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1.
Background and objective
Acetabular cup orientation, consisting of pelvic positioning, version and inclination, can influence short-term and long-term results after total hip arthroplasty (THA). The radiographic measurement of acetabular cup inclination represents an indicator of quality for the EndoCert certification in Germany. The purpose of this study was to determine the intrarater and interrater reliability of radiographic measurements of acetabular cup inclination after THA.Material and methods
In this study four independent investigators with different levels of expertise retrospectively performed measurements on radiograms (anteroposterior pelvic radiogram) from 99 patients. The intraclass correlation coefficient (ICC) and Pearson’s correlation coefficient were determined and were considered statistically significant with r?>?0.8 and p?<?0.05.Results and conclusion
A high correlation was found for both intrarater and interrater reliability based on determination of Pearson’s correlation coefficient and the ICC with r?>?0.9 and p?<?0.001 for all measurements. Based on these results the radiographic measurement of acetabular cup inclination can be considered as a simple measuring tool with high intrarater and interrater reliability. As cup orientation consists of inclination, version and positioning, the exclusive measurement of cup inclination for radiological quality assessment needs to be discussed critically.2.
3.
Takahito Yuasa Katsuhiko Maezawa Masahiko Nozawa Kazuo Kaneko 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(6):599-603
Background/purpose
In this study, cementless THA was performed for RA patients, and its clinical outcomes, as well as radiographic findings and implant survival rates, were examined more than 10 years after surgery in comparison with the outcomes of the same procedure performed for patients with hip osteoarthritis (OA) during the same period.Method
We studied 28 cases of THA for RA clinically and radiologically at a minimum follow-up duration of 10 years. The patients consisted of 4 males and 22 females, with a mean age at the time of surgery of 53.1. The clinical and radiographic results were compared with an age-matched and sex-matched group of patients who had undergone THA for the diagnosis of primary or secondary OA.Results
In the RA group, the mean Harris hip score was 48.3 before surgery, and improved to 76.8 at the time of the final survey. In the control group, the score also improved from 46.8 before to 86.5 after surgery, while revealing significant differences between the groups (p = 0.0002). In the RA group, 2 joints required revision THA on the acetabular side due to aseptic loosening, while such revision was not performed on the femoral side despite the presence of more than 2 mm of subsidence in 2 joints. The implant survival rate was 92.9 and 100 % in the RA and control groups, respectively, without significant differences (p = 0.493).Conclusions
Although its clinical outcomes were significantly different from those for OA, a satisfactory implant survival rate was achieved, at 92.9 % in RA patients.4.
Introduction
The outcomes of total hip arthroplasty (THA) for the treatment of posttraumatic arthritis after acetabular fractures were inferior to those after primary non-traumatic THA.Methods
This study was performed in academic level I trauma center. From January 2011 to December 2014, a consecutive series of 21 patients (9 females), with average age of 56.7 years (range 29–75 years) who had posttraumatic hip joint arthritis after acetabular fractures, were included in our study. All patients underwent cementless THA. The average duration of follow-up was 26 months (range 24–36 months).Results
At the latest follow-up, all patients could walk independently, thirteen (62%) patients had excellent Harris hip score, five (24%) had good HHS, and 3 (14%) had fair score. WOMAC scale decreased from 63 (range 42–92) to 4 (range 0–19). Two patients (9.5%) had heterotopic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups or around the femoral stem.Conclusion
Cementless THA is an ideal treatment for posttraumatic hip arthritis with anatomic restoration of the hip center to improve the functional results and decrease the incidence of complications and revision rate.5.
