共查询到20条相似文献，搜索用时 15 毫秒
1.
Taro Tezuka Nathanael D. Heckmann Russell J. Bodner Lawrence D. Dorr 《The Journal of arthroplasty》2019,34(1):3-8
Background
The Lewinnek “safe zone” is not always predictive of stability after total hip arthroplasty (THA). Recent studies have focused on functional hip motion as observed on lateral spine-pelvis-hip x-rays. The purpose of this study was to assess the correlation between the Lewinnek safe zone and the functional safe zone based on hip and pelvic motion in the sagittal plane.Methods
Three hundred twenty hips (291 patients) underwent primary THA using computer navigation. Two hundred ninety-six of these hips (92.5%) were within the Lewinnek safe zone as determined by inclination of 40° ± 10° and anteversion of 15° ± 10°. All patients had preoperative and postoperative standing and sitting lateral spinopelvic x-rays. The combined sagittal index (CSI), a combination of sagittal acetabular and femoral position, was measured for each patient and used to assess the functional safe zone. Data analysis was performed to identify hips in the Lewinnek safe zone inside and outside the sagittal functional safe zone. Predictive factors for hips outside the functional safe zone were identified.Results
Of the 296 hips within the Lewinnek safe zone, 254 (85.8%) were also in the functional safe zone. Forty-two patients were outside the functional safe zone based on CSI; 19 had an increased standing CSI and 23 had a decreased sitting CSI, all were considered at risk for dislocation. Predictive factors for falling outside the functional safe zone were increased femoral mobility (P < .001, r = 0.632), decreased spinopelvic mobility (P < .001, r = 0.455), and pelvic incidence (P < .001, r = 0.400).Conclusion
In this study, 14.2% of hips within the Lewinnek safe zone were outside the functional safe zone, identifying a potential reason hips dislocate despite having “normal” cup angles. The best predictor for falling outside the functional safe zone, both preoperatively and postoperatively, was femoral mobility, not the sagittal cup position (ie, cup anteinclination).Level of Evidence
Level III, retrospective review. 相似文献2.
David Novikov Afshin A. Anoushiravani Kevin K. Chen Theodore S. Wolfson Nimrod Snir Ran Schwarzkopf 《The Journal of arthroplasty》2019,34(3):522-526
Background
Advancements in the management of human immunodeficiency virus (HIV) now permit HIV-positive patients to have longer life spans, increasing their cumulative risk of developing an advanced degenerative joint disease, necessitating total hip arthroplasty (THA). The purpose of this study was to provide an extended follow-up on a previously published study on a cohort of HIV-positive THA recipients in an effort to confirm the safety and longevity of THA in this population.Methods
This study is a follow-up on a previous study comprised of 41 hips in 31 HIV-positive THA recipients. At this follow-up, 5 patients from the original cohort required contralateral THA. Postoperative complications were recorded up to the patient’s last follow-up date. A survivorship analysis was performed using the Kaplan-Meier method with revision THA as the end point.Results
Since the last report, 2 additional hips were revised (one for aseptic loosening and one for a periprosthetic fracture), and 5 patients underwent contralateral THA. This resulted in a total of 5 (13.8%) hips requiring revision THA at the latest follow-up. The mean follow-up interval for the original cohort and for the contralateral 5 hips was 78.9 ± 50.2 months and 54.6 ± 45.3 months, respectively. Kaplan-Meier survivorship analysis with revision THA for any reason as the end point demonstrated survivorship of 93% (2 years), 90% (5 years), and 81% (10 and 14 years) after primary THA, respectively.Conclusion
Our study suggests that it is possible to achieve a low incidence of postoperative infection in HIV-positive THA recipients. In addition, our study demonstrates that non-hemophiliac HIV-positive patients have comparable revision rates to previously published reports on HIV-negative patients of similar age, underscoring the clinical efficacy of highly active antiretroviral therapy. 相似文献3.
