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1.
Xigong Li Yang Lu Junying Sun Xiangjin Lin Tiansi Tang 《The Journal of arthroplasty》2017,32(2):475-479
Background
The purpose of this study was to evaluate the functional and radiographic results of patients with Crowe type-IV hip dysplasia treated by cementless total hip arthroplasty and double chevron subtrochanteric osteotomy.Methods
From January 2000 to February 2006, cementless total hip arthroplasty with a double chevron subtrochanteric shortening osteotomy was performed on 18 patients (22 hips) with Crowe type-IV dysplasia. The acetabular cup was placed in the position of the anatomic hip center, and subtrochanteric femoral shortening osteotomy was performed with the use of a double chevron design. The clinical and radiographic outcomes were reviewed with a mean follow-up of 6.5 years (5-10 years).Results
The mean amount of femoral subtrochanteric shortening was 38 mm (25-60 mm). All osteotomy sites were healed by 3-6 months without complications. The mean Harris Hip Score improved significantly from 47 points (35-65 points) preoperatively to 88 points (75-97 points) at the final follow-up. The Trendelenburg sign was corrected from a positive preoperative status to a negative postoperative status in 12 of 22 hips. No acetabular and femoral components have loosened or required revision during the period of follow-up.Conclusion
Cementless total hip arthroplasty using double chevron subtrochanteric osteotomy allowed for restoration of anatomic hip center with safely functional limb lengthening, achieved correction of preoperative limp, and good functional and radiographic outcomes for 22 Crowe type-IV dislocation hips at the time of the 5- to 10-year follow-up. 相似文献2.
Duan Wang Ling-Li Li Hao-Yang Wang Fu-Xing Pei Zong-Ke Zhou 《The Journal of arthroplasty》2017,32(4):1211-1219
Background
When surgeons reconstruct hips with a high dislocation related to severe developmental dysplasia of the hip (DDH) in total hip arthroplasty (THA), archiving long-term stable implant fixation and improving patient function and satisfaction remain challenging. The purpose of this study was to evaluate the 10-year outcomes of transverse subtrochanteric shortening osteotomy in cementless, modular THA in Crowe type IV-Hartofilakidis type III DDH.Methods
We reviewed 62 patients (76 hips) who underwent cementless THA with transverse subtrochanteric shortening osteotomy from 2002-2010. There were 49 women and 13 men with a mean age of 38.8 years, all of whom had Crowe type IV DDH. Mean follow-up period was 10 years. The acetabular cup was implanted in placement of the anatomical hip center in all hips.Results
The mean Harris Hip Score significantly improved from 38.8 points to 86.1 points. Similarly, modified Merle d'Aubigne and Postel Hip Score, Hip dysfunction and Osteoarthritis Outcome Score, and SF-12 also significantly improved. The mean limb length discrepancy was reduced from 4.3 cm to 1.0 cm. At mean follow-up of 10 years, there were 3 cases of postoperative dislocation, 2 cases of transient nerve palsy, 1 case of nonunion, and 4 cases of intraoperative fracture. Revision surgery was performed in 2 patients due to isolated loosening of acetabular component and femoral stem, respectively.Conclusion
Our data demonstrated that the cementless, modular THA combined with transverse subtrochanteric shortening osteotomy was an effective and reliable technique with high rates of successful fixation of the implants and satisfactory clinical outcomes. 相似文献3.
