Heterotopic ossification as a complication of total hip replacement]

Heterotopic ossification is the most common complication after THR. The authors present the distribution of frequency of ectopic ossification after cementless THR using Mittelmeier and Parhofer-M?nch prosthesis and it's influence on THR outcome. 151 hip joints were evaluated with a follow-up period of more than 2 years. All procedures were performed by a lateral approach. The ectopic ossification was verified according to the Brooker classification. Clinical evaluation was performed according to the d'Aubigne-Postel method in Charnley's modification. The 3rd degree ectopic ossification was found in 14 hip joint and 4th degree ectopic ossification in 2 hip joints (together 10.6%). The positive correlation between the degree of ossification (3rd and 4th) and the decrease of range of motion of the hip joint along with an increase in pain after THR was found.     

髂腰肌撞击——全髋关节置换术后并发症的诊治

目的分析全髋关节置换术后髂腰肌撞击假体引起疼痛原因及治疗措施。方法19例人工全髋关节置换术因髂腰肌撞击髋臼假体引起髋部疼痛患者,5例采用保守治疗无效后行髂腰肌肌腱切断术,12例行髂腰肌肌腱切断术,2例髋臼假体翻修。结果术后所有患者疼痛均明显减轻,Harris评分术前47～70（59±5．3）分,术后达83-95（92±1．7）分。双髋对比屈髋力量17例无明显下降,2例部分下降但并不影响髋关节功能。结论人工全髋关节置换术后因髂腰肌撞击髋臼假体引起髋部疼痛的患者,保守治疗常常效果不佳,而髂腰肌肌腱切断术效果较好。     

Necrotizing fasciitis: a rare complication of total hip replacement

Necrotizing fasciitis is a rare, but life-threatening emergency. We report a case history of necrotizing fasciitis in a previously healthy woman. A review of the literature suggests that this is the first report of necrotizing fasciitis complicating total hip replacement surgery.     

Massive intrapelvic synovial cyst as a complication of total hip replacement arthroplasty: a case report

The authors report a case of massive intrapelvic synovial cyst complicating total hip arthroplasty in a 35-year-old woman with rheumatoid arthritis. The clinical presentation raised the possibility of a coincidental soft-tissue malignant tumour. This was ruled out by ultrasonography, computed tomography, fine-needle aspiration with examination of cells and culture and, ultimately, by image intensification in the operating room during aspiration of the cyst and injection of the adjacent hip joint with Hypaque. The authors conclude that perforation of the acetabular floor at total hip arthroplasty was likely the precipitating event. After 1 year there was no indication for surgical excision of the cyst.     

Fracture of the acetabular cup as an early complication of total hip replacement]

The authors have presented 12 patients with non traumatic fracture of the acetabular cup of the Weller hip prosthesis. All the fractures have occurred 10 to 40 months following hip arthroplasty 9 of the broken sockets have been removed at the time of revision arthroplasty. They showed marked destruction with multiple fragmentation of the polethylen. The area of the destruction was surrounded by active tissue reaction described as resorbtion granulation. The remowed fragments of the polethylen have been examined physicochemically and showed marked increase in the degree of crystalisation. The authors have come to the conclusion that the main reason for the failure of the presented series of the polietylene cups was defect of the material used in their production.     

Leukocytoclastic vasculitis as a complication of infected total hip prosthesis

We present a case of leukocytoclastic vasculitis, associated with an exacerbation of chronic osteomyelitis in a pseudoarthrosis of the hip. Skin lesions of the lower limb were the most prominent features.

---

Résumé  Nous présentons un cas de vasculite leucocytoclastique apparue après exacerbation d"une osteomyelite chronique évoluant aprés ablation d"une prothèse totale de hanche. Les traits plus dominants sont les lésions cutanées sur le membre inférieur.

---

---

Accepted: 27 April 2000     

Meralgia paraesthetica. A complication of a patient-positioning device in total hip replacement

We describe three patients who developed meralgia paraesthetica after the use of a well-padded and carefully-placed patient-positioning device in total hip replacement.     

Bladder and ureteral displacement complication of total replacement hip arthroplasty.

An unusual case of bladder and lower ureteral displacement owing to extruded cement in the pelvis through the acetabulum after total hip arthroplasty is described. The literature is reviewed.     

Prosthesis displacement as a complication of reduction of a dislocated total hip arthroplasty

Acute displacement at the cement—prosthesis interface of the femoral component of a hip arthroplasty that occurred as a consequence of attempted reduction of a dislocation is described. Although this complication is theoretically possible with a polished tapered stem design, it is previously unrecognized, and may be avoidable if fluoroscopic control is used during closed reduction of a dislocation.     