David S. Peitgen Moritz M. Innmann Christian Merle Tobias Gotterbarm Babak Moradi Marcus R. Streit 《The Journal of arthroplasty》2019,34(1):77-81
Background
Although falling is becoming a major problem in the elderly, little is known about the long-term incidence of postoperative periprosthetic femoral fractures (PFF) after total hip arthroplasty (THA) using uncemented stems with a minimum follow-up of 26 years postoperatively.Methods
In a consecutive series, the cumulative incidence of PFF after uncemented THA using a straight, collarless, tapered titanium stem was retrospectively reviewed in 354 hips (326 patients). After a mean follow-up of 28 (26-32) years postoperatively, 179 hips had died and 5 hips had been lost to follow-up. Kaplan-Meier survival analysis was used to estimate cumulative percentage probability of PFF.Results
At final follow-up, a total of 27 fractures in 27 patients had occurred. In 15 hips, the stem had to be revised, and in 10 the fracture was treated by open reduction and internal fixation. Two patients declined further surgery. The cumulative percentage probability of PFF was 1.6% (95% confidence interval, 0.7 to 3.8) at 10 years and 13.2% (95% confidence interval, 8.5 to 20.2) at 29 years after primary THA. There was no association between the occurrence of fracture and gender, age at primary THA, cup revision, or canal fill index.Conclusion
Our findings indicate that PFF is the major mode of failure in the long term after uncemented THA using a tapered titanium stem. More research is needed to evaluate the reasons and risk factors for PFF after THA, thus providing better prophylaxis for those at risk and to compare the long-term incidence using different fixation methods and implants.Level of evidence
IV. 相似文献4.
Wei-Nan Zeng Jun-Li Liu Xiao-Lin Jia Qiang Zhou Liu Yang Yun Zhang 《The Journal of arthroplasty》2019,34(1):102-107
Background
Total hip arthroplasty (THA) is technically challenging in patients with high dislocation of the hip secondary to suppurative arthritis. The technical difficulty is attributable to the complex hip anatomy and the potential risk of recurrent infection in these patients. This study investigated the midterm results of THA in patients with Crowe type III and IV high dislocation of the hip secondary to suppurative arthritis.Methods
This study retrospectively reviewed 45 patients (45 hips) who underwent cementless THA with a mean quiescent infection period of 34.2 years. This study included 23 men and 22 women (mean age, 45.9 years) at the time of operation. The mean follow-up was 6.4 years. Clinical and radiographic outcomes and complications were evaluated.Results
The mean Harris hip score significantly improved from 48.1 to 87.6. The modified Merle d'Aubigné-Postel, Western Ontario and McMaster Universities Arthritis Index, low back pain visual analog scale, and the 12-item short-form health survey scores also improved significantly. The mean limb length discrepancy was reduced from 38.9 mm to 6.4 mm. Postoperative dislocation occurred in 2, temporary sciatic nerve paralysis in 3, and intraoperative fracture in 2 patients. Infection and femoral stem loosening necessitated hip revision surgery in 1 patient each.Conclusion
THA could provide good joint function and significantly improve quality of life at the time of midterm follow-up in patients undergoing high hip dislocation secondary to suppurative arthritis. However, a relatively high incidence of complications occurred which can be treated. 相似文献5.
Jun-Il Yoo Javad Parvizi Ji-ung Song Yong-Chan Ha Young-Kyun Lee Kyung-Hoi Koo 《The Journal of arthroplasty》2017,32(7):2199-2203
Background
In total hip arthroplasty (THA) of hips with coxa vara, the femoral stems might be inserted in a varus alignment. To avoid varus insertion, we designed a technique, which we termed “trochantoplasty.” In this procedure, the medial half of the greater trochanter was removed during THA.Methods
We evaluated 30 patients (31 hips) who had coxa vara deformity and underwent THA using trochantoplasty at the mean follow-up of 5 years (range, 3-9 years).Results
All stems were inserted in the neutral position. One Vancouver type 1 periprosthetic femoral fracture occurred after a fall at postoperative 2 months. At the latest follow-up, the mean power of abductor was 4.3 (range, 3-5). Four patients had moderate limp whereas 26 patients had slight limp. The abduction at 90° flexion ranged from 15° to 45° (mean, 35°). There was no revision. All prostheses had bone-ingrown stability without any detectable wear or osteolysis. The mean Harris hip score was improved from 66.9 to 89.4 points.Conclusion
Trochantoplasty can be used to avoid varus insertion of the femoral stem while performing THA in patients with coxa vara deformity without compromising the abductor mechanism. 相似文献6.