Huiwu Li Jiawei Xu Xinhua Qu Yuanqing Mao Kerong Dai Zhenan Zhu 《The Journal of arthroplasty》2017,32(3):849-856
Background
This study compares the outcome between THA with and without femoral shortening osteotomy for unilateral mild to moderate high hip dislocation in developmental dysplasia of the hip patients.Methods
The data on 42 hips in 42 patients who had undergone THA for unilateral mild to moderate high hip dislocation were retrospectively reviewed after being prospectively collected. In 22 patients, hips were reduced by soft tissue release and direct leverage using an elevator, without the osteotomy. The remaining 20 patients were treated with a subtrochanteric transverse shortening osteotomy. The mean follow-up of patients was 5 years (standard deviation = 1.0) for the nonosteotomy group and 6.2 years (standard deviation = 1.6) for the osteotomy group.Results
The Harris Hip Score significantly improved in both groups. In the nonosteotomy group, we observed a lower leg length discrepancy compared with the osteotomy group (0.4 cm and 2.2 cm, respectively). Four patients (18.2%) in the nonosteotomy group and 15 patients (75%) in the osteotomy group developed a limp (P < .0001). Three patients (13%) developed femoral nerve palsy in the nonosteotomy group, but they all recovered completely within 6 months after the surgery. Nineteen patients in the nonosteotomy group showed knee valgus deformity immediately after the surgery but only 4 cases in the osteotomy group.Conclusion
Compared with THA with femoral shortening osteotomy, THA without the osteotomy was associated with a lower number of patients who developed a limp at the end of follow-up; however, the rehabilitation was slower and more difficult, and a larger number of patients showed reversible nerve palsy and knee valgus deformity. 相似文献4.
Brent A. Lanting Matthew G. Teeter James L. Howard Steven J. MacDonald Douglas W. Van Citters 《The Journal of arthroplasty》2017,32(8):2574-2579
Background
Trunnion tribocorrosion in total hip arthroplasties is concerning, but retrieval studies often are subjective or lack comparison groups. Quantitative comparisons of clinically relevant implants are required. The purpose of this investigation was to evaluate material loss in metal-on-metal (MoM) and metal-on-polyethylene (MoP) total hip articulations while controlling for trunnion design and head size.Methods
The 166 retrieved femoral heads from 2 manufacturers were analyzed. Four cohorts based on head size, trunnion design, manufacturer, and articulation type (MoM vs MoP) were created. Corrosion was measured by a coordinate measurement machine, and material loss was assessed (MATLAB).Results
Retrieved femoral heads from MoP articulations had 5 times less trunnion material loss than MoM articulations, on average, for both manufacturers. There was no difference in material loss between large modular head (>40 mm) and 36-mm MoM hip trunnion. Implants with a material loss above the detectable limit demonstrated a correlation with time in vivo only in MoP articulations.Conclusion
Retrieved femoral heads from MoP bearing couples had a lower magnitude of material loss than MoM couples, independent of head diameter. A time in vivo effect was only seen in MoP bearings. 相似文献5.
Ahmed El-Bakoury Hazem Hosny Mark Williams Jonathan Keenan Rathan Yarlagadda 《The Journal of arthroplasty》2017,32(2):541-545
Background
Periprosthetic fracture following total hip arthroplasty is a significant problem faced by hip surgeons, and its management in elderly patients remains a considerable challenge.Methods
We retrospectively reviewed 28 Vancouver B2 and B3 periprosthetic femoral fractures (PFF) treated with revision of the femoral stems by distally locked, hydroxyapatite-coated uncemented stems (Cannulok). Patients were aged 75 years or older at the time of surgery.Results
The mean follow-up was 44.6 months (range, 24-102). The mean postoperative Oxford hip score was 30.1 (range, 10-46). The rate of fracture union was 95.8%, and the survivorship of the stem was 100% at the end of follow-up.Conclusion
The management of PFF in elderly is associated with increased postoperative morbidity and mortality. The use of a distally locked, hydroxyapatite-coated femoral stem is a valid option for the treatment of PFF to achieve fracture union with a low rate of revision. 相似文献6.
