Modular Femoral Stems for Revision Total Hip Arthroplasty

Background  

Modular femoral stems are one option for revision THA surgeons and allow offset restoration, leg length discrepancy correction, and stability independent of distal stem fixation. The complexity of revision THA usually leads surgeons to use multiple revision hip designs to address these issues.     

The Utilization of Metal Augments Allows Better Biomechanical Reconstruction of the Hip in Revision Total Hip Arthroplasty With Severe Acetabular Defects: A Comparative Study

Background

Reconstructing the normal hip biomechanics is important for a successful revision total hip arthroplasty (THA). Little is known about whether using metal augments in revision THA is biomechanically superior to traditional techniques.

A Comparison of Two Implant Systems in Restoration of Hip Geometry in Arthroplasty

Background  

Restoration of hip offset and leg length during THA is often limited by available implant geometries. The recent introduction of femoral components with a modular junction at the base of the neck (two modular junction components) has expanded the options to restore femoral offset and leg length.     

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Background  

Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon.     

Total Hip Arthroplasty or Arthroscopy for Pigmented Villonodular Synovitis of the Hip: A Retrospective Study with 3-Year Follow-Up at Minimum

Objective

Pigment Villonodular synovitis of the hip, a rare pain proliferation of the synovium, was treated successfully with total hip arthroplasty and arthroscopy. Most recent results come from small case series with no study comparing arthroscopy and arthroplasty. In this study, we aimed to show and compare the clinical outcomes of arthroscopy and total hip arthroplasty (THA) in pigment Villonodular synovitis of the hip.

Methods

This was a retrospective clinical trial with data from patients with pigment Villonodular synovitis of the hip between 2010 and 2019. The study included 17 patients in the THA group, and 20 patients in the arthroscopy group. The clinical outcomes were evaluated at 3, 6, and 12 months, at 1 and 2 years, and every 5 years afterward. The clinical efficacy was measured using the Harris hip scores (HHSs) and visual analogue scale (VAS) score.

Results

The mean HHS improved from 45.24 ± 10.36 to 78.94 ± 19.11 in the THA group (t = −6.394, P = 0.000) and 45.30 ± 11.08 to 71.60 ± 19.78 (t = −5.187, P = 0.000) in the arthroscopy group from pre-operation to the final follow-up. There is no significant difference between the two groups (t = 1.051, P = 0.301). The mean VAS improved from 3.65 ± 0.79 to 0.35 ± 0.70 (t = 12.890, P = 0.000) in the THA group and 4.05 ± 0.94 to 1.35 ± 1.79 (t = 5.979, P = 0.001) in the arthroscopy group postoperatively. There is no significant difference between the two groups (t = 1.329, P = 0.193). Recurrence of PVNS was diagnosed in four patients (20%) of the arthroscopy group and they underwent THA after arthroscopy, and the mean interval was 44.25 ± 6.98 months. All patients reached level 5 muscle strength by the final follow-up. All the patients' buckling ranges were over 105 degrees. Their internal and external hip rotation was over 15 degrees. Their hip adduction was over 20 degrees, and abduction over 30 degrees.

Conclusion

Both THA and arthroscopy in the setting of PVNS can improve patients' function and lead to a low rate of local recurrence. By selecting patients well for each approach, one can expect a reasonable result.     

Minimum 10-Year Outcome of One-Stage Total Hip Arthroplasty Without Subtrochanteric Osteotomy Using a Cementless Custom Stem for Crowe III and IV Hip Dislocation

Background

Options for total hip arthroplasty (THA) in high dislocated hips include subtrochanteric osteotomy (STO), high hip center positioning, and 2-stage surgery with progressive lowering using an external fixator before THA. We described the long-term results of 1-stage THA performed without STO, using a cementless customized stem associated if necessary with sequential tenotomies and/or greater trochanteric osteotomy.

Squeaking in Metal-on-Metal Hip Resurfacing Arthroplasties

Background  

While most reports of audible squeaking in total hip arthroplasty (THA) have focused on ceramic bearings, squeaking can occur in metal-on-metal bearings and may be an important clinical complication to consider during patient followup.     

An Articulating Antibiotic Spacer Controls Infection and Improves Pain and Function in a Degenerative Septic Hip

Background  

Treating septic arthritis of the hip with coexisting advanced degenerative disease is challenging. The use of primary total hip arthroplasty (THA) has led to postoperative infection rates as high as 22%. Insertion of antibiotic spacers with subsequent reimplantation of a THA controls infection and improves pain and function in patients with periprosthetic infections.     

Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips

Background  

Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) can be technically challenging. Restoring the anatomic center of hip rotation may require femoral osteotomy. Techniques using cementless components are widely reported but less is known about using cemented components that may be more appropriate with osteopenic bone.     

Aspirin Decreases Heterotopic Ossification After Hip Resurfacing

Background  

Heterotopic ossification (HO) is a concern for patients undergoing hip surgery, especially surface replacement arthroplasty (SRA) who tend to be younger, more active, and anticipate good motion. It is unclear, however, whether HO occurs more frequently after SRA than traditional total hip arthroplasty (THA) and whether aspirin influences the risk.     

