Effect of hip hemiarthroplasty on articular cartilage and bone in a canine model

The purpose of this study was to determine if acetabular articular cartilage damage occurs in the presence or absence of changes in subchondral plate thickness or porosity and trabecular bone architecture after hip hemiarthroplasty. Eight canines were sacrificed 6 months after receiving unilateral hemiarthroplasties in which a cobalt chrome alloy femoral head was used. The acetabular cartilage, subchondral plate, and trabecular bone were quantitatively evaluated. Although the articular cartilage in the treated hip showed gross and histologic degenerative changes, there were no differences in the treated and contralateral hips in any of the trabecular bone parameters or subchondral plate thickness. However, the subchondral plate porosity was increased 2.6-fold in the treated hip. Therefore, degradation of cartilage can occur in the absence of thickening of the subchondral plate or alterations in the supporting trabecular bone architecture. These observations provide a better understanding of the role that periarticular bone has in the degenerative process after hemiarthoplasty.     

Bulk Femoral Head Autograft Without Decortication in Uncemented Total Hip Arthroplasty : Seven- to Ten-Year Results

Superolateral acetabular bone defect is a serious challenge in uncemented total hip arthroplasty for acetabular dysplasia. We report a bulk bone autografting technique without decortication of the acetabulum and femoral head contact surfaces in 22 joints. Mean follow-up time was 8.3 years, and survival rates were 100% for loosening and revision end points. The preoperative Japanese orthopedic association hip score increased from 49.5 to 94.0. Although trabecular bridging and graft remodeling occurred in all cases, complete trabecular reorientation was observed in only 15 joints. Eccentric polyethylene wear was observed in 8 of 22 joints, and osteolysis, in 1 joint. Our technique is easy to perform, and midterm results were favorable; thus, we conclude that it may be an effective option for bulk bone autografting.     

Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results

Superolateral acetabular bone defect is a serious challenge in uncemented total hip arthroplasty for acetabular dysplasia. We report a bulk bone autografting technique without decortication of the acetabulum and femoral head contact surfaces in 22 joints. Mean follow-up time was 8.3 years, and survival rates were 100% for loosening and revision end points. The preoperative Japanese orthopedic association hip score increased from 49.5 to 94.0. Although trabecular bridging and graft remodeling occurred in all cases, complete trabecular reorientation was observed in only 15 joints. Eccentric polyethylene wear was observed in 8 of 22 joints, and osteolysis, in 1 joint. Our technique is easy to perform, and midterm results were favorable; thus, we conclude that it may be an effective option for bulk bone autografting.     

成人常见髋关节疾病双侧髋关节解剖参数的研究

目的探讨行全髋关节置换术中利用对侧相对正常髋关节的解剖参数作为模板重建患侧髋关节的准确性。 方法选取2019年9月至2020年12月于大连医科大学附属第一医院关节外科行首次单侧全髋关节置换术的患者作为研究对象。纳入标准：患侧诊断为髋关节骨关节炎、股骨头坏死或髋关节发育不良Crowe Ⅰ型；对侧髋关节形态不影响测量。排除标准：患侧髋关节既往手术史；畸形严重影响测量；髋关节发育不良Crowe Ⅱ型及以上。最后共纳入82例患者，其中33例男性，49例女性，年龄范围29~74岁。根据患者X线及CT影像数据，分别测量患者患侧及对侧髋臼前倾角、髋臼外展角、股骨前倾角、颈干角以及股骨偏心距，并计算其各自的联合前倾角。运用t检验、Pearson相关性分析等统计学方法分析双侧髋关节解剖参数的对称性。 结果对股骨头坏死及髋关节骨关节炎患者来说，除双侧股骨偏心距患侧小于对侧外(t＝0.523，P <0.05)，余双侧髋关节解剖参数包括髋臼前倾角、髋臼外展角、股骨前倾角、联合前倾角及颈干角的差异均无统计学意义(均为P>0.05)。Pearson相关性分析显示股骨头坏死及骨关节炎患者股骨偏心距的不对称性与颈干角有相关性(r＝-0.519，P<0.001)，颈干角的不对称性与股骨前倾角(r＝0.303，P＝0.041)以及股骨偏心距有相关性，联合前倾角的不对称性与髋臼外展角(r＝0.311，P＝0.035)、颈干角(r＝0.049，P＝0.032)有相关性。Crowe Ⅰ型髋关节发育不良患者的髋臼前倾角(t＝2.081，P＝0.045)、股骨偏心距(t＝3.934，P<0.001)患侧小于对侧，颈干角患侧大于对侧(t＝3.792，P＝0.001)；而双侧髋臼外展角、股骨前倾角、联合前倾角差异均无统计学意义(均为P>0.05)。Pearson相关性分析发现股骨偏心距的不对称性与颈干角(r＝-0.709，P<0.001)、股骨前倾角(r＝-0.349，P＝0.037)有相关性。Crowe Ⅰ型髋关节发育不良患者的股骨偏心距小于股骨头坏死患者或髋关节骨关节炎患者，而髋臼前倾角、髋臼外展角、颈干角大于后者。 结论对于股骨头坏死患者及髋关节骨关节炎患者来说利用对侧肢体作为模板重建患侧髋关节是可行的。而Crowe Ⅰ型髋关节发育不良患者双侧髋关节解剖形态差异较大，对这类患者的全髋关节置换术需个体化。     

