Average Harris Hip Score Research Articles

A comparative study between proximal femoral nail and proximal femoral locking plate in subtrochanteric femoral fractures: A prospective analysis of 36 cases

Background: Subtrochanteric fractures constitute 10-30% of the hip fractures. Various implants were used to fix the fractures. Proximal femoral locking plate (PFLP) allows either direct anatomic reduction or indirect reduction and bridge plating techniques. Due to biomechnical advantage proximal femoral nails (PFN) have found superior to other implants.Objectives: To compare the Radiological and Functional Outcome of Subtrochanteric Fractures treated with proximal femoral nail (PFN) and Proximal femoral locking plate (PFLP) and to find out the more appropriate implant for the specific fracture pattern.Methods: 36 patients with Subtrochanteric femur fracture were operated and fixed by proximal femoral nail and proximal femoral locking plate (18 in each group). Follow up done for 24 months. Outcome was assessed by Harris Hip Score (HHS) and radiologically.Results: The patients treated by proximal femoral nailing required significantly less time for full weight bearing (16.06 weeks) as compared to the patients treated by proximal femoral locking plate (21.41 weeks).Radiological union was significantly delayed in the patients treated by proximal femoral locking plate (mean time 21.41 weeks) as compared to the patients treated by proximal femoral nailing (16.39 weeks). Nailing group had slightly better average HHS (93) than in the plating group (89.44).Conclusion: PFN have the advantage by taking less operative time, high rate of union, minimal soft tissue damage, less infection rate and early postoperative rehabilitation. In our study we found that both PFN & PFLP can be satisfactorily used in the treatment of Subtrochanteric fractures. There was significantly no major difference between implants with respect to anatomical alignment, limb length discrepancy, postoperative infection and most importantly the final outcome measured by Harris Hip Score.

Outcomes after Total Hip Arthroplasty Using a Cementless S-ROM Modular Stem for Patients with High Hip Dislocation Secondary to Hip Pyogenic Arthritis.

ObjectiveTo evaluate the midterm results of the cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy for the treatment of high hip dislocation secondary to hip pyogenic arthritis.MethodsWe retrospectively reviewed the data of 49 patients (49 hips) with an average infection quiescent period of 37.4 years who underwent cementless total hip arthroplasty (THA) with simultaneous subtrochanteric transverse shortening osteotomy from July 2008 to June 2012. There were 23 men and 26 women with a mean age of 44.3 years at the time of surgery. The following clinical outcomes were evaluated: the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, Harris hip score (HSS), modified Merle d'Aubigne‐Postel hip (MAP) score, low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign. Radiographic outcomes and complications were also evaluated.ResultsThe mean follow‐up period was 8.7 years (range, 5.5–10 years). No infection recurrence was observed after THA. The average HSS significantly improved from 45.0 to 84.8. The WOMAC score improved from 70.1 ± 3.5 (range, 65–76) to 43.1 ± 13.4 (range, 21–67). The modified MAP score improved from 5.9 ± 1.9 (range, 3–9) to 14.3 ± 2.4 (range, 11–18). The low back pain visual analog scale score, 12‐item short‐form health survey questionnaire score, limp, and Trendelenburg sign also improved significantly. The average limb length discrepancy decreased from 39.6 mm (range, 30–55 mm) to 7.2 mm (range, 0–22 mm). Two patients had temporary sciatic nerve paralysis but recovered within 6 months without any functional defects; one had an intraoperative fracture fixed by cerclage wires. One hip required revision surgery because of femoral stem aseptic loosening.ConclusionsThe cementless S‐ROM modular femoral stem used with subtrochanteric transverse shortening osteotomy is safe and effective for high hip dislocation secondary to pyogenic arthritis and provides satisfactory midterm results. Significant improvements in clinical function were observed, as were high rates of stable fixation of the cementless implant, restoration of more normal limb lengths, and a low incidence of complications.