Min Chen Zhengliang Luo Xiaofeng Ji Peng Cheng Guolin Tang Xifu Shang 《The Journal of arthroplasty》2017,32(1):131-138
Background
The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject.Methods
A total of 248 patients (295 hips) were recruited for primary THAs from July 1, 2014 to December 31, 2014. In total, 126 hips (42.7%) underwent THAs using the DAA in the lateral decubitus position. The technical feasibility and early results were evaluated.Results
The orientation of the acetabular component was 16.5° ± 4.9° anteversion and 43.3° ± 3.5° abduction. Intraoperative proximal femoral fracture occurred in one hip. The superficial wound complications occurred in 2 hips and the hematoma in one hip while in hospital. The lateral femoral cutaneous nerve injury was noted in 43 hips. The early dislocation occurred in 2 hips. Heterotopic ossification was Brooker class I in 5 hips and class II in 1 hip. No aseptic loosening, postoperative periprosthetic fracture, and deep infection occurred in our series.Conclusion
The DAA for THA in the lateral decubitus position may be a valuable alternative if the DAA in the supine position is difficult to implement owing to absence of a special operating room table. This technique also seems to provide satisfactory clinical and radiographic outcomes with an acceptable complication in our early follow-up. 相似文献7.
Yuta Sakemi Keisuke Komiyama Kensei Yoshimoto Kyohei Shiomoto Miho Iwamoto Yasuharu Nakashima 《Journal of orthopaedic science》2019,24(2):269-274
Background
Due to anterior bone defects, high and/or posterior placement of an acetabular cup is often required to achieve sufficient coverage in patients with hip dysplasia. We examined whether posterior cup placement affected the postoperative range of motion (ROM) in primary total hip arthroplasty (THA).Methods
Using computer software, bone coverage and ROM were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia. We determined the cup position to satisfy cup center-edge (Cup-CE) angle ≥0° and the required ROM. The cup was placed at the anatomic hip center and moved in 2-mm increments anteroposteriorly and 10-mm increments vertically.Results
At vertical anatomic hip center, less than 68.8% hips fulfilled Cup-CE ≥0° regardless of anteroposterior position. Significantly more hips at higher hip center with posterior cup placement achieved Cup-CE ≥0° than hips at vertical anatomic hip center, and 10 mm higher hip center was the most suitable for achieving bone coverage. However, posterior and superior cup placement significantly decreased the flexion and IR due to early bone impingement, whereas ER and extension were not affected. A smoothing spline curve demonstrated that more posterior cup placement than 4.8 mm and 3.6 mm did not satisfy the required ROM at 10 mm and 20 mm higher hip center, respectively.Conclusions
Posterosuperior cup placement gained more bone coverage but decreased the range of hip flexion and internal rotation. Consequently, posterosuperior cup placement did not satisfy the required ROM. 相似文献8.
