Adult Hip Reconstruction Research Articles

Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants.

(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015-1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020-31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients' management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic.

Geometrical Analysis of the Proximal Femur and the Clinical Application in Total Hip Replacement: A Study of the Igbo Population of South East Nigeria.

Adult hip reconstruction following trauma and hip pathologies depends on a sound knowledge of the proximal femoral geometry (PFG), which varies from one ethnic population to another. The aim of the study, therefore, was to evaluate parameters of the proximal femoral geometry in Igbos of South Eastern Nigeria. A 5-year review of normal X-rays of the pelvis showing both hips of patients' age 18-64 between 1 January 2012 to 31 December 2016 at Radiology Department of University of Nigeria Teaching Hospital Enugu was done. There were 554 patients, 273 (49.3%) males and 281 (50.7%) females. The values of the head width established in this study showed there was a mean difference between the right and left proximal femurs, which was statistically significant (P < 0.05). There was statistical significant difference (P < 0.05) between the means of the parameters of the proximal femoral geometry when compared between gender, the only exception being the left medial cortical thicknes, which did not show any difference (P > 0.05). A comparison of means of PFG parameters of the Igbos and that of the Turkish population showed that there was statistically significant difference on both sides. Our study demonstrated that there was no difference in the means of both sides of femoral neck width and the intertrochanteric width of the left side. The correlations between PFG parameters showed that there was strong positive correlation that was significant apart from the right acetabular angle that did not correlate with other parameters.

Friday, September 28, 2018 8:00 AM–9:00 AM interdisciplinary spine forum: abstract presentations: 143. Categorizing the Hip-Spine Syndrome: a step toward a collaborative multidisciplinary classification

BACKGROUND CONTEXT Recently, there has been increased recognition of the interplay between degenerative conditions of the hip and spine (Hip-Spine Syndrome, HiSS). Loss of lumbar lordosis (LL) of more than 10° in proportion to the pelvic incidence (PI), PI-LL mismatch, has been emphasized as a marker of sagittal spinal malalignment. The impact of positive spinal sagittal malalignment on increased hip extension (pelvic posterior tilt in spinal literature) and subsequently the acetabular version is established. Communication between adult hip reconstruction and spinal deformity surgeons regarding HiSS is ineffective without common language, an established definition, or mutual radiographic imaging protocols. PURPOSE This study aimed to characterize various presentations of HiSS and suggest a simple method to distinguish between them. STUDY DESIGN/SETTING Retrospective review of a prospectively collected adult spinal deformity database. PATIENT SAMPLE A total of 1,389 patients who presented to a single center with orthopaedic complaints between 2013 and 2016. OUTCOME MEASURES Demographics, parameters related to spinopelvic alignment (PI, PT, LL, PI-LL), global spinal alignment (TPA, SVA, GSA), and lower extremities (SFA, KF, pelvic shift) from full-body sagittal radiographic imaging, and Kellgren–Lawrence grade. METHODS Demographic information was collected and full-body (FB) sagittal radiographs were analyzed using dedicated software to measure spinopelvic, global sagittal spinal alignment, lower extremity, and FB sagittal radiographic parameters. FB coronal radiographs were analyzed by two reviewers to assess hip osteoarthritis (HOA) via Kellgren–Lawrence grade. Patients were grouped based on their sagittal spinal alignment (PI-LL mismatch) and HOA into: HiSS None (PI LL 10°, HOA Grade 0; n=297), or HiSS Hip-Spine (PI-LL>10°, HOA Grades 3–4; n=30). All radiographic parameters were compared between the groups. P-values were Bonferroni method-adjusted. Significance level was set at p RESULTS A total of 1,389 patients were included with a mean age of 62.5±11.1 years and mean BMI of 27.6±5.7kg/m2. A total of 62% of the study population was female. HiSS Hip-Spine (n=30) had significantly greater pelvic posterior tilt (sagittal retroversion) in comparison to HiSS Hip (n=78) and HiSS None Types (n=444) (25.2° vs. 11.3° and 16.5°, respectively; p .05). CONCLUSIONS This study proposes a novel HiSS categorization system based on established spinal deformity and HOA classification methods. Radiographically, HiSS Hip-Spine Type patients can be distinguished by Adult Reconstructive Surgeons by measuring pelvic tilt angle. Increased PT>25° in HOA patients is a marker for sagittal spinal deformity that has the potential to impact acetabular version.