Purpose
A tapered straight cementless stem was used for revision in a group of old and very old patients. We wanted to know whether the use of this implant could achieve satisfactory results despite age and osteoporosis.Methods
We retrospectively analysed data of 77 elderly patients (77 hips) who underwent revision in cemented and uncemented primary total hip arthroplasties (THA). The patients had a mean age of 82.2 years (range, 75–92 years) at revision surgery. They were monitored for a mean follow up of 7.1 years (range, 5.0–10.2 years). During the minimum follow-up period 11 patients died of unrelated causes, leaving 66 patients (66 hips) for evaluation.Results
During the period of study three stems failed due to aseptic loosening, three hips dislocated and were successfully treated by closed reduction and bracing. No infection, osteolysis or significant stress shielding around the stems was observed. The survivorship at an average of 7.1-year follow-up was 95.5%.Conclusions
These results indicate that this stem is an excellent alternative in revision THA in patients of 75 years or older.6.
Caroline Scemama Vincent Lestrat Benoit Combourieu Thierry Judet 《International orthopaedics》2016,40(9):1821-1825
Purpose
Hip fusion conversion has shown mixed results, in particular a higher rate of failure than primary total hip replacement. Conversion is usually carried out by a lateral approach.Methods
We reported a series of 37 hip fusion conversions performed by an anterior approach. Clinical and radiographic outcomes of this unusual approach were reported at eight years of follow up.Results
At eight years of follow up, survivorship was 86. 6 % (IC 95 %: 62.4–95.7 %). Sixteen patients reported good relief of the pre-operative back spine or knee pain. PMA score was significantly improved. Two implant aseptic loosenings needing revision surgery were reported.Conclusion
The anterior approach seemed to be as good as the other hip approaches for hip fusion conversion to total hip replacement.7.
The focally constrained liner is a reasonable option for revision of unstable total hip arthroplasty
Tatu J. Mäkinen Simcha G. Fichman Wael A. Rahman Tomas Amenabar Oleg Safir Allan E. Gross Paul R. T. Kuzyk 《International orthopaedics》2016,40(11):2239-2245
Purpose
Revision surgery for a patient with previous recurrent dislocations or abductor muscle dysfunction has been considered to be a complication-prone procedure regardless of the type of constrained implant used. We investigated the survivorship of a focally constrained acetabular liner used for revision total hip arthroplasty in patients with abductor insufficiency or previous recurrent dislocations.Methods
We retrospectively reviewed 98 patients in whom a focally constrained acetabular liner was used to treat abductor insufficiency or previous recurrent dislocations. The mean age was 69.4 years (37–92) and 64 of these were females. Previously, the patients had undergone a mean of two (1–5) revisions. The mean follow-up was 38 (12–66) months. Kaplan-Meier survival curves were calculated and Log-rank test was used to test the difference in survivorship between patients with abductor insufficiency and previous dislocations.Results
Sixteen patients needed a further re-revision for any cause. Thus, the revision-free survivorship was 84.3 % at five years. Five patients suffered a dislocation with a mean of five months post-operatively and were managed with repeat revision. Five patients failed at the implant-host bone interface. Three of these failures occurred after cementing the constrained liner into a pre-existing shell.Conclusions
The focally constrained liner provided a reasonable option for revision total hip arthroplasty in patients with hip instability. Failures were observed in patients with acetabular osteolysis but seemingly well-fixed component and unrecognized impingement.8.
9.
Takaaki Fujishiro Takafumi Hiranaka Shingo Hashimoto Shinya Hayashi Masahiro Kurosaka Taiki Kanno Takeshi Masuda 《International orthopaedics》2016,40(4):697-702
Purpose
The purpose of the present study was to: (1) investigate the variation of both acetabular and femoral component version in a large series of consecutive primary THA patients, and (2) to better define the associations of acetabular and femoral component alignment and clinical factors with subsequent hip dislocation in those patients.Methods
We analyzed CT scans of 1,555 consecutive primary THAs and measured version of the components. We also documented the frequency and direction of subsequent dislocation as well as femoral head size, posterior tissue repair, any history of previous hip surgery, and gender.Results
The dislocation rate after THA was 3.22 %. The dislocation risk was 1.9 times higher if cup anteversion was not between 10° and 30°. Compared to hips that did not dislocate, those that experienced anterior dislocation had a significantly greater combined anteversion; those that dislocated posteriorly had a significantly smaller combined anteversion. Hips with previous rotational acetabular osteotomy or head size smaller than 28 mm correlated with an increased dislocation rate.Conclusion
The dislocation risk could be higher if cup anteversion was not between 10° and 30°. Greater combined anteversion could be a risk factor of anterior dislocation, and posterior dislocation could be more common in smaller combined anteversion.10.