Microvascular density of rapidly destructive arthropathy of the hip joint

PURPOSE: To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head. METHOD: Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted. RESULT: The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count. CONCLUSION: These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.     

Novel three‐dimensional MRI technique for study of cartilaginous hip surfaces in Legg‐Calvé‐Perthes disease

Treatment of Legg‐Calvé‐Perthes disease (LCPD) may improve if new knowledge can be obtained regarding how articular cartilage changes shape during the course of this disorder. A new technique is presented showing how analyses of magnetic resonance images can be used to quantify the three‐dimensional changes in the femoral and acetabular articulating cartilage surfaces of children with LCPD. Ten male subjects (8 ± 1 years) with unilateral LCPD were enrolled in this IRB approved study. Sets of magnetic resonance images of both hips were obtained at three different times. Three‐dimensional virtual models of the cartilage were created from these images, and mathematical spheres were fit to the articulating surfaces. Five parameters (size, shape deformity (sphericity error), radial growth rate, joint fit, and joint incongruity) were used to quantify cartilage surface shape. Data were analyzed by using a linear mixed‐model. Joint incongruity, i.e., the distance between the centers of the femoral and acetabular spheres, was slightly more than 2.5 times larger (p = 0.001) in LCPD hips than the contralateral normal hips. Cartilage shape deformity was 65% larger in hips with LCPD than in normal hips. Growth rates of the femoral head and the opposing acetabular surface showed that distortion of the femoral surface occurred first and the opposing acetabular surface followed. Mean radial difference (acetabular surface radius minus femoral surface radius) in LCPD hips was less than half (p < 0.01) the value of normal hips. Interobserver variability was ～10% of the value attributable to LCPD. This is the first known report presenting a technique that quantifies the three‐dimensional size, deformity, growth, fit. and incongruity of the femoral and acetabular articulating cartilaginous surfaces of LCPD and contralateral normal hips. The data obtained support the use of this technique and provide pilot data for a future clinical study of LCPD. Objective assessment of cartilage shape enabled by this technique may aid future diagnoses, enable monitoring of three‐dimensional femoral and acetabular remodeling, and permit quantitative assessment of treatment efficacy. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 981–988, 2009     