Markus T. Berninger Sven Hungerer Jan Friederichs Fabian M. Stuby Christian Fulghum Rolf Schipp 《The Journal of arthroplasty》2019,34(5):920-925
Background
Developmental hip dysplasia is the most common cause of secondary hip osteoarthritis. Due to severe acetabular bone deficiency, cup positioning in total hip arthroplasty (THA) of dysplastic hips remains a surgical challenge. The aim was to analyze the functional outcome of far proximal cup positions in primary THA.Methods
Fifty patients (61 hips) with THA for severe dysplastic osteoarthritis and a far proximal cup position were included. Patients were divided according to the heights of the implanted cups with increasing vertical distance from the interteardrop line (group A: 55-65 mm, group B: 65-75 mm, group C: >75 mm). Functional outcome was assessed at latest follow-up (38 ± 16 months) by Lower Extremity Functional Score, Tegner Activity Score, and Harris Hip Score (HHS). Patients answered a Patient Satisfaction Questionnaire. Leg length discrepancy was estimated radiographically.Results
The Lower Extremity Functional Score significantly decreased in C (45.3 ± 25) compared to A (66.7 ± 15.3) and B (67.9 ± 9.9). The Tegner Activity Score significantly increased in all subgroups from preoperative to postoperative (2.2 ± 1.3 to 4.1 ± 1.4; P < .05). The mean overall HHS was 89.3 ± 14.7 (A: 89.5 ± 14.3, B: 94.3 ± 6.5, C: 78.3 ± 22.1). The HHS domains of activity of daily life and gait were significantly reduced in C (P < .05). Patients described a high satisfaction level with the surgery. No significant differences were found with regard to preoperative and postoperative leg lengthening (P = .881). Neither dislocations, impingement problems nor neurologic complications were observed.Conclusion
Primary THA without any concomitant surgical interventions with a far proximal cup position offers a safe and effective treatment option in severe dysplastic hip osteoarthritis. 相似文献9.
Chahine C. Assi Hanane B. Barakat Jacques H. Caton Elie N. Najjar Camille T. Samaha Kaissar F. Yammine 《The Journal of arthroplasty》2019,34(2):333-337
Background
The dual mobility cups (DMCs) were shown to reduce dislocation rate following total hip arthroplasty for any etiology, including femoral neck fractures. No reported studies evaluating DMC results for femoral neck fracture in a Middle Eastern population were found in the literature.Methods
This study aims to look for mortality rate, clinical, and functional outcomes in a population having specific rituals involving extreme hip positions as part of their daily activities.Results
Of an initial sample of 174 patients (177 operated hips), 18 (10.3%) patients (20 hips) died after a mean of 39.6 ± 13.8 months (ranging from 2 to 49 months) with only 3 (1.7%) during the first post-operative year. Twelve patients (13 hips) were lost to follow-up and 19 patients (19 hips) had their radiological data incomplete. In the final sample of 125 patients (125 hips), no dislocation, aseptic loosening, or infection was encountered. The mean modified Hip Harris Score was of 94.8 ± 8.4. The mean modified Hip Harris Score of 40 patients who used to practice regularly oriental sitting position or prayers was 94.1 ± 3.1. After surgery, 36 of these 40 patients (90%) described their hip as “a forgotten hip.” Multivariate analyses found correlation only between mortality and cardiovascular co-morbidities.Conclusion
DMC implants showed excellent clinical and functional results. The majority of patients having rituals and customs involving extreme hip positions were able to resume their daily activities. The observed low mortality rate should incite future research to investigate its correlation with the use of DMCs. 相似文献10.