Kyeong-Hyeon Park Joon-Woo Kim Hee-June Kim Hee-Soo Kyung Jong-Keon Oh Tae-Joon Cho Il Seo Chang-Wug Oh 《Journal of orthopaedic science》2017,22(3):474-480
Purpose
Varus or valgus deformity of the distal femur may progress into knee osteoarthritis. To delay or prevent this, various types of corrective osteotomy techniques have been used to shift the mechanical axis from the diseased compartment to the healthy one. We introduced a new, minimally invasive osteotomy of the distal femur with the assistance of temporary external fixation.Methods
We retrospectively studied 25 legs that underwent open-wedge osteotomy of the distal femur, involving insertion of a Schanz pin at the medial femoral condyle and another pin at the distal diaphysis of the femur. At the meta-diaphyseal junction, osteotomy was performed. After achieving angular correction, two pins were locked for temporary external fixation and a locking plate was fixed at the lateral side of the femur submuscularly. Radiological and functional outcomes were evaluated, including mechanical lateral distal femoral angle (m-LDFA), mechanical axis deviation, tibiofemoral angle, osseous union, and knee joint motion.Results
The minimum follow-up was 12 months (mean, 39 months; range, 12–88 months). Bone healing occurred in all legs, with an average of 16.6 weeks. The m-LDFA was corrected from 77.7° (18 valgus) and 104.6° (7 varus) to 88.1° after surgery, with an average correction of 12.9°. At the final follow-up, the mechanical axis deviation averaged 7.6 mm and the tibia-femoral angle averaged 5.6°. Most of legs (88%) achieved acceptable m-LDFA (87° ± 3°).Conclusions
A new, minimally invasive osteotomy of the distal femur offers excellent bone healing with few complications, attributable to preserved blood supply. 相似文献7.
Brian T. Barlow Philippe A. Ortiz John W. Boles Yuo-yu Lee Douglas E. Padgett Geoffrey H. Westrich 《The Journal of arthroplasty》2017,32(5):1535-1542
Background
The recent experiences with adverse local tissue reactions have highlighted the need to establish what are normal serum levels of cobalt (Co), chromium (Cr), and titanium (Ti) after hip arthroplasty.Methods
Serum Co, Cr, and Ti levels were measured in 80 nonconsecutive patients with well-functioning unilateral total hip arthroplasty and compared among 4 bearing surfaces: ceramic-on-ceramic (CoC); ceramic-on-polyethylene (CoP); metal-on-polyethylene (MoP), and dual mobility (DM). The preoperative and most recent University of California, Los Angeles (UCLA) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were compared among the different bearing surfaces.Results
No significant difference was found among serum Co and Cr levels between the 4 bearing surface groups (P = .0609 and P = .1577). Secondary analysis comparing metal and ceramic femoral heads demonstrated that the metal group (MoP, modular dual mobility (Stryker Orthopedics, Mahwah, NJ) [metal]) had significant higher serum Co levels compared with the ceramic group (CoC, CoP, MDM [ceramic]) (1.05 mg/L ± 1.25 vs 0.59 mg/L ± 0.24; P = .0411). Spearman coefficient identified no correlation between metal ion levels and patient-reported outcome scores.Conclusion
No serum metal ion level differences were found among well-functioning total hip arthroplasty with modern bearing couples. Significantly higher serum Co levels were seen when comparing metal vs ceramic femoral heads in this study and warrants further investigation. Metal ion levels did not correlate with patient-reported outcome measures. 相似文献8.
Purpose
To identify factors influencing overall radiologic changes in the distal radioulnar joint after ulnar shortening osteotomy (USO) in patients with idiopathic ulnar impaction syndrome.Materials and methods
A total of 310 patients who had undergone USO between May 2007 and December 2013 were included in this retrospective case–control study. The patients were classified into two groups (with or without radiologic findings of new arthritic changes), after which the following factors were analyzed: 1) demographic factors; 2) radiologic aspects, including ulnar variance (UV), morphological DRUJ type (classified according to Tolat et al.), and union period after USO; and 3) operative aspects, including the triangular fibrocartilage complex degeneration type, use of a parallel double-blade saw, type of plate used for fixation, and plate position on the volar or dorsal ulnar surface.Results
Group 1 (no arthritic changes) consisted of 243 patients, whereas Group 2 (arthritic changes) consisted of 67 patients. Univariate and multivariate analyses showed that the presence of lunate cystic changes, amount of shortening, and the union period were significantly associated with newly developed arthritic changes in the distal radioulnar joint (DRUJ) after USO. The morphological DRUJ type was not a significant factor. Arthritic changes were significantly more prevalent in patients with a shortening amount >4.5 mm and a union period <3.25 months.Conclusions
Radiologic arthritic changes after USO, were associated with the presence of cystic changes in the lunate, a shortening amount (>4.5 mm), and early bony union (<3.25 months).Type of study/level of evidence
Therapeutic level III. 相似文献9.