Unstable Intertrochanteric Femur Fracture in Elderly Treated with Bipolar Hemiarthroplasty Versus Dynamic Hip Screw - A Prospective Comparative Study

Introduction: Intertrochanteric fractures are one of the most common fractures in elderly population and have a huge impact on the health care system of the society. Objectives: The objective of our study was to compare functional outcome and complication rates of bipolar hemiarthroplasty to dynamic hip screw which is a established procedure for unstable intertrochanteric fracture femur. Materials and Methods: The present study included 50 patients over the age of 55 years, 25 undergoing bipolar hemiarthroplasty and 25 undergoing dynamic hip screw for unstable intertrochanteric fracture femur and their functional outcomes were compared with Harris hip score. Results: We found that the average Harris hip score was better for the bipolar hemiarthroplasty group than for the dynamic hip screw group at 6 months. Conclusion: Bipolar hemiarthroplasty is an effective alternative to dynamic hip screw for unstable intertrochanteric fractures in elderly patients as it has a good function outcome and lower complication rate. A larger randomized control trial has to be conducted to arrive at a conclusion.

First application of three-dimensional designing total hip arthroplasty with long uncemented stem for fibrous dysplasia patients combined with hip joint osteoarthritis

BackgroundIn order to treat proximal femur fibrous dysplasia (FD) patients combined with hip joint osteoarthritis (OA), the three-dimensional (3D) designing osteotomy and implantation of femoral component was firstly used for deformity correction and total hip arthroplasty (THA). The purpose is to present the detailed design, perioperative management and evaluate short-term clinical outcomes of this novel therapeutic method.MethodA retrospective study was performed in twelve FD patients combined with hip joint OA who were treated in our hospital between July 2013 and April 2015. Seven patients received 3D designing combined osteotomy and THA, and the other five patients underwent 3D designing THA only.ResultsAll patients were followed-up with an average duration of 47 months (range, 35–56 months). There was no infection, dislocation, postoperative wound problems or mechanical failures. For the seven patients receiving 3D designing corrective osteotomy, the mean extremity lengthening was 2.8 (range, 1.5–4) cm. The average duration of bone union was 4.2 months. The average Harris Hip Score was improved from 46.08 (range, 13–67) points preoperatively to 93.72 (range, 83–100) points at the last follow-up. The average modified criteria of Guille was improved from 3.2 (range, 1–7) points preoperatively to 8.6 (range, 6–10) points at the last follow-up.ConclusionsThe 3D designing THA with long uncemented stem, including 3D designing corrective osteotomy and implantation of long prosthesis stem, seems to be a reliable method for FD patients combined with hip joint OA. Through preoperative 3D design, corrective osteotomy and implantation of long prosthesis stem can be precise to re-store alignment, uttermost preserve host bone, obtain primary stem stability and provide necessary condition for long-term stem survival, finally leading to better limb function. Besides, perioperative management should be abided strictly for late stability. Nevertheless, the outcomes of long-term follow-up and larger cases are still required.

An excellent 5-year survival rate despite a high incidence of distal femoral cortical hypertrophy in a short hip stem.

Although reported results on short stems sound very promising, the occurrence of distal femoral cortical hypertrophy is often observed. The aim of the present study was to report 5-year survival data of a commercially available trochanter sparing short stem and investigate the clinical impact of distal femoral cortical hypertrophy on the outcome. 123 total hip arthroplasties were performed on 120 patients from April 2008 to May 2010 (mean age 62, range 29-89 years; 71 hips from male patients, 58%). Clinical and radiological data were collected preoperative, at 6 weeks, 1, 2, 3, and 5 years postoperative to assess the outcome. Radiographs taken immediately postoperative as well as 1 and 5 years postoperative were used to identify and assess cortical hypertrophy. 1 stem had to be revised due to aseptic loosening, resulting in a Kaplan-Meier survival analysis with endpoint for stem revision of 99.2% (95% Confidence Interval 94.1-99.9) at 5 years. 96 radiological and 95 clinical follow-ups were analysed 5 years postoperative. 68 (71%) hips showed distal femoral cortical hypertrophy after 5 years. The average Harris Hip Score and Oxford Hip Score improved 33 (standard deviation (SD) 15.1, range 2-70), 18 (SD 12.1, range -10-43) points, respectively. Overall 16% of the patients reported thigh pain, unrelated to the presence of cortical hypertrophy. This short stem shows an excellent 5-year survival rate and good clinical outcome despite a high incidence of cortical hypertrophy. However, the question of the mechanism of load transfer arises.

