Postoperative hip motion and functional recovery after simultaneous bilateral total hip arthroplasty for bilateral osteoarthritis

Background  Simultaneous bilateral total hip arthroplasty (THA) can offer a potential benefit of greater postoperative hip motion without the negative influence of contralateral hip disabilities, compared to two-stage THA. However, postoperative changes in hip motion after simultaneous bilateral THA have rarely been reported. The purpose of this study was to clarify the efficacy of simultaneous procedures on postoperative hip motion and functional recovery. Methods  We retrospectively compared hip motion in 27 patients treated with simultaneous bilateral THA to those in 11 patients with two-stage bilateral THA, 35 patients with unilateral THA for unilateral disease, and 15 patients with unilateral THA for bilateral disease. We also evaluated the clinical manifestations according to the Japanese Orthopaedic Association (JOA) hip scores and compared the outcomes among the groups. All of the THA surgeries were primarily performed through a posterolateral approach using cement-less prostheses. The diagnosis at surgery was dysplastic osteoarthritis in all patients, and the patients were followed up for at least 4 years. Results  The postoperative improvement of motion in hip flexion was significantly greater in patients treated with simultaneous procedures compared to patients with two-stage THA and unilateral THA for bilateral disease. The differences in improvement of motion in hip abduction were less marked than the improvement in hip flexion among the groups. Although there were no significant differences in pain scores among the groups, the values for activity of daily living were significantly greater in patients treated with simultaneous bilateral THA and patients with unilateral THA for unilateral disease than in patients with unilateral and two-stage bilateral THA for bilateral disease. Conclusions  The simultaneous procedure was considered to be more effective in patients with bilateral hip osteoarthritis and demonstrated a substantial improvement in hip motion and functional recovery after THA.     

Results of total hip arthroplasty for dialysis arthropathy in long-term hemodialysis patients

Background  The number of hemodialysis patients has progressively increased in Japan. Among the orthopedic complications in this population, chronic hip arthropathy associated with long-term hemodialysis is one of the most devastating problems. Total hip arthroplasty (THA) is often indicated. However, varying results have been reported for THA in these patients. This study was undertaken to assess the risk-benefit ratio of THA performed in patients with dialysis hip arthropathy. Methods  We evaluated 17 patients (19 hips) with dialysis hip arthropathy who underwent THA. The duration of hemodialysis before surgery ranged from 10 to 27 years. Histological examination of the tissue samples revealed accumulation of amyloid deposits in all cases. Three patients died within 2 years after operation; the remaining 14 patients (16 hips) were followed for a minimum of 3 years. Results  The cumulative survival rate of the prostheses in these 16 hips up to the latest follow-up was 94%. Regarding surgery-related complications, deep infection occurred in one hip, and revision THA was required in one patient with recurrent dislocation and aseptic loosening. Conclusions  THA for dialysis hip arthropathy in long-term hemodialysis patients is associated with substantial local and general risks. Despite the substantial risk, THA for this patient population seems to afford reasonably satisfactory results.     

Cemented revision total hip arthroplasty with impaction bone grafting in Gaucher's disease

Total hip arthroplasty in Gaucher's disease has been associated with high rates of loosening after all types of arthroplasty. We present a patient with type 1 Gaucher's disease who underwent revision cemented total hip arthroplasty for aseptic loosening after 12 months of enzyme replacement therapy. Major osteolysis was managed by impaction morcellized bone grafting. An excellent clinical and radiographic result was obtained at 5-year follow-up. Enzyme replacement therapy combined with modern revision techniques may offer improved outcomes for patients with Gaucher's disease.     

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced neck of femur fracture

Displaced neck of femur fracture is a common clinical problem among the elderly population. Our aim is to review previously published randomized controlled trials to establish if total hip arthroplasty (THA) or hemiarthroplasty will offer a superior clinical outcome in this group of patients. We conducted literature search for relevant randomized controlled trials. A total of 407 patients from 3 trials were included in this meta-analysis. In the long-term follow-up, we found that THA patients were able to ambulate better, reported less pain compared with their hemiarthroplasty counterparts, and were less likely to undergo a repeated hip surgery. Considering the more favorable long-term outcomes in THA patients, we conclude that there may be a case to offer THA as the primary treatment of these patients.     