Nicholas A. Bedard Robert A. Burnett David E. DeMik Yubo Gao Steve S. Liu John J. Callaghan 《The Journal of arthroplasty》2017,32(12):3777-3781
Background
Bearing surface issues related to trunnionosis or metal-on-metal (MoM) articulations have likely impacted recent trends in bearing surface choice. The purpose of this study is to evaluate trends in total hip arthroplasty (THA) bearing surface use, including 2015 data, with respect to the date of operation and patient demographics.Methods
The Humana dataset was reviewed from 2007 through 2015 to analyze bearing surface usage in primary THA. Four bearing surface types were identified by International Classification of Disease, 10th Revision codes and trended throughout the years: metal-on-polyethylene (MoP), ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and MoM. Prevalence was analyzed as a function of age and sex.Results
Of the 28,504 primary THA procedures, the most commonly used bearing was MoP (46.1%), followed by CoP (33.2%), MoM (17.1%), and ceramic-on-ceramic (3.6%). The use of CoP bearings significantly increased from 6.4% in 2007 to 52.0% in 2015, while MoM bearings decreased during this period. MoP bearings decreased over 2012-2015 (P < .001). CoP usage decreased with age, while MoP bearings increased with a transition occurring at 65-69 years of age. Women were more likely to receive MoP bearings (odds ratio [OR] 1.2), while men were more likely to receive MoM and CoP bearings (OR 1.1). Multivariate logistic regression showed age to be an independent predictor of bearing surface choice with patients 65 and older more likely to receive MoP bearings (OR 3.2).Conclusion
Bearing surface choice in primary THA has changed tremendously from 2007 to 2015. MoM bearing use has decreased as a result of adverse effects. Age continues to remain a significant factor in bearing surface choice. 相似文献10.
Purpose
Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup.Methods
We report a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein for valgus osteotomy was added to reduction fixation secured with a commonly available 135° dynamic hip screw and plate.Results
Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3.Conclusion
135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results. 相似文献11.
Shigeo Fukunishi Shoji Nishio Yu Takeda Tomokazu Fukui Yuki Fujihara Shohei Okahisa Shinichi Yoshiya 《Journal of orthopaedic science》2017,22(5):898-904
Background
The number of hemodialysis patients has been progressively increasing in our country. On the other hand, chronic hip arthropathy associated with long-term hemodialysis is a devastating problems affecting patients' quality of life. In our previous study, we proposed a classification system for radiological abnormalities seen in hemodialysis-related hip lesions. The purpose of the study was to propose the surgical strategy for hip disorders caused by long-term hemodialysis.Methods
Patients with a history of hemodialysis for more than 10 years, 191 hip lesions in 165 consecutive patients who visited our institute due to hip symptoms. Various abnormalities were identified in 116 out of 191 hips. A retrospective assessment of the patient record and radiographs was performed for the included subjects examining the natural course of the disease process as well as the results of surgical treatment.Results
Seventy-six hip lesions (69.0%) were conservatively managed at the time of the initial visit. Surgeries were performed for 75 hips (64.7%) during the study period. Among those, surgical treatment was indicated for 40 hips at the time of the initial visit. On the other hand, surgeries were performed for 35 hips during the subsequent follow-up period due to progression of the disease process.Conclusions
Based on the analysis of our surgical experiences by the retrospective chart review, we have established a flowchart of the treatment strategy for chronic hip arthropathy in long-term hemodialysis patients.Study design
This study is retrospective clinical study. 相似文献12.
