this serious complication. Methods: A comprehensive review of the literature was performed using the search engine PubMed with the keywords ‘hip’, ‘hemiarthroplasty’ and ‘dislocation’. Two hundred and forty three articles were identified and assessed by the 3 authors independently. Data from fifty-two articles pertinent to the review on hemiarthroplasty dislocation epidemiology, risk factors and management were extracted in a standardised fashion. Results: Following review of the papers multiple causative factors relating to HA dislocation were identified and grouped into 4 broad categories for analysis. The factors with the strongest correlation with dislocation included patient cognition, previous failed surgery, delay to surgery, surgical approach and femoral offset. Conclusion: Hip hemiarthroplasty remains the gold standard for elderly patients with intracapsular neck of femur fractures. In each individual case the factors most strongly associated with postoperative dislocation should be recognised. Delays to surgery should be minimised and the posterior approach avoided. In addition to good surgical technique, particular attention should be paid to restoring the patient’s native femoral offset and post operatively those with cognitive impairment should be closely monitored.
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Affiliation(s)
- Carl Jones
- SpR in Trauma and Orthopaedics Waikato Hospital, Pembroke Street, Hamilton, New Zealand
| | - Nikolai Briffa
- Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, United Kingdom St Georges Hospital, Blackshaw Road, Tooting, SW17 0QT, London, UK
| | - Joshua Jacob
- SpR in Trauma and Orthopaedics Waikato Hospital, Pembroke Street, Hamilton, New Zealand
| | - Richard Hargrove
- SpR in Trauma and Orthopaedics Waikato Hospital, Pembroke Street, Hamilton, New Zealand
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9
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Kunkel ST, Sabatino MJ, Kang R, Jevsevar DS, Moschetti WE. A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:217-232. [PMID: 28852880 DOI: 10.1007/s00590-017-2033-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND We performed a systematic review and meta-analysis to assess whether the direct anterior approach (DAA) is associated with improved functional and clinical outcomes compared to other surgical approaches for hemiarthroplasty for displaced femoral neck fractures. MATERIALS AND METHODS Randomized trials and cohort studies of hemiarthroplasty performed via DAA versus another surgical approach (anterolateral, lateral, posterolateral, posterior) were included. Our primary outcome was postoperative functional mobility. Secondary outcomes included overall complication rate, dislocation rate, perioperative fracture, infection rate, re-operation rate, overall mortality, operative time, pain, intra-operative blood loss, and length of stay. RESULTS Nine studies met inclusion criteria, comprising a total of 698 hips (330 direct anterior, 57 anterolateral, 89 lateral, 114 posterolateral, 108 posterior approach). With regard to functional mobility, DAA was favored in 4 studies, and no study favored another approach over DAA. DAA had a significantly lower dislocation rate compared to posterior capsular approaches. Analysis of other secondary outcomes did not identify statistically significant differences. CONCLUSION This is the first systematic review and meta-analysis of the DAA for hemiarthroplasty. Available evidence suggests superior early functional mobility with the DAA. The DAA is associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty.
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Affiliation(s)
- Samuel T Kunkel
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Matthew J Sabatino
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Ravinder Kang
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - David S Jevsevar
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Wayne E Moschetti
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
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10
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Arthroscopic Capsular Reconstruction of the Hip With Acellular Dermal Extracellular Matrix: Surgical Technique. Arthrosc Tech 2016; 5:e1001-e1005. [PMID: 27909667 PMCID: PMC5124028 DOI: 10.1016/j.eats.2016.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/05/2016] [Indexed: 02/03/2023] Open
Abstract
Atraumatic instability of the hip has become an increasingly studied occurrence in recent years. There are several established surgical techniques that help restore stability of the native hip joint. In some cases, these procedures are not an option. As the phenomenon has become recognized more frequently, a greater number of revision surgeries are warranted in patients with ligamentous laxity. A durable solution for irreparable microinstability needs to be formulated to address this vulnerable patient demographic. We describe the surgical technique for capsular reconstruction with acellular dermal extracellular matrix.
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11
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Federer AE, Karas V, Nho S, Coleman SH, Mather RC. Capsular Suspension Technique for Hip Arthroscopy. Arthrosc Tech 2015; 4:e317-22. [PMID: 26759769 PMCID: PMC4680905 DOI: 10.1016/j.eats.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/05/2015] [Indexed: 02/03/2023] Open
Abstract
Hip arthroscopy has recently become a common procedure to treat central and peripheral hip pathology. Capsulotomies are necessary in these procedures, and negotiating adequate visualization, as well as capsular preservation, is a challenge. We describe a capsular suspension technique that allows for adequate visualization of the central and peripheral compartments while facilitating preservation of the native hip capsule. This technique eliminates the need for additional personnel for retraction, potentially decreases iatrogenic hip injury, eliminates the need for excessive capsular debridement, and allows for capsular closure under minimal tension.
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Affiliation(s)
- Andrew E. Federer
- Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Vasili Karas
- Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Shane Nho
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Struan H. Coleman
- Hospital for Special Surgery, New York, New York, U.S.A.,Weill Cornell Medical College, New York, New York, U.S.A
| | - Richard C. Mather
- Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, U.S.A.,Address correspondence to Richard C. Mather III, M.D., M.B.A., Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, U.S.A.
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12
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Carulli C, Macera A, Matassi F, Civinini R, Innocenti M. The use of a dual mobility cup in the management of recurrent dislocations of hip hemiarthroplasty. J Orthop Traumatol 2015; 17:131-6. [PMID: 26187813 PMCID: PMC4882292 DOI: 10.1007/s10195-015-0365-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 06/15/2015] [Indexed: 01/22/2023] Open
Abstract
Background Dislocation is one of the most frequent causes of failure of hemiarthroplasties of the hip, which is the most common treatment for femoral neck fractures in elderly patients. A revision with conversion to total hip arthroplasty is the gold standard in case of failure of closed reduction: however, the use of standard or modular components shows variable outcomes. The use of a dual mobility cup has been evaluated in patients with unstable implants, given the good outcomes obtained in primary and revision surgery. The aim of this study was to assess the results of revisions by dual mobility cups in unstable hemiarthroplasties. Materials and methods Thirty-one patients (mean age 75.4 years) were retrospectively evaluated between 2006 and 2010 after conversion to total hip arthroplasty with dual mobility cups for recurrent dislocations. The mean number of dislocations was 2.6 (range 2–5). The evaluation was performed by the American Society of Anesthesiologists physical function score (ASA) and the Harris hip score, and several radiologic criteria. Results The mean follow-up was 3.8 years. No recurrence of dislocation was recorded. The ASA score remained unchanged, and the mean Harris hip score improved from 62.2 before dislocation to 76.0 points postoperatively. Conclusions Dual mobility cups may be a useful option in the treatment of a hemiarthroplasty dislocation. No risk of a new revision due to instability after insertion of dual mobility cups resulted in our experience, and this option may be strongly considered in cases of revisions of unstable hemiarthroplasties. Level of evidence IV.
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Affiliation(s)
- Christian Carulli
- Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy.
| | - Armando Macera
- Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy
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