Long-term results of valgus-extension femoral osteotomy for advanced osteoarthritis of the hip

We treated 31 hips in 30 patients with advanced osteoarthritis of the hip secondary to acetabular dysplasia, by valgus-extension femoral osteotomy. The mean follow-up was 12.7 years (10 to 17). Acetabuloplasty was added in ten severely dysplastic hips. In 28 hips, radiological widening of the joint space was seen three years after operation, but in 12 had narrowed again by ten years. Survivorship analysis showed that the rate of survival was 82% using the pain score as the index of failure, and 72% based on radiological findings at ten years. Better long-term results were obtained in hips which had an acetabular head index greater than 70% or a roof osteophyte more than 5 mm in length three years after operation. Acetabuloplasty should be added for the hip which is severely dysplastic and with a poorly developed roof osteophyte.     

High tibial osteotomy using a dynamic axial external fixator

High tibial osteotomy is an accepted treatment for unicompartmental osteoarthritis of the knee. Conventional osteotomy can be a demanding procedure with potential for complications. Opening wedge high tibial osteotomy using an external fixator is an alternative that may have advantages in comparison with classic methods. The aims of the current study were to determine if opening wedge osteotomy using hemicallotasis techniques is safer than, and the outcome comparable with that of, conventional techniques. Seventy-six high tibial osteotomies were performed in 65 patients for primary osteoarthritis. The mean age of the patients was 54.8 years (range, 36-70 years). The mean followup was 6 years. The only serious complication occurred in one patient, who had chronic osteomyelitis develop 2 years after surgery. There were no neurologic or vascular complications. The authors think this technique is safer than conventional techniques. Survivorship at 5 and 10 years was 89% and 63%, respectively. The mean knee score in osteotomies was 26.6 (maximum possible score, 48). The outcome is comparable with, or better than, that of other techniques for osteotomy. Subsequent knee replacement, in cases requiring conversion, was straightforward. The mean score in knees that had osteotomies that were converted to total knee replacements was 33.7.     

Bombelli's valgus-extension osteotomy for osteoarthritis due to acetabular dysplasia: results at 10 to 14 years

Severe osteoarthritis due to acetabular dysplasia (n = 17) was treated with valgus-extension osteotomy, and the patients' clinical outcomes 10–14 years after operation were evaluated according to clinical factors (Japanese Orthopaedic Association hip score; JOA score) and by roentgenography. The mean JOA score 10 years or later had improved by 22 points compared with the preoperative score. On roentgenography, joints which had preoperative roof osteophyte had better postoperative formation of roof osteophyte. The JOA score was higher in the 12 joints which had osteophyte 5 mm or longer than in those joints with osteophyte that was 5 mm or shorter. Postoperative joint space widening occurred in 15 joints (88.2%) 3–6 months postoperatively, and it reached the maximum at 3–5 years. In patients who had a large bone cyst in the femoral head preoperatively, the cyst collapsed, and deformation of femoral head occurred after operation, but remodeling of the joint surface occurred naturally and the congruity improved. In the 6 joints in which the preoperative acetabular head index was less than 60% and the acetabular angle was larger than 30°, the JOA score at 10 years or later was lower than that of the other joints. Based on these findings, valgus-extension osteotomy was evaluated as a useful surgical method for advanced or terminal osteoarthritis in young or middle-aged patients. Predictive factors for long-term prognosis would be the preoperative length of roof osteophyte, joint space widening, and the degree of femoral head covering. Received: December 1, 1999 / Accepted: May 29, 2000     

Pelvic support osteotomy for unstable hips using hybrid external fixator: case series and review of literature

Background  

Instability of the hip joint is a source of great discomfort to the patient due to pain, limp and leg-length discrepancy. Pelvic support osteotomy with Ilizarov hip reconstruction, along with its various modifications, has emerged as a standard treatment modality for this difficult problem. We present a series of patients with unstable hips treated with a modification of the monolateral fixator—the hybrid external fixator.     

