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Upadhyay PK, Shah N, Kumar V, Mirza SB. Hydroxyapatite ceramic-coated femoral components in younger patients followed up for 27 to 32 years. Bone Jt Open 2024; 5:286-293. [PMID: 38591124 PMCID: PMC11002557 DOI: 10.1302/2633-1462.54.bjo-2023-0136.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Aims This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. Methods We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient's comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results.
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Affiliation(s)
- Piyush K. Upadhyay
- Cumberland Infirmary, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
- School of Engineering University of Warwick, Coventry, UK
| | - Nirav Shah
- University Hospitals Sussex NHS Foundation Trust, West Sussex, UK
| | - Vishal Kumar
- Manchester University NHS Foundation Trust (MFT), Manchester, UK
| | - Saqeb B. Mirza
- Trauma and Orthopaedics, University Hospital Wales, Cardiff, UK
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Broekhuis D, Meurs WMH, Kaptein BL, Karunaratne S, Carey Smith RL, Sommerville S, Boyle R, Nelissen RGHH. High accuracy of positioning custom triflange acetabular components in tumour and total hip arthroplasty revision surgery. Bone Jt Open 2024; 5:260-268. [PMID: 38555947 PMCID: PMC10981996 DOI: 10.1302/2633-1462.54.bjo-2023-0185.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Aims Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival.
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Affiliation(s)
- Demien Broekhuis
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Willemijne M. H. Meurs
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart L. Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Scott Sommerville
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rob G. H. H. Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Homma Y, Zhuang X, Watari T, Hayashi K, Baba T, Kamath A, Ishijima M. Differences in acoustic parameters of hammering sounds between successful and unsuccessful initial cementless cup press-fit fixation in total hip arthroplasty. Bone Jt Open 2024; 5:154-161. [PMID: 38423101 PMCID: PMC10904203 DOI: 10.1302/2633-1462.53.bjo-2023-0160.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Aims It is important to analyze objectively the hammering sound in cup press-fit technique in total hip arthroplasty (THA) in order to better understand the change of the sound during impaction. We hypothesized that a specific characteristic would present in a hammering sound with successful fixation. We designed the study to quantitatively investigate the acoustic characteristics during cementless cup impaction in THA. Methods In 52 THAs performed between November 2018 and April 2022, the acoustic parameters of the hammering sound of 224 impacts of successful press-fit fixation, and 55 impacts of unsuccessful press-fit fixation, were analyzed. The successful fixation was defined if the following two criteria were met: 1) intraoperatively, the stability of the cup was retained after manual application of the torque test; and 2) at one month postoperatively, the cup showed no translation on radiograph. Each hammering sound was converted to sound pressures in 24 frequency bands by fast Fourier transform analysis. Basic patient characteristics were assessed as potential contributors to the hammering sound. Results The median sound pressure (SP) of successful fixation at 0.5 to 1.0 kHz was higher than that of unsuccessful fixation (0.0694 (interquartile range (IQR) 0.04721 to 0.09576) vs 0.05425 (IQR 0.03047 to 0.06803), p < 0.001). The median SP of successful fixation at 3.5 to 4.0 kHz and 4.0 to 4.5 kHz was lower than that of unsuccessful fixation (0.0812 (IQR 0.05631 to 0.01161) vs 0.1233 (IQR 0.0730 to 0.1449), p < 0.001; and 0.0891 (IQR 0.0526 to 0.0891) vs 0.0885 (IQR 0.0716 to 0.1048); p < 0.001, respectively). There was a statistically significant positive relationship between body weight and SP at 0.5 to 1.0 kHz (p < 0.001). Multivariate analyses indicated that the SP at 0.5 to 1.0 kHz and 3.5 to 4.0 kHz was independently associated with the successful fixation. Conclusion The frequency bands of 0.5 to 1.0 and 3.5 to 4.0 kHz were the key to distinguish the sound characteristics between successful and unsuccessful press-fit cup fixation.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Xu Zhuang
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taiji Watari
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atul Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Community Medicine and Research for Bone and Joint Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pathophysiology for Locomotive Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Husum HC, Hellfritzsch MB, Maimburg RD, Møller-Madsen B, Henriksen M, Lapitskaya N, Kold S, Rahbek O. Pubofemoral distances correlate to acetabular morphology and sonological instability in screening for hip dysplasia. Bone Jt Open 2024; 5:3-8. [PMID: 38164740 PMCID: PMC10758888 DOI: 10.1302/2633-1462.51.bjo-2023-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Aims The present study seeks to investigate the correlation of pubofemoral distances (PFD) to α angles, and hip displaceability status, defined as femoral head coverage (FHC) or FHC during manual provocation of the newborn hip < 50%. Methods We retrospectively included all newborns referred for ultrasound screening at our institution based on primary risk factor, clinical, and PFD screening. α angles, PFD, FHC, and FHC at follow-up ultrasound for referred newborns were measured and compared using scatter plots, linear regression, paired t-test, and box-plots. Results We included 2,735 newborns, of whom 754 received a follow-up hip ultrasound within six weeks of age. After exclusion, 1,500 hips were included for analysis. Sex distribution was 372 male and 380 female, and the mean age at examination was 36.6 days (4 to 87). We found a negative linear correlation of PFD to α angles (p < 0.001), FHC (p < 0.001), and FHC during provocation (p < 0.001) with a 1 mm increase in PFD corresponding to a -2.1° (95% confidence interval (CI) -2.3 to -1.9) change in α angle and a -3.4% (95% CI -3.7 to -3.0) change in FHC and a -6.0% (-6.6 to -5.5) change in FHC during provocation. The PFD was significantly higher with increasing Graf types and in displaceable hips (p < 0.001). Conclusion PFD is strongly correlated to both α angles and hip displaceability, as measured by FHC and FHC during provocation, in ultrasound of newborn hips. The PFD increases as the hips become more dysplastic and/or displaceable.
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Affiliation(s)
- Hans-Christen Husum
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
| | - Michel B. Hellfritzsch
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke D. Maimburg
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Children’s Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Møller-Madsen
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Midwifery, University College of Northern Denmark, Aalborg East, Denmark
| | - Mads Henriksen
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Natallia Lapitskaya
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
- Danish Paedatric Orthopaedic Research, Aarhus University Hospital, Aarhus, Denmark
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Berwin JT, Duffy SDX, Gargan MF, Barnes JR. Long-term patient-centred outcomes of periacetabular osteotomy in a large consecutive series. Bone Jt Open 2023; 4:964-969. [PMID: 38112276 PMCID: PMC10729422 DOI: 10.1302/2633-1462.412.bjo-2023-0081.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Aims We assessed the long-term outcomes of a large cohort of patients who have undergone a periacetabular osteotomy (PAO), and sought to validate a patient satisfaction questionnaire for use in a PAO cohort. Methods All patients who had undergone a PAO from July 1998 to February 2013 were surveyed, with several patient-reported outcome measures (PROMs) and radiological measurements of preoperative acetabular dysplasia and postoperative correction also recorded. Patients were asked to rate their level of satisfaction with their operation in achieving pain relief, restoration of activities of daily living, ability to perform recreational activity, and their overall level of satisfaction with the procedure. Results A total of 143 PAOs were performed between 1998 and 2013. Of those, 90 postoperative surveys were returned. Only 65 patients (73 hips) had both pre- and postoperative radiographs available for measurement. The mean time to follow-up was 15 years (6.5 to 20). Most patients were female (91%), with a mean age of 26.4 years (14.9 to 48.3) at the time of their surgery. A statistically significant improvement in radiological correction was detected in all hips (p < 0.001). A total of 67 patients (92.3%) remained either very satisfied or satisfied with their PAO. The internal consistency of the patient satisfaction questionnaire, measured using Cronbach's α, ranged from 0.89 to 0.94 indicating 'good' to 'excellent' reliability. Conclusion Outcomes of importance to patients undergoing a PAO include several key domains: pain relief, improve activities of daily living, and improve recreational ability. Our study demonstrates high rates of long-term patient satisfaction in all domains, and found the patient satisfaction questionnaire to be a valid and reliable instrument for use in this cohort.
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Affiliation(s)
- James T. Berwin
- The Department of Paediatric Orthopaedics, Bristol Royal Children’s Hospital, Bristol, UK
| | - Sean D. X. Duffy
- The Department of Paediatric Orthopaedics, Bristol Royal Children’s Hospital, Bristol, UK
| | - Martin F. Gargan
- The Department of Paediatric Orthopaedics, Bristol Royal Children’s Hospital, Bristol, UK
| | - James R. Barnes
- The Department of Paediatric Orthopaedics, Bristol Royal Children’s Hospital, Bristol, UK
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Dantas P, Gonçalves SR, Grenho A, Mascarenhas V, Martins J, Tavares da Silva M, Gonçalves SB, Guimarães Consciência J. Hip joint contact pressure and force: a scoping review of in vivo and cadaver studies. Bone Joint Res 2023; 12:712-721. [PMID: 38043570 PMCID: PMC10693937 DOI: 10.1302/2046-3758.1212.bjr-2022-0461.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Aims Research on hip biomechanics has analyzed femoroacetabular contact pressures and forces in distinct hip conditions, with different procedures, and used diverse loading and testing conditions. The aim of this scoping review was to identify and summarize the available evidence in the literature for hip contact pressures and force in cadaver and in vivo studies, and how joint loading, labral status, and femoral and acetabular morphology can affect these biomechanical parameters. Methods We used the PRISMA extension for scoping reviews for this literature search in three databases. After screening, 16 studies were included for the final analysis. Results The studies assessed different hip conditions like labrum status, the biomechanical effect of the cam, femoral version, acetabular coverage, and the effect of rim trimming. The testing and loading conditions were also quite diverse, and this disparity limits direct comparisons between the different researches. With normal anatomy the mean contact pressures ranged from 1.54 to 4.4 MPa, and the average peak contact pressures ranged from 2 to 9.3 MPa. Labral tear or resection showed an increase in contact pressures that diminished after repair or reconstruction of the labrum. Complete cam resection also decreased the contact pressure, and acetabular rim resection of 6 mm increased the contact pressure at the acetabular base. Conclusion To date there is no standardized methodology to access hip contact biomechanics in hip arthroscopy, or with the preservation of the periarticular soft-tissues. A tendency towards improved biomechanics (lower contact pressures) was seen with labral repair and reconstruction techniques as well as with cam correction.
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Affiliation(s)
- Pedro Dantas
- Orthopaedic and Traumatology Center, Hospital CUF Descobertas, Lisbon, Portugal
- Department of Orthopaedic Surgery, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Sergio R. Gonçalves
- Orthopaedic and Traumatology Center, Hospital CUF Descobertas, Lisbon, Portugal
- Department of Orthopaedic Surgery, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - André Grenho
- Department of Orthopaedic Surgery, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | | | - Jorge Martins
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Wasim AS, Tahir M, Ridha A, Sinha A, Hussain S. A Standardised Protocol for Pre-operative Pelvic Radiographs for Templating in Total Hip Arthroplasty. Cureus 2023; 15:e50687. [PMID: 38229784 PMCID: PMC10791152 DOI: 10.7759/cureus.50687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
PURPOSE Digital templating using pre-operative radiographs enables pre-operative planning for total hip arthroplasty (THA). This allows surgeons to reproduce hip biomechanics effectively, reducing the risk of post-operative complications. Pelvic radiographs demonstrating the head, neck, trochanters, and proximal one-third of the femoral shaft allow calculation of key measurements including femoral offset and limb length discrepancy (LLD). Currently, no standardised guideline exists for obtaining pre-operative radiographs for templating in THA. Materials and methods: A single-blinded retrospective cohort study assessing the quality of pre- and post-operative radiographs of 195 patients who underwent elective THA for osteoarthritis over a two-year period was performed. Quality was rated as good, fair or poor, respectively, depending upon whether ≥2, 1 or none of the following were met: Pubic symphysis (PS) and coccyx in a straight line with 1-3 cm between the superior edge of the PS and tip of coccyx, trochanters distinguishable, obturator rings symmetric. Post-operative images were assessed to determine whether the distal end of the implanted prosthesis was visible. Results: The sample consisted of 195 patients. Pre-operatively 115 (59%) radiographs were classified as good, 71 (36.4%) fair and 9 (4.6%) poor. Post-operatively 46 (23.6%) were classified as good, 114 (58.4%) as fair and 30 (15.4%) as poor. In the post-operative radiographs, 25.6% did not include the distal tip of the prosthesis. Conclusion: This study highlights significant scope to improve the quality of pre-operative radiographs, allowing accurate templating to optimise outcomes for THA. A protocol is recommended whereby the pelvic radiograph is centred on the PS at the lesser trochanter level, ensuring adequate exposure of the proximal femur, acetabulum and iliac crests.
