Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients

To reduce the disability after hip disarticulation, we developed a special surgical procedure in patients having a proximal femoral tumor with a large tumor involving the sciatic nerve or neoplasms involving the tibia and femur. The hip was disarticulated, but we preserved a musculocutaneous flap. A modular endoprosthesis was then placed in the acetabulum or, in case of an extraarticular resection of the hip joint, it was placed in the iliac bone. A trevira tube was used for reconstruction of the joint capsule and fixation of soft tissues. We performed this procedure in 5 patients who had a good functional outcome.     

Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients.

To reduce the disability after hip disarticulation, we developed a special surgical procedure in patients having a proximal femoral tumor with a large tumor involving the sciatic nerve or neoplasms involving the tibia and femur. The hip was disarticulated, but we preserved a musculocutaneous flap. A modular endoprosthesis was then placed in the acetabulum or, in case of an extraarticular resection of the hip joint, it was placed in the iliac bone. A trevira tube was used for reconstruction of the joint capsule and fixation of soft tissues. We performed this procedure in 5 patients who had a good functional outcome.     

Hip rotationplasty for malignant tumors of the proximal part of the femur

Disarticulation of the hip and hemipelvectomy have been the only surgical alternatives available for the adequate local control of malignant tumors of the proximal part of the femur in patients who are still growing. The use of proximal or total femoral implants is restricted to patients who have reached skeletal maturity. To improve the quality of survival for patients who have not yet reached skeletal maturity and have a malignant tumor of the proximal part of the femur, I have modified the rotationplasty procedure described by Van Nes for use in such lesions. After en bloc resection of the tumor, the distal part of the femur with the knee joint and leg is rotated 180 degrees and fixed to the lateral side of the pelvis. The knee joint then functions as a hinge hip joint and the ankle joint functions as a knee joint. This procedure was performed in eight patients, three of whom were followed for more than two years. All patients walked well with a prosthesis and the functional results were excellent. At the time of writing, there had been no recurrence of a tumor or pulmonary metastasis.     

骨盆部分切除术治疗骨盆肿瘤的部位分型与术式选择

探针对骨盆部肿瘤控其发生部位进行分型,选择相应的手术方式,以最大限度保留患侧肢体的功能。方法通过对１９８０年－１９９５年２０例骨盆腔肿瘤手术的总结,提出按肿瘤及部位即骶髂关节及髋关节是否被丰 坏将骨盆腔为四型     

Transarticular tumor invasion via ligamentum teres: A clinical-pathologic study of 12 patients

We studied 12 patients who were operated on for malignant tumors in and around the hip joint. A correlative study, including preoperative staging studies and anatomical-pathologic aspects of the hip joint, was performed. in 4 of the 12 patients, we found direct histologic evidence of tumor invasion from the head of the femur through the ligamentum teres to the acetabular fovea and vice versa. It seems that the ligamentum teres is a potential route for transarticular spread of a tumor.     

Ultrasound-Guided Establishment of Hip Arthroscopy Portals

We describe ultrasound-guided establishment of hip arthroscopy portals. The surface projections of anatomic structures around the hip joint (including the nerve, vessels, femoral neck, and acetabulum) were marked. The entry points were then planned for the anterolateral and anterior portals and, if necessary, the posterolateral portal. The anterolateral portal was first placed. Through the use of real-time ultrasound guidance, a pin was inserted into the hip joint and 20 mL of normal saline solution was injected. A K-wire was then inserted into the joint space over the needle. The arthroscopic trocar was introduced along the K-wire, and the arthroscope was inserted to confirm the establishment. The anterior portal was then established. The hip joint was flexed slightly. The previous procedure was duplicated to insert the K-wire. The path of the pin was confirmed by viewing from the arthroscope in the anterolateral portal. If necessary, the posterolateral portal was established by the same procedure.     

Purse-String Capsule Repair to Reduce Proximal Femoral Arthroplasty Dislocation for Tumor—A Novel Technique With Results

Hip joint dislocation is the most common complication after proximal femoral arthroplasty with a large endoprosthesis. Average dislocation rates are around 15%. In an attempt to decrease dislocations after proximal femoral arthroplasty for tumor resections, we devised a novel closure of the hip capsule. This technique uses a 3-mm cottony Dacron suture placed about the hip capsule in a circumferential, purse-string manner. Thirty-nine patients received hip hemiarthroplasty with purse-string capsular closure. Seven patients were lost to follow-up, leaving 36 patients available for analysis. One patient dislocated (2.8%). We believe this technique is useful in preventing dislocation in patients undergoing proximal femoral arthroplasty for oncologic disease.     