Purpose
The aim of this study was to evaluate clinical and radiographic findings of stage 3 or lower osteonecrosis of the femoral head (ONFH) with intact acetabular cartilage in patients treated with bipolar hemiarthroplasty (BHA).Methods
A total of 79 hips that underwent BHA for ONFH were included in this study. The average observation period was 7.6 years. Clinical results were evaluated using the Harris hip score. We performed radiographic analysis to assess the migration of the outer cup, the permanent image around the outer cup, and loosening of the stem.Results
The total Harris hip score improved from 50 points before surgery to 92 points at final follow-up, while pain improved from 14 points to 36 points. Flexion improved from 94° to 120° and abduction from 27° to 37°. One patient on dialysis showed progress in terms of inward migration, and revision surgery was performed on the patient 14 years after the original surgery.Conclusions
Midterm performance of BHA for stage 3 or lower ONFH at our hospital was good.11.
Background
Acetabular fractures in the elderly and severely comorbid patient can be associated with high morbidity and mortality; however, differences in outcomes of acute ORIF versus non-operative care of acetabular fractures in a subgroup of elderly (>75 years) and/or severely comorbid younger patients (>65) remain unclear.Patients and methods
A retrospective review of 243 patients who sustained an acetabular fracture between April 2005 and November 2014 was performed. Eighty-seven patients met inclusion criteria: age > 75 with or without comorbidities or age > 65 if complicated by two or more medical comorbidities. Outcomes measures evaluated were 1-year mortality, duration of hospital stay, return to pre-injury ambulation status and treatment failure marked by conversion to a total hip arthroplasty (THA) within 1 year of treatment.Results
Thirty-seven patients with acetabular fractures were treated with surgical fixation, and 49 were treated non-operatively. Operative patients did not demonstrate a statistically significant difference in mortality within 1 year of treatment compared to non-operatively treated patients. Operative patients demonstrated a statistically significant increase in treatment failure marked by a conversion to a THA within 1 year when compared to conservatively treated patients. No differences in age, duration of follow-up, or ability to return to baseline at latest clinical follow-up were found between groups. However, non-operatively treated patients had a higher incidence of Alzheimer’s disease/Dementia and Parkinson’s compared to operatively treated patients.Conclusion
Analysis of our small cohort suggests that there may be a role for the non-operative treatment of acetabular fractures in this debilitated patient population despite a somewhat longer length of hospital stay at the time of injury. Conversion to THA was significantly higher at 1 year in our operated patients. No differences in mortality at 1 year were noted between patient groups. Return to baseline ambulation status was slightly higher in the non-operated group but not significantly so. However, a potential bias to more likely treat complex fractures operatively cannot be ruled out, as non-operative fractures were most often anterior column variants, usually more amenable to non-operative care.Level of evidence
Prognostic Level III.12.