Heat generated by hip resurfacing prostheses: an in vivo pilot study

In order to determine the magnitude of temperature increases in resurfaced hips, temperature sensors were placed percutaneously in both hip joints of 12 volunteer patients who had 1 or both joints resurfaced. Temperature recordings were made with patients at rest (baseline) and after patients walked for 20 and 60 minutes. The hip resurfacing procedures were performed 12 to 36 months prior to this study using 9 different acetabular bearing surface components. At baseline (resting), a ceramic femoral prosthesis articulating with a poly-ether-ether-ketone (PEEK) acetabular prosthesis generated a temperature increase of 4°C compared to a normal contralateral hip. After 60 minutes of walking, a ceramic femoral prosthesis articulating with a polyurethane acetabular prosthesis generated a temperature increase of 5°C, whereas a ceramic femoral prosthesis articulating with a metal acetabular prosthesis generated a temperature increase of 6°C, a cobalt-chromium alloy femoral prosthesis on a polyethylene acetabular prosthesis generated a temperature increase of 7°C, and a cobalt-chromium alloy metal-on-metal prosthesis generated a temperature increase of 8°C. Resurfaced hips generate more heat than arthritic and normal hips, and arthritic hips generate more heat than normal hips. A resurfaced hip with a ceramic femoral and PEEK or polyurethane acetabulum generated less heat than a resurfaced hip of the same design using a cobalt-chromium femur and either cobalt-chromium, or polyethylene for the acetabulum. Frictional heat generated in a resurfaced hip is not immediately dissipated and may result in increased bearing surface wear. Extended periods of elevated temperature within joints may inhibit periarticular cell growth and perhaps contribute to bone resorption or component loosening over the long term.     

Femoral head autograft in simultaneous primary and revision total hip arthroplasty

Bilateral total hip arthroplasty during one anesthetic procedure can be beneficial in properly selected patients. For patients who have a failed hip arthroplasty requiring revision and a contralateral arthritic hip requiring primary arthroplasty, bilateral surgery permits the resected femoral head from the primary procedure to be used as a fresh autogenous bone—graft during the revision procedure. Four patients underwent combined primary hip arthroplasty and contralateral revision hip arthroplasty during one anesthetic procedure. The femoral head obtained during the primary procedure was used as a structural acetabular bone—graft in three patients, and bone slurry was used to fill cavitary acetabular defects in one patient. A femoral neck autograft was used to reconstruct a calcar defect in one of the patients. After an average follow-up period of 27 months, all hips were functioning well with healed bone—grafts and stable prosthetic components.     

Simultaneous primary total hip arthroplasty and contralateral revision hip arthroplasty: role for use of femoral head autograft

We report the outcome of revision hip arthroplasty for patients with acetabular bone loss in whom the femoral head retrieved from arthritic contralateral hip during the same anesthesia was used as autograft for acetabular reconstruction. Thirty-two hips in 16 patients with a mean age of 63.8 years (range, 43-79 years) were followed for an average of 3.5 years. All primary arthroplasties were successful. Evidence of autograft incorporation was found in all except 2 patients. The acetabular component failed and required revision in the latter 2 patients. The use of femoral head autograft in a select group of patients with symptomatic arthritis of hip and a failed prosthetic hip with severe bone loss in the contralateral side is a viable option. However, this technique should not be applied to acetabular reconstructions in which protected weight-bearing in the postoperative period may be necessary.     

