Acetabular Placement Accuracy With the Direct Anterior Approach Freehand Technique

Background

Acetabular cup placement in total hip arthroplasty (THA) has been recognized as an important factor in operative success, and accurate cup placement has been the impetus for novel medical technologies.

Acetabular Total Hip Arthroplasty Revision: A Summary of Operative Factors,Outcomes, and Comparison of Approaches

BackgroundRevision total hip arthroplasty (THA) presents a greater risk to patients than primary THA, and surgical approach may impact outcomes. This study aimed to summarize acetabular revisions at our institution and to compare outcomes between direct anterior and posterior revision THA.MethodsA series of 379 acetabular revision THAs performed from January 2010 through August 2022 was retrospectively reviewed. Preoperative, perioperative, and postoperative factors were summarized for all revisions and compared between direct anterior and posterior revision THA.ResultsThe average time to acetabular revision THA was 10 years (range, 0.04 to 44.1), with mechanical failure (36.7%) and metallosis (25.6%) being the most prevalent reasons for revision. No differences in age, body mass index, or sex were noted between groups. Anterior revision patients had a significantly shorter length of stay (2.2 versus 3.2 days, P = .003) and rate of discharge to a skilled nursing facility (7.5 versus 25.2%, P = .008). In the 90-day postoperative period, 9.2% of patients returned to the emergency department (n = 35) and twelve patients (3.2%) experienced a dislocation. There were 13.2% (n = 50) of patients having a rerevision during the follow-up period with a significant difference between anterior and posterior approaches (3.8 versus 14.7%, respectively, P = .049).ConclusionThis study provides some evidence that the anterior approach may be protective against skilled nursing facility discharge and rerevision and contributes to decreased lengths of stay. We recommend surgeons select the surgical approach for revision THA based on clinical preferences and patient factors.     

联体解剖型钛板在髋臼后壁粉碎性骨折中的应用

目的探讨联体解剖型钛板内固定治疗髋臼后壁粉碎性骨折的临床疗效。方法自2013-05—2014-09采用联体解剖型钛板内固定治疗21例髋臼后壁粉碎性骨折(联体解剖板组),与自2010-01—2013-04采用重建钢板治疗的32例髋臼后壁粉碎性骨折的临床资料(重建板组)进行比较。结果联体解剖板组均获平均9.8(6~12)个月随访,本组手术时间(60±12.5)min,术中出血量(150±37.5)ml。末次随访髋关节功能按改良Merle d'Aubingne-Postel评分优良率85.7%。重建板组均获平均11.4(8~17)个月随访,本组手术时间(103±25.5)min,出血量(260±95.5)ml,髋关节功能按改良Merle d'Aubingne-Postel评分优良率84.4%。联体解剖板组手术时间(t=2.970,P0.05)、术中出血量(t=5.847,P0.05)均少于重建板,差异有统计学意义。2组治疗效果的优良率比较差异无统计学意义(P0.05)。结论采用联体解剖板固定治疗髋臼后壁粉碎性骨折能够获得与重建板相同的临床效果,且其手术时间、术中出血量较少,手术操作难度较低。     

经皮逆行拉力螺钉固定髋臼后柱骨折的有限元对比研究

目的：通过有限元法,对经坐骨结节和坐骨小切迹两种不同逆行拉力螺钉内固定方案的生物学稳定性进行比较,为临床应用提供理论依据。方法利用三维有限元软件,建立经坐骨结节（A组）和坐骨小切迹（B组）两种不同逆行拉力螺钉固定髋臼后柱骨折的有限元模型,模拟双足站立位和坐位,分别对其进行力学稳定性比较。结果对比站立位和坐位下两种内固定方案髋臼关节面骨折线节点位移均数及拉力螺钉最大应力,站立位位移均数A组＜B组（ P＝0．932＞0．05）,差值无明显统计学意义;坐位位移均数A组＞B组（P＝0．004＜0．05）,差值具有统计学意义。在坐位时拉力螺钉取得最大应力36．053Mpa。结论两种逆行拉力螺钉方案均可为髋臼后柱骨折提供坚强内固定,经坐骨小切迹置入后柱逆行拉力螺钉表现出更好的坐位生物力学稳定性。     

Metal-on-metal hip resurfacing: the effect of cup position and component size on range of motion to impingement

The aim of this dry bone study was to determine the range of hip motion to impingement for different hip resurfacing cup positions and component sizes. The maximum angles of hip flexion, extension, abduction, and adduction were calculated from 3-dimensional coordinates for: 1. Cup inclination of 30 degrees , 40 degrees , 50 degrees , 60 degrees , and 70 degrees with fixed anteversion; 2. Cup anteversion of 0 degrees , 10 degrees , 25 degrees , 35 degrees , and 45 degrees with fixed inclination; and 3. 3 different component sizes on the same size dry bones. An acetabular component inclination of 50 degrees and an anteversion of 25 degrees allowed the most physiologic range of hip motion. A larger-diameter femoral component relative to the native femoral neck diameter resulted in a greater range of hip motion to impingement.     