Ting-Xian Ling Jin-Long Li Kai Zhou Qiang Xiao Fu-Xing Pei Zong-Ke Zhou 《The Journal of arthroplasty》2018,33(2):453-459
Background
Given the lack of studies of acetabular defect reconstruction in primary total hip arthroplasty (THA) using tantalum augments, this study aims to evaluate clinical and radiographic results for treatment with tantalum augments to reconstruct acetabular defects in primary THA.Methods
We retrospectively reviewed 19 patients (19 hips) with acetabular defects who underwent primary THA using tantalum augments, with a minimum follow-up of 2 years. Clinical, radiographic, and surgical data were retrospectively evaluated.Results
Mean follow-up was 5.1 years (range 2.5-7.6). Harris Hip Score improved from 35.8 (range 19-56) preoperatively to 85.3 (63-98) at last follow-up (P < .01). Oxford Hip Score, University of California Los Angeles activity scale, and Short Form-12 score also improved significantly from presurgery to last follow-up. Mean operation time and blood loss were 124.7 minutes and 530 mL, respectively. Mean hip center position was 2.97 cm (range 2.35-3.58) horizontally and 2.06 cm (1.29-2.92) vertically, and mean acetabular inclination was 38.9° (range 27°-47°) at last follow-up. These parameters were not significantly different from those recorded immediately postoperatively (P > .05). There was no aseptic loosening, cup and augment migration, screw breakage, or presence of hip infection at last follow-up. All hips were radiographically stable.Conclusion
Porous tantalum augments combined with titanium shells lead to satisfactory clinical and radiographic outcomes for the reconstruction of acetabular defect in primary THA at a mean 5.1 years of follow-up. This approach confers anatomical cup placement, simple operation, and a high rate of stable fixation. 相似文献11.
Arthur L. Malkani Kevin J. Himschoot Kevin L. Ong Edmund C. Lau Doruk Baykal John R. Dimar Steven D. Glassman Daniel J. Berry 《The Journal of arthroplasty》2019,34(5):907-911
Background
Patients undergoing primary total hip arthroplasty (THA) following lumbar spine fusion have an increased incidence of dislocation compared to those without prior lumbar fusion. The purpose of this study is to determine if timing of THA prior to or after lumbar fusion would have an effect on dislocation and revision incidence in patients with both hip and lumbar spine pathology.Methods
One hundred percent Medicare inpatient claims data from 2005 to 2015 were used to compare dislocation and revision risks in patients with primary THA with pre-existing lumbar spine fusion vs THA with subsequent lumbar spine fusion within 1, 2, and 5 years after the index THA. A total of 42,300 patients met inclusion criteria, 28,668 patients of which underwent THA with pre-existing lumbar spinal fusion (LSF) and 13,632 patients who had prior THA and subsequent LSF. Patients who had THA first followed by LSF were further stratified based on the interval between index THA and subsequent LSF (1, 2, and 5 years), making 4 total groups for comparison. Multivariate cox regression analysis was performed adjusting for age, socioeconomic status, race, census region, gender, Charlson score, pre-existing conditions, discharge status, length of stay, and hospital characteristics.Results
Patients with prior LSF undergoing THA had a 106% increased risk of dislocation compared to those with LSF done 5 years after THA (P < .001). Risk of revision THA was greater in the pre-existing LSF group by 43%, 41%, and 49% at 1, 2, and 5 years post THA compared to the groups with THA done first with subsequent LSF. Dislocation was the most common etiology for revision THA in all groups, but significantly higher in the prior LSF group (26.6%).Conclusion
Results of this study demonstrate that sequence of surgical intervention for concomitant lumbar and hip pathology requiring LSF and THA respectively significantly impacts the fate of the THA performed. Patients with prior LSF undergoing THA are at significantly higher risk of dislocation and subsequent revision compared to those with THA first followed by delayed LSF.Level of Evidence
3. 相似文献12.