Retrospective Long-Term Follow-Up Survival Analysis of the Management of Osteonecrosis of the Femoral Head With Pedicled Vascularized Iliac Bone Graft Transfer

BackgroundOsteonecrosis of the femoral head (ONFH) often affects young, active adults and leads to the destruction of the hip joint and disabling arthritis. Several procedures have been developed to prevent conversion to total hip arthroplasty (THA), especially in young patients who have a high rate of hip revision surgery. The aim of this long-term follow-up is to analyze the results of vascularized iliac bone flap transfer for ONFH treatment. MethodsWe retrospectively reviewed 856 patients (1006 hips) who accepted hip-preserving surgery with vascularized iliac bone grafting due to ONFH (Ficat and Arlet stages II-IV) from January 1985 to December 2012 at our hospital. Radiographic assessment was performed with the Ficat and Arlet system, clinical assessment was performed with the Harris Hip Score system, and quality of life was evaluated with the 36-Item Short Form Survey. The hips included 575 stage II hips, 382 stage III hips, and 49 stage IV hips. We defined clinical failure as conversion to THA or any other hip-preserving surgery because of hip symptoms. ResultsA total of 856 patients (1006 hips) were eventually followed up with an average time of 15 years (range 5-25). In total, 75 patients were lost to follow-up, and 105 hips were converted to THA. The average Harris Hip Score was 87.43 ± 6.42 points at the last follow-up, representing a great improvement compared to the 66.42 ± 6.52 points obtained preoperatively. The Kaplan-Meier survival analysis showed no difference in the 15-year survival rate between patients with stages II and III disease (using THA as an end point). However, the survival rate was lower for patients with stage IV disease than that for patients with stages II and III disease. The survival rate for patients in the glucocorticoid group was lower than that for patients in the idiopathic, alcoholic, and trauma groups. The Physical Component Summary scores ranged from 78 ± 10 to 85 ± 14 postoperatively compared to 30 ± 14 to 55 ± 15 preoperatively, and the postoperative Mental Component Summary scores (range from 34 ± 11 to 59 ± 12) were significantly higher than the preoperative scores (range from 72 ± 11 to 90 ± 10), representing great improvement in patient quality of life. Postoperative complications occurred in 86 patients (4.5%) during the follow-up, including 23 patients with deep venous thrombosis, 16 patients with meralgia paresthetica (which resolved), and 47 patients with secondary wound healing. ConclusionThe vascularized iliac bone flap grafting technique yields significant improvement (particularly in the precollapse disease stages in young patients) for restoration of the biomechanical support of the collapsed femoral head and reconstruction of the blood supply to the osteonecrotic area. This procedure allows these patients to avoid or delay the need for THA surgery.