Lessons learned from study of congenital hip disease in adults

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term “congenital hip disease” and its classification as dysplasia, low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease, which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD, especially those with low and high dislocation, are: Wide exposure, restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

AAOS Annual Meeting Roundup

The Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) continues to be one of the largest meetings focused on the practice and science of orthopaedic and trauma surgery. It is characterised by a robust international attendance, with an academic program delivered by true leaders and innovators in the field. This year, the AAOS Annual Meeting was held from March 11 to 15 in New Orleans, Louisiana. The educational program offered a combination of a large collection of instructional course lectures, symposia, and scientific exhibits representing a wide range of orthopaedic subspecialties. This year, the Central Program Committee received a record number of original scientific abstracts and from a field of 5,646 abstracts submitted, a total of 825 abstracts were selected for podium presentations, and 569 abstracts were selected for poster presentations. Each subspecialty committee determined the best papers and posters presented in their respective subspecialty sections. These papers and posters were presented in a symposium moderated by Steven Frick, MD a-nd William Mihalko, MD, entitled “Best of the AAOS.” This session really represents a cross section of the finest orthopaedic research from the past year and each of these representative papers and posters deserves discussion. Five papers were selected from the program in adult hip reconstruction covering topics as varied as quality improvement programmes to bearing surfaces. An innovative use of the database of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was used by Meddenick et al to identify risk factors for readmission following primary total hip replacement (THR).1 During the study period 9441 THR procedures were performed, and 345 unplanned re-admissions occurred giving an overall readmission rate of 3.65%. A number of independent predictive risk factors for re-admission were identified, including: low serum albumin, chronic steroid use, increased number of medical comorbidities, …

Failure of bulk bone grafts after total hip arthroplasty for hip dysplasia.

Bulk bone grafts are used in total hip arthroplasty (THA) when adequate acetabular cup coverage cannot be achieved. Data from literature show mainly good short-term and mid-term results with contradictory long-term results. The aim of this study was to investigate acetabular cup stability and graft integrity after dysplastic adult hip reconstruction with total hip endoprosthesis and bulk bone graft for acetabular deficiency. Seventy-two hips in 64 patients that underwent THA with bone autograft or allograft were assessed immediately after operation, 6 months and 1, 2, 3 and 10 years after operation. Acetabular angle, acetabular cup coverage, bone graft width, and bone graft height were measured and questionnaire was designed to determine acetabular cup stability and grade graft integrity. Four investigators graded grafts and inter-rater and intra-rater reliability of the questionnaire was tested. All measured parameters in all patients and in patients with autograft and those with allograft separately showed significant changes consistent with graft failure and acetabular cup instability when level of significance was set at p < 0.05. Results of this study show significant decrease in acetabular cup stability when either autograft or allograft is used for cemented acetabular reconstruction of dysplastic hip. Further, allografts showed twice as rapid failure as autografts. Although these results contradict both good short-term and long-term results in published literature, they present warning for future use of free bulk bone grafts in reconstructive hip surgery.

Vascular Tumor in Metal-on-polyethylene THA Requiring Hemipelvectomy

Total hip arthroplasty with metal-on-polyethylene implants and metal-on-metal articulations have been an area of recent interest. This article describes a patient with a persistent small soft tissue mass on the anterior groin following total hip arthroplasty with negative findings on infection workup, including blood work and aspiration. Subsequent biopsy findings were consistent with organizing thrombus and necrosis. It then developed into an expansile soft tissue groin mass with significant femoral and pelvic bony destruction and soft tissue infiltration. Metallosis, the formation of a pseudocapsule, and aseptic lymphocyte vasculitis-associated lesions have also been an area of interest following adult hip reconstruction. Occasionally, the formation of subsequent lesions make revision surgery impossible to perform due to bony destruction and soft tissue limitations. Although few in number, most studies or cases that have linked metal-on-metal implants to pseudotumors have been treated with revision surgery and replacement of articulating surfaces. This case highlights a metal-on-polyethylene total hip arthroplasty with a mass presenting with pseudotumor-like characteristics. However, final histology demonstrated fibroadipose tissue with fat necrosis and fibrosis, thickened vascular vessels, and diffuse chronic inflammation with lymphocytic infiltrates, which are more consistent with an atypical inflammatory vascular tumor. The current case illustrates treatment difficulties and provides surgical options for when this event occurs. Although aseptic lymphocyte vasculitis-associated lesions have been observed with metal-on-polyethylene articulations, the multiorgan involvement in this case is unique. In this case, radical excision with hemipelvectomy and complex flap closure was a last resort treatment solution that staved off the prospect of patient mortality.

Instructional Course Lectures. Volume 49.

Charles T. Price, editor. Rosemont, Illinois: American Academy of Orthopaedic Surgeons; 2000. $120.00 (members) or $150.00 (nonmembers), 702 pp. The Annual Meeting of the American Academy of Orthopaedic Surgeons that was held in February 1999 offered 211 Instructional Courses and Lecture Demonstration Courses, with 711 individual lectures. From these, Price selected sixty-six topics for this volume. The text is impressive with regard to its scope, the intellectual and experiential heft of the authors, and the meticulous and attractive presentation of the material. The first and longest of the twelve sections focuses on adult hip reconstruction and contains seventeen chapters, all of which are devoted to difficult salvage problems. Many of the authors of these chapters have been major contributors to the science and art of total hip …