Arthrodesis of the hip joint using an external fixator

Arthrodesis of the hip has been plagued by high rates of nonunion, and by complications associated with prolonged cast immobilization. To prevent these problems, we devised a procedure for hip arthrodesis using an external fixator in combination with internal fixation at the fusion site. We have treated nine patients with this technique. All of the arthrodeses were solidly united without wound infections at the most recent follow-up. Patients were able to leave their hospital bed and walk on the affected limb with a cane shortly after surgery. This was possible because the external fixator was low in profile, as it was applied from the anterosuperior iliac spine to the femoral shaft, and provided rigid stabilization of the arthrodesis. The technique resulted in a reduction in the period of bed rest, immediate postoperative mobilization, shorter periods of hospitalization, no limitation in the range of knee and ankle motion, improvement in the patient's ability to carry out the personal hygeine, and fewer complications. Received for publication on July 24, 1998; accepted on March 5, 1999     

Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement

Background:

Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates.

Materials and Methods:

We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally.

Results:

Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed.

Conclusion:

The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.     

Subtrochanteric valgus-extension osteotomy for neglected congenital dislocation of the hip in young adults

Thirty-five patients with unilateral or bilateral neglected congenital dislocation of the hip (CDH) were treated with subtrochanteric valgus-extension osteotomy between 1975 and 1992. There were 29 females and 6 males in the group. A total of 50 osteotomies was performed. The mean age of the patients was 22 years; the mean follow-up was 7 years. Before operation, the main complaints were pain and gait abnormalities. Leg-length discrepancy was another problem, especially for unilateral cases. The main indication for the operation was pain. This pelvic support osteotomy was performed to correct the instability of the hip and as a result of this to relieve pain. Patients were retrospectively evaluated based upon Harris Hip Score and self-evaluation. The mean Harris Hip Score was 49 before operation and improved to 72 after the operation. Alleviation of the pain was the most significant functional outcome of the treatment. It was also noted that limping could be improved if an adequate rehabilitation program was followed. We conclude that in neglected CDH cases with pain, limping and lumbar hyperlordosis in the young adult, a subtrochanteric valgus-extension osteotomy can give satisfactory results.     

Isolated varus intertrochanteric osteotomy for hip dysplasia in 52 patients: long-term results

Great strides have been made in the field of total hip arthroplasty, but the issue of wear and osteolysis continue to be a problem, mostly for young adults. For this population varus rotational osteotomy still remains a viable alternative to total hip arthroplasty. The purpose of this prospective study was to describe the indications, the technique and the functional outcome of an isolated varus femoral osteotomy in 52 patients with hip dysplasia. We obtained very good results with a significant improvement of hip function and pain relief. We conclude that with appropriate selection of the patient the procedure may prevent or postpone the development of secondary osteoarthritis.     

Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia

Background  

Accurate assessment of acetabular morphology and its relationship to the femoral head is essential for planning a periacetabular osteotomy. We observed the acetabular coverage after virtual Bernese osteotomy using computer-aided technique.     

Treatment of the sequelae of primary pathology of the hip by correction osteotomy and femoral lengthening using a combined external fixator

It is not an exceptional event to observe the sequelae of primary pathology of the hip in young patients that, as such, are not of the ideal age for replacement surgery. Moreover, one must not overlook the difficulties involved in replacement surgery for the treatment of inveterate modifications in the normal hip anatomy. Often, among the sequelae of primary pathology of the hip, deformities of the lower limb must also be included, associated or consequent, which also need treatment. For these reasons, the authors, in three selected cases, used a combined external fixator (circular and lateral) by means of which they were at the same time able to correct the axial deformity (with a support osteotomy), and the residual hypometria (with femoral lengthening). Osteotomy plus lengthening, using an external fixator, avoid hypometria of the limb and deformity in valgus of the knee, and allow for results which would otherwise not be obtained with replacement surgery alone.     