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Affiliation(s)
- Abdus S Wasim
- Orthopaedics and Trauma, Sandwell and West Birmingham NHS Trust, Birmingham, GBR
| | - Muaaz Tahir
- Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, GBR
| | - Ali Ridha
- Orthopaedics and Trauma, Sandwell and West Birmingham NHS Trust, Birmingham, GBR
| | - Amil Sinha
- Orthopaedics and Trauma, Sandwell and West Birmingham NHS Trust, Birmingham, GBR
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Denyer S, Eikani C, Sheth M, Schmitt D, Brown N. Diagnosing periprosthetic joint infection. Bone Jt Open 2023; 4:881-888. [PMID: 37984446 PMCID: PMC10659814 DOI: 10.1302/2633-1462.411.bjo-2023-0094.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
Aims The diagnosis of periprosthetic joint infection (PJI) can be challenging as the symptoms are similar to other conditions, and the markers used for diagnosis have limited sensitivity and specificity. Recent research has suggested using blood cell ratios, such as platelet-to-volume ratio (PVR) and platelet-to-lymphocyte ratio (PLR), to improve diagnostic accuracy. The aim of the study was to further validate the effectiveness of PVR and PLR in diagnosing PJI. Methods A retrospective review was conducted to assess the accuracy of different marker combinations for diagnosing chronic PJI. A total of 573 patients were included in the study, of which 124 knees and 122 hips had a diagnosis of chronic PJI. Complete blood count and synovial fluid analysis were collected. Recently published blood cell ratio cut-off points were applied to receiver operating characteristic curves for all markers and combinations. The area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated. Results The results of the analysis showed that the combination of ESR, CRP, synovial white blood cell count (Syn. WBC), and polymorphonuclear neutrophil percentage (PMN%) with PVR had the highest AUC of 0.99 for knees, with sensitivity of 97.73% and specificity of 100%. Similarly, for hips, this combination had an AUC of 0.98, sensitivity of 96.15%, and specificity of 100.00%. Conclusion This study supports the use of PVR calculated from readily available complete blood counts, combined with established markers, to improve the accuracy in diagnosing chronic PJI in both total hip and knee arthroplasties.
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Affiliation(s)
- Steven Denyer
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Carlo Eikani
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Monica Sheth
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Daniel Schmitt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Nicholas Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
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Subbiah Ponniah H, Logishetty K, Edwards TC, Singer GC. Survivorship and risk factors for revision of metal-on-metal hip resurfacing. Bone Jt Open 2023; 4:853-858. [PMID: 37944559 PMCID: PMC10635743 DOI: 10.1302/2633-1462.411.bjo-2023-0084.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Aims Metal-on-metal hip resurfacing (MoM-HR) has seen decreased usage due to safety and longevity concerns. Joint registries have highlighted the risks in females, smaller hips, and hip dysplasia. This study aimed to identify if reported risk factors are linked to revision in a long-term follow-up of MoM-HR performed by a non-designer surgeon. Methods A retrospective review of consecutive MoM hip arthroplasties (MoM-HRAs) using Birmingham Hip Resurfacing was conducted. Data on procedure side, indication, implant sizes and orientation, highest blood cobalt and chromium ion concentrations, and all-cause revision were collected from local and UK National Joint Registry records. Results A total of 243 hips (205 patients (163 male, 80 female; mean age at surgery 55.3 years (range 25.7 to 75.3)) with MoM-HRA performed between April 2003 and October 2020 were included. Mean follow-up was 11.2 years (range 0.3 to 17.8). Osteoarthritis was the most common indication (93.8%), and 13 hips (5.3%; 7M:6F) showed dysplasia (lateral centre-edge angle < 25°). Acetabular cups were implanted at a median of 45.4° abduction (interquartile range 41.9° - 48.3°) and stems neutral or valgus to the native neck-shaft angle. In all, 11 hips (4.5%; one male, ten females) in ten patients underwent revision surgery at a mean of 7.4 years (range 2.8 to 14.2), giving a cumulative survival rate of 94.8% (95% confidence interval (CI) 91.6% to 98.0%) at ten years, and 93.4% (95% CI 89.3% to 97.6%) at 17 years. For aseptic revision, male survivorship was 100% at 17 years, and 89.6% (95% CI 83.1% to 96.7%) at ten and 17 years for females. Increased metal ion levels were implicated in 50% of female revisions, with the remaining being revised for unexplained pain or avascular necrosis. Conclusion The Birmingham MoM-HR showed 100% survivorship in males, exceeding the National Institute for Health and Care Excellence '5% at ten years' threshold. Female sex and small component sizes are independent risk factors. Dysplasia alone is not a contraindication to resurfacing.
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Callary SA, Sharma DK, D’Apollonio TM, Campbell DG. Large articulations do not increase wear rates of thin second-generation highly cross-linked polyethylene liners at ten years. Bone Jt Open 2023; 4:839-845. [PMID: 37926113 PMCID: PMC10625862 DOI: 10.1302/2633-1462.411.bjo-2023-0124.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Aims Radiostereometric analysis (RSA) is the most accurate radiological method to measure in vivo wear of highly cross-linked polyethylene (XLPE) acetabular components. We have previously reported very low wear rates for a sequentially irradiated and annealed X3 XLPE liner (Stryker Orthopaedics, USA) when used in conjunction with a 32 mm femoral heads at ten-year follow-up. Only two studies have reported the long-term wear rate of X3 liners used in conjunction with larger heads using plain radiographs which have poor sensitivity. The aim of this study was to measure the ten-year wear of thin X3 XLPE liners against larger 36 or 40 mm articulations with RSA. Methods We prospectively reviewed 19 patients who underwent primary cementless THA with the XLPE acetabular liner (X3) and a 36 or 40 mm femoral head with a resultant liner thickness of at least 5.8 mm. RSA radiographs at one week, six months, and one, two, five, and ten years postoperatively and femoral head penetration within the acetabular component were measured with UmRSA software. Of the initial 19 patients, 12 were available at the ten-year time point. Results The median proximal, 2D, and 3D wear rates calculated between one and ten years were all less than 0.005 mm/year, with no patient recording a proximal wear rate of more than 0.021 mm/year. Importantly, there was no increase in the wear rate between five and ten years. Conclusion The very low wear rate of X3 XLPE liners with larger articulations remains encouraging for the future clinical performance of this material.
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Affiliation(s)
- Stuart A. Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide and Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
| | - Deepti K. Sharma
- Centre for Orthopaedic and Trauma Research, The University of Adelaide and Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Taisha M. D’Apollonio
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
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Joseph PJS, Khattak M, Masudi ST, Minta L, Perry DC. Radiological assessment of hip disease in children with cerebral palsy: development of a core measurement set. Bone Jt Open 2023; 4:825-831. [PMID: 37909150 PMCID: PMC10618048 DOI: 10.1302/2633-1462.411.bjo-2023-0060.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Aims Hip disease is common in children with cerebral palsy (CP) and can decrease quality of life and function. Surveillance programmes exist to improve outcomes by treating hip disease at an early stage using radiological surveillance. However, studies and surveillance programmes report different radiological outcomes, making it difficult to compare. We aimed to identify the most important radiological measurements and develop a core measurement set (CMS) for clinical practice, research, and surveillance programmes. Methods A systematic review identified a list of measurements previously used in studies reporting radiological hip outcomes in children with CP. These measurements informed a two-round Delphi study, conducted among orthopaedic surgeons and specialist physiotherapists. Participants rated each measurement on a nine-point Likert scale ('not important' to 'critically important'). A consensus meeting was held to finalize the CMS. Results Overall, 14 distinct measurements were identified in the systematic review, with Reimer's migration percentage being the most frequently reported. These measurements were presented over the two rounds of the Delphi process, along with two additional measurements that were suggested by participants. Ultimately, two measurements, Reimer's migration percentage and femoral head-shaft angle, were included in the CMS. Conclusion This use of a minimum standardized set of measurements has the potential to encourage uniformity across hip surveillance programmes, and may streamline the development of tools, such as artificial intelligence systems to automate the analysis in surveillance programmes. This core set should be the minimum requirement in clinical studies, allowing clinicians to add to this as needed, which will facilitate comparisons to be drawn between studies and future meta-analyses.
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Affiliation(s)
| | - Mohammed Khattak
- University of Liverpool, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
| | | | | | - Daniel C. Perry
- University of Liverpool, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
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12
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Wagener N, Löchel J, Hipfl C, Perka C, Hardt S, Leopold VJ. Psychological status affects postoperative quality of life, function, and pain after periacetabular osteotomy. Bone Jt Open 2023; 4:758-765. [PMID: 37821094 PMCID: PMC10567161 DOI: 10.1302/2633-1462.410.bjo-2023-0104.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Aims Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO. Methods In all, 202 consecutive patients who underwent PAO for developmental dysplasia of the hip (DDH) at our institution from 2015 to 2017 were included and followed up at 63 months (SD 10) postoperatively. Of these, 101 with complete data sets entered final analysis. Patients were assessed by questionnaire. Psychological status was measured by Brief Symptom Inventory (BSI-18), health-related quality of life was raised with 36-Item Short Form Survey (SF-36), hip functionality was measured by the short version 0f the International Hip Outcome Tool (iHOT-12), Subjective Hip Value (SHV), and Hip Disability and Outcome Score (HOS). Surgery satisfaction and pain were assessed. Dependent variables (endpoints) were postoperative quality of life (SF-36, HOS quality of life (QoL)), joint function (iHOT-12, SHV, HOS), patient satisfaction, and pain. Psychological distress was assessed by the Global Severity Index (GSI), somatization (BSI Soma), depression (BSI Depr), and anxiety (BSI Anx). Influence of psychological status was assessed by means of univariate and multiple multivariate regression analysis. Results In multiple multivariate regression, postoperative GSI, BSI Soma, and BSI Depr had a negative effect on postoperative SF-36 (e -2.07, -3.05, and -2.67, respectively; p < 0.001), iHOT-12 (e -1.35 and -4.65, respectively; p < 0.001), SHV (e -1.20 and -2.71, respectively; p < 0.001), HOS QoL (e -2.09 and -4.79, respectively; p < 0.001), HOS Function (e -1.00 and -3.94, respectively; p < 0.001), and HOS Sport (e -1.44 and -5.29, respectively; p < 0.001), and had an effect on postoperative pain (e 0.13 and 0.37, respectively; p < 0.001). Conclusion Psychological distress, depression, and somatization disorders affect health-related quality of life, perceived joint function, and sports ability. Pain perception is significantly increased by somatization. However, patient satisfaction with surgery is not affected.
