Ceramic on ceramic hip arthroplasty in fused hips

Background:Most literature in the field of total hip arthroplasty (THA) for fused hips, until date has reported the results of using metal on polyethylene and ceramic on polyethylene bearings. Results of THA using ceramic on ceramic (CoC) bearings in fused hips have not been published in literature. This study reports the results of cementless THA using CoC articulation perfomed in fused hips.Results:Mean Harris hip score improved from 42.4 to 84.2 and mean leg lengthening of 36.6 mm was achieved. In the average 5.4 years (range 2.8-9.1 years) followup there were no cases with osteolysis around acetabular cup and femoral stem. In this study, there was no case of ceramic fracture. There was one case of squeaking.Conclusion:This study suggests that cementless THA performed for fused hips with CoC bearings can provide good early clinical results.     

Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis

Ankylosing spondylitis (AS) is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function. Functional impairment is significant, with spine and hip involvement, and is predominantly seen in the younger age group. Total hip arthroplasty (THA) for fused hips with stiff spines in AS results in considerable improvement of mobility and function. Spine stiffness associated with AS needs evaluation before THA. Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis. Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern. Care should be taken to reduce acetabular component anteversion at THA in these fused hips, as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation. Fused hips require femoral neck osteotomy, true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome. Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA. Risks at THA in AS include intraoperative fractures, dislocation, heterotopic ossification, among others. There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.     

Total hip arthroplasty after arthrodesis of the hip joint

The results of 15 conversions of a hip arthrodesis into a total hip arthroplasty performed in the years 1980-1995 are reported. Fifteen patients (8 men, 7 women) underwent total hip arthroplasty 30.9 (range 2-61) years after spontaneous or operative fusion of a hip joint. The primary indications of the conversion were low-back pain (n = 10), knee pain (n = 2) and hip problems (n = 3). At follow-up examination 5.4 (range 2-13.3) years postoperatively, the Harris Hip Score averaged 86.0 (range 70.1-99.0). Six patients were pain-free, 7 had less pain, 2 felt no improvement of pain. All patients confirmed that they would undergo the operation again. The Trendelenburg sign was negative or mild in 8 patients and moderate to severe in 7. Aseptic loosening of 2 stems (1 cemented, 1 cementless) and 2 deep infections required revision surgery. We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. However, full function with no pain and a negative Trendelenburg sign could be obtained in only 20% (3/15) of the cases.     

先天性和陈旧性髋关节脱位的全髋置换术

目的 探讨先天性髋关节脱位和陈旧性髋关节脱位患者人工全髋关节置换术的适应证和髋臼假体安放位置的选择.方法 先天性髋关节脱位10例(13髋)和陈旧性髋关节脱位6例(6髋),均采用改良Gibson入路,髋臼假体安放在髋关节假臼位置,关闭切口时尽可能修复髋关节周围软组织结构.结果 16例均经1～3年随访,疗效评定参照Charnley标准,关节功能优10例(11髋),良好3例(5髋),可3例(3髋).结论 先天性髋关节脱位和陈旧性髋关节脱位人工全髋关节置换术的髋臼假体位置的选择不能一概而论,应根据移位的远近、骨质条件和重建软组织平衡的难易程度而定.     

Cementing techniques for primary total hip arthroplasty

Total hip arthroplasty is a well-established procedure in the treatment of end-stage degenerative arthritis of thehip. Long-term follow-up studies have indicated varied results in cemented arthroplasty and has prompted further research into additional methods of fixation other than cement as well as the improvement of cementing techniques. More recent long-term follow-up studies of cemented arthroplasty have demonstrated that superb results can be achieved and maintained, but require precision in both the preparation of bone, cementing techniques, and positioning of the implant.This article outlines the precise technology necessary to achieve long-term stability in cemented total hip arthroplasty in both the acetabulum and femur. No attempt has been made to discriminate specific shapes and types of materials of the individual implants.     