Long-term management results of Pemberton's ilium osteotomy in combination with inter-trochanter derotation-varisation osteotomy in hip dysplasia of childhood

AIM: The aim of the present study was to obtain long-term functional and radiographic results after a pericapsular osteotomy of the ilium (Pemberton) and a simultaneously performed derotation-varisation osteotomy of the proximal femur in children with developmental dysplasia of the hip (DDH) after the end of the maturity process. METHOD: The clinical results and x-ray measurements of 79 patients with 100 operated hips were analysed. The average follow-up time after surgery was 14 years and 7 months (range: 10.4 to 19.5 years). The indication for operation was determined using the acetabular angle of more than two standard deviations. RESULTS: The clinical investigation shows that 85 % of the operated patients had no functional limitations. 14 % of the patients had minor limitations and 1 % had major limitations in their hip movement. No patient suffered constant hip pain; 62 % had no pain even after long walking; 32 % had pain after walking for more than an hour; 6 % complained of hip pain after walking for less than an hour. The radiological measurements show that 95.9 % of the patients had normal or mildly pathological ACM angle scores, and 92.8 % had normal or mildly pathological CE angle scores. CONCLUSION: Surgical treatment of residual hip dysplasia by simultaneously performed pericapsular ilium and proximal femur osteotomy is very effective. Although a radiographically almost normal acetabulum could be documented in patients after the end of the maturity process, revalgisation of the proximal femur occurred. With an appropriate acetabular correction additional osteotomy of the femur might therefore be unnecessary.     

Bilateral total hip arthroplasty: a simultaneous procedure.

Fifty patients undergoing bilateral total hip replacement as a simultaneous procedure at the Indiana University Medical Center were compared with 50 patients undergoing unilateral total hip replacement. There was an increase in phlebitis and myositis ossificans in the patients undergoing bilateral total hip replacement and while their range of motion was less, there was no difference in mortality with one death in each group. The hospital time for patients in the bilateral group averaged 1 week longer than for those with unilateral hip replacement. The operating time and blood loss in patients of the bilateral group was approximately twice that of patients in the control group. There have been no infections as yet in the bilateral group. On the basis of these preliminary results, we can consider bilateral total hip arthroplasty feasible although it carries a slightly increased risk.     

Acute correction of proximal tibial deformities in adolescents using Ilizarov external fixator: focal-dome versus straight-cut osteotomy

Straight-cut osteotomy was compared with focal-dome osteotomy in two similar groups of patients with proximal tibial deformities. Acute correction of deformity was carried out for 27 patients with a total of 36 bone segments. Ilizarov external fixator was used in all cases. No significant difference was found between the two groups in terms of bone healing, external fixation time and stability of osteotomy. The follow-up ranged from 24 to 63 months. In this study, the focal-dome osteotomy was not found to be superior to straight-cut osteotomy, which is simpler to perform and more versatile for deformity correction.     

Bilateral caudal epidural neuromodulation for refractory urinary retention: a salvage procedure

PURPOSE: Sacral neuromodulation with InterStim is approved for idiopathic urinary retention with a success rate of approximately 69%. To our knowledge currently no alternatives exist for patients in whom S3 neuromodulation fails. We report a new technique and our experience with bilateral caudal epidural neuromodulation in patients in urinary retention in whom unilateral or bilateral S3 InterStim failed. MATERIALS AND METHODS: Eight patients with multifactorial urinary retention in whom S3 InterStim previously failed underwent retrograde placement of bilateral tined leads into the caudal epidural space for sacral nerve stimulation. Patients with a 50% or greater clinical response underwent stage 2 Synergy-Versitrel implantable pulse generator placement. Patients were evaluated with voiding diaries, the Urinary Distress Inventory Questionnaire short form, quality of life assessment, need for catheterization and post-void residual urine preoperatively, and 6 months after implantation. RESULTS: Five of the 8 patients experienced return of micturition and underwent placement of a permanent implantable pulse generator. At 6-month followup 4 of the 5 patients voided to completion. One patient improved more than 50% and now catheterizes once daily with a post-void residual urine of 200 cc. There was a significant decrease in obstructive symptoms on the Urinary Distress Inventory Questionnaire short form and improved overall quality of life. CONCLUSIONS: To our knowledge this is the first report of the use of bilateral caudal epidural neuromodulation for refractory urinary retention. This therapy can be successful in patients in whom prior InterStim therapy failed.