Total hip replacement for high dislocated hips without femoral shortening osteotomy

When performing total hip replacement (THR) in high dislocated hips, the presence of soft-tissue contractures means that most surgeons prefer to use a femoral shortening osteotomy in order to avoid the risk of neurovascular damage. However, this technique will sacrifice femoral length and reduce the extent of any leg-length equalisation. We report our experience of 74 THRs performed between 2000 and 2008 in 65 patients with a high dislocated hip without a femoral shortening osteotomy. The mean age of the patients was 55 years (46 to 72) and the mean follow-up was 42 months (12 to 78). All implants were cementless except for one resurfacing hip implant. We attempted to place the acetabular component in the anatomical position in each hip. The mean Harris hip score improved from 53 points (34 to 74) pre-operatively to 86 points (78 to 95) at final follow-up. The mean radiologically determined leg lengthening was 42 mm (30 to 66), and the mean leg-length discrepancy decreased from 36 mm (5 to 56) pre-operatively to 8.5 mm (0 to 18) postoperatively. Although there were four (5%) post-operative femoral nerve palsies, three had fully resolved by six months after the operation. No loosening of the implant was observed, and no dislocations or infections were encountered. Total hip replacement without a femoral shortening osteotomy proved to be a safe and effective surgical treatment for high dislocated hips.     

Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae

We retrospectively evaluated the postoperative results of total hip arthroplasty (THA) in patients presenting with Crowe group IV dislocated hips. Overall, results were compared with regard to the type of osteotomy performed (Z or oblique) to define the correct indications for surgical technique and choice of prosthetic implant. Thirty-three subtrochanteric shortening and derotational osteotomies in primary THA were performed in 26 patients secondary to congenital hip dislocation. A Z osteotomy was performed in 14 cases and an oblique osteotomy in 19. The surgical approach was direct lateral, and surgery was aimed at restoring the anatomic hip center. Femoral and acetabular fixation was uncemented. The most used stem was the S-ROM (DePuy, Leeds, United Kingdom), and the couplings used were ceramic-ceramic (7 cases), ceramic-polyethylene (3 cases), metal-polyethylene (15 cases), and metal-metal (3 cases). Mean follow-up was 88±45 months. According to the Merle D'Aubigné score, the overall clinical results were good in 23 cases, satisfactory in 6, and fair in 4. Union of the osteotomy occurred in 97% of cases, and the mean time required for osteotomy union was 6±2 months without significant differences between Z and oblique osteotomies. At last follow-up, there was loosening of 1 cup and 1 stem, and revision was necessary. Twelve percent of patients experienced postoperative dislocation and 9% developed neuropraxia of the femoral nerve. The clinical and radiological results were similar in both groups, with a high rate of pain relief, an improvement in limb-length discrepancy, and reduced limping, leading to a smaller or no insole. Currently, the more complex Z osteotomy has been abandoned, because a modular stem prosthesis with metaphyseal sleeve allows the oblique osteotomy to be used with an easier and shorter surgical procedure.     

Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip

A surgical technique, which uses a transverse osteotomy, for subtrochanteric femoral shortening and derotation in total hip arthroplasty for high-riding developmental dislocation of the hip is described. Anteversion is set by rotating the osteotomy fragments, and torsional stability is augmented with allograft struts and cables when indicated. Eight patients with 9 total hip arthroplasties were followed for an average of 43 months (range, 24–84 months). Good to excellent results were obtained in 87% of patients (7 of 8). Eight of 9 osteotomies (89%) demonstrated radiographic evidence of healing at an average of 5 months. One patient had an asymptomatic nonunion of the osteotomy site but still had a good overall clinical result. Another patient suffered fatigue failure of a distally ingrown porous device, which necessitated revision total hip arthroplasty 18 months after surgery. Subtrochanteric osteotomy in total hip arthroplasty for developmental dislocation of the hip allows for acetabular exposure and diaphyseal shortening while facilitating femoral derotation. Furthermore, proximal femoral bone stock is maintained and some of the potential complications of greater trochanteric osteotomy may be avoided.     

Treatment of high hip dislocation with a cementless stem combined with a shortening osteotomy

Introduction

The purpose of this study was to review the clinical and radiographic outcomes and report the major complications in a group of hips with Crowe type IV developmental dysplasia that underwent reconstruction with a cementless total hip arthroplasty and a transverse subtrochanteric shortening osteotomy fixed with locking compression plate and screws.

Method

Fifteen consecutive patients (21 hips) who had coxarthrosis secondary to Crowe Group IV developmental dysplasia of the hip were treated with a cementless prosthesis and a transverse subtrochanteric osteotomy fixed with locking compression plates at a mean age of 41. The mean follow-up period was 5?years. The acetabular cup was placed in the position of the anatomical hip center in every patient. Subtrochanteric femoral shortening osteotomy was fixed with plates and screws in all patients.