Masanobu Ohishi Yasuharu Nakashima Takuaki Yamamoto Goro Motomura Jun-ichi Fukushi Satoshi Hamai Yusuke Kohno Yukihide Iwamoto 《International orthopaedics》2016,40(8):1601-1606
Purpose
Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip dysplasia.Methods
The subjects included 66 hips in 64 patients, with the mean follow-up period of 7.3 years. THA was performed at a mean period of 17.1 years after intertrochanteric femoral osteotomy. Valgus osteotomy was performed in 42 hips, and varus osteotomy in 24. Clinical results were evaluated by using the Merle d’Aubigne-Postel score. Implant survival was determined with revision as the end point, and any related complications were investigated.Results
The Merle d’Aubigne-Postel score improved from 9.4 to 16.1 at the final follow-up, without any implant loosening. However, periprosthetic femoral fractures were observed in four hips (6.0 %), one intra-operatively and three within three weeks after THA. Among these cases, three hips previously had varus osteotomy (12.5 %) and one hip had valgus osteotomy (2.3 %). Two hips were revised with full porous stems and circumferential wiring. The five and ten year cumulative survivorship rates were 97 % (range, 88.8–99.3 %) and 97 % (88.8–99.3 %), respectively.Conclusions
Although the use of a press-fit cementless stem yielded acceptable results in most of the patients, perioperative femoral fracture was a major complication especially in the patients previously treated with intertrochanteric varus osteotomy. Careful planning and implant selection could be emphasized for these cases.13.
Tomonori Baba Yasuhiro Homma Hidenori Ochi Yu Ozaki Mikio Matsumoto Katsuo Shitoto Kazuo Kaneko 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(2):189-194
Introduction
Clinical outcomes of total hip arthroplasty (THA) to treat rapidly destructive coxarthrosis (RDC) have been reported, but to our knowledge, there have been no studies comparing implants. The aim of this study was to examine the effectiveness of acetabular reconstruction for RDC by comparing the clinical results of THA using a Kerboull-type plate with an uncemented cup.Patients and methods
Among 921 primary THAs performed between 2006 and 2014, 27 were performed for the treatment for RDC using a Kerboull-type plate or a conventional uncemented cup. A Kerboull-type plate for acetabular reinforcement device was used in 13 hips and an uncemented cup in 14 hips. The mean follow-up period was 61.2 months.Results
The duration of surgery was 156.8 ± 36.4 min in the Kerboull-type plate group and 103.3 ± 14.4 min in the uncemented cup group, being significantly longer in the former (P = 0.0002). In the Kerboull-type plate group and the uncemented cup group, the 5-year survival rates were 100 and 83.9 %, respectively. Recurrent dislocation was observed in two cases in which the posterior approach had been used.Conclusions
In our study, the loosening of the acetabular components was noted in 14.3 % of uncemented cup-applied cases, but no loosening was noted in any Kerboull-type plate-applied case. Therefore, for RDC, in which objective evaluation of fragile bone quality is difficult, the use of the Kerboull-type plate, which disperses weight-bearing of the acetabular, may be an effective means to achieve early functional recovery as well as a long-term favorable outcome.14.
Marion Opperer Yuo-yu Lee Francisco Nally Alvaro Blanes Perez Kaveh Goudarz-Mehdikhani Alejandro Gonzalez Della Valle 《International orthopaedics》2016,40(4):703-708
Purpose
In order to diminish total hip arthroplasty (THA) dislocation rate, surgeons strive to achieve adequate component orientation, offset and limb length. In addition, dislocation rate can theoretically be reduced by increasing head diameter and by choosing implants with favorable head-to-neck and cup-to head ratios. We assessed nine radiographic and implant-related parameters associated with an increased risk of dislocation in patients who sustained a dislocation and in those with a stable arthroplasty.Methods
A total of 1,487 consecutive elective primary THAs performed by a single surgeon, using a posterolateral approach were reviewed at an average follow-up of 18 months (range, 1–112). Fixation was hybrid in 85 % of hips and non-cemented in 15 %. Thirty-eight patients (38 hips, 2.5 %) sustained at least one dislocation. Thirty-seven patients with good quality, standardized anteroposterior radiographs were selected as a “study group”. The study group was matched-paired (1:3) with patients who had a stable arthroplasty based on gender, age, BMI, diagnosis and follow-up. Variables compared between the groups included: head size, cup size, head-to-neck ratio, cup-to-head ratio, leg-length discrepancy, offset, cup inclination, cup version and cup orientation based on the safe zone defined by Lewinnek et al.Results
None of the nine parameters showed a statistically significant difference between the groups.Discussion
In this study, 90 % of patients who developed a dislocation had properly positioned acetabular components. In addition, the vast majority of patients in the study group had adequate restoration of limb length and offset. The results of our study may be useful for the orthopedic surgeons who discuss instability following THA surgery, particularly in patients with radiographically sound reconstructions.15.