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Affiliation(s)
- Nele Wagener
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Jannis Löchel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Vincent J. Leopold
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
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13
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Uemura K, Otake Y, Takashima K, Hamada H, Imagama T, Takao M, Sakai T, Sato Y, Okada S, Sugano N. Development and validation of an open-source tool for opportunistic screening of osteoporosis from hip CT images. Bone Joint Res 2023; 12:590-597. [PMID: 37728034 PMCID: PMC10509772 DOI: 10.1302/2046-3758.129.bjr-2023-0115.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Aims This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images. Methods The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm3). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis. Results CT-aBMD was successfully measured in 976/978 hips (99.8%). A significant correlation was found between CT-aBMD and DXA-BMD (r = 0.941; p < 0.001). In the ROC analysis, the area under the curve to diagnose osteoporosis was 0.976. The diagnostic sensitivity and specificity were 88.9% and 96%, respectively, with the cutoff set at 0.625 g/cm2. Conclusion Accurate DXA-BMD measurements and diagnosis of osteoporosis were performed from CT images using the system developed herein. As the models are open-source, clinicians can use the proposed system to screen osteoporosis and determine the surgical strategy for hip surgery.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshito Otake
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Japan
| | - Kazuma Takashima
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takashi Imagama
- Department of Orthopaedics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Masaki Takao
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Takashi Sakai
- Department of Orthopaedics, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yoshinobu Sato
- Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Japan
| | - Seiji Okada
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Graduate School of Medicine, Osaka University, Suita, Japan
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14
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Lim KBL, Lee NKL, Yeo BS, Lim VMM, Ng SWL, Mishra N. How well do we assess the adequacy of bending films in scoliosis? Bone Jt Open 2023; 4:689-695. [PMID: 37673418 PMCID: PMC10482508 DOI: 10.1302/2633-1462.49.bjo-2023-0057.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Aims To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so. Methods Six surgeons and eight radiographers were invited to participate in four online surveys. The generic survey comprised erect and left and right bending radiographs of eight individuals with scoliosis, with an average age of 14.6 years. Respondents were asked to indicate whether each bending film was optimal (adequate) or suboptimal. In the first survey, they were also asked if they currently assessed the adequacy of bending films. A similar second survey was sent out two weeks later, using the same eight cases but in a different order. In the third survey, a guide for assessing bending film adequacy was attached along with the radiographs to introduce the novel T1-45B method, in which the upper endplate of T1 must tilt ≥ 45° from baseline for the study to be considered optimal. A fourth and final survey was subsequently conducted for confirmation. Results Overall, 12 (86%) of 14 respondents did not use any criteria to assess the bending film adequacy; the remaining two each described a different invalidated method. In total, 12 (86%) of the respondents felt T1-45B was easy to learn and apply. There was fair to substantial intra-rater reliability (k = 0.25 to 0.88) which improved to fair to almost perfect (k = 0.38 to 0.88) post-introduction of the guide. Inter-rater reliability varied considerably among the rater groups but similarly increased following introduction of the guide (kS1 = 0.19 to 0.34, kS2 = 0.33 to 0.43 vs kS3 = 0.49 to 0.5, kS4 = 0.35 to 0.43). Conclusion Many surgeons and radiographers do not assess spinal bending films for adequacy. We propose that the change in the plane of the upper endplate of T1 on side-bending can be used in this evaluation. In the T1-45B method, a change of ≥ 45° on side bending qualifies as an adequate bend effort.
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Affiliation(s)
- Kevin B. L. Lim
- Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
- Division of Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Nicole K. L. Lee
- Division of Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Beatrice S. Yeo
- Division of Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Stacy W. L. Ng
- Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Neeraj Mishra
- Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
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15
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Poacher AT, Hathaway I, Crook DL, Froud JLJ, Scourfield L, James C, Horner M, Carpenter EC. The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip. Bone Jt Open 2023; 4:635-642. [PMID: 37607720 PMCID: PMC10444535 DOI: 10.1302/2633-1462.48.bjo-2022-0158.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Aims Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH.
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Affiliation(s)
| | | | | | | | | | - Catherine James
- Trauma Department, University Hospital of Wales, Cardiff, UK
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16
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Anderson PM, Heinz T, Rak D, Arnholdt J, Holzapfel BM, Dorsch S, Weißenberger M, von Eisenhart-Rothe R, Jaenisch M, Ertl M, Wagner M, Windhagen H, Rudert M, Jakuscheit A. Accuracy of Positioning and Risk Factors for Malpositioning Custom-Made Femoral Stems in Total Hip Arthroplasty-A Retrospective Multicenter Analysis. J Pers Med 2023; 13:1285. [PMID: 37763052 PMCID: PMC10532930 DOI: 10.3390/jpm13091285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Total hip arthroplasty (THA) is commonly performed using off-the-shelf implants. In the case of a severe mismatch between the anatomy of the proximal femur and the geometry of the stem, the use of custom-made stems might become necessary. The goal of this study was to investigate the precision of the implantation of custom-made stems of one manufacturer (CTX stem, AQ Implants) and to determine risk factors for malpositioning. All patients receiving a custom-made CTX stem between 2014 and 2020 at six high-volume academic centers were retrospectively recruited. The achieved position of the stem, as determined by stem version, stem coronal angle, and implantation depth on radiographs, was compared to the plan. The influence of radiographic and demographic parameters on the position was investigated. The results revealed a high variability of the achieved implant position in relation to the preoperative plan. While the stem coronal angle only differed slightly from the intended position, the stem version and the implantation depth showed a high frequency and amount of deviation. Right stems showed significantly higher positions than planned. Surgeons must be aware of this potential problem when implanting custom-made stems.
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Affiliation(s)
- Philip Mark Anderson
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Tizian Heinz
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Dominik Rak
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Jörg Arnholdt
- Department of Orthopedic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Silke Dorsch
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Manuel Weißenberger
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Max Ertl
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany;
| | - Michael Wagner
- Department of Orthopaedics and Trauma Surgery, Klinikum Nürnberg Campus Süd, Paracelsus Medical University, Breslauer Straße 201, 90472 Nürnberg, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Annastift Hannover, Medical School Hannover, Borries Str. 1-6, 30625 Hannover, Germany;
| | - Maximilian Rudert
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
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17
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Makaram NS, Prescott RJ, Alexander P, Robb JE, Gaston MS. Validation of a modified Care and Comfort Score and responsiveness to hip surgery in children with cerebral palsy in Gross Motor Function Classification System levels IV and V. Bone Jt Open 2023; 4:580-583. [PMID: 37558227 PMCID: PMC10412107 DOI: 10.1302/2633-1462.48.bjo-2023-0051.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
AIMS The purpose of this study was to assess the reliability and responsiveness to hip surgery of a four-point modified Care and Comfort Hypertonicity Questionnaire (mCCHQ) scoring tool in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V. METHODS This was a population-based cohort study in children with CP from a national surveillance programme. Reliability was assessed from 20 caregivers who completed the mCCHQ questionnaire on two occasions three weeks apart. Test-retest reliability of the mCCHQ was calculated, and responsiveness before and after surgery for a displaced hip was evaluated in a cohort of children. RESULTS Test-retest reliability for the overall mCCHQ score was good (intraclass correlation coefficient 0.78), and no dimension demonstrated poor reliability. The surgical intervention cohort comprised ten children who had preoperative and postoperative mCCHQ scores at a minimum of six months postoperatively. The mCCHQ tool demonstrated a significant improvement in overall score from preoperative assessment to six-month postoperative follow-up assessment (p < 0.001). CONCLUSION The mCCHQ demonstrated responsiveness to intervention and good test-retest reliability. The mCCHQ is proposed as an outcome tool for use within a national surveillance programme for children with CP.
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Affiliation(s)
- Navnit S. Makaram
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | | | - Phyllida Alexander
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
| | - James E. Robb
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Mark S. Gaston
- Department of Orthopaedics and Trauma, Royal Hospital for Children and Young People, Edinburgh, UK
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18
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Genc AS, Agar A, Güzel N. Evaluation of Psoas Muscle Atrophy and the Degree of Fat Infiltration After Unilateral Hip Arthroplasty. Cureus 2023; 15:e41506. [PMID: 37551232 PMCID: PMC10404381 DOI: 10.7759/cureus.41506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE Atrophy of the muscles around the hip and thigh has been reported in patients with hip osteoarthritis (OA). Total hip arthroplasty (THA) reduces pain and improves quality of life and activity levels. Muscle strength of the hip and thigh also improves after THA. This study aimed to determine whether there is significant psoas muscle atrophy and to evaluate the degree of fat infiltration after unilateral hip arthroplasty. SUBJECT AND METHODS Patients who underwent unilateral total hip arthroplasty for primary hip osteoarthritis and who had lumbar vertebra magnetic resonance imaging (MRI) for any reason in the one-year preoperative and postoperative period were evaluated retrospectively. The degree of fat infiltration was also graded visually based on a modified Goutallier rating system. RESULTS The study was conducted with a total of 58 patients aged between 38 and 75, including 15 males and 43 females. Compared to the preoperative psoas muscle area values on the operated sides of the patients participating in the study, the decrease in the postoperative psoas muscle area was found to be statistically significant (p:0.000; p<0.05). Furthermore, the decrease in psoas muscle area on the non-operated side of the patients was also statistically significant (p:0.000; p<0.05). There was also a positive correlation between preoperative and postoperative psoas muscle areas (p:0.000; p<0.05). CONCLUSION Early identification of psoas muscle mass reduction may allow for a more proactive psoas strength improvement program to improve post-operative function and mobility.
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Affiliation(s)
- Ahmet Serhat Genc
- Orthopedics and Traumatology Department, Samsun Training and Research Hospital, Samsun, TUR
| | - Anil Agar
- Orthopedics and Traumatology Department, Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, TUR
| | - Nizamettin Güzel
- Orthopedics and Traumatology Department, Samsun Training and Research Hospital, Samsun, TUR
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Abstract
Aims Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in total hip arthroplasty (THA). Commonly, preoperative protocols simulate two functional positions (standing and relaxed sitting) but do not consider other common positions that may increase postoperative impingement and possible dislocation. This study investigates the feasibility of simulating commonly encountered positions, and positions with an increased risk of impingement, to lower postoperative impingement risk in a CT-based 3D model. Methods A robotic arm-assisted arthroplasty planning platform was used to investigate 11 patient positions. Data from 43 primary THAs were used for simulation. Sacral slope was retrieved from patient preoperative imaging, while angles of hip flexion/extension, hip external/internal rotation, and hip abduction/adduction for tested positions were derived from literature or estimated with a biomechanical model. The hip was placed in the described positions, and if impingement was detected by the software, inspection of the impingement type was performed. Results In flexion, an overall impingement rate of 2.3% was detected for flexed-seated, squatting, forward-bending, and criss-cross-sitting positions, and 4.7% for the ankle-over-knee position. In extension, most hips (60.5%) were found to impinge at or prior to 50° of external rotation (pivoting). Many of these impingement events were due to a prominent ischium. The mean maximum external rotation prior to impingement was 45.9° (15° to 80°) and 57.9° (20° to 90°) prior to prosthetic impingement. No impingement was found in standing, sitting, crossing ankles, seiza, and downward dog. Conclusion This study demonstrated that positions of daily living tested in a CT-based 3D model show high rates of impingement. Simulating additional positions through 3D modelling is a low-cost method of potentially improving outcomes without compromising patient safety. By incorporating CT-based 3D modelling of positions of daily living into routine preoperative protocols for THA, there is the potential to lower the risk of postoperative impingement events.
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Affiliation(s)
- Wei S. Tung
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Claire Donnelley
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Aidin E. Pour
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Steven Tommasini
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
| | - Daniel Wiznia
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut, USA
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20
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Lambers AP, Marley MA, Jennings R, Bucknill A. Accuracy of Leg Length and Offset Measurements During Total Hip Arthroplasty Using an Imageless Navigation System. Cureus 2023; 15:e38689. [PMID: 37292554 PMCID: PMC10244823 DOI: 10.7759/cureus.38689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Leg length and offset are important considerations in total hip arthroplasty (THA). Navigation systems are capable of providing intra-operative measurements of leg length and offset, and high accuracy has been shown in experimental studies. This study assesses the accuracy of an imageless navigation system with a pinless femoral array (Hip 5.1, BrainLAB, Feldkirchen, Germany) in measuring leg length and offset changes in vivo. Methods A prospective, consecutive series of 37 patients undergoing navigated THA were included in the study. Intra-operative measurements of leg length and offset were recorded using the navigation system. For each patient, pre- and post-operative digital radiographs were scaled and analyzed to provide radiographic measurements for comparison. Results Measurements of leg length change made by the navigation system showed a strong correlation with the size of change measured radiographically (R = 0.71; p<0.0001). The mean difference between the radiographic and navigational measurement was 2.6mm ± 3.0mm (0.0-16.0mm) (mean, SD, range). The navigation system was accurate to within 1mm of the radiographic measurement in 49% of cases, within 2mm in 66% of cases, and within 5mm in 89% of cases. Measurements of offset change by the navigation system also showed a correlation with radiographic measurements, albeit less pronounced (R = 0.35; p=0.035). The mean difference between navigational and radiographic measurements was 5.5mm ± 4.7mm (0.0-16.0mm) (mean, SD, range). The navigation system was accurate within 1mm of the radiographic measurement in 22% of cases, within 2mm in 35% of cases, and within 5mm in 57% of cases. Conclusions This research demonstrates in vivo that an imageless, non-invasive navigation system is a reliable tool for intra-operative leg length (accurate within 2mm) and to a lesser extent offset measurement (accurate within 5mm) when compared to standard practice of plain film radiographs.