Benign Giant Cell Tumour or Localised Osteitis Fibrosa Cystica

Charnley total hip arthroplasties (THA) and Christiansen THA were carried out in two concurrent groups of patients, consisting of 113 hips in 87 patients and 90 hips in 81 patients respectively. The mean age of the patients was about 65 years, two thirds had idiopathic arthrosis, and only two had rheumatic hip disease. The two groups of patients were similar with regard to sex, age, weight, etiology of arthrosis, and standard laboratory tests, but different with regard to the surgeons who operated on them. Postoperative films showed that the stems of the prostheses were in the neutral and the varus position in the Christiansen group, and in the valgus, neutral and varus position in the Charnley group.

Neither group had any deaths, or deep infections in the postoperative period. Only minor postoperative complications were noted. At follow-up, 5-8 years later, the failure (revision) rate of Charnley THA to Christiansen THA was 1 to 7.7 and 1 Charnley cup was revised as against 19 Christiansen cups. The methodological weaknesses in the comparative clinical trial did not explain the inferior long-term results of the Christiansen THA.     

The Charnley Versus the Christiansen Total Hip Arthroplasty: A Comparative Clinical Study

Charnley total hip arthroplasties (THA) and Christiansen THA were carried out in two concurrent groups of patients, consisting of 113 hips in 87 patients and 90 hips in 81 patients respectively. The mean age of the patients was about 65 years, two thirds had idiopathic arthrosis, and only two had rheumatic hip disease. The two groups of patients were similar with regard to sex, age, weight, etiology of arthrosis, and standard laboratory tests, but different with regard to the surgeons who operated on them. Postoperative films showed that the stems of the prostheses were in the neutral and the varus position in the Christiansen group, and in the valgus, neutral and varus position in the Charnley group.

Neither group had any deaths, or deep infections in the postoperative period. Only minor postoperative complications were noted. At follow-up, 5-8 years later, the failure (revision) rate of Charnley THA to Christiansen THA was 1 to 7.7 and 1 Charnley cup was revised as against 19 Christiansen cups. The methodological weaknesses in the comparative clinical trial did not explain the inferior long-term results of the Christiansen THA.     

The Charnley versus the Christiansen total hip arthroplasty. A comparative clinical study

Charnley total hip arthroplasties (THA) and Christiansen THA were carried out in two concurrent groups of patients, consisting of 113 hips in 87 patients and 90 hips in 81 patients respectively. The mean age of the patients was about 65 years, two thirds had idiopathic arthrosis, and only two had rheumatic hip disease. The two groups of patients were similar with regard to sex, age, weight, etiology of arthrosis, and standard laboratory tests, but different with regard to the surgeons who operated on them. Postoperative films showed that the stems of the prostheses were in the neutral and the varus position in the Christiansen group, and in the valgus, neutral and varus position in the Charnley group. Neither group had any deaths, or deep infections in the postoperative period. Only minor postoperative complications were noted. At follow-up, 5-8 years later, the failure (revision) rate of Charnley THA to Christiansen THA was 1 to 7.7 and 1 Charnley cup was revised as against 19 Christiansen cups. The methodological weaknesses in the comparative clinical trial did not explain the inferior long-term results of the Christiansen THA.     