Results

The mean Harris hip score improved from 36.2?±?9.8 points to 90.8?±?2.5 points. Trendelenburg sign was positive in seven hips and two patients complained about continuing anterior thigh pain at the final follow-up. There was no infection. No cases of nonunion were encountered. Two patients had dislocation on early postoperative period (15th and 20th postoperative day). Of these patients, femoral head was changed to 28?mm with stem revision in one patient, and one had acetabular component revision with use of constrained acetabular liner. There was one permanent sciatic nerve palsy. One patient had implant related pain during lying laterally. Plate and screws were removed at postoperative 16th month.

Conclusion

Cementless total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of patients with Crowe Group IV developmental dysplasia of the hip is an effective technique to reduce the hip to its original acetabular location and restore the rotational deformities. Plate and screw fixation is a viable option for a secure and stable fixation of femoral stem after subtrochanteric osteotomy.     

Total hip replacement in congenital high hip dislocation following iliofemoral monotube distraction

The aim of this study was to prospectively evaluate our single-centre one- and five-year results of anatomically correct cementless total hip arthroplasty in unilateral and bilateral Crowe type IV high hip dislocations in ten hips following iliofemoral monotube soft tissue distraction. Six consecutive patients (five females and one male) with unilateral and two female patients with bilateral high hip dislocation with an average age of 46 years and height of dislocation up to 110 mm were treated in our institution. Limb lengthening was achieved up to 100 mm. The mean leg-length-discrepancy was −4 mm postoperatively. Harris hip score increased significantly at one year (p < 0.001) and significantly further (p < 0.05) at five years postoperative. WOMAC, VAS pain scale as well as gait and pain-free walking distance also improved significantly at follow-up. Two pin infections and one temporary peroneal nerve palsy occurred during monotube extension. Three cup protrusions that required revision surgery were observed in two patients. This study shows that iliofemoral distraction prior to total hip replacement achieves leg length equality and improved gluteal function and therefore gait in patients with Crowe type IV hip dislocation.     

Treatment of Crowe IV high hip dysplasia with total hip replacement using the Exeter stem and shortening derotational subtrochanteric osteotomy

We evaluated all cases involving the combined use of a subtrochanteric derotational femoral shortening osteotomy with a cemented Exeter stem performed at our institution. With severe developmental dysplasia of the hip an osteotomy is often necessary to achieve shortening and derotation of the proximal femur. Reduction can be maintained with a 3.5 mm compression plate while the implant is cemented into place. Such a plate was used to stabilise the osteotomy in all cases. Intramedullary autograft helps to prevent cement interposition at the osteotomy site and promotes healing. There were 15 female patients (18 hips) with a mean age of 51 years (33 to 75) who had a Crowe IV dysplasia of the hip and were followed up for a mean of 114 months (52 to 168). None was lost to follow-up. All clinical scores were collected prospectively. The Charnley modification of the Merle D'Aubigné-Postel scores for pain, function and range of movement showed a statistically significant improvement from a mean of 2.4 (1 to 4), 2.3 (1 to 4), 3.4 (1 to 6) to 5.2 (3 to 6), 4.4 (3 to 6), 5.2 (4 to 6), respectively. Three acetabular revisions were required for aseptic loosening; one required femoral revision for access. One osteotomy failed to unite at 14 months and was revised successfully. No other case required a femoral revision. No postoperative sciatic nerve palsy was observed. Cemented Exeter femoral components perform well in the treatment of Crowe IV dysplasia with this procedure.     

Total hip arthroplasty with step-cut subtrochanteric femoral shortening osteotomy in high riding hip dislocated patients with previous femoral osteotomy

Background

To evaluate the long-term clinical and radiological outcomes of cementless total hip arthroplasty (THA) in high riding hip dislocated patients with previous proximal femoral osteotomy.

Total hip replacement after intertrochanteric osteotomy

Summary From 1980 to 1993 we inserted 216 total prostheses into hips which had been treated by varus and valgus-extension intertrochanteric osteotomy. The technique of the operation was more difficult than in hips operated on for the first time because of anatomical changes produced by the osteotomy in the surrounding structures. We have had complications which taught us how to prevent and deal with these problems.

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Résumé Au cours de ces dernières 14 années (1980–1993) nous avons mis en place 216 prothèses de hanche chez des patients antérieurement opérés par ostéotomie fémorale intertrochantérienne de valgisation-extension ou de varisation. Dans ces cas la réalisation de l'opération a été beaucoup plus difficile que sur les hanches vierges, parce que l'ostéotomie avait entraîné la modification de plusieurs structures anatomiques (os, tendons, muscles, nerfs, vaisseaux). Nous avons eu en effet un certain nombre de complications qui nous ont montré comment faire face aux dangers que l'on peut rencontrer pendant l'opération, à titre préventif ou curatif. Naturellement les précautions à prendre sont différentes selon le type d'ostéotomie préalablement réalisée (varisation ou valgisation-extension).