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21
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Poacher AT, Froud JLJ, Caterson J, Crook DL, Ramage G, Marsh L, Poacher G, Carpenter EC. The cost effectiveness of potential risk factors for developmental dysplasia of the hip within a national screening programme. Bone Jt Open 2023; 4:234-240. [PMID: 37051819 PMCID: PMC10067325 DOI: 10.1302/2633-1462.44.bjo-2022-0135.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Aims Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. Methods A five-year prospective registry study investigating every live birth in the study’s catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the Graf classification system, defined as grade IIb or above or rapidly regressing IIa disease (≥4o at four weeks follow-up). Multivariate odds ratios were calculated to establish significant association, and risk differences were calculated to provide quantifiable risk increase with DDH, positive predictive value was used as a measure of predictive efficacy. The cost-effectiveness of using these risk factors to predict DDH was evaluated using NHS tariffs (January 2021). Results The prevalence of DDH that required treatment within our population was 5/1,000 live births. The rate of missed presentation of DDH was 0.43/1000 live births. Breech position, family history, oligohydramnios, and foot deformities demonstrated significant association with DDH (p < 0.0001). The presence of breech presentation increased the risk of DDH by 1.69% (95% confidence interval (CI) 0.93% to 2.45%), family history by 3.57% (95% CI 2.06% to 5.09%), foot deformities by 8.95% (95% CI 4.81% to 13.1%), and oligohydramnios nby 11.6% (95 % CI 3.0% to 19.0%). Primary risk factors family history and breech presentation demonstrated an estimated cost-per-case detection of £6,276 and £11,409, respectively. Oligohydramnios and foot deformities demonstrated a cost-per-case detected less than the cost of primary risk factors of £2,260 and £2,670, respectively. Conclusion The inclusion of secondary risk factors within a national screening programme was clinically successful as they were more cost and resource-efficient predictors of DDH than primary risk factors, suggesting they should be considered in the national guidance. Cite this article: Bone Jt Open 2023;4(4):234–240.
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Affiliation(s)
- Arwel T. Poacher
- Trauma Department, University Hospital of Wales, Cardiff, UK
- Correspondence should be sent to Arwel T. Poacher. E-mail:
| | | | | | | | | | - Luke Marsh
- Cardiff University School of Medicine, Cardiff, UK
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22
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Faraj S, de Windt TS, van Hooff ML, van Hellemondt GG, Spruit M. Custom-made acetabular revision arthroplasty for pelvic discontinuity: Can we handle the challenge? : a prospective cohort study. Bone Jt Open 2023; 4:53-61. [PMID: 36718581 PMCID: PMC10011926 DOI: 10.1302/2633-1462.42.bjo-2022-0159.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous total hip arthroplasty (THA). METHODS Data were extracted from a single centre prospective database of patients with PD who were treated with a CTAC. Patients were included if they had a follow-up of two years. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance and clinical relevance. RESULTS A total of 18 females with 22 CTACs who had a mean age of 73.5 years (SD 7.7) were included. A significant improvement was found in HOOS (p < 0.0001), mOHS (p < 0.0001), EQ-5D-3L utility (p = 0.003), EQ-5D-3L NRS (p = 0.013), VAS pain rest (p = 0.008), and VAS pain activity (p < 0.0001) between baseline and final follow-up. Minimal clinically important improvement in mOHS and the HOOS Physical Function Short Form (HOOS-PS) was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. CONCLUSION CTAC in patients with THA acetabular loosening and PD can result in stable constructs and significant improvement in functioning and health-related quality of life at two years' follow-up. Further follow-up is necessary to determine the mid- to long-term outcome.Cite this article: Bone Jt Open 2023;4(2):53-61.
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Affiliation(s)
- Sayf Faraj
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Tommy S de Windt
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Miranda L van Hooff
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Orthopedic Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Maarten Spruit
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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23
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Cheok T, Smith T, Wills K, Jennings MP, Rawat J, Foster B. Universal screening may reduce the incidence of late diagnosis of developmental dysplasia of the hip : a systematic review and meta-analysis. Bone Joint J 2023; 105-B:198-208. [PMID: 36722053 DOI: 10.1302/0301-620x.105b2.bjj-2022-0896.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS We investigated the prevalence of late developmental dysplasia of the hip (DDH), abduction bracing treatment, and surgical procedures performed following the implementation of universal ultrasound screening versus selective ultrasound screening programmes. METHODS A systematic search of PubMed, Embase, The Cochrane Library, OrthoSearch, and Web of Science from the date of inception of each database until 27 March 2022 was performed. The primary outcome of interest was the prevalence of late detection of DDH, diagnosed after three months. Secondary outcomes of interest were the prevalence of abduction bracing treatment and surgical procedures performed in childhood for dysplasia. Only studies describing the primary outcome of interest were included. RESULTS A total of 31 studies were identified, of which 13 described universal screening and 20 described selective screening. Two studies described both. The prevalence of late DDH was 0.10 per 1,000 live births (95% confidence interval (CI) 0.00 to 0.39) in the universal screening group and 0.45 per 1,000 live births (95% CI 0.31 to 0.61) in the selective screening group. Abduction bracing treatment was performed on 55.54 per 1,000 live births (95% CI 24.46 to 98.15) in the universal screening group versus 0.48 per 1,000 live births (95% CI 0.07 to 1.13) in the selective screening group. Both the universal and selective screening groups had a similar prevalence of surgical procedures in childhood for dysplasia being performed (0.48 (95% CI 0.32 to 0.63) vs 0.49 (95% CI 0.31 to 0.71) per 1,000 live births, respectively). CONCLUSION Universal screening showed a trend towards lower prevalence of late DDH compared to selective screening. However, it was also associated with a significant increase in the prevalence of abduction bracing without a significant reduction in the prevalence of surgical procedures in childhood for dysplasia being performed. High-quality studies comparing both treatment methods are required, in addition to studies into the natural history of missed DDH.Cite this article: Bone Joint J 2023;105-B(2):198-208.
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Affiliation(s)
- Tim Cheok
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand
| | - Thomas Smith
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Kenneth Wills
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Matthew P Jennings
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia
| | - Jaideep Rawat
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Orthopaedic Surgery, Women's and Children's Hospital, Adelaide, Australia
| | - Bruce Foster
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
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24
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Fu Z, Zhang Z, Deng S, Yang J, Li B, Zhang H, Liu J. MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip. Bone Joint J 2023; 105-B:140-147. [PMID: 36722051 PMCID: PMC9869706 DOI: 10.1302/0301-620x.105b2.bjj-2022-0547.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS Eccentric reductions may become concentric through femoral head 'docking' (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI. METHODS We reviewed 103 patients with DDH successfully treated by CR and spica casting in a single institution between January 2016 and December 2020. MRI was routinely performed immediately after CR and at the end of each cast. Using MRI, we described the labrum-acetabular cartilage complex (LACC) morphology, and measured the femoral head to triradiate cartilage distance (FTD) on the midcoronal section. A total of 13 hips with initial complete reduction (i.e. FTD < 1 mm) and ten hips with incomplete MRI follow-up were excluded. A total of 86 patients (92 hips) with a FTD > 1 mm were included in the analysis. RESULTS At the end of the first cast period, 73 hips (79.3%) had a FTD < 1 mm. Multiple regression analysis showed that FTD (p = 0.011) and immobilization duration (p = 0.028) were associated with complete reduction. At the end of the second cast period, all 92 hips achieved complete reduction. The LACC on initial MRI was inverted in 69 hips (75.0%), partly inverted in 16 hips (17.4%), and everted in seven hips (7.6%). The LACC became everted-congruent in 45 hips (48.9%) and 92 hips (100%) at the end of the first and second cast period, respectively. However, a residual inverted labrum was present in 50/85 hips (58.8%) with an initial inverted or partly inverted LACC. CONCLUSION An eccentric reduction can become concentric after complete reduction and LACC remodelling following CR for DDH. Varying immobilization durations were required for achieving complete reduction. A residual inverted labrum was present in more than half of all hips after LACC remodelling.Cite this article: Bone Joint J 2023;105-B(2):140-147.
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Affiliation(s)
- Zhe Fu
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Zhongli Zhang
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Shuzhen Deng
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Jianping Yang
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Bing Li
- Department of Joint, Tianjin Hospital, Tianjin, China
| | - Huadong Zhang
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Jun Liu
- Department of Joint, Tianjin Hospital, Tianjin, China,Correspondence should be sent to Jun Liu. E-mail:
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25
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Buchan SJ, Lindisfarne EA, Stabler A, Barry M, Gent ED, Bennet S, Aarvold A. The Free-Gliding screw for slipped capital femoral epiphysis : is it safe, does it glide, and does age matter? Bone Joint J 2023; 105-B:215-219. [PMID: 36722064 DOI: 10.1302/0301-620x.105b2.bjj-2022-0700.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide. METHODS All patients with SCFE who underwent fixation using FG SCFE screws after its introduction at our institution, with minimum three years' follow-up, were reviewed retrospectively as part of ongoing governance. All pre- and postoperative radiographs were evaluated. The demographics of the patients, the grade of slip, the extent of lengthening of the barrel of the screw and the restoration of Klein's line were recorded. Subanalysis was performed according to sex and age. RESULTS A total of 19 hips in 13 patients were included. The mean age of the patients at the time of surgery was 11.5 years (9 to 13) and the mean follow-up was 63 months (45 to 83). A total of 13 FG SCFE screws were used for the fixation of mild or moderate SCFE, with six contralateral prophylactic fixations. No hip with SCFE showed a further slip after fixation and there were no complications. Lengthening occurred in 15 hips (79%), with a mean lengthening of the barrel of 6.8 mm (2.5 to 13.6) at final follow-up. Remodelling occurred in all hips with lengthening of the barrel. There was statistically more lengthening in patients who were aged < 12 years, regardless of sex (p = 0.002). CONCLUSION The FG SCFE screw is effective in preventing further slip in patients with SCFE. Lengthening of the barrel occurred in most hips, and thus allowed remodelling. This was most marked in younger children, regardless of sex. Based on this study, this device should be considered for use in patients with SCFE aged < 12 years instead of standard pinning in situ.Cite this article: Bone Joint J 2023;105-B(2):215-219.
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Affiliation(s)
| | | | | | | | - Edward D Gent
- Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
| | - Simon Bennet
- Southampton Children's Hospital, Southampton, UK
| | - Alexander Aarvold
- Southampton Children's Hospital, Southampton, UK.,University of Southampton, Southampton, UK
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Aarvold A, Perry DC, Mavrotas J, Theologis T, Katchburian M. The management of developmental dysplasia of the hip in children aged under three months : a consensus study from the British Society for Children's Orthopaedic Surgery. Bone Joint J 2023; 105-B:209-214. [PMID: 36722054 PMCID: PMC9869707 DOI: 10.1302/0301-620x.105b2.bjj-2022-0893.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children's Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening. METHODS A Delphi consensus study was performed among the membership of BSCOS. Statements were generated by a steering group regarding aspects of the management of DDH in children aged under three months, namely screening and surveillance (15 questions), the technique of ultrasound scanning (eight questions), the initiation of treatment (19 questions), care during treatment with a splint (ten questions), and on quality, governance, and research (eight questions). A two-round Delphi process was used and a consensus document was produced at the final meeting of the steering group. RESULTS A total of 60 statements were graded by 128 clinicians in the first round and 132 in the second round. Consensus was reached on 30 out of 60 statements in the first round and an additional 12 in the seond. This was summarized in a consensus statement and distilled into a flowchart to guide clinical practice. CONCLUSION We identified agreement in an area of medicine that has a long history of controversy and varied practice. None of the areas of consensus are based on high-quality evidence. This document is thus a framework to guide clinical practice and on which high-quality clinical trials can be developed.Cite this article: Bone Joint J 2023;105-B(2):209-214.