Radiographic comparison of cementing techniques in total hip arthroplasty

Using a single prosthetic design, the authors conducted a radiographic comparison of the results of changes in cementing techniques in 58 total hip arthroplasties with respect to the initial postoperative and equivalent follow-up radiographs. The study period, 1975-1982, spanned the advent of cement restrictors, canal preparation, and pressurization techniques. In matched patients, the use of modern cementing techniques and canal preparation led to a significant improvement in the initial postoperative radiographic appearance and subsequent loosening rate of the femoral component, suggesting that these techniques may change the expected rate of late femoral component loosening, based on previous studies done with prepressurization cementing techniques.     

Total hip arthroplasty in the underweight

The outcomes of 20 patients diagnosed with osteoarthritis or rheumatoid arthritis with body mass index less than 18.5 (considered underweight) who received total hip arthroplasty at a single institution were reviewed. Surgical complications in the first 30 days after surgery included 1 prolonged surgical site drainage and 3 posterior dislocations. Two patients experienced medical complications that included hematemesis, confusion, aspiration pneumonia, and death. Sixty-five percent of the patients received at least one blood transfusion. Harris hip scores improved from 35 to 81 (P < .05) at an average of 6.1 years (2-10.1 years) of follow-up. Total hip arthroplasty is effective in patients who are underweight; however, they appear to be at an increased risk of dislocation and blood transfusion.     

Total hip arthroplasty for posttraumatic arthritis after acetabular fracture

Total hip arthroplasty (THA) outcomes for posttraumatic arthritis after acetabular fracture have yielded inferior results compared to primary nontraumatic THA. Recently, improved results have been demonstrated using cementless acetabular reconstruction. Thirty-two patients underwent THA for posttraumatic arthritis after acetabular fracture; 24 were treated with open reduction internal fixation, and 8 were managed conservatively. Time from fracture to THA was 36 months (6-227 months). Average follow-up was 4.7 years (2.0-9.7 years). Harris Hip score increased from 28 (0-56) to 82 points (20-100). Six patients required revision. Five-year survival with revision, loosening, dislocation, or infection as an end point was 79%. Survival for aseptic acetabular loosening was 97%. Revision surgery correlated with nonanatomic restoration of the hip center and a history of infection (P < .05). Despite obvious challenges, advances in fracture management and cementless acetabular fixation in THA demonstrate improved results for posttraumatic arthritis following acetabular fracture.     

全髋置换术治疗髋关节发育不良

目的探讨髋关节发育不良(DDH)全髋关节置换术的临床方法与疗效。方法对48例DDH继发骨性关节炎的患者(56髋)进行全髋关节置换术。其中CroweⅠ型24髋,Ⅱ型19髋,Ⅲ/Ⅳ型13髋。术前应用影像学方法评估髋臼和股骨的形态学变化。手术采用常规髋关节置换术,恢复髋关节旋转中心35例(40髋),采用自体股骨头结构性植骨重建髋臼旋转中心6例(8髋),髋臼假体内置5例(6髋),高位重建髋臼2例(2髋)。结果 48例均获得随访,时间3个月～8年。关节假体稳定,关节功能正常,双下肢短缩均有明显改善,未出现感染、脱位、神经损伤并发症。Ⅰ、Ⅱ和Ⅲ/Ⅳ型患者按Harris髋关节评分,分别由术前的(47.3±6.5)分、(42.7±5.5)分和(38.6±7.8)分增加到术后的(92.4±4.1)分、(88.2±4.7)分和(83.9±6.6)分,与术前比较差异有统计学意义(P<0.05)。结论对成人DDH按照Crowe分型采用不同方法行全髋关节置换,是一种可靠而有效的方法。充分的软组织松解、重建髋臼和股骨近端的结构以及正确选择假体是手术成功的关键。     