Esophageal replacement by Lexer's esophagoplasty: adenocarcinoma as late complication

The most successful method for esophageal reconstruction in the early 20th century was the jejunodermatoesophagoplasty after Lexer, involving the presternal formation of a skin tube for passage reconstruction. A 59-year-old patient presented to our hospital with adenocarcinoma at the dermatojejunostomy 47 years after undergoing a Lexer procedure. The neoesophagus was removed, and the passage was reconstructed by a retrosternal colonic interposition. Although squamous cell carcinoma is known as a late complication of dermatoesophagoplasties, this is a reported case of adenocarcinoma formation.     

Uncemented total hip replacement

Between Jan. 1, 1976 and Dec. 31, 1981, 257 patients (age range from 21 to 65 years) with osteoarthritis of one or both hips were treated with ceramic hip replacement (Mittelmeier type). The cause of the osteoarthritis was variable. Hip replacement was carried out for the following conditions: rheumatoid arthritis including ankylosing spondylitis, aseptic necrosis of femoral head including post-traumatic and idiopathic forms, osteoarthritis of unknown origin, osteoarthritis following dysplasia or subluxation of the hips and loosened cemented hip prosthesis. The operative technique is described. Full weight bearing is not permitted for 16 weeks postoperatively, but mobilization and isometric exercises begin 2 days after operation and isotonic exercises are introduced later. Complications included fracture of the femoral shaft during operation, fracture of the acetabulum, protrusion, dislocation and infection early after operation (within 16 weeks) and aseptic loosening and pulmonary embolism (after 16 weeks). The results with this new type of hip replacement are encouraging. Good results based on patient satisfaction were obtained in 79% and poor results in 13%.     

Penetration of a long stem prosthesis into the knee joint: a complication of total hip replacement

The unusual occurrence of penetration of the stem of a femoral prosthesis into the knee joint during total hip replacement and the method used to deal with this complecation successfully, without replacing the prosthesis, is described.     

Metal-on-metal total hip replacement

Metal-on-metal bearings have wear rates that are 20 to 100 times lower than metal-on-conventional polyethylene. The amount of wear generally is the same order of magnitude for the head and the cup. There is an initial run-in period of higher wear followed by lower, steady-state wear. Wear rate is a function of the interplay of material(s), macrogeometry, microgeometry, and the resultant type and amount of lubrication. The wear resistance and clinical performance of a metal-on-metal bearing are more sensitive to macrogeometry and lubrication than a metal-on-polyethylene bearing. Metal wear particles are nanometers in linear dimension. They are much smaller and more numerous than the submicron polyethylene wear particles, but the volume of periprosthetic inflammatory tissue is less. Osteolysis seems to be relatively rare. Little is known about the systemic distribution of metal particles and ions. The significance of systemic distribution also is not known. The levels of serum and urine Co and Cr ions are elevated in patients with metal-on-metal bearings, but the long-term, steady-state levels are not much higher than those from corrosion of modular femoral components. Because of the elevated levels of Co and Cr ions, there is a greater risk of delayed type hypersensitivity. There also is concern about the potential for malignant degeneration secondary to prolonged exposure to these elements. The available data are insufficient to address this concern. Rigorous long-term studies are needed. It will take decades of close clinical observation to determine if the benefits of metal-on-metal bearings outweigh the associated risks.     

Femoral stem displacement as a complication of reduction of a dislocated total hip arthroplasty

Acute displacement at cement-prosthesis interface of a polished femoral component of hip arthroplasty occurring as a consequence of attempted closed manipulation is rare. This complication can be avoided by placing cement over the shoulder of the prosthesis and using fluoroscopic control during closed manipulation if there is a dislocation.     

Iliopsoas tendonitis a complication after total hip arthroplasty

The causes of pain after total hip arthroplasty are multiple. We present a series of 15 patients (16 cases) who presented with pain related to the iliopsoas tendon. All patients had previously undergone cementless hip arthroplasty and presented with similar symptoms and clinical signs. Surgery was carried out after failure of conservative measures. Release of the iliopsoas tendon from the lesser trochanter gave good symptomatic relief in all except one patient who required reposition of acetabular prosthesis, with the average Harris Hip Score improving from 58 (range, 44-70) to 91 (range, 78-95) postoperatively. This relatively uncommon condition should be considered in the differential diagnosis of all patients who present with groin pain after total hip arthroplasty. Surgical release of the iliopsoas tendon can give excellent results in these patients.