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Affiliation(s)
- Alexander Aarvold
- Southampton Children’s Hospital, Southampton, UK,University of Southampton, Southampton, UK,Correspondence should be sent to Alexander Aarvold. E-mail:
| | - Daniel C. Perry
- NDORMS, University of Oxford, Oxford, UK,Institute Population Health, University of Liverpool, Liverpool, UK,Alder Hey Children’s Hospital, Liverpool, UK
| | - Jason Mavrotas
- St Helens and Knowsley Teaching Hospitals NHS Foundation Trust, Liverpool, UK
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27
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Boschung A, Faulhaber S, Kiapour A, Kim YJ, Novais EN, Steppacher SD, Tannast M, Lerch TD. Femoral impingement in maximal hip flexion is anterior-inferior distal to the cam deformity in femoroacetabular impingement patients with femoral retroversion : implications for hip arthroscopy. Bone Joint Res 2023; 12:22-32. [PMID: 36620909 PMCID: PMC9872041 DOI: 10.1302/2046-3758.121.bjr-2022-0263.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS Femoroacetabular impingement (FAI) patients report exacerbation of hip pain in deep flexion. However, the exact impingement location in deep flexion is unknown. The aim was to investigate impingement-free maximal flexion, impingement location, and if cam deformity causes hip impingement in flexion in FAI patients. METHODS A retrospective study involving 24 patients (37 hips) with FAI and femoral retroversion (femoral version (FV) < 5° per Murphy method) was performed. All patients were symptomatic (mean age 28 years (SD 9)) and had anterior hip/groin pain and a positive anterior impingement test. Cam- and pincer-type subgroups were analyzed. Patients were compared to an asymptomatic control group (26 hips). All patients underwent pelvic CT scans to generate personalized CT-based 3D models and validated software for patient-specific impingement simulation (equidistant method). RESULTS Mean impingement-free flexion of patients with mixed-type FAI (110° (SD 8°)) and patients with pincer-type FAI (112° (SD 8°)) was significantly (p < 0.001) lower compared to the control group (125° (SD 13°)). The frequency of extra-articular subspine impingement was significantly (p < 0.001) increased in patients with pincer-type FAI (57%) compared to cam-type FAI (22%) in 125° flexion. Bony impingement in maximal flexion was located anterior-inferior at femoral four and five o'clock position in patients with cam-type FAI (63% (10 of 16 hips) and 37% (6 of 10 hips)), and did not involve the cam deformity. The cam deformity did not cause impingement in maximal flexion. CONCLUSION Femoral impingement in maximal flexion was located anterior-inferior distal to the cam deformity. This differs to previous studies, a finding which could be important for FAI patients in order to avoid exacerbation of hip pain in deep flexion (e.g. during squats) and for hip arthroscopy (hip-preservation surgery) for planning of bone resection. Hip impingement in flexion has implications for daily activities (e.g. putting on shoes), sports, and sex.Cite this article: Bone Joint Res 2023;12(1):22-32.
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Affiliation(s)
- Adam Boschung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Senta Faulhaber
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ata Kiapour
- Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-jo Kim
- Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eduardo N. Novais
- Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Simon D. Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland,Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA, Till D. Lerch. E-mail:
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28
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Hardwick-Morris M, Wigmore E, Twiggs J, Miles B, Jones CW, Yates PJ. Leg length discrepancy assessment in total hip arthroplasty: is a pelvic radiograph sufficient? Bone Jt Open 2022; 3:960-968. [PMID: 36510730 PMCID: PMC9783271 DOI: 10.1302/2633-1462.312.bjo-2022-0146.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Leg length discrepancy (LLD) is a common pre- and postoperative issue in total hip arthroplasty (THA) patients. The conventional technique for measuring LLD has historically been on a non-weightbearing anteroposterior pelvic radiograph; however, this does not capture many potential sources of LLD. The aim of this study was to determine if long-limb EOS radiology can provide a more reproducible and holistic measurement of LLD. METHODS In all, 93 patients who underwent a THA received a standardized preoperative EOS scan, anteroposterior (AP) radiograph, and clinical LLD assessment. Overall, 13 measurements were taken along both anatomical and functional axes and measured twice by an orthopaedic fellow and surgical planning engineer to calculate intraoperator reproducibility and correlations between measurements. RESULTS Strong correlations were observed for all EOS measurements (rs > 0.9). The strongest correlation with AP radiograph (inter-teardrop line) was observed for functional-ASIS-to-floor (functional) (rs = 0.57), much weaker than the correlations between EOS measurements. ASIS-to-ankle measurements exhibited a high correlation to other linear measurements and the highest ICC (rs = 0.97). Using anterior superior iliac spine (ASIS)-to-ankle, 33% of patients had an absolute LLD of greater than 10 mm, which was statistically different from the inter-teardrop LLD measurement (p < 0.005). DISCUSSION We found that the conventional measurement of LLD on AP pelvic radiograph does not correlate well with long leg measurements and may not provide a true appreciation of LLD. ASIS-to-ankle demonstrated improved detection of potential LLD than other EOS and radiograph measurements. Full length, functional imaging methods may become the new gold standard to measure LLD.Cite this article: Bone Jt Open 2022;3(12):960-968.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, NSW, Australia,Flinders University, Adelaide, SA, Australia,Correspondence should be sent to Max Hardwick-Morris. E-mail:
| | - Estelle Wigmore
- 360 Med Care, Sydney, NSW, Australia,Flinders University, Adelaide, SA, Australia
| | | | | | - Christopher W. Jones
- Curtin University Faculty of Health Sciences, School of Medicine, Perth, WA, Australia,Orthopaedics WA, Murdoch, WA, Australia,Fiona Stanley Hospital, Murdoch, WA, Australia,St. John of God Murdoch Hospital, Murdoch, WA, Australia,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia
| | - Piers J. Yates
- Orthopaedics WA, Murdoch, WA, Australia,Fiona Stanley Hospital, Murdoch, WA, Australia,St. John of God Murdoch Hospital, Murdoch, WA, Australia,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia,University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, Perth, WA, Australia
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Latijnhouwers D, Pedersen A, Kristiansen E, Cannegieter S, Schreurs BW, van den Hout W, Nelissen R, Gademan M. No time to waste; the impact of the COVID-19 pandemic on hip, knee, and shoulder arthroplasty surgeries in the Netherlands and Denmark. Bone Jt Open 2022; 3:977-990. [PMID: 36537253 PMCID: PMC9783280 DOI: 10.1302/2633-1462.312.bjo-2022-0111.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS This study aimed to investigate the estimated change in primary and revision arthroplasty rate in the Netherlands and Denmark for hips, knees, and shoulders during the COVID-19 pandemic in 2020 (COVID-period). Additional points of focus included the comparison of patient characteristics and hospital type (2019 vs COVID-period), and the estimated loss of quality-adjusted life years (QALYs) and impact on waiting lists. METHODS All hip, knee, and shoulder arthroplasties (2014 to 2020) from the Dutch Arthroplasty Register, and hip and knee arthroplasties from the Danish Hip and Knee Arthroplasty Registries, were included. The expected number of arthroplasties per month in 2020 was estimated using Poisson regression, taking into account changes in age and sex distribution of the general Dutch/Danish population over time, calculating observed/expected (O/E) ratios. Country-specific proportions of patient characteristics and hospital type were calculated per indication category (osteoarthritis/other elective/acute). Waiting list outcomes including QALYs were estimated by modelling virtual waiting lists including 0%, 5% and 10% extra capacity. RESULTS During COVID-period, fewer arthroplasties were performed than expected (Netherlands: 20%; Denmark: 5%), with the lowest O/E in April. In the Netherlands, more acute indications were prioritized, resulting in more American Society of Anesthesiologists grade III to IV patients receiving surgery. In both countries, no other patient prioritization was present. Relatively more arthroplasties were performed in private hospitals. There were no clinically relevant differences in revision arthroplasties between pre-COVID and COVID-period. Estimated total health loss depending on extra capacity ranged from: 19,800 to 29,400 QALYs (Netherlands): 1,700 to 2,400 QALYs (Denmark). With no extra capacity it will take > 30 years to deplete the waiting lists. CONCLUSION The COVID-19 pandemic had an enormous negative effect on arthroplasty rates, but more in the Netherlands than Denmark. In the Netherlands, hip and shoulder patients with acute indications were prioritized. Private hospitals filled in part of the capacity gap. QALY loss due to postponed arthroplasty surgeries is considerable.Cite this article: Bone Jt Open 2022;3(12):977-990.
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Affiliation(s)
- Daisy Latijnhouwers
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands,Correspondence should be sent to Daisy Latijnhouwers. E-mail:
| | - Alma Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eskild Kristiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Suzanne Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Berend W. Schreurs
- Dutch Arthroplasty Register, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wilbert van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Anderson CG, Brilliant ZR, Jang SJ, Sokrab R, Mayman DJ, Vigdorchik JM, Sculco PK, Jerabek SA. Validating the use of 3D biplanar radiography versus CT when measuring femoral anteversion after total hip arthroplasty : a comparative study. Bone Joint J 2022; 104-B:1196-1201. [PMID: 36317354 DOI: 10.1302/0301-620x.104b11.bjj-2022-0194.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIMS Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate femoral stem version in postoperative total hip arthroplasty (THA) patients and compare the accuracy of hipEOS to CT. We hypothesize that there will be no significant difference in calculated femoral stem version measurements between the two imaging methods. METHODS In this study, 45 patients who underwent THA between February 2016 and February 2020 and had both a postoperative CT and EOS scan were included for evaluation. A fellowship-trained musculoskeletal radiologist and radiological technician measured femoral version for CT and 3D EOS, respectively. Comparison of values for each imaging modality were assessed for statistical significance. RESULTS Comparison of the mean postoperative femoral stem version measurements between CT and 3D hipEOS showed no significant difference (p = 0.862). In addition, the two version measurements were strongly correlated (r = 0.95; p < 0.001), and the mean paired difference in postoperative femoral version for CT scan and 3D biplanar radiography was -0.09° (95% confidence interval -1.09 to 0.91). Only three stem measurements (6.7%) were considered outliers with a > 5° difference. CONCLUSION Our study supports the use of low-dose biplanar radiography for the postoperative assessment of femoral stem version after THA, demonstrating high correlation with CT. We found no significant difference for postoperative femoral version when comparing CT to 3D EOS. We believe 3D EOS is a reliable option to measure postoperative femoral version given its advantages of lower radiation dosage and shorter examination time.Cite this article: Bone Joint J 2022;104-B(11):1196-1201.
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Affiliation(s)
- Christopher G Anderson
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Zachary R Brilliant
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seong J Jang
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Ruba Sokrab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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Qu H, Mou H, Wang K, Tao H, Huang X, Yan X, Lin N, Ye Z. Risk factor investigation for hip dislocation after periacetabular tumour resection and endoprosthetic reconstruction via thin-slice CT-based 3D model. Bone Joint J 2022; 104-B:1180-1188. [PMID: 36177644 DOI: 10.1302/0301-620x.104b10.bjj-2022-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Dislocation of the hip remains a major complication after periacetabular tumour resection and endoprosthetic reconstruction. The position of the acetabular component is an important modifiable factor for surgeons in determining the risk of postoperative dislocation. We investigated the significance of horizontal, vertical, and sagittal displacement of the hip centre of rotation (COR) on postoperative dislocation using a CT-based 3D model, as well as other potential risk factors for dislocation. METHODS A total of 122 patients who underwent reconstruction following resection of periacetabular tumour between January 2011 and January 2020 were studied. The risk factors for dislocation were investigated with univariate and multivariate logistic regression analysis on patient-specific, resection-specific, and reconstruction-specific variables. RESULTS The dislocation rate was 13.9% (n = 17). The hip COR was found to be significantly shifted anteriorly and inferiorly in most patients in the dislocation group compared with the non-dislocation group. Three independent risk factors were found to be related to dislocation: resection of gluteus medius (odds ratio (OR) 3.68 (95% confidence interval (CI) 1.24 to 19.70); p = 0.039), vertical shift of COR > 18 mm (OR 24.8 (95% CI 6.23 to 128.00); p = 0.001), and sagittal shift of COR > 20 mm (OR 6.22 (95% CI 1.33 to 32.2); p = 0.026). CONCLUSION Among the 17 patients who dislocated, 70.3% (n = 12) were anterior dislocations. Three independent risk factors were identified, suggesting the importance of proper restoration of the COR and the role of the gluteus medius in maintaining hip joint stability.Cite this article: Bone Joint J 2022;104-B(10):1180-1188.