Radiological diagnosis of screw penetration of the hip joint in acetabular fracture reconstruction

Screw penetration of the hip joint following acetabular fracture reconstruction is a relatively uncommon complication but, if not corrected, may have a catastrophic effect on the postoperative function of the hip joint. Intraoperative radiographs and postoperative standard anteroposterior (AP) radiographs frequently show super-imposition of the screws and acetabulum. Computed tomographic (CT) scanning has been the only diagnostic technique available allowing documentation of screw penetration into the hip joint. CT scan, however, can be performed only after termination of surgery. In search for a radiological view that will help in diagnosing screw penetration into the hip joint both intra- and postoperatively, we undertook a controlled study of 25 patients having either a posterior or extensile lateral surgical approach and six cadaveric specimens. A combination of a cross-table lateral view of the hip and a Judet iliac view proved more informative than AP or Judet obturator views in demonstrating absence or presence of the screw in the hip joint (if the screws were placed along the posterior wall or column). Intraoperative AP radiographs projected as a Judet obturator view were the least helpful in making this determination. When screw penetration is suspected, we recommend the use of intraoperative fluoroscopy in multiple projections or intraoperative arthrogram in the lateral projection of the pelvis. Also, Judet iliac and cross-table lateral radiographs in the operating room while the patient is still under anesthesia might exclude any screw penetration into the hip joint.     

Infiltration of sarcomas into the hip joint: comparison of CT,MRI and histologic findings in 67 cases

We analyzed the incidence, route, and characteristics of hip joint infiltration in pelvic or proximal femoral sarcomas. 67 patients with a sarcoma that originated around the hip joint (50 pelvic and 17 femoral) were included in this study. Preoperative CT and MRI were matched with the histological findings in tumor specimens. Tumor infiltration into the hip joint was suspected on the basis of preoperative imaging in 29 patients due to articular cartilage disruption, diffuse signal changes in the acetabulum or femoral neck, signs of a tumor in the joint, or markedjoint effusion. Of these 29 patients, 15 showed tumor invasion on histological examination. 12 of 31 chondrosarcomas, none of 12 Ewing's sarcomas, and 3 of 24 osteosarcomas infiltrated into the hip joint (p = 0.008). 10 of 26 low-grade sarcomas and 5 of 41 high-grade sarcomas infiltrated into the hip joint (p = 0.02). The joint infiltration rate of the chondrosarcomas was related to their size. Of 10 tumors originating in the acetabulum, 9 penetrated through or around the osseous-ligamentous junction and one through the acetabular cartilage. In 5 proximal femur lesions, all infiltrated the joint through the femoral neck, 3 of them also through the ligamentum teres.     

Articulated distraction of the hip joint in the treatment of benign aggressive tumors located around the hip joint

Introduction The proximal femur and acetabulum are frequent sites for benign active and aggressive lesions. The risk of pathologic fracture is great when a bone-destroying pathology involves an anatomic location such as the hip joint that undergoes profound mechanical loading. If the destruction involves a large area around the joint, secure fixation cannot be achieved with internal fixation implants. The study investigates use of articulated hip distraction to protect reconstructions performed for the treatment of benign active or aggressive tumors presenting with pathologic fracture.Patients and methods Five patients with a pathologic fracture of the proximal, intracapsular femur or the acetabulum were operated on at the authors' institution between 1997 and 1999. Following histopathologic approval of a benign tumor, all lesions were curetted, chemocauterized, and grafted and osteosynthesis was performed. The reconstruction was protected with an articulated hip distraction external fixator. All patients were mobilized in the immediate postoperative period.Results The patients were kept in external fixators for an average of 19.8 weeks (range: 16–24). The fixator was removed when bony consolidation was observed in anteroposterior and lateral x-rays of the lesion. The patients were followed for an average of 47 months (range: 38–56) after frame removal. None of the lesions recurred. At the last follow-up examination, all patients displayed an excellent function according to the Musculoskeletal Tumor Society Rating Scale. Conclusion According to the authors' knowledge, this investigation is the first in the literature describing the use of articulated joint distraction in the treatment of benign active and aggressive lesions around the hip joint. The procedure adopts principles of joint distraction into bone tumor surgery.     

The treatment of pigmented villonodular synovitis of the hip. A case report and literature review

Pigmented villonodular synovitis (PVS) is a rare occurrence in the hip joint. A 33-year-old female with PVS of the right hip was successfully treated by synovectomy and total hip arthroplasty. The literature includes 64 cases of PVS involving the hip, with an average patient age of 34.8 years. Multiple methods of initial treatment were encountered including synovectomy alone, synovectomy and total hip arthroplasty, radiation therapy, and arthrodesis. Synovectomy is only effective when articular cartilage is preserved. Total hip arthroplasty, although of concern in such a young population, appears to be the procedure of choice for either advanced cases of PVS or those that have failed joint-sparing procedures.     