Olivier Freddy Hitz Xavier Flecher Sébastien Parratte Matthieu Ollivier Jean-Noël Argenson 《The Journal of arthroplasty》2018,33(7):2197-2202
Background
Options for total hip arthroplasty (THA) in high dislocated hips include subtrochanteric osteotomy (STO), high hip center positioning, and 2-stage surgery with progressive lowering using an external fixator before THA. We described the long-term results of 1-stage THA performed without STO, using a cementless customized stem associated if necessary with sequential tenotomies and/or greater trochanteric osteotomy.Methods
Ninety-eight consecutive THA without STO were performed using this technique. Of those 98 hips, 26 hips with high dislocation (12 class III and 14 class IV according to the Crowe classification) were evaluated at an average follow-up of 16 (10-22) years.Results
At the time of last follow-up, the mean Harris Hip Score was 86 points (37-100). The mean leg-length discrepancy was 7 ± 5 mm (0-17). Two transient (7.7%) nerve palsies (1 sciatic and 1 femoral) were notified. A revision was required for 6 hips (23.1%). Kaplan-Meier survivorship analysis at 15 years regarding aseptic loosening of the femoral component was 87.5% (95% confidence interval, 76.5-99.1). During the same period, acetabular implant survivorship free from revision for aseptic loosening was 96.1% (95% confidence interval, 92.7-99.9).Conclusion
The combination of intramedullary fit and extramedullary adaptation for offset and anteversion provided by the custom stem can avoid additional procedures associated to THA in high developmental dysplasia of the hip. The clinical function and long-term survival reported in this series is encouraging for THA performed in case of high hip dislocation. 相似文献13.
Tyler E. Calkins Brian Darrith Kamil T. Okroj Roman Drabchuk Chris Culvern Craig J. Della Valle 《The Journal of arthroplasty》2019,34(1):9-14
Background
Time trade-off, standard gamble, and willingness to pay assess the number of years, risk of death, and income a patient would give up for perfect health. These questions were used to evaluate the impact knee arthritis, hip arthritis, or failed total knee (TKA) or hip arthroplasty (THA) has on patients’ health-related quality of life prior to surgery.Methods
Three hundred sixty patients including 176 undergoing primary TKA, 127 undergoing primary THA, 31 undergoing revision TKA, and 26 undergoing revision THA were assessed. Time trade-off and standard gamble were converted to utility scores with 1.0 suggesting perfect health and 0 suggesting preference for death rather than living in current state. Willingness to pay is the percentage of yearly income that a patient would pay for perfect health.Results
The mean time trade-off, standard gamble, and willingness to pay scores were 0.74, 0.83, and 0.32 without significant difference between procedures with the numbers available for study (P = .16, .31, and 0.41, respectively). Increasing body mass index was correlated with decreasing time trade-off scores (P = .014).Conclusion
Patients scheduled for primary or revision THA and TKA would accept an average 17% risk of death, lose 2.6 years of an additional 10-year life expectancy, and pay 32% of their income for perfect health. The time trade-off (0.74) was similar to patients with history of acute myocardial infarction (0.74) or minor stroke (0.72) and worse than those with chronic hepatitis C (0.83) or human immunodeficiency virus/acquired immunodeficiency syndrome infection (0.86). These data highlight the high value that patients place on adult reconstructive procedures. 相似文献14.
Purpose
Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup.Methods
We report a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein for valgus osteotomy was added to reduction fixation secured with a commonly available 135° dynamic hip screw and plate.Results
Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3.Conclusion
135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results. 相似文献15.
Huiwu Li Yao Yuan Jiawei Xu Yongyun Chang Kerong Dai Zhenan Zhu 《The Journal of arthroplasty》2018,33(3):794-799
Background
A number of methods for reduction in high hip dislocation in total hip arthroplasty (THA) are time-consuming and laborious, and require great surgical skills. This study aimed to introduce a new reduction technique to achieve rapid, safe, and easy reduction in high hip dislocation.Methods
We retrospectively reviewed 74 THA patients (82 hips; 44 women, 30 men) with severe hip dysplasia who underwent direct leverage using a Hohmann retractor into the anatomical acetabulum without femoral shortening osteotomy between September 2007 and January 2014. Forty-nine hips were classified as Crowe III and 33 hips were classified as Crowe IV. The mean follow-up period was 5.1 years (range 2-8).Results
Mean Harris Hip Score increased from 42.1 (range 24-71) before surgery to 89.9 (range 76-100) at final follow-up examination. The legs were lengthened by a mean of 3.0 cm (range 1.1-5.5) and 2.5 cm (range 1.1-3.5) in Crowe III hips and 3.6 cm (range 1.9-5.5) in Crowe IV hips postoperatively. The average leg-length discrepancy at the final follow-up examination was 0.4 cm (standard deviation 0.5 cm). One greater trochanteric fracture occurred during the hip reduction process. One patient developed femoral nerve palsies and recovered completely at 3 weeks postoperatively.Conclusion
Direct leverage using the Hohmann retractor for the reduction in high hip dislocation in THA without femoral shortening osteotomy is simple, safe, and effective. 相似文献16.