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Affiliation(s)
- Hao Qu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haochen Mou
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Keyi Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huimin Tao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaobo Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nong Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wessling M, Gebert C, Hakenes T, Dudda M, Hardes J, Frieler S, Jeys LM, Hanusrichter Y. Reconstruction of Paprosky III defects with custom-made implants: do we get them in the correct position? : short-term radiological results. Bone Joint J 2022; 104-B:1110-1117. [PMID: 36177641 DOI: 10.1302/0301-620x.104b10.bjj-2022-0508.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. METHODS A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up. RESULTS Mean CT defined discrepancy (Δ) between planned and achieved AV and IC was 4.5° (SD 3°; 0° to 12°) and 4° (SD 3.5°; 1° to 12°), respectively. Malpositioning (Δ > 10°) occurred in five hips (10.6%). Native COR reconstruction was planned in 42 cases (93%), and the mean 3D deviation vector was 15.5 mm (SD 8.5; 4 to 35). There was no significant influence in malpositioning found for femoral stem retention, surgical approach, or fixation method. CONCLUSION At short-term follow-up, we found that PPR offers a viable solution for rTHA in cases with massive acetabular bone loss, as highly accurate positioning can be accomplished with meticulous planning, achieving anatomical reconstruction. Accuracy of achieved placement contributed to reduced complications with no injury to vital structures by screw fixation.Cite this article: Bone Joint J 2022;104-B(10):1110-1117.
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Affiliation(s)
- Martin Wessling
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
| | - Carsten Gebert
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Tilmann Hakenes
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany
| | - Marcel Dudda
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
| | - Jendrik Hardes
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.,Department of Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Sven Frieler
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Seattle Science Foundation, Seattle, Washington, USA.,Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Sciences, Aston University, Birmingham, UK
| | - Yannik Hanusrichter
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.,Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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García-Rey E, Cruz-Pardos A, Saldaña L. New polyethylenes in total hip arthroplasty : a 20- to 22-year follow-up study. Bone Joint J 2022; 104-B:1032-1038. [PMID: 36047028 DOI: 10.1302/0301-620x.104b9.bjj-2022-0434.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in total hip arthroplasty (THA). We investigated whether the improvement observed at the earlier follow-up continued, resulting in decreased osteolysis and revision surgery rates over the second decade. METHODS Between January 1999 and December 2001, 90 patients underwent surgery using the same acetabular and femoral components with a 28 mm metallic femoral head and either a Durasul or Sulene liner. A total of 66 hips of this prospective randomized study were available for a minimum follow-up of 20 years. The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Dorr method on digitized radiographs with a software package. RESULTS In the Durasul group, no patients underwent revision due to loosening or showed radiological evidence of osteolysis. In the Sulene group, four patients (four hips) were revised due to femoral component loosening. The 20-year cumulative failure incidence in the presence of the competing event of death for revision surgery was 4.5% (95% confidence interval (CI) 0.8 to 13.6) in the Durasul group, and 8.9% (95% CI 2.8 to 19.5) in the Sulene group. The mean wear one year after surgery was 0.09 mm (SD 0.007) in the Durasul group and 0.24 (SD 0.015) in the Sulene group (p < 0.001). From one to 20 years after surgery, the mean total penetration was 0.32 mm (SD 0.045) in the Durasul group and 1.07 mm (SD 0.13) in the Sulene group (p < 0.001). Mean femoral head penetration at 20 years was approximately 70.0% less in the Durasul group than the Sulene group. CONCLUSION The significant reduction in femoral head penetration obtained with the Durasul compared with Sulene in uncemented THA resulted in lower osteolysis and revision rates after 20 years.Cite this article: Bone Joint J 2022;104-B(9):1032-1038.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain.,Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain
| | - Ana Cruz-Pardos
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
| | - Laura Saldaña
- Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain.,Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
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Morris WZ, Justo PGS, Williams KA, Kim YJ, Millis MB, Novais EN. The incidence and risk factors for stress fracture following periacetabular osteotomy. Bone Joint J 2022; 104-B:1017-1024. [PMID: 36047021 DOI: 10.1302/0301-620x.104b9.bjj-2021-1391.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union. METHODS We retrospectively reviewed all periacetabular osteotomies (PAOs) performed for developmental dysplasia of the hip (DDH) at one institution over a six-year period between 2012 and 2017. Perioperative factors were recorded, and included demographic and surgical data. Postoperatively, patients were followed for a minimum of one year with anteroposterior and false profile radiographs of the pelvis to monitor for evidence of stress fracture and union of osteotomies. We characterized the incidence and locations of stress fractures, and used univariate and multivariable analysis to identify factors predictive of stress fracture and the association of stress fracture on osteotomy union. RESULTS A total of 331 patients underwent PAO during the study period with 56 (15.4%) stress fractures: 46 fractures of the retroacetabular posterior column, five cases of ischiopubic stress fracture, and five cases of concurrent ischiopubic and retroacetabular stress fractures. Overall, 86% (48/56) healed without intervention. Univariate analysis revealed that stress fractures occurred more frequently in females (p = 0.040), older patients (mean age 27.6 years (SD 8.4) vs 23.8 (SD 9.0); p = 0.003), and most often with the use of the broad Mast chisel (28.5%; p < 0.001). Multivariable analysis revealed that increasing age (odds ratio (OR) 1.04; 95% CI 1.01 to 1.07; p = 0.028) and use of the broad Mast chisel (OR 5.1 (95% CI 1.3 to 19.0) compared to narrow Ganz chisel; p = 0.038) and surgeon (p = 0.043) were associated with increased risk of stress fracture. Patients with stress fractures were less likely to have healed osteotomies after one-year follow-up (76% vs 96%; p < 0.001). CONCLUSION Stress fracture of the posterior column may be an under-recognized complication following PAO, and the rate may be influenced by surgical technique. Consideration should be given to using a narrow chisel during the ischial cut to reduce the risk of stress propagation through the posterior column.Cite this article: Bone Joint J 2022;104-B(9):1017-1024.
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Affiliation(s)
- William Z Morris
- Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, USA.,Department of Orthopaedic Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Pedro G S Justo
- Instituto de Ortopedia e Traumatologia, Santa Catarina, Brazil
| | - Kathryn A Williams
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Young-Jo Kim
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael B Millis
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children's Hospital, Boston, Massachusetts, USA
| | - Eduardo N Novais
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children's Hospital, Boston, Massachusetts, USA
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Behman AL, Bradley CS, Maddock CL, Sharma S, Kelley SP. Testing of an Ultrasound-Limited Imaging Protocol for Pavlik harness Supervision (TULIPPS) in developmental dysplasia of the hip: a randomized controlled trial. Bone Joint J 2022; 104-B:1081-1088. [PMID: 36047018 DOI: 10.1302/0301-620x.104b9.bjj-2022-0350.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS There is no consensus regarding optimum timing and frequency of ultrasound (US) for monitoring response to Pavlik harness (PH) treatment in developmental dysplasia of the hip (DDH). The purpose of our study was to determine if a limited-frequency hip US assessment had an adverse effect on treatment outcomes compared to traditional comprehensive US monitoring. METHODS This study was a single-centre noninferiority randomized controlled trial. Infants aged under six months whose hips were reduced and centred in the harness at initiation of treatment (stable dysplastic or subluxable), or initially decentred (subluxated or dislocated) but reduced and centred within four weeks of PH treatment, were randomized to our current standard US monitoring protocol (every clinic visit) or to a limited-frequency US protocol (US only at end of treatment). Groups were compared based on α angle and femoral head coverage at the end of PH treatment, acetabular indices, and International Hip Dysplasia Institute (IHDI) grade on one-year follow-up radiographs. RESULTS Overall, 100 patients were included; 42 patients completed the standard protocol (SP) and 40 completed the limited protocol (LP). There was no significant difference in mean right α angle at the end of treatment (SP 70.0° (SD 3.2°) ; LP 68.7° (SD 2.9°); p = 0.033), nor on the left (SP 69.0° (SD 3.5°); LP 68.1° (SD 3.3°); p = 0.128). There was no significant difference in mean right acetabular index at follow-up (SP 23.1° (SD 4.3°); LP 22.0° (SD 4.1°); p = 0.129), nor on the left (SP 23.3° (SD 4.2°); LP 22.8° (SD 3.9°); p = 0.284). All hips had femoral head coverage of > 50% at end of treatment, and all were IHDI grade 1 at follow-up. In addition, the LP group underwent a 60% reduction in US use once stable. CONCLUSION Our study supports reducing the frequency of US assessment during PH treatment of DDH once a hip is reduced and centred.Cite this article: Bone Joint J 2022;104-B(9):1081-1088.
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Affiliation(s)
- Amy L Behman
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Catharine S Bradley
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Connor L Maddock
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Smriti Sharma
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Simon P Kelley
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
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Özdemir E, Kuijpers MFL, Visser J, Schreurs BW, Rijnen WHC. Thirty years of experience with instrumented femoral impaction bone grafting and a cemented polished Exeter stem : a prospective cohort study of 208 revision arthroplasties performed between 1991 and 2007. Bone Joint J 2022; 104-B:1039-1046. [PMID: 36047023 DOI: 10.1302/0301-620x.104b9.bjj-2022-0150.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS The aim of this study is to report the long-term outcomes of instrumented femoral revisions with impaction allograft bone grafting (IBG) using the X-change femoral revision system at 30 years after introduction of the technique. METHODS We updated the outcomes of our previous study, based on 208 consecutive revisions using IBG and the X-change femoral revision system in combination with a cemented polished stem, performed in our tertiary care institute between 1991 and 2007. Kaplan-Meier survival analyses were used to determine the survival rate of the revisions with endpoint revision for any reason and aseptic loosening. Secondary outcomes were radiological loosening and patient-reported outcome measures. RESULTS Mean age at revision total hip arthroplasty (THA) was 64.9 years (30 to 86). The most prevalent diagnosis for the femoral revision was aseptic loosening. At review in May 2021, 81 patients (85 hips) were still alive and 118 patients (120 hips; 58%) had died. Three patients (3 hips; 1%) were lost to follow-up at 11, 15, and 16 years after surgery, respectively. Data of all deceased and lost patients were included until final follow-up. The mean follow-up was 13.4 years (0 to 28). During the follow-up, 22 re-revisions were performed. The most common reason for re-revision was infection (n = 12; 54%). The survival with endpoint re-revision for any reason was 86% (95% confidence interval (CI) 79 to 91) at 20 years and 74% (95% CI 43 to 89) at 25 years after surgery. The survival for endpoint re-revision for aseptic loosening was 97% (95% CI 91 to 99) after both 20 and 25 years. CONCLUSION We conclude that femoral IBG is a valuable technique that can reconstitute femoral bone loss in the long term. After 25 years of follow-up, few re-revisions for aseptic loosening were required. Also, the overall revision rate is very acceptable at a long follow-up. This technique is especially attractive for younger patients facing femoral revisions with extensive bone loss.Cite this article: Bone Joint J 2022;104-B(9):1039-1046.
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Affiliation(s)
- Erim Özdemir
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn F L Kuijpers
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jetze Visser
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B W Schreurs
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim H C Rijnen
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
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Thummala AR, Xi Y, Middleton E, Kohli A, Chhabra A, Wells J. Does surgery change pelvic tilt? : an investigation in patients with osteoarthritis of the hip, dysplasia, and femoroacetabular impingement. Bone Joint J 2022; 104-B:1025-1031. [PMID: 36047020 DOI: 10.1302/0301-620x.104b9.bjj-2022-0095.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. METHODS The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). RESULTS The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). CONCLUSION There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients.Cite this article: Bone Joint J 2022;104-B(9):1025-1031.
