Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study

With a randomized clinical trial, we compared the incidence and severity of heterotopic ossification in cohorts of patients who have undergone either surface replacement arthroplasty or total hip arthroplasty at a minimum follow-up of 1 year. Surface replacement arthroplasty group had a significantly higher rate of severe heterotopic ossification (Brooker grades 3-4) than the total hip arthroplasty group, 12.6% (13/103) vs 2.1% (2/97) respectively (P = .02). Grade 4 heterotopic ossification was observed (4.9%, 5/103) exclusively in the surface replacement arthroplasty group. Patients with severe heterotopic ossification had significantly inferior functional outcome scores. Surgeons offering surface replacement must be aware of this risk and use meticulous surgical technique and consider routine prophylaxis against heterotopic ossification.     

Influence of stem size on clinical outcome of primary total hip arthroplasty with cementless extensively porous-coated femoral components

This study retrospectively evaluated the clinical outcome of primary total hip arthroplasty as a function of stem diameter in 1545 patients implanted with extensively porous-coated stems. Less than 2% of femoral components were loose or revised; femoral survivorship was 97.9% at 15 years. Of patients with stable components, 95 to 97% had increased function, decreased pain, and overall satisfaction. Although 17% of patients indicated activity-limiting pain, only 3% were dissatisfied with the results of their hip arthroplasty. Logistic regression demonstrated no statistical relationship between stem size and either revision, loosening, pain, or satisfaction. We conclude that patients with large-diameter, extensively porous-coated femoral components are no more likely to be revised, loose, or have thigh or activity-limiting pain than patients with smaller diameter stems.     

Long-term results of total hip arthroplasty in protrusio acetabuli

Ninety-three total hip arthroplasties were examined radiographically and clinically to investigate the best method of correction in protrusio acetabuli. Fifty-three percent were treated with cement alone, 36% with mesh or protrusio shell, and 11% with bone graft. Long-term follow-up study revealed a high percentage of immediate and late radiolucent lines. The highest rate of loosening, 50%, occurred in the cement alone group, which had not been corrected to within 10 mm of anatomic position. Sex, cause of protrusio, age at operation, and degree of osteopenia were not significantly different between the groups. The follow-up period was longer in the cement alone group, but this did not account for the excessively high rate of loosening. Correction of the anatomic position in protrusio deformity is vital, whether accomplished with cement, mesh, protrusio shell, or bone graft. Late radiolucent lines are common and do not reliably indicate loosening.     

术前功能对初次人工全髋关节置换术后早期功能的影响

[目的]探讨术前功能状态对初次全髋关节置换术(THA)术后早期功能的影响.[方法]对2006年1月-2008年1月期间在本科行初次非骨水泥型全髋关节置换的髋关节骨性关节炎95例患者进行随访研究,其中男49例,女46例,平均年龄62.7岁(50～76周岁),随访时间大于24个月.根据患者术前Harris评分(HHS)将患...     

A comparison between patient recall and concurrent measurement of preoperative quality of life outcome in total hip arthroplasty

The objective is to evaluate the reliability of patients' recall of preoperative pain and function during the immediate postoperation period after total hip arthroplasty. A prospective cohort of 104 patients completed a survey about their quality of life before operation, and recalled preoperative status at 3 days, 6 weeks, and 12 weeks after operation. Quality of life was measured by the Western Ontario and McMaster University Osteoarthritis Index, the Oxford-12 hip score, and the 12-item Short-Form score. The intraclass correlation coefficient and Spearman correlation coefficient were used to compare preoperative quality of life scores to the scores recalled. The reliability of recall remained high up to 3 months postoperation. Patients are able to accurately recall their preoperative function for up to 3 months after total hip arthroplasty.     

A comparison of the outcome of cemented all-polyethylene and cementless metal-backed acetabular sockets in primary total hip arthroplasty

We compared, after a 10-year-minimum follow-up, the outcome of 50 cemented all-polyethylene Charnley acetabular sockets with that of 51 cementless metal-backed sockets in 2 comparable cohorts of young patients. Although the revision rate for the cemented and cementless group was 28% and 35%, respectively, the revision rate for aseptic loosening was 28% for the cemented and 12% for the cementless group. The mean polyethylene wear was 0.112 and 0.114 mm/y, respectively, for the 2 groups. Linear osteolysis was observed in 18 of 50 cemented sockets. Expansile osteolysis presented in 10 of 51 cementless sockets and only in one of the cemented sockets. In conclusion, cementless components had more durable fixation than cemented components. However, they presented more aggressive expansile osteolysis caused by the coexistence of polyethylene and metal debris.     