Subarachnoid anesthesia in a patient with type I Gaucher disease

Gaucher's disease is a rare genetic disorder characterized by lack or functional insufficiency of glucocerebrosidase, an enzyme accountable for intracellular hydrolysis of glucosyl ceramide and other glycosphingolipids, which results in macrophage storage in the mononuclear-macrophage system. The severity of Gaucher's disease is correlated with the extent to which the central nervous system is involved. It is associated with the so-called Gaucher's cells in the bone marrow, but is specifically diagnosed by showing enzyme acid beta-glucosidase activity in a sample of blood leukocyte or cultured macrophages from skin biopsy. In the last 10 years, an enzyme replacement therapy (alglucerase) for the disease has been available, which has significantly changed approaches to its treatment. Here we report the case of a 56-year-old female patient with type I Gaucher's disease who underwent surgery for subcapital hip fracture with subarachnoid anesthesia. Type I Gaucher's disease clinical and pathophysiologic aspects relevant to anesthetic management are discussed. As very few similar cases have been reported in the anesthesiology literature, it is our belief that the present case may help to elucidate some controversial issues relating to the perioperative anesthetic management of patients with type I Gaucher's disease.     

全髋关节置换术治疗髋部疾病合并帕金森病的早期临床评估

目的回顾性分析髋部疾病合并帕金森病接受全髋关节置换术（THA）的病例,探讨THA在此类患者中应用的早期临床疗效以及安全性。方法选择2006年1月到2012年1月,本组接收的髋部疾病合并帕金森病的患者17例,其中股骨颈骨折9例,股骨头坏死5例,发育性髋关节发育不良3例。所有病例均采用THA术,所有病例均采用后外侧入路进行手术。结果 17例患者术后平均随访44个月（14-69个月）,其中1例于术后14个月因肺炎而死亡,出现脱位2例,其余未见明显并发症。术前髋关节Harris评分为46.1分（33-65分）,术后6个月Harris评分为83.6分（55-98分）,较术前比较有统计学差异（t=15.64,P〈0.05）,其中优5例,良9例,可2例,差1例,优良率为82.4%。术后2年Harris评分平均为81.5分（66-97分）,较术前也有明显增加（t=17.59,P〈0.05）。其中优4例,良7例,可5例,死亡1例,优良率为68.8%。结论对于髋部疾病合并帕金森的患者来说,THA早期临床效果较满意,可作为治疗的该类疾病的一种较好的选择。但是不能忽视其并发症发生率的升高,风险的增加,而且长期效果主要与帕金森病的进展情况相关。因此在选择为合并帕金森病的患者进行手术时仍需慎重。     

人工全髋关节置换术治疗化脓性髋关节炎后遗骨关节病的研究进展

目的总结人工全髋关节置换术(total hip arthroplasty,THA)治疗化脓性髋关节炎后遗骨关节病的研究进展。方法广泛查阅国内外近年相关文献,就THA治疗化脓性髋关节炎后遗骨关节病的时机、髋臼侧及股骨侧处理方法以及假体类型选择等方面进行总结分析。结果THA是治疗化脓性髋关节感染后遗骨关节病的有效手段,为避免感染复发,建议感染静止期达10年以上时手术。此类患者可能存在髋臼侧发育不良,髋臼覆盖率差,行THA时可选择高位造臼、髋臼内陷截骨、结构性植骨、Cage、钽金属垫块或3D打印假体等方式处理;股骨侧可能存在股骨髓腔细小、股骨颈前倾角增大、颈干角增大、大转子延长和骨质差等问题,行THA时可通过股骨截骨及选择合适型号假体进行处理。化脓性髋关节炎后遗骨关节病患者多较年轻,为获得更好的远期假体生存率,首选非骨水泥型假体。结论THA可有效治疗化脓性髋关节炎后遗骨关节病,但手术难度大、手术并发症相对较多,术者应有充分认识。     

Revision total hip arthroplasty – Salvage procedures using bone allografts in Japan

Total hip arthroplasty (THA) and hemiarthroplasty have improved hip joint function of patients suffering from hip disease or trauma with excellent clinical results and long-term survivorship. Conversely, there has been an increase in the number of revision surgeries after THA and hemiarthroplasty due to bone deficiency. The reconstruction of deficient bone remains a challenging problem following THA. While performing revision surgery, we have previously classified the preoperative bone deficiency using X-ray, CT and three-dimensional CT imaging according to location and severity of the deficiencies. We then predicted the shape and amount of the required bone allograft and the type of implant. Due to the accepted reconstruction methods of bone deficiency following revision surgeries, it is important to pre-operatively assess the site and size of the bone deficiency to be repaired in the revision THA (re-THA). Bone allograft makes it possible to repair massive bone deficiency, recover bone stock, and improve long-term implant stability. Performing bone allograft will require a bone bank for harvesting, treating, and storing bone in Japan.     