     

Total hip replacement after intertrochanteric osteotomy

Forty-five hips were analyzed in 42 patients treated with total hip replacements (THR) after earlier intertrochanteric osteotomies. At time of osteotomy, the patients' mean age was 50 years (range: 14 to 65). Total hip replacement was performed at a mean interval of 11.9 years later (standard deviation: 7.7). Narrowing or closure of the medullary canal made insertion of the prosthesis stem difficult in 10 cases. After THR, the patients were followed for a mean of 6 years (range: 3 to 11). At follow up, the hips had a mean Mayo score of 81 (SD = 13) points (17 excellent, 12 good, 7 fair, 9 poor). The failure rate was 6.7%. Being overweight had an adverse effect on outcome. Intertrochanteric osteotomy may impair results after subsequent THR.     

Extensive subtrochanteric shortening osteotomy enables the conversion of a long lasting resection arthroplasty to a total hip replacement

This case report presents the results of a conversion hip arthroplasty after a long lasting Girdlestone situation of 15 years in combination with an extensive shortening of the leg of 7.2 centimeters. An extensive subtrochanteric shortening osteotomy of 3.5 centimeters was necessary to restore leg length and the rotational centre of the hip. Functional outcome was excellent within the long run and a restoration of the independence of the patient was achieved.     

Revision total hip replacement without trochanteric osteotomy

Revision total hip replacement has traditionally required a trochanteric osteotomy for successful cement removal and component reinsertion. In this study the authors have concluded that in most instances the revision total hip replacement procedure can be successfully performed without trochanteric osteotomy. The advantages are underscored by the high percentage of trochanteric complications with trochanteric osteotomy for revision total hip replacement and the ease of rehabilitation without trochanteric osteotomy. Also, improved functional results without trochanteric osteotomy were noted. The specific indications for the procedure included revision total hip replacement with ununited prior trochanteric osteotomy, revision total hip replacement with femoral shaft fractures, and revision total hip replacement with stem fractures requiring only acetabular revision. The contraindications to the procedure are fibrous union or ununited trochanteric osteotomy from prior total hip replacement, severe acetabular protrusion of the acetabular component, advanced myositis ossificans, ankylosis of the hip, and advanced proximal femoral osteoporosis. The operating room records, x-rays, and outpatient records of 63 total hip revisions in 52 patients were reviewed. There was a minimum 2-year follow up with a range from two years to seven years. The patients were divided into two groups, comparing 21 trochanteric osteotomized revisions to 44 with trochanteric sparing techniques. Both groups were analyzed for age, type of implant, intraoperative perforation of femur, intraoperative femoral shaft fractures, intraoperative cortical window, component malpositioning extraneous cement, intraoperative blood loss, operating time, postoperative leg length inequality, persistent abductor weakness, average first day of ambulation, wound infection, dislocation, nonunion of the trochanter, and postoperative pain. In the nonosteotomized group, there was a 21% decreased blood loss, a 14% decrease in persistent abductor weakness, a 14% decrease in subluxation and dislocation, a 30% decrease operating time and a 50% reduction in intraoperative femoral perforation. In the osteotomized group there were six cases of fibrous union of the greater trochanter, two cases requiring removal of broken wires for trochanteric bursitis. A detailed surgical technique and representative cases are presented. In carefully selected cases, revision total hip replacement is optimally performed without trochanteric osteotomy. Postoperative trochanteric problems of nonunion, broken wires, bursitis, and abductor weakness can effectively be eliminated by avoiding trochanteric osteotomy.(ABSTRACT TRUNCATED AT 400 WORDS)     

Trochanteric osteotomy in total hip replacement for congenital hip disease

We studied the effect of trochanteric osteotomy in 192 total hip replacements in 140 patients with congenital hip disease. There was bony union in 158 hips (82%), fibrous union in 29 (15%) and nonunion in five (3%). The rate of union had a statistically significant relationship with the position of reattachment of the trochanter, which depended greatly on the pre-operative diagnosis. The pre-operative Trendelenburg gait substantially improved in all three disease types (dysplasia, low and high dislocation) and all four categories of reattachment position. A persistent Trendelenburg gait post-operatively was noticed mostly in patients with defective union (fibrous or nonunion). Acetabular and femoral loosening had a statistically significant relationship with defective union and the position of reattachment of the trochanter. These results suggest that the complications of trochanteric osteotomy in total hip replacement for patients with congenital hip disease are less important than the benefits of this surgical approach.     