肿瘤型与常规型人工全髋关节置换股骨假体安放的对比研究

目的通过对比两种人工全髋关节置换手术股骨假体安放的技术,提高对术中股骨假体安放及假体周围软组织修复的认识。 方法2012年1月至2016年1月,选取郑州市骨科医院骨病骨肿瘤科同期收治的髋部肿瘤、股股骨头坏死、股骨颈骨折行髋关节置换手术治疗的患者,排除肿瘤已全身转移且不宜手术治疗的患者,并随机分为对照组和观察组行人工全髋关节置换者90例95髋,男53例56髋,女37例39髋;年龄12～81岁,平均(55±14)岁。其中行肿瘤型人工全髋关节假体置换者(A组)12例12髋;行常规初次人工全髋关节置换者(B组)78例83髋。术中两组患者参照多处解剖标志安放股骨假体,并最大限度重建假体周围软组织解剖结构。对两组患者的手术时间、术中术后出血量、住院天数和髋关节Harris评分进行秩和检验和方差分析。 结果两组患者90例获3～30个月的随访,平均(36±7)个月的随访。在手术时间和术中术后出血量上两组比较差异无统计学意义(P>0.05);住院天数两组比较差异有统计学意义(t＝2.027,P<0.05)。两组患者术前、术后Harris评分经统计学分析,差异有统计学意义(F＝4.662,P<0.05),两组患者其术后髋关节功能得到提高,差异有统计学意义(F＝2.679,P<0.05),术后B组患者的髋关节功能优于A组患者。随访期内两组患者均未发现术后下肢不等长、术后关节脱位、感染、假体松动、假体周围骨折、坐骨神经损伤等并发症。肿瘤型假体组1例由于外展肌力不全,出现行走步态异常。 结论股骨假体位置的正确安放及假体周围组织完整性的保持和术后重建恢复是术后髋关节获得良好功能的前提条件。     

Total hip arthroplasty in dwarfism. A case report

In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early age. In these patients a joint replacement is a demanding procedure due to the peculiar joint deformity and the small size of the bones. We present a case of a bilateral hip replacement in a dwarf patient. In order to reduce intraoperative complications and improve the joint kinematics a thorough preoperative planning was performed by a CT based computerised system. On the basis of the planning we chose a conical shaped stem that enable as to restore limb length and offset with a low risk of femoral fracture. In conclusion, we consider total hip replacement in dwarfism a safe and effective procedure if an accurate preoperative planning is performed.     

Metallallergie bei Patienten vor bzw. nach endoprothetischem Gelenkersatz

The object of the present study was to determine the incidence of metal sensitivity in patients with joint replacement arthroplasties before and after surgery and whether this is of significance as regards the final outcome of the operative procedure. A questionnaire-based survey involved 1,335 patients with an average age of 61 years and joint replacement arthroplasties before and after surgery. A history of dermal sensitivity to metal was given in 99 (7%) patients with almost equal frequency in the pre- and postoperative groups (7.6 vs 7.2%). In only 27 of 99 cases was the metal sensitivity recorded in the patient chart. In 46 cases investigation was done after knee or hip replacement arthroplasty with an average implant time in situ of 68 months. In 32 of 46 patients a sensitivity to the implanted material was known and they did not show any complications related to the metal sensitivity.It is currently unclear whether metal sensitivity could be induced by joint replacement arthroplasties and it remains uncertain whether loosening or infection causes the sensitization as a consequence of increased release of metal ions or vice versa. To draw further conclusions considerably more detailed studies involving more patients are clearly indicated.     

Hip joint remodeling in an adult following excision of a giant cell tumor involving the acetabulum: a case report and literature review

We describe a 47-year-old man with a giant cell tumor of bone involving the acetabulum treated with curettage and bone grafting which resulted in good remodeling of the hip joint. The patient had a 15 × 18-cm² mass lesion extending from the right ischium to the acetabulum. Treatment included curettage, phenol, and ethanol application as an adjuvant, and cancellous bone allografting was performed on the subchondral area of the acetabulum. The posterior column of the acetabulum was disappeared by tumor invasion. Despite central migration of the femoral head, adequate hip joint repair was achieved without surgery 5.5 years postoperatively and with no tumor recurrence. The patient could walk without pain or ambulation aids; hip range of motion was 100° for flexion, 0° for extension, 30° for abduction, 45° for external rotation, and 10° for internal rotation, and the functional result was 93.3% in the Enneking scoring system. We performed intralesional curettage with phenol and ethanol adjuvant therapy for pelvic giant cell tumor without tumor recurrence, and good repair of a hip joint adaptation can be achieved even in an adult patient.     