类风湿性关节炎继发严重髋臼内陷的全髋关节置换

目的探讨类风湿性关节炎继发严重髋臼内陷患者行全髋关节置换术治疗的临床疗效。 方法2011年1月至2014年11月,对解放军兰州总医院收治18例(20髋)类风湿性关节炎的严重髋臼内陷患者进行随访观察,其中男6例,女12例;年龄37～68岁,平均(46±8)岁。纳入病例均类风湿性关节炎继发严重髋臼内陷,髋臼内陷依Sotello-Garza和Charnley分型：Ⅰ型(内陷1～5 mm)0例,Ⅱ型(内陷6～15 mm)15例(17髋),Ⅲ型(内陷>15 mm)3例(3髋)。排除标准为先天性、创伤性或髋关节骨关节炎所继发的髋臼内陷。手术采用后外侧入路,股骨颈截骨后股骨头逆行取出,取自体松质颗粒骨打压植骨重建髋臼,采用压配方式植入生物型多孔髋臼假体。随访时采用Harris髋关节评分评估髋关节功能,X线平片观察假体是否有松动和再次内陷以及植骨愈合情况。对手术前、后髋关节功能、股骨头中心到Kohler线的距离等计量资料采用t检验分析。 结果手术时间为55～131 min,平均(89±8)min。失血量为165～480 ml,平均(295±11)ml。术中未发生血管、神经损伤以及髋臼和股骨劈裂骨折。随访时间2.5～6年,平均(4.5±1.7)年。术后X线片示4.5个月自体移植骨均与髋臼融合。末次随访的Harris髋关节评分由术前(55±9)分(40～65分)提高至(92±13)分(89～95分),差异有统计学意义(t ＝22.81,P <0.01)。股骨头中心到Kohler线的距离由置换前的(20± 4)mm增加到置换后的(21±3)mm,差异有统计学意义(t ＝2.312,P <0.01);随访期间均无髋臼假体松动发生。 结论类风湿性关节炎继发严重髋臼内陷的髋臼骨质菲薄且局部骨质疏松严重,髋臼形态不规则。采用自体股骨头颗粒骨移植填充髋臼结合生物型钽金属骨小梁髋臼杯假体,可恢复髋关节旋转中心并获得满意的近中期临床效果。     

变异髋臼初次全髋人工关节置换术前设计及临床意义

目的:探讨变异髋臼初次全髋人工关节置换术中髋臼假体的正确放置位置及手术疗效。方法:对34例(38髋)接受全髋关节置换的髋臼变异的各类髋关节疾病进行术前设计,其中男20例,女14例,平均年龄56.1岁(29~75岁)。股骨头坏死继发骨性关节炎15例(19髋),髋臼发育不良继发骨性关节炎12例,创伤性骨关节炎5例,髋关节融合术后1例,髋关节人工股骨头置换术后1例。结果:术后患者均获得随访,平均随访11个月(5~38个月)。根据Harris髋关节功能评分评定,优(>90分)12髋,良(80~90分)23髋,尚可(70~79分)3髋,失败0髋(<70分)。评定结果:术前Harris评分平均47.9分,术后平均90.3分。结论:对于髋臼解剖结构异常的髋关节疾病患者行全髋人工关节置换时,通过术前对髋臼正确位置的设计,使髋关节中心置于正确的位置上,既可简化术中操作的难度,又可以使臼杯假体得到牢固固定及良好的骨覆盖,有利于人工全髋关节的长期疗效。     

实验性髋臼发育不良的病理形态学研究

目的 :探讨造成髋关节发育不良的病理发病机制。方法 :将 18只幼兔的左髋关节屈曲膝关节伸直位石膏固定 4周 ,比较双侧髋关节的X线片及病理组织学变化。结果 :髋关节屈曲膝关节伸直位石膏固定 4周造成了髋关节发育不良的动物模型。髋臼变浅、股骨头变小、向外上方移位。X线片可见髋臼指数增大 ,由固定前的 (2 8.44± 3 .91)°增大为 (3 3 .17± 3 .65 )° ;臼头指数减小 ,由固定前的 (75 .2 0± 4.41) %减小为 (5 8.71± 8.2 1) %。组织学观察可见关节软骨退行性改变。结论 :髋关节屈曲膝关节持续伸直位状态 ,容易造成髋关节发育不良。随着时间的延长 ,病理变化加重。及早复位 ,髋关节可以恢复正常     

In vivo hip joint contact distribution and bony impingement in normal and dysplastic human hips

Our objectives were to clarify the 3D articular contact areas of the in vivo normal hip joint and acetabular dysplasia during specific positions using magnetic resonance imaging (MRI), voxel‐based registration, and proximity mapping. Forty‐two normal and 24 dysplastic hips were examined. MRI was performed at four positions: neutral; 45° flexion; 15° extension; and the Patrick position. Femur and pelvis bone models were reconstructed at the neutral position and superimposed over the images of each different position using voxel‐based registration. The inferred cartilage contact and bony impingement were investigated using proximity mapping. The femoral head translated in the anterior or posteroinferior, anterosuperior, and posteroinferior direction from neutral to 45° flexion, 15° extension, and the Patrick position, respectively. Multiple regression analyses showed age, femoral head sphericity, and acetabular sphericity to be associated with higher hip instability. The present technique using subject‐specific models revealed the in vivo hip joint contact area in a population of healthy individuals and dysplastic patients without radioactive exposure. These results can be used for analyzing disease progression in the dysplastic hip and pathogenesis of acetabular labral tear. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1611–1619, 2013     

Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years

We retrospectively evaluated 42 hips which had undergone acetabular reconstruction using the Kerboull acetabular reinforcement device between September 1994 and December 1998. We used autogenous bone chips from the ilium and ceramic particle morsellised grafts, even in large acetabular bone defects, in the early stages of the study. Thereafter, femoral head allograft was used as bulk graft in patients with large acetabular defects. Ceramic blocks and the patients' contralateral femoral head were also used as bulk graft. The mean follow-up period was 8.7 years (4.3 to 12). Survivorship analysis was performed using radiological failure of the acetabular component, irrespective of whether it was revised, or not, as the end-point. The survival rate of the morsellised graft group (25 hips) and the bulk graft group (17 hips) at ten years was 53% (95% confidence interval (CI) 42.5% to 63.5%) and 82% (95% CI 72.4% to 91.6%), respectively. The mid-term results of revision total hip replacement with the Kerboull device were better when bulk graft was used in any size of bone defect.     

Diagnostic criteria for non-traumatic osteonecrosis of the femoral head. A multicentre study.

Six major and seven minor diagnostic criteria have been developed by the Japanese Investigation Committee for osteonecrosis of the femoral head (ONFH). We have carried out a multicentre study to clarify these. We studied prospectively 277 hips in 222 patients, from six hospitals, who had ONFH and other hip pathology and from whom histological material was available. We identified five criteria with high specificity: 1) collapse of the femoral head without narrowing of the joint space or acetabular abnormality on radiographs, including the crescent sign; 2) demarcating sclerosis in the femoral head without narrowing or acetabular abnormality; 3) a 'cold-in-hot' appearance on the bone scan; 4) a low-intensity band on T1-weighted images (band pattern); and 5) evidence of trabecular and marrow necrosis on histological examination. With any combination of two of these criteria, the sensitivity and specificity of the diagnosis were 91% and 99%, respectively.     

Revision of the acetabular component without cement after a previous acetabular reconstruction with use of a bulk femoral head graft in patients who had congenital dislocation or dysplasia. A follow-up note

BACKGROUND: Revision of an acetabular component that has failed after a total hip arthroplasty in which a bulk femoral head autogenous graft or allograft was used as a structural graft for acetabular reconstruction is an uncommon but complex and challenging procedure. We previously reported the results for seventy hips at an average of 16.5 years after a total hip arthroplasty in which an acetabular reconstruction had been performed with a femoral head graft. In the present study, we evaluated a subset of nine hips from that series that had a subsequent revision of the acetabular component without cement. The purpose of the current study was to assess the usefulness of the bone graft in this revision. METHODS: The nine patients (nine hips) were followed clinically and radiographically for an average of seventy-six months (range, sixty-one to 114 months) after the index revision. In six hips the autogenous femoral head graft previously had been bolted to the lateral side of the ilium, and in one hip the femoral head allograft had been affixed in this manner. In the two remaining hips, the allograft had been placed within the acetabulum. The hips were classified according to the extent of acetabular bone loss, with use of criteria described previously. Three hips had stage-I bone loss; four, stage-II; and two, stage-IIB. A porous-coated hemispherical acetabular component was inserted without cement and fixed with screws in each hip. At least 70 percent of the porous coating was in contact with viable bone. RESULTS: At the time of the latest follow-up after the index revision, all nine acetabular components were functioning well without loosening or osteolysis and none had been revised. The average Harris hip score was 77 points (range, 61 to 98 points) compared with 49 points (range, 27 to 96 points) preoperatively. One hip had had revision of the femoral stem, and another had had exchange of the acetabular liner because of recurrent dislocations. There was no additional resorption of the residual bulk graft that was in contact with the metal shell in any hip. CONCLUSIONS: In this small series of complex acetabular revisions, the healed bulk graft provided valuable additional bone stock for the support of an acetabular component that was inserted without cement. Insertion of the acetabular component into the available bone, which consisted in major part of host bone and in minor part of united revascularized bulk graft, resulted in a well functioning hip after an intermediate duration of follow-up. In all except two hips, the enlarged bone stock allowed insertion of a larger acetabular component than had been used previously.     