Acetabular component revision using a porous tantalum biomaterial: a case series

Biologic ingrowth can be difficult to achieve in acetabular component revision, especially in cases with significant bone loss. The purpose of this study was to review our clinical results of acetabular component revisions in patients with significant bone loss using a porous tantalum biomaterial. This is a retrospective review of 25 patients. There were 16 females and 9 males with a mean age of 71.7 ± 10.54 years. The mean follow up was 39 ± 11.09 months (range, 28-55 months). All patients in this series had combined segmental and cavitary bone loss, Paprosky type 2 or type 3. Of 22 patients in this series, 21 had a well-fixed and functioning implant at latest follow up. All 21 patients developed ingrowth along the tantalum surface despite compromised host bone. There were no cases of dislocation or aseptic loosening. Porous tantalum appears to be a promising material for use in revision hip arthroplasty to facilitate biologic ingrowth in patients with acetabular bone loss.     

不稳定骨盆骨折合并髋臼骨折的手术治疗

目的探讨手术治疗不稳定骨盆骨折合并髋臼骨折的临床疗效。方法对15例不稳定骨盆骨折合并髋臼骨折患者进行手术复位内固定,术后早期功能锻炼。结果患者均获随访,时间12～38个月。术中无血管神经损伤发生,无切口感染、内固定松动及断裂、骨不愈合、明显双下肢不等长。髋臼骨折复位效果按MattaX线评估标准：优8例,良5例,一般2例。功能恢复根据Majeed评分标准：优5例,良8例,可2例。结论手术治疗不稳定骨盆骨折合并髋臼骨折可获得满意的临床疗效。     

Evaluation of stair motion contributes to new insights into hip osteoarthritis‐related motion pathomechanics

Stair motion in the presence of hip osteoarthritis (OA) has received less attention than level walking. Its more strenuous aspect may shed the light on different locomotor strategies when compared to walking. We, therefore, aimed to define stair motion features associated to hip OA and to evaluate whether these specific features would differ from level walking and better characterize the hip pathological condition. Principal component and linear discriminant analyses were, respectively, used as data reduction and classification techniques. Our study highlighted that most of stair motion features associated to hip OA were similar to the ones of walking. Stair descent presented with the lowest misclassification error rate, ranging from 12% to 19% (estimated by cross‐validation). But, features that may be considered as a mechanism to reduce demand on the hip abductors were found to be more important in the stair ascent condition. This was reflected by both, greater importance in the classification rule and variance compared with walking, that is, decreased hip internal rotation moment at mid‐stance (72.50% vs. 57.63%) and increased trunk lateroflexion toward affected side (56.43% vs. 29.37%). This study emphasized the importance of investigating stair motion in hip osteoarthritic population by highlighting specific locomotor strategies. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:187–196, 2016.     

Second-generation cementless total hip arthroplasty in patients with osteonecrosis of the femoral head

The results of cementless total hip arthroplasties in patients with osteonecrosis have been inferior to those in patients with other diagnoses. Fifty-eight primary total hip arthroplasties with insertion of a femoral stem with a circumferentially proximal porous coating and a cementless acetabular component were followed for a mean of 11.1 years. Fifty-seven (98%) of 58 stems were biologically stable, and one stem was loose. There were acetabular revisions in 18 hips (31%) because of polyethylene wear and osteolysis. One hip (1.7%) underwent revision of both acetabular and femoral components. Osteolysis around the acetabular component was seen on radiographs in 22 hips (37.9%). Femoral osteolysis was seen in 9 hips (15.5%), and there was no osteolysis below the lesser trochanter in any hip. Second-generation femoral prostheses provide excellent fixation in patients with osteonecrosis of the femoral head. However, a high rate of polyethylene wear and osteolysis in these high-risk patients remains a challenging problem.     

髋臼横形伴后壁骨折的诊断和治疗

目的探讨髋臼横形伴后壁骨折的诊断方法和治疗效果.方法15例髋臼横形伴后壁骨折,通过X线平片、CT平扫及重建图像确诊,均手术治疗,其中改良Kocher-Langenbeck(K-L)入路10例、前后联合入路5例,均采用钢板和拉力螺钉固定.结果随访1～4年(平均2年),关节功能按改良d'Aubigne和Postel功能评定标准,解剖复位者12例中关节功能优良10例、可2例;复位欠佳2例中关节功能良1例、可1例;不满意复位1例关节功能差.结论髋臼横形伴后壁骨折一般采用手术治疗,手术入路为改良K-L入路或前后联合入路,骨折固定方法应满足解剖复位、坚强固定和安全的要求.