Keisuke Akiyama Katsuya Nakata Makoto Kitada Mitsuyoshi Yamamura Hajime Owaki Takeshi Fuji 《The Journal of arthroplasty》2018,33(2):415-422
Background
Internal rotation of the hip and lateral patellar tilt increases after total hip arthroplasty (THA). However, it remains unknown whether these parameters change with time after the index THA.Methods
A total of 91 patients undergoing 2-stage bilateral primary THAs between January 2008 and May 2014 were included to assess the association of chronological changes in internal rotation of the hip or lateral patellar tilt with anthropometric and perioperative parameter and changes in alignment after the index THA. Chronological changes were assessed as changes between postoperative computed tomography on the index surgery and the preoperative computed tomography on the contralateral THA. Internal rotation of the hip was defined as the angle between the posterior intercondylar line and a line passing through the posterior inferior iliac spines. Lateral patellar tilt was defined as the angle between the posterior intercondylar line and a line joining the medial and lateral edges of the patella.Results
Internal rotation of the hip and lateral patellar tilt changed until 2 years after the index surgery by a mean of ?2° (range ?17.3° to 17.7°) and ?2° (range ?18.2° to 5.3°), respectively. Adductor tenotomy was associated with increasing internal rotation of the hip with time (adjusted R2 0.076); leg lengthening and larger preoperative femorotibial angle were associated with decreasing lateral patellar tilt with time (adjusted R2 0.159).Conclusion
Both internal rotation of the hip at rest and lateral patellar tilt decreased by approximately 2° until 2 years after surgery and there was a large variation in chronological change. 相似文献17.
Cody C. Wyles Joseph A. Panos Matthew T. Houdek Robert T. Trousdale Daniel J. Berry Michael J. Taunton 《The Journal of arthroplasty》2019,34(3):517-521
Background
Spondyloepiphyseal dysplasia (SED) is rare genetic condition which leads to skeletal and joint deformities that can predispose patients to degenerative joint disease. There are limited reports on the results of total hip arthroplasty (THA) in this patient population. The purpose of this study is to review clinical and radiographic outcomes of THA performed in patients with SED at one institution.Methods
Among 43,917 patients undergoing primary THA from 1970 to 2015, we identified 50 THAs performed in 29 patients with SED; 21 patients underwent bilateral THA (none simultaneous). There were 16 females and 13 males; mean age, body mass index, and height were 39 years, 28.7 kg/m2, and 145 cm, respectively. All patients were able to ambulate prior to the THA. Mean follow-up was 11 years (range 2-38).Results
Mean implant survival for primary THA in SED patients at the 5, 10, and 20-year time points was 96%, 85%, and 55%, respectively. Thirteen patients required revision THA, most commonly for polyethylene wear (n = 6) and aseptic loosening (n = 5), and 4 additional patients underwent nonrevision reoperations. Prior to surgery, 90% of patients had severe or moderate pain, which was reduced to 8% of patients postoperatively (P < .001). Mean Harris Hip Score improved from 47 to 87 (P < .001). Prior to surgery, 64% of patients required gait aids, which reduced to 34% postoperatively (P < .001).Conclusion
THA provided significant pain reduction and improvement in function, with a majority of patients ambulating independently following the procedure. There was a high incidence of complications following THA in patients with SED, most commonly secondary to polyethylene wear and osteolysis from conventional polyethylene and historical implants.Level of Evidence
Level IV, Therapy. 相似文献18.