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Affiliation(s)
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Population Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emily Middleton
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ajay Kohli
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
AIMS To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child. METHODS A follow-up investigation was undertaken on a cohort of 28 children previously reported at a mean of 4.8 years. The present study looked at 26 patients who had an arthrodesis of the hip as a child at a mean follow-up of 20 years (15 to 29). RESULTS The mean Harris Hip Score (HHS) increased from 39.60 (SD 11.06) preoperatively to 81.02 (SD 8.86; p = 0.041) at final review. At latest follow-up, the HHS was found to be excellent in four patients (15%), good in 11 (42%), and fair in 11 (42%). A total of 16 patients (62%) reported mild low back pain, five (19%) had moderate pain, and five (19%) patients had no back pain. Mild ipsilateral knee pain was reported by 19 (73%), moderate pain by one (4%), and no pain by six (23%) patients. Mild contralateral hip pain was reported by ten patients (38%), and no pain by 16 (62%). The 36-Item Short Form Health Survey scores were very good in four patients (15%), good in 18 (70%), and poor in four (15%), with a mean score of 70.92 (SD 12.65). Of 13 female patients who had given birth, 12 did so with uncomplicated vaginal delivery. All patients had to modify their posture for toileting, putting on lower body clothes, foot care, and putting on shoes. CONCLUSION Our results show that with hip arthrodesis, most patients have relatively good function at long-term follow-up, although some pain is experienced in adjacent joints, and modification in some activities of daily living is common.Cite this article: Bone Joint J 2022;104-B(9):1089-1094.
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Affiliation(s)
- Bibek Banskota
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Prakash Yadav
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Ansul Rajbhandari
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Rajendra Aryal
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
| | - Ashok K Banskota
- Hospital and Rehabilitation Centre for Disabled Children, Banepa, Nepal
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Kołodziejczyk K, Czubak-Wrzosek M, Kwiatkowska M, Czubak J. Hip dysplasia in adolescence: osteotomy in childhood improves the results of periacetabular osteotomy in adolescents and young adults : a prospective study. Bone Joint J 2022; 104-B:775-780. [PMID: 35775182 PMCID: PMC9251135 DOI: 10.1302/0301-620x.104b7.bjj-2021-1771.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. METHODS Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment. RESULTS Significant improvements in radiological parameters were achieved in all measurements in all groups (p < 0.05). The greatest improvement was in CEA (mean of 19° (17.2° to 22.3°) in Group B), medialization (mean of 3 mm (0.9 to 5.2) in Group C), distalization (mean of 6 mm (3.5 to 8.2) in Group B), FHC (mean of 17% (12.7% to 21.2%) in Group B), and ilioischial angle (mean of 5° (2.3° to 8.1°) in Group B). There were significant improvements in the mean HHS and gluteal muscle performance scores postoperatively in all three groups. CONCLUSION The greatest correction of radiological parameters and clinical outcomes was found in patients who had undergone hip surgery in childhood. Although the surgical treatment of DDH in childhood makes subsequent hip surgery more difficult due to scarring, adhesions, and altered anatomy, it requires less correction of the deformity and has a beneficial effect on the outcome of PAO in adolescence and early adulthood. Cite this article: Bone Joint J 2022;104-B(7):775-780.
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Affiliation(s)
- Kamil Kołodziejczyk
- Department of Orthopaedics, Children's Orthopaedics and Traumatology, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Czubak-Wrzosek
- Department of Spine Disorders and Orthopedics, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Magdalena Kwiatkowska
- Department of Orthopaedics, Children's Orthopaedics and Traumatology, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jaroslaw Czubak
- Department of Orthopaedics, Children's Orthopaedics and Traumatology, Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland
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Abstract
AIMS Acetabular retroversion is a recognized cause of hip impingement and can be influenced by pelvic tilt (PT), which changes in different functional positions. Positional changes in PT have not previously been studied in patients with acetabular retroversion. METHODS Supine and standing anteroposterior (AP) pelvic radiographs were retrospectively analyzed in 69 patients treated for symptomatic acetabular retroversion. Measurements were made for acetabular index (AI), lateral centre-edge angle (LCEA), crossover index, ischial spine sign, and posterior wall sign. The change in the angle of PT was measured both by the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac (PS-SI) index. RESULTS In the supine position, the mean PT (by SFP) was 1.05° (SD 3.77°), which changed on standing to a PT of 8.64° (SD 5.34°). A significant increase in posterior PT from supine to standing of 7.59° (SD 4.5°; SFP angle) and 5.89° (SD 3.33°; PS-SI index) was calculated (p < 0.001). There was a good correlation in PT change between measurements using SFP angle and PS-SI index (0.901 in the preoperative group and 0.815 in the postoperative group). Signs of retroversion were significantly reduced in standing radiographs compared to supine: crossover index (0.16 (SD 0.16) vs 0.38 (SD 0.15); p < 0.001), crossover sign (19/28 hips vs 28/28 hips; p < 0.001), ischial spine sign (10/28 hips vs 26/28 hips; p < 0.001), and posterior wall sign (12/28 hips vs 24/28 hips; p < 0.001). CONCLUSION Posterior PT increased from supine to standing in patients with symptomatic acetabular retroversion. The features of acetabular retroversion were less evident on standing radiographs. The low PT angle in the supine position is a factor in the increased appearance of acetabular retroversion. Patients presenting with symptoms of hip impingement should be assessed by supine and standing pelvic radiographs to highlight signs of acetabular retroversion, and to assist with optimizing acetabular correction at the time of surgery. Cite this article: Bone Joint J 2022;104-B(7):786-791.
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Nakashima Y, Ishibashi S, Kitamura K, Yamate S, Motomura G, Hamai S, Ikemura S, Fujii M. 20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips. Bone Joint J 2022; 104-B:767-774. [PMID: 35775172 DOI: 10.1302/0301-620x.104b7.bjj-2021-1767.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). METHODS A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors. RESULTS THA was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% CI 84.8 to 100), 86.7% (95% CI 79.8 to 94.3), and 54.8% (95% CI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable PROMs. An advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable OHS, but not with other PROMs. CONCLUSION This study demonstrated the durability of TOA for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (OHS), it was not necessarily associated with worse patient satisfaction and joint awareness. Cite this article: Bone Joint J 2022;104-B(7):767-774.
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Affiliation(s)
- Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Yamate
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Ji B, Li G, Zhang X, Xu B, Wang Y, Chen Y, Cao L. Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection : a mean seven years' follow-up. Bone Joint J 2022; 104-B:867-874. [PMID: 35775176 DOI: 10.1302/0301-620x.104b7.bjj-2021-1704.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection represent a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion in treating this condition. METHODS A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single-stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had undergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two-stage revision, and four had a failed one-stage revision before their single-stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated. RESULTS A total of 68 patients (87.1%) were free of infection at a mean follow-up time of 85 months (24 to 133). The seven-year infection-free survival was 87.6% (95% confidence interval (CI) 79.4 to 95.8). No significant difference in infection-free survival was observed between hip and knee PJIs (91.5% (95% CI 79.9 to 100) vs 84.7% (95% CI 73.1 to 96.3); p = 0.648). The mean postoperative Harris Hip Score was 76.1 points (63.2 to 92.4) and Hospital for Special Surgery score was 78. 2 (63.2 to 92.4) at the most recent assessment. Polymicrobial and fungal infections accounted for 14.1% (11/78) and 9.0% (7/78) of all cases, respectively. CONCLUSION Single-stage revision with intra-articular antibiotic infusion can provide high antibiotic concentration in synovial fluid, thereby overcoming reduced vascular supply and biofilm formation. This supplementary route of administration may be a viable option in treating PJI after multiple failed prior surgeries for reinfection. Cite this article: Bone Joint J 2022;104-B(7):867-874.
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Affiliation(s)
- Baochao Ji
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Guoqing Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Xiaogang Zhang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Boyong Xu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yang Wang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yongjie Chen
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
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Stadelmann VA, Rüdiger HA, Nauer S, Leunig M. Impact of capsular preservation on patient-reported outcomes and complication rates in total hip arthroplasty using the direct anterior approach. Bone Joint J 2022; 104-B:826-832. [PMID: 35775167 DOI: 10.1302/0301-620x.104b7.bjj-2021-1765.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS It is not known whether preservation of the capsule of the hip positively affects patient-reported outcome measures (PROMs) in total hip arthroplasty using the direct anterior approach (DAA-THA). A recent randomized controlled trial found no clinically significant difference at one year postoperatively. This study aimed to determine whether preservation of the anterolateral capsule and anatomical closure improve the outcome and revision rate, when compared with resection of the anterolateral capsule, at two years postoperatively. METHODS Two consecutive groups of patients whose operations were performed by the senior author were compared. The anterolateral capsule was resected in the first group of 430 patients between January 2012 and December 2014, and preserved and anatomically closed in the second group of 450 patients between July 2015 and December 2017. There were no other technical changes between the two groups. Patient characteristics, the Charlson Comorbidity Index (CCI), and surgical data were collected from our database. PROM questionnaires, consisting of the Oxford Hip Score (OHS) and Core Outcome Measures Index (COMI-Hip), were collected two years postoperatively. Data were analyzed with generalized multiple regression analysis. RESULTS The characteristics, CCI, operating time, and length of stay were similar in both groups. There was significantly less blood loss in the capsular preservation group (p = 0.037). The revision rate (n = 3, (0.6%) in the resected group, and 1 (0.2%) in the preserved group) did not differ significantly (p = 0.295). Once adjusted for demographic and surgical factors, the preserved group had significantly worse PROMs: + 0.24 COMI-Hip (p < 0.001) and -1.6 OHS points (p = 0.017). However, the effect sizes were much smaller than the minimal clinically important differences (MCIDs) of 0.95 and 5, respectively). The date of surgery (influencing, for instance, the surgeon's age) was not a significant factor. CONCLUSION Based on the MCID, the lower PROMs in the capsular preservation group do not seem to have clinical relevance. They do not, however, confirm the expected benefit of capsular preservation reported for the posterolateral approach. Cite this article: Bone Joint J 2022;104-B(7):826-832.
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Affiliation(s)
- Vincent A Stadelmann
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Hannes A Rüdiger
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Selina Nauer
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Michael Leunig
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
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Martin H, Robinson PG, Maempel JF, Hamilton D, Gaston P, Safran MR, Murray IR. Pre- and intraoperative decision-making challenges in hip arthroscopy for femoroacetabular impingement. Bone Joint J 2022; 104-B:532-540. [PMID: 35491576 DOI: 10.1302/0301-620x.104b5.bjj-2021-1553.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J 2022;104-B(5):532-540.
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Affiliation(s)
- Hannah Martin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | | | - David Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
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Gaston MS, Wordie SJ, Wagner P, Hägglund G, Robb JE. The CPUP Hip Score predicts displacement of the hip in children with cerebral palsy. Bone Joint J 2022; 104-B:640-644. [PMID: 35491586 DOI: 10.1302/0301-620x.104b5.bjj-2021-0301.r5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The Uppföljningsprogram för cerebral pares (CPUP) Hip Score distinguishes between children with cerebral palsy (CP) at different levels of risk for displacement of the hip. The score was constructed using data from Swedish children with CP, but has not been confirmed in any other population. The aim of this study was to determine the calibration and discriminatory accuracy of this score in children with CP in Scotland. METHODS This was a total population-based study of children registered with the Cerebral Palsy Integrated Pathway Scotland. Displacement of the hip was defined as a migration percentage (MP) of > 40%. Inclusion criteria were children in Gross Motor Function Classification System (GMFCS) levels III to V. The calibration slope was estimated and Kaplan-Meier curves produced for five strata of CPUP scores to compare the observed with the predicted risk of displacement of the hip at five years. For discriminatory accuracy, the time-dependent area under the receiver operating characteristic curve (AUC) was estimated. In order to analyze differences in the performance of the score between cohorts, score weights, and subsequently the AUC, were re-estimated using the variables of the original score: the child's age at the first examination, GMFCS level, head shaft angle, and MP of the worst hip in a logistic regression with imputation of outcomes for those with incomplete follow-up. RESULTS The discriminatory accuracy of the score in the new population of 367 children was high (AUC 0.78 (95% confidence interval (CI) 0.71 to 0.86)). The calibration of the score was insufficient (slope 0.48 (95% CI 0.31 to 0.65)), and the absolute risks of displacement of the hip in this population were overestimated. The AUC increased with re-estimated weights (0.85 (95% CI 0.79 to 0.91)). CONCLUSION The CPUP Hip Score had a high ability to discriminate between children at different levels of risk for displacement of the hip. The score overestimated the absolute risks of displacement in this population, which may have resulted from differences in the way children were initially registered in the two programmes. The results are promising, but the score weights may need re-estimation before its clinical application in Scotland. Cite this article: Bone Joint J 2022;104-B(5):640-644.