Dongmin Xu Hiroshi Koyama Hiroki Furuhashi Shoichi Nishikino Hironobu Hoshino Yukihiro Matsuyama 《Journal of orthopaedic science》2017,22(6):1102-1106
Background
In total hip arthroplasty (THA) surgery, hip muscle preservation is important in strengthening the stability of the hip and improving the activities of the patient. However, whether the type of femoral stem affects the recovery of the hip muscles remains unknown. The aim of this study was to compare the postoperative hip muscle recovery among femoral stem varieties after THA.Methods
The computed tomography (CT) images of 44 patients (44 hips) who underwent THA using an anterolateral approach were reviewed. Twenty-two patients received a fit-and-fill (FF) stem and 22 received the tapered-wedge (TW) stem. The volumes of the gluteus maximus (GMA), gluteus medius (GME), and obturator internus (OI) were measured on three-dimensional models reconstructed using preoperative and 6-month postoperative CT images. Relationships between muscle volume changes and factors including the femoral stem length were evaluated.Results
The GMA and GME volumes increased postoperatively by 8.2% and 8.3%, respectively, in the FF stem group and 7% and 6%, respectively, in the TW stem group, with no group differences. In contrast, the OI volume decreased postoperatively by 17.8% in the FF group and was preserved in TW group (p < 0.001). Moreover, OI volume was decreased in 19 patients (86%) in the FF group and in 11 patients (50%) in the TW group (p = 0.01). The normalized stem length was significantly associated with the postoperative change in OI volume (r = ?0.45, p = 0.002).Conclusions
The TW stem showed a significant advantage over the FF stem in terms of OI preservation. Surgeons should pay close attention during surgery to avoid OI injury when using different femoral stem types. We suggest that a short and reduced lateral shoulder femoral stem is a better choice for the preservation of external rotation muscles. 相似文献13.
Ryosuke Yamaguchi Takuaki Yamamoto Goro Motomura Satoshi Ikemura Kenyu Iwasaki Garida Zhao Yukihide Iwamoto 《Journal of orthopaedic science》2017,22(4):687-692
Background
Although several morphological abnormalities or variances of the hip joint have been proposed to be associated with hip joint degeneration, few studies have investigated any radiological features in patients with transient osteoporosis of the hip (TOH). The purpose of this study is to evaluate the morphological variances of the hip joint in TOH patients radiographically.Methods
The TOH group consisted of 31 hips in 31 patients. Age- and gender-matched asymptomatic hips in patients with unilateral osteonecrosis of the femoral head were served as controls. Radiographs and MRI were utilized to examine the following parameters: acetabular dysplasia, acetabular overcoverage, acetabular retroversion, and asphericity of the femoral head–neck junction. Also, localization of the main bone marrow edema (BME) lesion was investigated.Results
TOH patients had a significantly higher incidence of acetabular retroversion (52% with a positive cross-over sign and 29% with posterior wall deficiency) than the controls (13%, P = 0.0023; 6%, P = 0.043, respectively), which was also confirmed by smaller acetabular anteversion angles on axial MRI. In addition, TOH patients tended to show asphericity of the anterior femoral head–neck junction compared to controls (39% vs. 13%, P = 0.040). In 90% of the TOH patients, the main BME lesion was located in the subchondral area of the superior portion of the femoral head, and 77% of the lesion were recognized as a band-like pattern in MRI.Conclusions
Acetabular retroversion and asphericity of the femoral head–neck junction were more commonly observed in TOH patients compared to controls. The main BME lesion was most frequently located in the superior portion of the femoral head. 相似文献14.
Siddharth M. Shah William L. Walter Stephen M. Tai Michelle F. Lorimer Richard N. de Steiger 《The Journal of arthroplasty》2017,32(9):2852-2856
Background
Dislocation is a leading cause of revision after primary total hip arthroplasty (THA). Although more common in the first few years after the procedure, dislocation can occur at any time. This study investigated the difference in late dislocation in ceramic-on-ceramic (CoC) bearings compared with metal-on-polyethylene and ceramic-on-polyethylene bearings in THA.Methods
Data were used from the Australian Orthopaedic Association National Joint Replacement Registry, and the cumulative percent revision for dislocation was estimated using the Kaplan-Meier method for the different bearing surfaces. There were 192,275 THAs included in the study with 101,915 metal-on–cross-linked polyethylene (MoXLPE), 30,256 ceramic-on–cross-linked polyethylene (CoXLPE), and 60,104 CoC.Results
The cumulative percent revision for dislocation at 13 years for MoXLPE, CoXLPE, and CoC groups was 1.2 (95% confidence interval [CI], 1.1-1.3), 1.0 (95% CI, 0.7-1.4), and 0.9 (95% CI, 0.8-1.1), respectively. There was an increased risk of revision for dislocation for MoXLPE compared with CoXLPE and CoC. When stratified for head size, there was no difference in the risk of revision for dislocation between MoXLPE, CoXLPE, and CoC in the 28- and 32-mm head sizes. With a head size of 36 mm, MoXLPE had a higher rate of dislocation compared with other materials.Conclusion
Bearing surface has little impact on revision for dislocation. 相似文献15.