Functional outcomes of bilateral hip necrosis: total hip arthroplasty versus extracorporeal shockwave

Introduction  This study compared the functional outcomes of total hip (THA) in one and shockwave (ESWT) in the other in 17 patients with bilateral hip necrosis. Method  In THA side, only one type of prosthesis was used and all components were press fixed. In ESWT side, each hip received 6,000 impulses of shockwave at 28 kv. Results  The evaluations included pain score and Harris hip score, radiographs and MR images. The magnitudes of improvement in pain and function favored the ESWT side. Thirteen patients rated ESWT better than THA; four patients reported comparable results between THA and ESWT, and none graded THA better than ESWT. Better functional outcomes were observed after ESWT for early hip necrosis than THA for late cases in patients with bilateral hip disease.     

Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fractures in patients over 70 years old

Objective:Total hip arthroplasty (THA)and hemiarthroplasty (HA) are effective methods currendy used to treat femoral neck fracture in elderly patients,but the two options remain controversial in patien...     

Total hip arthroplasty in the very young patient

The surgical management of end-stage hip disease in patients aged <30 years remains a challenge. Hip-preserving surgical procedures in the setting of advanced disease often do not provide adequate pain relief, but the implications of joint arthroplasty surgery in the very young patient are a matter of concern. The outcome of total hip arthroplasty (THA) in these patients varies, largely because of the wide spectrum of diagnoses associated with hip disease in this group, the complexity of deformities requiring THA, and the need for prolonged durability. The greatest number of THAs in this population is performed for secondary osteoarthritis or osteonecrosis, whereas most reports in the orthopaedic literature have focused on the outcomes of cemented THA in patients with juvenile rheumatoid arthritis. Given the frequent complexity of THA in the very young patient, special attention should be given to preoperative planning, implant selection, and patient education as well as to joint-preservation techniques to facilitate future hip arthroplasty surgery.     

The Need for Total Hip Arthroplasty in Perthes Disease: A Long-term Study

Background  

Legg-Calvé-Perthes disease (LCPD) was described a century ago. In previous long-term reports of patients with LCPD, nonoperative treatment varied considerably. The likelihood of hip osteoarthritis (OA) developing in patients with LCPD and possible need for THA are not well defined.     

A 27-year experience with splenectomy for Gaucher's disease

Gaucher's disease is an inherited metabolic disorder caused by the defective activity of acid beta-glucosidase and the resultant accumulation of glucosyl ceramide-laden macrophages in the liver, bone, and spleen. Splenectomy is the preferred treatment for patients with Gaucher's disease who develop massive splenomegaly with accompanying hypersplenism and/or mechanical pressure symptoms. The charts of 48 patients with Gaucher's disease undergoing splenectomy at our institution between January 1963 and December 1989 were analyzed to determine the short- and long-term results of this procedure. Thirty-five (73%) patients had total splenectomy, whereas 13 (27%) patients had partial splenectomy. There was one postoperative death (after total splenectomy), and 13 patients (27%) had postoperative complications. Eleven patients (23%) presented with accelerated bone disease after total splenectomy (mean follow-up: 96 months). No patients having partial splenectomy (mean follow-up: 25 months) developed progressive bone disease. Eight patients have died since surgery. All four deaths due to malignant disease occurred in patients after total splenectomy. The results of this largest-ever reported series of splenectomy for Gaucher's disease confirm that while either total or partial splenectomy can be performed with minimal morbidity and mortality, total splenectomy is accompanied by more aggressive bone disease and a predisposition to malignancy. Prospective, randomized trials are needed to substantiate whether partial splenectomy is indeed the treatment of choice for splenomegaly associated with Gaucher's disease.     