全髋置换术治疗成人髋臼发育不良伴骨性关节炎

目的 探讨全髋关节置换术治疗髋臼发育不良(DDH)伴髋关节骨性关节炎的手术疗效.方法 对11例(12髋)因DDH致髋关节骨性关节炎患者行全髋关节置换术.根据Zionts分级,Ⅰ度7髋,Ⅱ度5髋.术前Harris评分28～63(48.1±9.4)分.结果 11例均获随访,时间6个月～6年.术后Harris评分为82～98(88.6±7.6)分.1例术后3年X线片示人工臼与植骨块间有透亮线,余患者人工臼位置均无移位、松动.有2例患肢轻度跛行,无疼痛,可以长距离行走.结论 全髋置换术解除患者症状,改善关节功能,提高生活质量,是一种行之有效的治疗方法.手术成功的关键在于加深髋臼、内移髋关节活动中心及适当植骨.     

全髋置换术治疗晚期髋关节骨关节炎

目的 探讨全髋置换术(THA)治疗晚期髋关节骨关节炎的疗效.方法 对46例(65髋) 晚期髋关节骨关节炎患者行全髋置换术.采用Harris髋评分系统评估临床疗效, X线观察评估股骨侧假体的移位与稳定性.结果 46例均获得随访, 时间1年2个月～5年.术后Harris评分平均为(88±4.0)分,优46髋,良8髋,一般9髋,差2髋,优良率为85%.1例发生移位,经药物治疗后好转.结论 全髋置换术是治疗晚期髋关节骨关节炎的有效方法.     

Cementless total hip arthroplasty in the treatment of severe hip dysplasia or dislocated hips

We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20–69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1–6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<0.05). The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<0.05). The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one. THA for DDH is a technically demanding procedure. This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH. It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals. A long-term follow-up is required in order to establish the role of this management strategy.     

全髋关节置换术治疗成人发育性髋关节脱位继发骨性关节炎

目的 分析全髋关节置换术(THA)治疗成人发育性髋关节脱位(DDH)伴骨性关节炎的经验、方法及疗效.方法 采用THA治疗成人DDH伴骨性关节炎患者24例(26髋),手术均采用非骨水泥的人工关节,髋臼的骨覆盖率70%,术中9例行转子下截骨术.结果 术后切口均一期愈合,无脱位及神经损伤等并发症,Ⅳ型患者术前患肢短缩均显著改善,平均0.9 cm.所有患者均获得随访,时间12～78个月,Harris 评分平均术前为45分,术后为85.5分.结论 THA是治疗DDH伴骨性关节炎的有效方法,术前周密的计划、术中根据需要考虑假体的选择、截骨与否及髋臼骨床的定位、准备与安装是手术成功的关键.     

Total hip arthroplasty following failed fixation of proximal hip fractures

Background:

Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA) following failed fixation of proximal hip fracture.

Materials and Methods:

In a retrospective study, 21 hips in 20 patients (13 females and seven males) with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years). Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T) fracture and two for subtrochanteric (S/T) fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients.

Results:

The average duration of follow-up was four years (2-13 years). The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval.

Conclusion:

Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.     

结构性植骨全髋关节置换在成人高位先天性髋关节脱位中的应用

[目的]探讨结构性植骨全髋关节置换治疗成人高位先天性髋关节脱位的临床疗效。[方法]2003年8月～2006年10月,采用结构性植骨全髋置换治疗成人高位先髋脱位22例,29髋。男10例,女12例。左13例,右16例,年龄平均34.6岁(23～42岁)。临床症状主要为患髋疼痛、不稳定和跛行。术前Harris评分平均为46.8分,双下肢长度差异平均为3.8cm,股骨头脱位高度平均为3.9cm,髋关节平均活动度:屈曲66.5°,外展23.8°,外旋20.4°,内旋5.3°。术中臼杯均安装于真臼处,自体股骨头结构性植骨使臼杯完全覆盖,充分软组织松解后髋关节复位。髋臼侧选用骨水泥假体18髋、小髋臼生物型假体5髋和普通生物型髋臼6髋;股骨侧选用生物型假体10髋、普通骨水泥假体13髋、窄直柄水泥假体柄4髋和长柄骨水泥假体柄2髋。观察手术时间、出血量、关节活动度、双下肢长度差异、并发症等并进行Harris关节功能评分。[结果]本组平均手术时间95min(70～135min),出血400ml(300～650ml);伤口均一期愈合,无1例感染;术后1周X线片示假体位置良好,人工髋臼外展角平均为48.6°,前倾角平均13.2°。本组22例均获随访,随访时间平均17.6个月(10～47个月),Harris评分平均89.2分(72～93分);髋关节平均活动度:屈曲115.3°,外展44.6°,外旋49.5°,内旋26.8°。双下肢长度差异平均1.2cm,2例术后股神经麻痹,术后4个月内恢复。随访期间未见明显植骨块吸收、假体松动和脱位。[结论]结构性植骨全髋关节置换是治疗成人高位先天性髋关节脱位的一种有效方法,很大程度地改善了患者的症状、功能和外形。结构性植骨可提供良好的髋臼覆盖,恢复髋关节旋转中心高度并可保留骨盆骨量。脱位高度小于4cm经软组织充分松解后能下拉复位,不会造成股神经及坐骨神经永久性麻痹。     