A relationship between stem orientation and function following total hip arthroplasty

A retrospective gait analysis of patients with cemented Charnley-Mueller total hip arthroplasties was conducted to determine if functional differences exist between patients with femoral stems placed in varus and valgus orientations. Twenty patients and ten normals were studied using gait analysis to quantify joint motion and moments during level walking. In addition, a radiographic analysis of stem placement and mechanics of the reconstructed hip was performed on the total hip patients. All patients selected for the study had excellent clinical results on the basis of a score of 95 or better on the Harris hip rating form. The patients were divided into two subgroupings on the basis of stem orientation. A valgus group was defined as having a valgus stem orientation relative to the femoral shaft, with the femoral head-shaft offset shortened by 5 mm or greater compared to the contralateral unoperated hip, while the varus group was defined on the basis of having a varus stem orientation relative to the femoral shaft, with the femoral head-shaft offset restored to normal or greater than normal. A difference in gait was found between the varus and valgus patient groupings. The varus group had abnormal gait characteristics in the range of hip motion, the flexion-extension moments at the hip, and stride length. The patients in the valgus group had statistically normal gait. The differences in the gait characteristics were interpreted as an attempt to alter forces on the hip joint for patients in the varus group. These alterations were possibly an early indication of a subtle adaptation in patients with varus-placed femoral stems since, historically, a greater percentage of the patients in this configuration, retrospectively, go on to mechanical failures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Resection hip arthroplasty for malignant pelvic tumor: Outcome in 5 patients followed more than 2 years

We describe the technique and outcome of resection hip arthroplasty with external fixator for malignant pelvic tumors involving the innominate bone. We used the procedure in 5 patients, all followed for more than 2 years. 4 of the patients are alive and 1 died of pulmonary metastasis. None of the patients experienced local tumor recurrence or infection. Lower limb function in 3 of the 5 patients was more than 70% with Enneking's criteria (Enneking et al. 1993). These 3 patients could walk without support and passively flex the hip up to 90 degrees. This resection hip arthroplasty allows early weight bearing with hip motion. We believe it is an excellent alternative to other procedures, such as endoprosthetic replacement, reconstruction with allograft or arthrodesis.     

Congenital hip dislocation and subtrochanteric pseudoarthrosis: Hip replacement based on computer-aided analysis

We describe the technique and outcome of resection hip arthroplasty with external fixator for malignant pelvic tumors involving the innominate bone. We used the procedure in 5 patients, all followed for more than 2 years. 4 of the patients are alive and 1 died of pulmonary metastasis. None of the patients experienced local tumor recurrence or infection. Lower limb function in 3 of the 5 patients was more than 70% with Enneking's criteria (Enneking et al. 1993). These 3 patients could walk without support and passively flex the hip up to 90 degrees. This resection hip arthroplasty allows early weight bearing with hip motion. We believe it is an excellent alternative to other procedures, such as endoprosthetic replacement, reconstruction with allograft or arthrodesis.     

Type-B-IIIa hip rotationplasty: an alternative operation for the treatment of malignant tumors of the femur in early childhood

BACKGROUND: The biological plasticity of the cartilaginous proximal part of the tibia in children makes it possible to use the tibia to reconstruct the lower extremity after excision of a sarcoma of the thigh. A type-B-IIIa rotationplasty is an alternative to prosthetic replacement in very young children who have a malignant tumor of the femur that requires extensive resection. METHODS: A type-B-IIIa rotationplasty was done in eight patients who had a femoral tumor: four had a Ewing sarcoma; three, an osteosarcoma; and one, a primitive neuroectodermal tumor. The ages ranged from two years and eight months to ten years and six months at the time of the procedure. RESULTS: All eight patients were able to bear full weight and had a good range of motion of the hip joint at a median of five years and one month (range, two years and four months to eight years) postoperatively. They also were able to participate in sports activities. Radiographs and magnetic resonance imaging studies confirmed that the lateral part of the tibial plateau had remodeled to form a structure that resembled a developing femoral head. Seven patients were operated on only once, and a second hospital stay was not necessary. The remaining patient had a prolonged hospitalization for revision of the wound. CONCLUSIONS: As an alternative to amputation or an extendable tumor prosthesis, a type-B-IIIa rotationplasty offers not only a better functional result but also biological reconstruction. Placement of the cartilaginous head of the tibia into the acetabulum permits development of a new femoral head. Thus, not only is the foot preserved as a functional knee joint but a newly formed hip joint develops as well.     

Resection of the obturator nerve for analgesic treatment of degenerative-deforming changes of the hip joint]

Resection of the obturator nerve in hip joint arthritis can eliminate or decrease pain depending on the obturator nerve share in the hip joint innervation. From 1986 to 1988 34 obturator neurectomies were performed in painful hip arthritis patients with temporary or permanent contraindications for hip arthroplasty. In 21 from 30 patients followed-up at least 3 months partial or total relief of pain was found. Extrapelvic obturator neurectomy technique and indications for this procedure were presented.