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Affiliation(s)
| | | | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Gunnar Hägglund
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
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Perry DC, Arch B, Appelbe D, Francis P, Craven J, Monsell FP, Williamson P, Knight M. The British Orthopaedic Surgery Surveillance study: Perthes' disease: the epidemiology and two-year outcomes from a prospective cohort in Great Britain. Bone Joint J 2022; 104-B:510-518. [PMID: 35360941 PMCID: PMC9020518 DOI: 10.1302/0301-620x.104b4.bjj-2021-1708.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aims The aim of this study was to evaluate the epidemiology and treatment of Perthes’ disease of the hip. Methods This was an anonymized comprehensive cohort study of Perthes’ disease, with a nested consented cohort. A total of 143 of 144 hospitals treating children’s hip disease in the UK participated over an 18-month period. Cases were cross-checked using a secondary independent reporting network of trainee surgeons to minimize those missing. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. Results Overall, 371 children (396 hips) were newly affected by Perthes’ disease arising from 63 hospitals, with a median of two patients (interquartile range 1.0 to 5.5) per hospital. The annual incidence was 2.48 patients (95% confidence interval (CI) 2.20 to 2.76) per 100,000 zero- to 14-year-olds. Of these, 117 hips (36.4%) were treated surgically. There was considerable variation in the treatment strategy, and an optimized decision tree identified joint stiffness and age above eight years as the key determinants for containment surgery. A total of 348 hips (88.5%) had outcomes to two years, of which 227 were in the late reossification stage for which a hip shape outcome (Stulberg grade) was assigned. The independent predictors of a poorer radiological outcome were female sex (odds ratio (OR) 2.27 (95% CI 1.19 to 4.35)), age above six years (OR 2.62 (95% CI (1.30 to 5.28)), and over 50% radiological collapse at inclusion (OR 2.19 (95% CI 0.99 to 4.83)). Surgery had no effect on radiological outcomes (OR 1.03 (95% CI 0.55 to 1.96)). PROMs indicated the marked effect of the disease on the child, which persisted at two years. Conclusion Despite the frequency of containment surgery, we found no evidence of improved outcomes. There appears to be a sufficient case volume and community equipoise among surgeons to embark on a randomized clinical trial to definitively investigate the effectiveness of containment surgery. Cite this article: Bone Joint J 2022;104-B(4):510–518.
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Affiliation(s)
- Daniel C Perry
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Trauma and Orthopaedics Department, Alder Hey Children's Hospital, Liverpool, UK.,Kadoorie Centre, Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
| | - Barbara Arch
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Duncan Appelbe
- Kadoorie Centre, Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
| | - Priya Francis
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joanna Craven
- North West Trauma and Orthopaedic Surgery (Cheshire and Merseyside), Health Education England, Liverpool, UK
| | | | - Paula Williamson
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Rajpura A, Asle SG, Ait Si Selmi T, Board T. The accuracy of restoration of femoral head centre of rotation in the anteroposterior plane after uncemented total hip arthroplasty : a CT-based study. Bone Joint Res 2022; 11:180-188. [PMID: 35343251 PMCID: PMC8963361 DOI: 10.1302/2046-3758.113.bjr-2021-0378.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS Hip arthroplasty aims to accurately recreate joint biomechanics. Considerable attention has been paid to vertical and horizontal offset, but femoral head centre in the anteroposterior (AP) plane has received little attention. This study investigates the accuracy of restoration of joint centre of rotation in the AP plane. METHODS Postoperative CT scans of 40 patients who underwent unilateral uncemented total hip arthroplasty were analyzed. Anteroposterior offset (APO) and femoral anteversion were measured on both the operated and non-operated sides. Sagittal tilt of the femoral stem was also measured. APO measured on axial slices was defined as the perpendicular distance between a line drawn from the anterior most point of the proximal femur (anterior reference line) to the centre of the femoral head. The anterior reference line was made parallel to the posterior condylar axis of the knee to correct for rotation. RESULTS Overall, 26/40 hips had a centre of rotation displaced posteriorly compared to the contralateral hip, increasing to 33/40 once corrected for sagittal tilt, with a mean posterior displacement of 7 mm. Linear regression analysis indicated that stem anteversion needed to be increased by 10.8° to recreate the head centre in the AP plane. Merely matching the native version would result in a 12 mm posterior displacement. CONCLUSION This study demonstrates the significant incidence of posterior displacement of the head centre in uncemented hip arthroplasty. Effects of such displacement include a reduction in impingement free range of motion, potential alterations in muscle force vectors and lever arms, and impaired proprioception due to muscle fibre reorientation. Cite this article: Bone Joint Res 2022;11(3):180-188.
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Affiliation(s)
- Asim Rajpura
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | | | | | - Tim Board
- Orthopaedics, Wrightington Hospital, Wigan, UK
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Abstract
Aims With increasing burden of revision hip arthroplasty (THA), one of the major challenges is the management of proximal femoral bone loss associated with previous multiple surgeries. Proximal femoral arthroplasty (PFA) has already been popularized for tumour surgeries. Our aim was to describe the outcome of using PFA in these demanding non-neoplastic cases. Methods A retrospective review of 25 patients who underwent PFA for non-neoplastic indications between January 2009 and December 2015 was undertaken. Their clinical and radiological outcome, complication rates, and survival were recorded. All patients had the Stanmore Implant – Modular Endo-prosthetic Tumour System (METS). Results At mean follow-up of 5.9 years, there were no periprosthetic fractures. Clearance of infection was achieved in 63.6% of cases. One hip was re-revised to pseudo arthroplasty for deep infection. Instability was noted in eight of the hips (32%), of which seven needed further surgery. Out of these eight hips with instability, five had preoperative infection. Deep infection was noted in five of the hips (20%), of which four were primarily revised for infection. One patient had aseptic loosening of the femoral component and awaits revision surgery. The Kaplan-Meier survivorship free of revision of any component for any reason was 72% (95% confidence interval (CI) 51.3% to 92.7%), and for revisions of only femoral component for any reason was 96% (95% CI 86.3% to 105.7%) at five years. Conclusion Dislocation and infection remain the major cause for failure, particularly in patients with pre-existing infection. The use of dual mobility cups, silver-coated implants, and less aggressive postoperative rehabilitation regimens would possibly aid in the reduction of complications. PFA performed in patients with periprosthetic fracture seem to fair better. This study supports the judicious use of PFA in non-oncological revision hip arthroplasties, and that they be performed by experienced revision arthroplasty surgeons. Cite this article: Bone Jt Open 2022;3(3):229–235.
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Affiliation(s)
- Kevin Syam
- Wrightington Hip Centre, Wigan, UK.,Robert Jones and Agnes Hunt Hospital, Oswestry, UK
| | - P Nithin Unnikrishnan
- Wrightington Hip Centre, Wigan, UK.,Robert Jones and Agnes Hunt Hospital, Oswestry, UK
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49
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Kingsbury SR, Smith LK, Shuweihdi F, West R, Czoski Murray C, Conaghan PG, Stone MH. A comparative study of patients presenting for planned and unplanned revision hip or knee arthroplasty. Bone Joint J 2022; 104-B:59-67. [PMID: 34969282 PMCID: PMC8779949 DOI: 10.1302/0301-620x.104b1.bjj-2021-0032.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to conduct a cross-sectional, observational cohort study of patients presenting for revision of a total hip, or total or unicompartmental knee arthroplasty, to understand current routes to revision surgery and explore differences in symptoms, healthcare use, reason for revision, and the revision surgery (surgical time, components, length of stay) between patients having regular follow-up and those without. METHODS Data were collected from participants and medical records for the 12 months prior to revision. Patients with previous revision, metal-on-metal articulations, or hip hemiarthroplasty were excluded. Participants were retrospectively classified as 'Planned' or 'Unplanned' revision. Multilevel regression and propensity score matching were used to compare the two groups. RESULTS Data were analyzed from 568 patients, recruited in 38 UK secondary care sites between October 2017 and October 2018 (43.5% male; mean (SD) age 71.86 years (9.93); 305 hips, 263 knees). No significant inclusion differences were identified between the two groups. For hip revision, time to revision > ten years (odds ratio (OR) 3.804, 95% confidence interval (CI) (1.353 to 10.694), p = 0.011), periprosthetic fracture (OR 20.309, 95% CI (4.574 to 90.179), p < 0.001), and dislocation (OR 12.953, 95% CI (4.014 to 41.794), p < 0.001), were associated with unplanned revision. For knee, there were no associations with route to revision. Revision after ten years was more likely for those who were younger at primary surgery, regardless of route to revision. No significant differences in cost outcomes, length of surgery time, and access to a health professional in the year prior to revision were found between the two groups. When periprosthetic fractures, dislocations, and infections were excluded, healthcare use was significantly higher in the unplanned revision group. CONCLUSION Differences between characteristics for patients presenting for planned and unplanned revision are minimal. Although there was greater healthcare use in those having unplanned revision, it appears unlikely that routine orthopaedic review would have detected many of these issues. It may be safe to disinvest in standard follow-up provided there is rapid access to orthopaedic review. Cite this article: Bone Joint J 2022;104-B(1):59-67.
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Affiliation(s)
- Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Lindsay K Smith
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Martin H Stone
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
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50
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Liechti EF, Neufeld ME, Soto F, Linke P, Busch SM, Gehrke T, Citak M. Favourable outcomes of repeat one-stage exchange for periprosthetic joint infection of the hip. Bone Joint J 2022; 104-B:27-33. [PMID: 34969284 DOI: 10.1302/0301-620x.104b1.bjj-2021-0970.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS One-stage exchange for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) is gaining popularity. The outcome for a repeat one-stage revision THA after a failed one-stage exchange for infection remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat one-stage exchange, and to investigate the association between the Musculoskeletal Infection Society (MSIS) staging system and further infection-related failure. METHODS We retrospectively reviewed all repeat one-stage revision THAs performed after failed one-stage exchange THA for infection between January 2008 and December 2016. The final cohort included 32 patients. The mean follow-up after repeat one-stage exchange was 5.3 years (1.2 to 13.0). The patients with a further infection-related failure and/or all-cause revision were reported, and Kaplan-Meier survival for these endpoints determined. Patients were categorized according to the MSIS system, and its association with further infection was analyzed. RESULTS A total of eight repeat septic revisions (25%) developed a further infection-related failure, and the five-year infection-free survival was 81% (95% confidence interval (CI) 57 to 92). Nine (28%) underwent a further all-cause revision and the five-year all-cause revision-free survival was 74% (95% CI 52 to 88). Neither the MSIS classification of the host status (p = 0.423) nor the limb status (p = 0.366) was significantly associated with further infection-related failure. CONCLUSION Repeat one-stage exchange for PJI in THA is associated with a favourable five-year infection-free and all-cause revision-free survival. Notably, the rate of infection control is encouraging when compared with the reported rates after repeat two-stage exchange. The results can be used to counsel patients and help clinicians make informed decisions about treatment. With the available number of patients, further infection-related failure was not associated with the MSIS host or limb status. Cite this article: Bone Joint J 2022;104-B(1):27-33.
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Affiliation(s)
- Emanuel F Liechti
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael E Neufeld
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Lower Limb (Adult Hip & Knee) Reconstruction, The University of British Columbia, Vancouver, Canada
| | - Fernando Soto
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Hospital Naval de Viña del Mar Almirante Nef, Vina del Mar, Chile
| | - Philip Linke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Sophia-Marlene Busch
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
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