Tetsuro Ishimatsu Masatoshi Naito Koichi Kinoshita Satohiro Ishii Takuaki Yamamoto 《Journal of orthopaedic science》2017,22(3):531-535
Background
Curved periacetabular osteotomy (CPO) is one of the joint preserving procedures for developmental dysplasia of the hip. CPO requires osteotomy of the medial wall of the acetabulum, which may cause narrowing of the bony birth canal and this step may result in increased risk of cesarean delivery. We analyzed the narrowest part of the bony birth canal using three-dimensional computed tomography (3D-CT) before and after bilateral CPO.Methods
Between February 2007 and March 2014, there were 29 cases of bilateral CPO in which both pre- and post-operative 3D-CT were available. Transverse diameters of the pelvic inlet, contraction, outlet, expansion, and teardrop were analyzed. Among them, the narrowest part of the bony birth canal was investigated, which being smaller than the normal lower threshold value for vaginal delivery (95 mm) was considered as a risk for cesarean delivery.Results
The transverse diameters of both pelvic expansion and teardrop significantly decreased after CPO (both p < 0.01), while other diameters showed no significant changes. Among these two diameters, the narrowest diameter of the bony birth canal was the pelvic teardrop in all 29 cases. That in 24 patients (82.8%) was greater than 95 mm, while that in five patients (17.2%) showed less than 95 mm.Conclusions
Based on 3D-CT analysis, the narrowest part of the bony birth canal after bilateral CPO was the pelvic teardrop. In this study, 82.8% of the patients showed pelvic teardrop diameter greater than 95 mm, while that of the other patients (17.2%) were less than 95 mm. 相似文献16.
Young-Kyun Lee Jung Taek Kim Ki-Choul Kim Yong-Chan Ha Kyung-Hoi Koo 《The Journal of arthroplasty》2017,32(11):3529-3532
Background
Surgical treatment has been invariably indicated for Vancouver type B periprosthetic femoral fractures (PFFs), which involve femoral diaphysis around stem. We evaluated the outcomes of nonoperative management in patients with minimally displaced type B PFFs around cementless stem.Methods
From October 2009 to March 2016, 60 type B PFFs were treated at 1 institution. Among them, 19 minimally (<5 mm) displaced PFFs (31.7%, 19/60), which occurred around cementless stems, were treated nonsurgically with use of teriparatide. There were 6 men and 13 women. The mean age was 77.9 years (range, 51-98 years) at the time of PFF. The femoral stem was stable (type B1) in 11 patients and unstable (type B2) in 8. Teriparatide was injected from 1 to 4 months (mean, 3.2 months). We evaluated time to radiologic union and union rate.Results
A successful union was obtained in 16 patients (89.5%, 17/19) at 2 to 6 months (mean, 3.5 months). The union rate was 100% (11/11) in type B1 fractures and 75% (6/8) in type B2 fractures.Conclusion
Our study showed that conservative treatment is feasible for the cases of type B1 minimally displaced periprosthetic fractures, and it may also be considered as an alternative option for type B2 minimally displaced periprosthetic fractures. 相似文献17.