Mitchell R. Klement Alexander J. Rondon Richard M. McEntee Matthew Kheir Matthew S. Austin 《The Journal of arthroplasty》2019,34(3):513-516
Background
Recent data suggested that unsupervised, self-directed physical therapy (SDPT) is both safe and efficacious for patients undergoing total hip arthroplasty (THA) and that formal outpatient physical therapy (OPPT) may not be routinely required. The purpose of this study was to evaluate the routine use of an SDPT program in a nonselect patient population.Methods
This is a multi-surgeon, single-institution, retrospective study of 941 consecutive patients discharged home, from January 2016 to December 2016, after primary, unilateral THA and enrolled in a web-based SDPT program. Patients were seen 4 weeks after surgery and OPPT was prescribed for perceived need, patient request, or if unable to use the web-based program. Patient-reported outcomes, medical comorbidities, and assessment of home environment were prospectively recorded.Results
Overall, 646 of 941 patients (68.7%) were not prescribed OPPT (SDPT-only group) while 295 of 941 patients (31.3%) were prescribed OPPT (SDPT + OPPT group). In the SDPT + OPPT group, 88.2% were for perceived need, 10.8% for patient request, and 1.0% due to inability to use the web-based platform. Multivariate analysis identified male sex (odds ratio, 0.64; 0.45-0.90; P = .012) and a higher preoperative Short Form-12 physical component (odds ratio, 0.98; 0.96-0.99; P = .036) as independent variables protective against requiring OPPT. At a minimum 6-month follow-up, the SDPT-only group had statistically higher hip disability and osteoarthritis outcome score junior compared to the SDPT + OPPT cohort (85.0 vs 80.9; P = .012).Conclusion
Web-based SDPT is safe and effective for most, but not all, patients eligible for home discharge after THA. It is critical to preserve OPPT services for the one-third of patients who require them.Level of Evidence
Level III. 相似文献19.
Sean P. Ryan Benjamin Wooster William Jiranek Samuel Wellman Michael Bolognesi Thorsten Seyler 《The Journal of arthroplasty》2019,34(1):88-92
Background
Conversion total hip arthroplasties (THAs) from prior free vascularized fibular grafting (FVFG) are infrequently reported in the literature. We characterized the perioperative outcomes of patients undergoing conversion THA and compared them with those of a matched cohort of patients undergoing primary THA for osteonecrosis of the femoral head and neck (ONFHN).Methods
The institutional database was queried for patients with FVFG requiring conversion to THA. This cohort was then matched 1:1 for age, gender, and American Society of Anesthesiologists (ASA) score for patients with ONFHN undergoing primary THA. Medical records were reviewed for intraoperative and postoperative complications, which were then compared between conversion and primary THA patient cohorts.Results
Two hundred eighty-eight THA patients were included for analysis (144 patients with FVFG matched to 144 patients with ONFHN and no prior FVFG). Patients with prior FVFG who underwent THA had significantly greater operative time and blood loss (P < .001). Although not significant, there were more intraoperative fractures in the FVFG cohort (P = .053). Postoperatively, patients with FVFG had significantly greater blood transfusions (P < .001) and hematoma formation (P = .004) than the matched cohort. There was no difference in length of stay, discharge disposition, or venous thromboembolism; however, patients who underwent conversion THA showed increased deep infection (P = .044) and rate of return to the operating room (P = .010).Conclusion
Although there are numerous treatment strategies for patients with ONFHN, many patients will ultimately require THA. Patients undergoing conversion after FVFG are more likely to have complications including increased blood loss, hematoma formation, and intraoperative fractures. Consequently, surgeons should concentrate on preoperative optimization and prepare for specific technical challenges. 相似文献20.
Daniel J. Blizzard Colin T. Penrose Charles Z. Sheets Thorsten M. Seyler Michael P. Bolognesi Christopher R. Brown 《The Journal of arthroplasty》2017,32(8):2474-2479