Julio J. Jauregui Qais Naziri Todd P. Pierce Randa K. Elmallah Jeffrey J. Cherian Ronald E. Delanois Michael A. Mont 《International orthopaedics》2016,40(4):681-686
Purpose
Due to the high number of total hip arthroplasties (THA) revised due to instability, the use of large femoral heads to reduce instability is justifiable. It is critical to determine whether or not large femoral heads used in conjunction with thin polyethylene liners lead to increased wear rates, which can lead to osteolysis. Therefore, by using validated wear-analysis software, we evaluated linear wear rates in a consecutive cohort of patients who underwent primary THA with thin polyethylene liners.Methods
All patients were selected from a consecutive, prospectively collected database of 241 THAs performed at a single institution by two fellowship-trained joint-reconstruction surgeons between July 2007 and June 2011. These patients were 1:1 matched to a cohort of patients who had conventional-thickness polyethylene liners.Results
No significant differences were observed between linear wear rates of thin or conventional-thickness liners. The Kaplan–Meier survivorship for both cohorts was 100 %, and no cases of polyethylene fracture were observed in either cohort.Conclusions
Our results suggest that according to a mean follow-up of 4 years, the use of thin liners in THA is promising. Longer follow-up is required to assess whether these outcomes are observed later.16.
Background
Measuring acetabular anteversion is relevant to routine follow-up of total hip arthroplasties (THAs) and for malfunctioning THAs. Imageless navigation facilitates acetabular component orientation relative to the anterior pelvic plane (APP) or to the APP adjusted for sagittal pelvic tilt (PT). The optimal plain radiographic method for the postoperative assessment of anteversion is not agreed upon.Questions/Purposes
(1) Do anteversion measurements on plain radiographs correlate more with APP anteversion or PT-adjusted anteversion? (2) Do measurements of anteversion performed on supine anteroposterior (AP) radiographs more accurately reflect intraoperative anteversion values for navigated THA compared to anteversion measured on cross-table lateral (CL) radiographs?Methods
Seventy patients receiving primary navigated THA were included. APP and PT-adjusted anteversion were recorded; the latter defined the intraoperative target for anteversion. Postoperative anteversion was measured on supine AP pelvis radiographs with computer software and CL radiographs with conventional methods. Intraoperative measurements were used as the reference standards for comparisons.Results
Mean intraoperative APP anteversion was 20.6°?±?5.6°. Mean intraoperative PT-adjusted anteversion was 22.9°?±?4.5°. Mean anteversion was 22.7°?±?4.7° on AP radiographs and 27.2°?±?4.2° on CL radiographs (p?<?0.001). Only correlations between PT-adjusted anteversion and radiographic assessments of anteversion were significant. The mean difference between PT-adjusted anteversion and anteversion on AP radiographs was ?0.2°?±?4.3°, while the mean difference between the PT-adjusted anteversion and anteversion measured on CL radiographs was 4.3?±?5.1° (p?<?0.001).Conclusion
Plain film assessment of anteversion was more accurate on supine AP radiographs than on CL radiographs, which overestimated acetabular anteversion.17.