全髋置换术治疗髋关节发育不良

目的探讨全髋置换术治疗髋关节发育不良(DDH)的手术方法并评价其临床疗效。方法12例DDH患者根据Crowe分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型4例,Ⅳ型2例。全部采用B iom et全髋假体置换。髋臼假体均为生物型固定,股骨假体除2例骨水泥固定,其余为生物型固定。3例髋臼重建利用自体股骨头于髋臼前外方植骨造盖,9例于真臼水平将髋臼内移;3例股骨重建于转子下截骨短缩并纠正前倾;Ⅲ、Ⅳ型DDH行关节周围软组织松解。结果患者术后均未出现坐骨神经麻痹、下肢深静脉栓塞、切口感染及早期人工关节脱位等并发症。肢体延长最多4.8 cm,平均2.8 cm。随访6个月~2年,Harris髋关节评分由术前平均40.7分提高到84.5分,未发生人工关节脱位或假体松动。结论对有症状的DDH或强烈要求改善步态的年轻患者,全髋置换术是一种有效的治疗方法。     

Early results of total hip arthroplasty in patients with developmental dysplasia of the hip compared with patients with osteoarthritis

We have investigated the results of primary total hip arthroplasty (THA) performed in patients with developmental dysplasia of the hip (DDH). Through the New Zealand Joint Registry, we identified all patients with DDH undergoing primary THA (n = 1205) and all patients with primary osteoarthritis (OA) undergoing primary THA (n = 40 589) between January 1, 1999, and December 31, 2008. Postoperative outcomes, baseline information, and operative characteristics were analyzed and compared between the DDH and the OA groups. There was no significant difference in Oxford Hip Score or revision rate between the 2 groups. Our results support THA as a successful surgical option in the management of degenerative arthritis in DDH, with comparable functional outcomes and revision rates to THA performed for primary OA.     

Locked inferior fracture dislocation after total hip arthroplasty

Acetabular fracture in conjunction with dislocation after total hip arthroplasty is a rarely reported event. We describe such a case with a unique fracture dislocation pattern, whereby the prosthetic femoral component dislocated inferiorly, fracturing the pelvis, and was locked in this position. The patient was treated with closed reduction under anesthesia and the fracture healed without further surgical intervention. However, she has experienced subsequent instability episodes and we have recommended revision surgery.     

Long-term results of harris total hip replacement

The long-term clinical and radiographic results of 38 Harris total hip replacements performed on 31 patients (average age, 50.7 years), with an average follow-up period of 11.5 years, were reviewed. According to a modified d'Aubigne-Postel hip rating system, 14 hips were rated excellent, 19 good, 4 fair, and 1 poor. Only one patient had revision surgery for symptomatic acetabular and femoral loosening. Eight acetabular components migrated, usually after 10 years; this did not correlate with an unsatisfactory clinical result, except in one hip. There was subsidence or loosening of the femoral component in five hips, usually associated with a technical error or severe calcar resorption; this occurred early and did correlate with an unsatisfactory clinical result. Clinical results were satisfactory in 86% of the hips with long-term follow-up study. However, radiographic failure occurred in 34% of the hips, with a predominance of late acetabular migration.     

计算机辅助全髋关节表面置换11例(16髋)随访报告

[目的]探讨非影像手术导航系统下进行全髋关节表面置换的方法和疗效.[方法]11例(16髋)在导航系统下进行全髋关节表面置换术,设定髋臼假体最佳植入角度为外展角45°,前倾角15°,股骨假体柄颈角为O°,柄干角140°.术后测定假体植入的角度情况,统计手术时间、出血量.[结果]术后手术导航系统植入髋臼假体的前倾角为(15.6±1.2)°、外展角为(45.3±1.5)°,股骨假体柄颈角为(2.2±1.8)°,柄干角为(140.5±2.0)°.平均随访2.5年(40～15个月),术前平均Harris评分35分(25～35分),术后为X线片发现1例髋臼假体周围出现透亮线,而无松动迹象.[结论]非影像手术导航系统下可以精确地植入假体,减少假体松动的发生,具有重要的临床价值.     

Comparison of the 2-incision and mini-incision posterior total hip arthroplasty technique: a retrospective match-pair controlled study

We compared the outcomes of the mini-posterior and 2-incision total hip arthroplasty approaches by analyzing 43 matched pairs of patients. The following outcomes were evaluated: (1) Harris Hip Score, (2) Medical Outcomes Study 36-Item Short-Form Health Survey, (3) the Medical Outcomes Study Sleep Scale, and (4) the Western Ontario and McMaster Osteoarthritis Index. Function was regained earlier by patients having the 2-incision total hip arthroplasty as determined by length of hospitalization (P = .002) and multiple return to function parameters, although this may be the result of hip precautions placed on the posterior group. Posterior mini-incision patients had less operating time (P < .0001) and blood loss (P = .001). Complications did not differ between surgical techniques. No patients were revised. The 2-incision operation was better for function and length of stay, and the posterior mini-incision was easier to perform, although these groups used different selection criteria.     