Femoroacetabular impingement. A common cause of hip complaints leading to arthrosis

The exact cause of the idiopathic osteoarthritis of the hip has not been identified, although the cause of hip degeneration in developmental dysplasia can clearly be attributed to an excessive axial loading. Based on the development of a surgical technique for the safe surgical dislocation of the hip and the associated possibility of intraoperative joint evaluation, we have found motion-induced joint damage in many of these hips. This begins peripherally at the acetabular rim, progressing centrally. This so-called "femoroacetabular impingement" (FAI), leads, by an increased acetabular coverage and/or a missing sphericity of the femoral head, to an abutment of the femoral head/neck junction against the acetabular rim, or even entering of the non-spherical femoral head into the hip. It initiates damage to the labrum and/or acetabular cartilage. Frequently, this becomes symptomatic in the second or third decade of life in patients with increased sport activity. Based on the predominance of the acetabular or femoral pathology, two different types of FAI, the pincer and the cam can be differentiated. Apart from these morphological alterations, supraphysiological mobility and overuse can contribute to FAI. The impingement concept has led to a new type of mainly intracapsular hip surgery.     

人工髋关节置换术后翻修病例分析

目的分析人工髋关节置换术后翻修的原因,评价全髋翻修术的临床效果。方法本组33例34髋。初次关节置换类型:全髋置换21例,双杯髋关节置换1例,人工股骨头置换11例。翻修原因:无菌性松动23例24髋,髋臼位置不良1例1髋,股骨头置换后髋臼磨损5例5髋,感染4例4髋。翻修距初次手术时间:1年以内5髋,1～2年1髋,5～10年18髋,10～13年10髋。翻修假体类型:非骨水泥型假体20髋,混合型假体7髋,骨水泥型假体7髋。结果平均随访3.5年。1例术后半年发生股骨柄松动进行再翻修,其余病例假体保留,优良率为82.4%。结论翻修的最常见原因为无菌性松动,人工股骨头置换时髋臼磨损也是翻修原因之一,对较年轻的股骨颈骨折患者,如行假体置换,最好采用全髋关节置换。翻修术采用非骨水泥型假体较好。     

A comparative radiographic morphometric analysis to assess the normal radiological morphology of the adult hip in indian population

ObjectiveOur objective is to analyze the normal radiological morphologic parameters of the adult hip joint of the Indian population and compare it with standard measurements and with other populations to assess the variations.MethodsA prospective analysis of the normal pelvis X-rays of 800 persons (1600 hips) was done. We have calculated the acetabular inclination, acetabular index, lateral center edge angle (LCEA) and neck-shaft angle (NSA), sphericity of the femoral head, congruity of the joint, version of the acetabulum, depth of acetabulum, and lateralization of the femoral head in normal X-rays of the pelvis in adult persons. We used RadiAnt DICOM viewer version 4.6.5.18450 (64bit) for measurement. Statistical analysis and mean values were calculated using SPSS software.ResultsThere were 978 X-rays of the male hip and 622 female. The acetabular inclination varied from 1 to 9. The mean acetabular index was 26.5. The LCEA was between 20 and 50. The mean neck-shaft angle was 133. There were 35, hips with an aspherical head. 94.2% X-rays the hip joint was congruent. There was 2.9% of the retroversion of acetabulum, 3.3% lateralization.ConclusionMost of the parameters were comparable to standard values the acetabular index was lower. LCEA and NSA were higher. The acetabular angle was lower. There were femoral head asphericity, joint incongruity, and lateralization of the femoral head in a small proportion of our general population.