Purpose
The purpose of this study is to clarify morphological changes of acetabular subchondral bone cyst after total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip.Methods
Two hundred and sixty-one primary cementless total hip arthroplasties of 208 patients, 18 males, 190 females, were retrospectively reviewed. Morphological changes of subchondral bone cyst were evaluated by computed tomography (CT). The mean cross-sectional area of the cyst from CT scans at 3 months postoperatively and after 7–10 years (average 8.4 years) were compared.Results
Acetabular subchondral bone cysts were found in 49.0% of all cases in preoperative CT scans. There was no cyst which was newly recognized in CT scan performed after postoperative 7–10 years. All the cross-sectional areas of the cysts evaluated in this study were reduced postoperatively.Conclusions
This study revealed that acetabular subchondral bone cysts do not increase or expand after total hip arthroplasty and indicated that the longitudinal morphological change of acetabular bone cysts in patients of developmental dysplasia of the hip do not influence long-term implant fixation in total hip arthroplasty.18.
H. Resch D. Krappinger P. Moroder M. Blauth J. Becker 《Operative Orthopadie und Traumatologie》2016,28(2):104-110
Objective
Treatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization.Indications
Acetabular fracture with or without previous hemi- or total hip arthroplasty.Contraindications
Non-displaced acetabular fractures.Surgical technique
Watson-Jones approach to provide accessibility to the anterior and supraacetabular part of the iliac bone. Angle-stable positioning of the roof-reinforcement plate without any fracture reduction. Cementing a polyethylene cup into the metal plate and restoring prosthetic femoral components.Postoperative management
Full weight-bearing mobilization within the first 10 days after surgery. In cases of two column fractures, partial weight-bearing is recommended.Results
Of 7 patients with periprosthetic acetabular fracture, 5 were available for follow-up at 3, 6, 6, 15, and 24 months postoperatively. No complications were recognized and all fractures showed bony consolidation. Early postoperative mobilization was started within the first 10 days. All patients except one reached their preinjury mobility level. This individual and novel implant is custom made for displaced acetabular and periprosthetic fractures in patients with osteopenic bone. It provides a hopeful benefit due to early full weight-bearing mobilization within the first 10 days after surgery.Limitations
In case of largely destroyed supraacetabular bone or two-column fractures according to Letournel additional synthesis via an anterior approach might be necessary. In these cases partial weight bearing is recommended.19.
Paul Yuh Feng Lee Madhu Rachala Kar Ho Teoh David John Woodnutt 《International orthopaedics》2016,40(9):1835-1842
Purpose
Modular cementless elastic acetabular systems have advantages over cemented and hard shell cementless acetabular systems. There are few reports on the medium-term and long-term follow up of this particular type of implant. This study describes our experience with the Atlas IIIp modular acetabular system, which is a thin shell cementless elastic acetabular implant for total hip replacement commercialized under this name in many countries.Methods
We prospectively followed 244 patients treated with Atlas IIIp acetabular system between 2001 and 2004. Minimum ten year follow up was available for 148 hips (139 patients) from the original cohort of 263 hips (244 patients). One hundred five patients had died from unrelated causes and were excluded from the results. Post-operative and follow up radiographs of patients were assessed; and Harris hip scores were used as clinical outcome. Revision for any reason was defined as the end point for survivorship analysis.Results
The mean pre-operative Harris hip score was 48 (S.D. 16) and the average post-operative score was 82 (S.D. 12). The mean follow up in our series was 11.5 years, ranging from ten to 13.5 years. Thirteen hips required further surgery in our cohort; of which ten cases required cup revision. The 13-years cumulative implant survival was 91.2 % and the risk of implant revision was 8.8 % at 13 years in 148 hips (139 patients). Kaplan-Meier analysis showed the implant survival rate of 95.2 % at ten years for revision for any reason and 99.4 % for aseptic loosening.Conclusions
Our clinical experience with this acetabular cup suggests good long-term survival rates that are similar to other cups on the market. The clinical experience in this study shows long-term survival rates that are consistent, acceptable and good results achieved with a low revision rate.Level of evidence: Therapeutic III; therapeutic study.20.