Total knee replacement following high tibial osteotomy versus total knee replacement without high tibial osteotomy: a systematic review and meta analysis

Introduction

Currently, there is no consensus as to whether total knee replacement(TKR) following high tibial osteotomy(HTO) provides similar postoperative outcomes as compared to TKR without previous HTO. Previous studies have provided limited evidence to small sample sizes and methodological inappropriateness.

Methods

A systematic search process was conducted utilising PRISMA guidelines. Electronic, peer reviewed and published literatures were searched. Databases searched include Embase, Medline, Cochrane Library, PubMed and cross references. Methodological appropriateness was assessed with Papadokastakis system and Critical Appraisal Skills questionnaire. Data were analysed for both clinical and statistical homogeneity. Meta analytic pooling was subsequently performed.

Results

11 studies including 2170 TKR procedures were analysed for systematic review. The study (TKR following previous HTO) and control (TKR without previous HTO) groups were adequately matched for age, sex ratio and follow-up. Meta analysis of six studies utilising KSS system and four studies utilising HSS system showed no significant (p > 0.05) difference between the two groups. Complications also showed no significant difference between the two groups. At an average follow-up of 7.2 years, with revision arthroplasty for any cause as the endpoint, survivorship for the study and control groups was 95 and 97 %, respectively. For revision arthroplasty with aseptic loosening as the end point, the survivorship was 98 % for both groups.

Conclusion

Systematic review and meta analysis suggested that TKR following HTO provides similar outcomes as compared to TKR without previous HTO. Therefore, a previous HTO does not negatively influence a future TKR, though the conversion process of HTO to TKR is technically challenging. Systematic review also identified paucity in prospective and long term studies.     

先天性髋关节脱位的全髋关节置换术

目的了解先天性髋关节脱位患者行全髋关节置换术后的中远期疗效。方法先天性髋关节脱位患者行全髋关节置换术32例36髋,随访28例31髋,随访时间平均9.5年(3.5~18年)。脱位分类:低位脱位或半脱位15髋,中位脱位11髋,高位脱位5髋。固定方法:髋臼侧,10髋为骨水泥固定,21髋为非骨水泥固定;股骨侧,12髋为骨水泥固定,19髋为非骨水泥固定。结果1例术中发生小转子劈裂,1例术后发生下肢静脉炎,3例两侧肢体不等长2cm以上,1例发生股动脉栓塞。4髋发生假体松动,1髋为大转子不愈合而松动,1髋为单纯假体柄松动,2髋为假体柄和髋臼假体均发生松动;其余27髋Harris评分为85分(术前48分)。结论先天性髋关节脱位的全髋关节置换术,手术相对比较复杂,并发症较多,手术中特别需要考虑两侧肢体的长度、外展肌的平衡、软组织的松解、髋臼骨缺损的处理及假体的选择。     

髋关节置换术后假体脱位的预防

查阅近年来关于全髋关节置换术后假体脱位的原因和预防措施研究的国内外相关文献,进行回顾及综合分析.术前对病人做详细的评估、选择合适的假体;术中提高假体位置安放的准确性、术后避免容易导致脱位的活动范围可以减少术后假体脱位的发生率.通过详细的术前、术中和术后处理可以降低术后假体脱位的发生率.     

Total hip replacement with or without trochanteric osteotomy

Summary In a consecutive series of primary total hip replacements (THR) 54 patients were operated upon with and 78 patients without trochanteric osteotomy. Follow-up at least 2.5 years postoperatively failed to disclose any differences between the two groups in bleeding during operation, the incidence of early complications or the infection rate. A longer operation time was noted for the osteotomized group. Mechanical failure was more frequent in the non-osteotomized group. The clinical end result was similar in both groups. In complicated cases or when accessibility to the operation site is poor a trochanteric osteotomy is recommended.

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Zusammenfassung In einer konsekutiven Studie von primären totalen Hüftgelenksendoprothesen wurden 54 Patienten mit und 78 Patienten ohne Osteotomie des Trochanter majors operiert. Die Nachuntersuchungsdauer betrug mindestens 2,5 Jahre. Es wurden keine Unterschiede bezüglich peroperativer Blutung, früher postoperative Komplikationen oder Infektionen zwischen den beiden Gruppen notiert. Die Operationszeit war bei denjenigen Patienten länger, bei welchen eine Trochanterosteotomie durchgeführt wurde. Eine Lockerung kam häufiger bei den Patienten vor, welche ohne Trochanterosteotomie operiert wurden. Das klinische Endergebnis war für beide Patientengruppen gleichartig. Bei komplizierten Fällen, oder wenn der Zugang zum Operationssitus schlecht ist, ist die Osteotomie des Trochanter majors zu empfehlen.