Surface Replacement of the Hip Can Result in Decreased Acetabular Bone Stock

Background  

The recent interest in hip resurfacing arthroplasty is motivated by its potential advantages over THA. One advantage of hip resurfacing arthroplasty is that it conserves bone on the femoral side; however, it is unclear whether it does so on the acetabular side.     

Factors That Predict Short-term Complication Rates After Total Hip Arthroplasty

Background  

There remains uncertainty regarding the relative importance of patient factors such as comorbidity and provider factors such as hospital volume in predicting complication rates after total hip arthroplasty (THA).     

Hip Arthroscopy in the Setting of Hip Osteoarthritis: Systematic Review of Outcomes and Progression to Hip Arthroplasty

Background

Hip arthroscopy is now commonly used to treat hip pain and pathology, including osteoarthritis (OA). Despite this, little is known about the effect of hip arthroscopy on outcomes of pain and function and progression to total hip arthroplasty (THA) in hip OA.

Questions/purposes

This systematic review aimed to (1) determine pain and function outcomes after hip arthroscopy in people with hip OA; (2) compare the outcome after hip arthroscopy between people with and without hip OA; and (3) report the likelihood of progression to THA in patients with hip OA after hip arthroscopy.

Methods

This review was conducted in accordance with the PRISMA statement. The Downs and Black checklist was used for quality appraisal. Studies scoring positively on at least 50% of items were included in final analyses. Standardized mean differences (SMDs) were calculated where possible or study conclusions are presented.

Results

Twenty-two studies were included in the final analyses. Methodological quality and followup time varied widely. Moderate to large SMDs were reported for people with and without hip OA; however, the positive effects of the intervention were smaller for people with hip OA. Greater severity of hip OA and older age each predicted more rapid progression to THA.

Conclusions

Patients with hip OA report positive outcomes from hip arthroscopy, although observed positive effects may be inflated as a result of methodological limitations of the included studies. Patients with hip OA had inferior results compared with those who did not. Chondropathy severity and patient age were associated with a higher risk and more rapid progression to THA. High-quality comparative studies are required to confirm the effects of hip arthroscopy on symptoms and structural change in people with hip OA.

Electronic supplementary material

The online version of this article (doi:10.1007/s11999-014-3943-9) contains supplementary material, which is available to authorized users.     

Midterm Results of Total Hip Arthroplasty in Patients With High Hip Dislocation After Suppurative Hip Arthritis

Background

Total hip arthroplasty (THA) is technically challenging in patients with high dislocation of the hip secondary to suppurative arthritis. The technical difficulty is attributable to the complex hip anatomy and the potential risk of recurrent infection in these patients. This study investigated the midterm results of THA in patients with Crowe type III and IV high dislocation of the hip secondary to suppurative arthritis.

Retrospective Analysis of Infection Rate After Early Reoperation in Total Hip Arthroplasty

Background  

Infection is a devastating complication of total hip arthroplasty (THA). Unavoidable reoperation during the acute recovery phase of hip arthroplasty has the potential for an increased infection rate but the risk is not well established nor is the fate of these infected hips.     

Are leg length and hip offset comparable after hip resurfacing and cementless total hip arthroplasty?

INTRODUCTION

The purpose of this study was to determine if hip resurfacing arthroplasty (HRA) and cementless total hip arthroplasty (THA) were comparable in correcting leg length and hip offset in patients with primary osteoarthritis.

METHODS

A retrospective analysis was performed of 80 patients who underwent either HRA or cementless THA for primary osteoarthritis (40 in each group) between 2006 and 2008. Standardised anteroposterior radiographs taken pre-operatively and at one year following surgery were used to calculate the total offset and leg length in both hips.

RESULTS

At one year following surgery, no leg length discrepancy was identified in either group. A difference of 0.39cm (p=0.046) remained between the mean total offset of the operated hip and the contralateral non-operated hip in the HRA group. No difference in offset was observed between the two hips after surgery in the THA group (p=0.875).

CONCLUSIONS

Leg length is restored by HRA and THA. A difference remains in offset after HRA although we attribute this to intentional medialisation of the acetabular cup.     

Additive Influence of Hip Offset and Leg Length Reconstruction on Postoperative Improvement in Clinical Outcome After Total Hip Arthroplasty

Background

There is a lack of prospective studies investigating the additive effect of both acetabular and femoral reconstruction parameters on the functional outcome following total hip arthroplasty (THA).

Higher Prevalence of Mixed or Solid Pseudotumors in Metal-on-Polyethylene Total Hip Arthroplasty Compared With Metal-on-Metal Total Hip Arthroplasty and Resurfacing Hip Arthroplasty

Background

Pseudotumors are a common finding in metal-on-metal (MoM) total hip arthroplasty (THA) and resurfacing hip arthroplasty (RHA). However, information on pseudotumors in metal-on-polyethylene (MoP) THA is limited.

Back Pain and Total Hip Arthroplasty: A Prospective Natural History Study

Background  

Many patients with degenerative joint disease of the hip have substantial degeneration of the lumbar spine. These patients may have back and lower extremity pain develop after THA and it may be difficult to determine whether the source of the pain is the hip or spine.     

Patient Perceived Outcomes After Primary Hip Arthroplasty: Does Gender Matter?

Background  

Total hip arthroplasty (THA) provides high functional scores and long-term survivorship. However, differences in function and disability between men and women before and after arthroplasty are not well understood.