Functional outcome of fracture neck of femur treated with total hip replacement versus bipolar arthroplasty in a South Asian population

Introduction Endoprosthetic replacement is a popular method of treatment for fracture neck of femur in the elderly. Unipolar, bipolar and total hip endoprosthesis are all used. The aim of this paper is to compare the functional results of bipolar arthroplasty with that of total hip arthroplasty in a South Asian population.Materials and methods Sixty-one patients who underwent prosthetic replacement for fracture neck of femur between May 1997 and Dec 2002 were followed-up prospectively. Twenty-nine patients were treated with total hip replacement and thirty-two were treated with bipolar arthroplasty. At the time of the last follow-up, twenty-four patients had expired and seventeen could not be traced. The results in the remaining twenty are presented.Results The period of follow up ranged from 24 months to 90 months, with a mean of 58.5 months. The mean Harris Hip Score for the bipolar group was 86.93, and for the total hip group was 83.82. More than a third of our patient population died within 5 years of endoprosthetic replacement.Conclusion The functional outcome is equally good whether bipolar or total hip replacement is used, in the elderly, in a South Asian population. More than a third of our patient population expired within 5 years of prosthetic replacement; therefore it may be wise to choose the less expensive treatment modality in resource poor countries.     

非骨水泥全髋关节置换术治疗股骨头缺血性坏死的疗效观察

[目的]对使用非骨水泥全髋关节置换术治疗股骨头缺血性坏死的患者进行临床及影像学随访,探讨其疗效、并发症及其影响因素。[方法]选取2000年3月~2007年11月以来因股骨头缺血性坏死在本院行非骨水泥全髋关节置换术并具有完整临床及影像资料的76例(91髋)患者进行随访。临床随访包括术前术后Harris评分及各种并发症。影像学评估包括双侧髋关节正位、患髋侧位片,判断股骨及髋臼假体的位置及其周围骨质的变化,并测量髋臼内衬线性磨损量。[结果]截至末次随访时,68例(82髋)获得随访,随访率为90.1%,随访时间平均为48.8个月。术前Harris评分平均为42分(5~86分),末次随访时为93分(53~99分),优良率为90.2%。术后1例患者发生与活动相关的大腿痛,影像学上9髋股骨假体发生早期不稳定,14髋发生应力遮挡,5髋发生异位骨化。无假体松动或翻修病例。[结论]非骨水泥全髋关节置换术治疗晚期股骨头缺血性坏死疗效确切,但存在一过性大腿痛、应力遮挡、异位骨化、假体磨损等并发症,故需长期随访。     

Quality of life outcomes in revision vs primary total hip arthroplasty: a prospective cohort study

This study included 143 patients who had revision total hip arthroplasty (THA) and 144 patients who had primary THA. The primary outcome variable in this study was the Western Ontario and McMaster Universities Osteoarthritis Index scores. Univariate and multivariate regression models were used to assess the relationship between surgical procedure and postoperative health related quality of life outcomes. The mean follow-up period was 1.7 years (range, 1-3 years). The mean preoperative function of patients with primary THA was significantly worse than that in the revision group (delta = -6.2; P = .013). Postoperative functional outcome was significantly better in patients with primary THA (delta = 6.5, P = .016) than in patients who had revision THA. The magnitude of improvement in quality of life is greater for the patient with primary THA in comparison to the patient with revision THA.     

Surgical exposures for primary total hip arthroplasty

The proper selection of a specific surgical approach to the hip should be based on the following: anticipated exposure requirements (femoral, acetabular, and iliac); the location of prior incisions; preoperative leg lengths and range of motion; soft-tissue tension and integrity; patient size; surgical goals; and the surgeon's familiarity with the involved anatomy, both normal and pathological.all hip surgeons should be knowledgeable of anterior, lateral, posterior, and trans-trochanteric capsular approaches to the hip; more complicated extensile exposures are generally performed by the more experienced hip surgeons in complex primary and revision total hip arthroplasty (THa). Detailed anatomic exposures to the hip are discussed in several text books. The purposes of this article are to discuss surgical principles, pertinent anatomy, and indications, advantages, limitations, and results of the more commonly used surgical approaches for simple and complex primary THa.     

Gait symmetry: a comparison of hip resurfacing and jumbo head total hip arthroplasty patients

Proponents of large femoral head total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) have touted the potential for restoration of more normal hip kinematics. This study examined 20 patients (10 THA and 10 HRA patients) approximately 18 months after surgery. Subjects were evaluated at a self-selected pace, while bilateral spatial-temporal gait variables, hip flexion/extension kinematics, and ground reaction forces were collected. For both groups, swing time was increased on the surgical side, whereas peak hip flexion, peak extension, and flexion at heel strike were decreased. Peak hip extension and peak vertical ground reaction forces were decreased in THA subjects compared with HRA subjects. After a large-diameter THA or HRA, subjects do not display symmetric gait approximately 18 months postoperatively. Total hip arthroplasty subjects demonstrated restricted hip extension and reduced limb loading when compared with HRA subjects.