Efficacy of cementless total hip arthroplasty in patients on long-term hemodialysis

We retrospectively reviewed 11 hip arthroplasties in 7 patients receiving long-term (15 years) hemodialysis for chronic renal failure. Osteonecrosis of the femoral head, osteoarthritis, and amyloid arthropathies were treated by total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA) using cementless anatomic medullary locking stem. The average follow-up period was 8 years and 3 months (range, 3-13 years). The D'Aubigne and Postel hip score was restored to 14.5 postoperatively from 7.7 preoperatively. All femoral cementless components achieved bone-ingrown fixation. Although 1 BHA resulted in central migration, there was no loosening of the cementless acetabular component. We are encouraged by the predictable long-term stability of the bone-implant interface achieved by cementless fixation with an extensively coated implant. Cementless THA remains a useful treatment option for patients on long-term hemodialysis.     

Demographic factors affecting long-term outcome of total hip arthroplasty

We report the outcome of total hip arthroplasty (THA) in a cohort of patients with complete long-term radiographic and clinical followup information from our database of more than 48,000 primary hip replacements. The purpose of the study was to evaluate the influence of various demographic factors and patient comorbidity (Charnley classification) on the long-term outcome of THA. The cohort was comprised of 25,990 total hip replacements (THRs) in 10,243 (46.6%) men and 11,754 (53.4%) women with a median age of 66 years (range, 20-96 years) at the time of arthroplasty. Our study confirmed that THA has an impressive efficiency and reliability in alleviating pain and improving function for almost all of the patients. Furthermore, the results are enduring with more than 90% of patients being satisfied with the outcome at 15 years. Clinical outcome measures reach their maximum at 2 to 5 years after arthroplasty and thereafter they decline gradually. Furthermore, patient age, gender, body mass index, and main diagnosis all have an influence on specific functional parameters. The Charnley classification has the most profound effect on the overall functional status of patients.     

Total hip arthroplasty in the treatment of developmental dysplasia of the hip

Total hip arthroplasty (THA) is the preferred treatment for patients with severe arthritis of the hip secondary to developmental hip dislocation or dysplasia. However, THA may be difficult due to bone and soft tissue problems that arise from hip dislocation or dysplasia. Another problem is that patients are usually young, which may affect the long-term survival of the prosthesis. Either cemented or uncemented components can be used depending on bone structure and bone stock. Uncemented components are more preferable because of the young age of the patients. From a biomechanical standpoint, the placement of the acetabular component in its true anatomical location is the main goal for survival and better functional results of THA. To ascertain the stability of the acetabular component, superior grafting, controlled medial wall perforation (medialization), or giving the position of a high hip center may be used. On the femoral side, various femoral components may be used with or without a shortening osteotomy. In this article, reconstruction options for developmental hip dysplasia are discussed depending on acetabular and femoral features of the deformity.     

Ceramic-on-ceramic total hip arthroplasty: A new standard

Total hip arthroplasty (THA) is durable and reliable at relieving pain and improving function in patients with end stage arthritis of the hip joint. Changing patient demographics, risk for aseptic loosening, and instability remain major barriers for long-term implant survivorship. Modern ceramic bearings used in THA have enjoyed good long-term clinical track record and the reliability of these components continues to improve with better materials, surgical technique, and implant design. Coupled with excellent wear characteristics and optimum bearing lubrication with larger head sizes, modern ceramic-on-ceramic THAs can address all of these concerns without the complications of volumetric polyethylene wear associated with the use of large metal ball heads with polyethylene. Consequently, modern ceramics represent the new standard in bearing surfaces for patients undergoing hip replacement surgery.