Total hip arthroplasty in chronic unreduced hip fracture-dislocation

We treated 15 patients with chronic unreduced hip fracture-dislocations at our hospital; all patients sustained the fracture-dislocations in motor vehicle accidents. All presented to our institution more than 6 months after initial treatment at their local hospitals with uncontained femoral heads; all underwent 1-stage total hip arthroplasty with bone grafting. These patients were monitored for a mean of 71.5 months (range, 36-96 months). All patients had significantly decreased pain, increased function, and increased range-of-motion scores using the Merle d'Aubigné scoring system. All grafts showed radiographic evidence of union. There were 2 dislocations, 1 transient peroneal nerve palsy, and 1 superficial infection. Total hip arthroplasty is effective for relieving pain and restoring function in chronic unreduced hip fracture-dislocations.     

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes

Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient's unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.     

非骨水泥型全髋关节置换术：228髋陶瓷承重面无异响

目的探索减少陶瓷对陶瓷承重面全髋关节置换术后关节异响与碎裂的技术要点。方法2001年4月至2008年4月,199例患者（228髋）应用陶瓷对陶瓷承重面行非骨水泥假体植入,男101例,女98例,年龄19—68岁,平均48．4岁;体重指数19．6～36．5,平均24．3。病因：晚期股骨头坏死（激素、酒精、创伤、特发）115例,髋关节发育不良继发骨关节炎25例,原发性骨关节炎（FAI、陈旧骨骺滑脱）24例,股骨颈骨折（陈旧、移位新鲜）13例,强直性脊柱炎（AS）累及髋关节12例,色素沉着绒毛结节滑膜炎、类风湿关节炎等10例。患者均由同一医师采用改良后外侧入路手术。结果所有患者均获得随访。随访时间1～8年。1髋强力外力后股骨头碎裂,1髋术后脱位,3髋从卧位到坐位及负重时有咔嚓响声。其余患者功能良好。结论选择合适的适应证,遵循规范技术操作,可使陶瓷承重面的全髋关节置换术的异响与碎裂降低到最小程度。     

Total hip arthroplasty for ankylosed hip secondary to heterotopic ossification

Heterotopic ossification (HO) secondary to traumatic brain injury occurs at various sites and most commonly at the elbow, shoulder, and hip. There are few published reports on the assessment and surgical resection techniques of HO. A complete preoperative physical examination and radiologic assessment with a computed tomographic scan are important for the thorough evaluation of a patient. We describe a patient with neurogenic HO of the hip secondary to traumatic brain injury who underwent a total hip arthroplasty (THA). In selected patients with hip HO, THA supplemented with postoperative radiotherapy and indomethacin prophylaxis can facilitate progressive functional movements of the hip. To our knowledge, there is no report in the English literature of a THA being preformed for HO.     

Total hip arthroplasty for arthrodesed hips

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure. This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses. Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients. In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty. Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm. A modular prosthesis allows versatility at surgery.