Andrew D. Stewart Hesham Abdelbary Paul E. Beaulé 《The Journal of arthroplasty》2017,32(9):2864-2868.e1
Background
Greater trochanteric fracture/nonunion can be a devastating complication with significant functional impact after total hip arthroplasty, and their fixation remains a challenge because of the significant forces being transmitted as well as the poor bone quality often associated with these fractures. The objective of this study is to investigate the rates of reoperation and trochanteric nonunion using a third-generation cable-plate system at one center.Methods
Thirty-five patients, mean age 72.9 years (range 46-98 years) with 24 women and 11 men, underwent fixation of their fractured greater trochanter using a third-generation cable-plate system. The indications were: periprosthetic fracture (n = 17), complex primary arthroplasty (n = 5), and complex revision arthroplasty (n = 13). Primary outcomes included rates of reoperation and radiographic union.Results
At a mean follow-up of 2.5 years, trochanteric union rate was 62.9% with nonunion rate of 31.4%, and fibrous union in 5.7%. In regard to quality of initial apposition, only 40% achieved a perfect bone on bone reduction. Ten patients (28.6%) had evidence of wire breakage. Five patients (14.3%) required reoperation and removal of the internal fixation because of lateral hip pain.Conclusion
Fixation of the trochanteric fractures remains a challenge with a relatively high reoperation rate. Poor bone quality and capacity to maintain a stable reduction continue to make this complication after total hip arthroplasty a difficult problem to solve. 相似文献18.
Yusuke Osawa Taisuke Seki Daigo Morita Yasuhiko Takegami Toshiaki Okura Naoki Ishiguro 《The Journal of arthroplasty》2017,32(10):3088-3092
Background
The objective of the present study was to investigate clinical, quality of life, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) after transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).Methods
We performed a case-control study. The participants were 29 patients (34 hips) who underwent THA after TRO (TRO group). These patients had a mean age at surgery of 51.6 years (range, 30-72 years) and underwent postoperative follow-up for a mean period of 10.5 years (range, 3-19 years). For the control group (primary group), we included 58 patients (68 hips) who underwent primary THA for ONFH, matching for age and gender.Results
The Harris Hip Scores at the last follow-up were significantly poorer in the TRO group than in the primary group. Similarly, preoperative and postoperative hip range of motion was significantly poorer in the TRO group than in the primary group. Quality of life (Short Form-36, Oxford Hip Score, and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) and complication rates were not significantly different between the groups. The survival rates at 10 years, with revision for any reason as the endpoint, were 81% in the TRO group and 91% in the primary group, showing no significant difference between the groups. The TRO group had a larger average postoperative leg length discrepancy and a higher rate of stem malalignment than the primary group.Conclusion
The clinical outcomes of THA after TRO for ONFH were poorer than those of primary THA. 相似文献19.
Donghai Li Xiaowei Xie Pengde Kang Bin Shen Fuxing Pei Changde Wang 《Journal of orthopaedic science》2017,22(6):1060-1065
Background
The purpose of this study was to evaluate the clinical results, survivorship and quick rehabilitation effects of modified surgery of percutaneously drilling and decompression through femoral head and neck fenestration combined with compacted autograft for early femoral head necrosis.Methods
We conducted a retrospective cohort study with 83 hips performed percutaneous decompression through femoral head and neck fenestration (Modified group) combined with autogenous bone grafting for early ONFH. For comparison, another 90 hips treated with conventional core decompression with bone grafting (Control group).Results
Median follow-up was 36 months (32–44 months). The length of incision, blood loss in operation, incision drainage, operation time and hospital stays in Modified group had better results than those in control group (P < 0.001). There were four cases in Modified group and five cases in control group had complications (P = 0.9). The VAS score and range of hip motion were better in Modified group during hospital stays summarily (P < 0.05). The average Harris score in modified group was higher than the control group at the first month (P = 0.005), while at other time of follow-up the two groups were with similar Harris scores (P > 0.05). There were 22 hips progressed to stage III in Modified group, while 23 hips progressed to stage III in control group (P = 0.89). The clinical success rate in Modified group were 86.7%, compared with that in control group (87.8%) ( P= 0.84).Conclusion
Percutaneous drilling and decompression through femoral head and neck fenestration combined with compacted autograft we reported showed an good surgical effect with a quick rehabilitation and had similar short-term effects compared with the conventional core decompression in treatment of early ONFH. 相似文献20.
Haonan Liu Liang He Guilin Zhang Xiaofeng Gong Ning Li 《Journal of orthopaedic science》2017,22(1):75-80