Assessment of efficacy of charnley type and modular type total hip prosthesis in patients undergoing total hip arthroplasty: A comparative study

Background: Arthroplasty is an operation to restore pain free motion to a joint and function to the muscles, ligaments and other soft tissue structures that control the joint. Evaluation of the long-term outcomes of an operative procedure is important to determine the durability of the results of the procedure. In addition, it provides a mean for comparison with the results of any changes in the procedure, including alterations in operative technique, implant design, type of joint - cemented and non-cemented hybrid that occur over times. Hence; we evaluated the results of total hip arthroplasty specially comparing most commonly performed modular type with charnley type i.e. fixed type of THR. In our institute modularity in respect to neck length is used.Materials & methods: 30 patients of either sex, who were operated for total hip replacement, were assessed. Each case was subjected to detailed history regarding age at operation, sex, indication of surgery, type of replacement, duration after replacement, any associated comorbid condition that may affect outcomes of total hip replacement, whether joint replacement was unilateral / bilateral. A scoring system used by Harris called as Harris hip scoring system was used to evaluate the patients. 100 points will be given to a person who can painlessly walk without any support or limp and the walkable distance should not be limited. All the results were analyzed by SPSS software. Results: 2(13.33%) patient in Charnley Group developed dislocation which was managed by closed reduction and traction for 6 weeks. 1(6.67%) Patient in Charnley Group developed peri prosthetic fracture which was managed by open reduction and internal fixation with plating and circlage wire. No patient in the group both groups had shortening more than 2 cms. There was no lengthening in any of the patients. The average Harris Hip Score in Modular Group patients was 85.67 and in Charnley Group was 79.87. Conclusion: Since appreciable limb length shortening and dislocation of hip after fixed type is seen in this study so our results shows that Modular type of hip prosthesis is better than fixed type prosthesis (Charnley type hip prosthesis).

Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities.

Surgical hip dislocation (SD) and periacetabular osteotomy (PAO) are well-described treatments for femoroacetabular impingement (FAI) and acetabular dysplasia, respectively. Occasionally, complex deformities require a combined SD/PAO; the morbidity of performing both procedures in a single stage has not been fully investigated. We performed a retrospective review of a consecutive group of patients undergoing combined SD/PAO to investigate the incidence and character of perioperative complications. Forty-five patients (46 hips) were identified. Perioperative complications were graded by the modified Clindo-Davien complication scheme. Mean follow-up was 36 months (range 12–128), and no patients were lost to follow-up. Six complications occurred in six hips (13%). Four (8.7%) complications were minor (Grades I or II): one Brooker Grade III heterotopic ossification requiring no treatment, one superior pubic ramus nonunion requiring no treatment and two superficial wound infections requiring antibiotics. Two (4.3%) complications were major (Grades III or IV): one coxa saltans interna and labral tear requiring hip arthroscopy with labral repair and iliopsoas lengthening, and one deep surgical site infection requiring irrigation and debridement followed by development of arthritis requiring conversion to arthroplasty. The average Harris hip score improved from 62 ± 13 preoperatively to 80 ± 19 at final follow-up. Except for the single joint replacement, there were no long-term disabilities. There were no major neurovascular injuries, osteonecrosis, fractures or trochanteric nonunions. Combined SD/PAO for the treatment of complex, concomitant deformities of the proximal femur and acetabulum is associated with an acceptable risk of complications. The vast majority of complications that occurred were managed without permanent disability. Level of Evidence: IV

Reconstruction of a hip socket using trabecular metal components

Introduction. Fixation of the acetabular component in patients with bone defects of the acetabulum is a difficult task due to the insufficient quantity and poor quality of the remaining bone tissue. During the last few years in our coun - try in arthroplasty of the acetabulum with severe bone defects were actively used implants made of trabecular metal.
 Purpose of study: was to evaluate short-term clinical and radiological results of the usage of trabecular metal components in patients with bone defects in revision and primary hip replacement.
 Patients and methods. 59 surgeries were performed using components of trabecular metal,53 of them were performed on the instability of the hip prosthesis,2 posttraumatic hip dysplasia,2 aseptic necrosis of the femoral head,2 high dislocation of the femoral head. Among the operated there were 37 women and 22 men, the average age was 58.219.9 years. According to the Paprosky classification, defects in 12 cases corresponded to type IIA, in 14 type IIB, in 6 type II, in 19 type IIIA, in 7 type IIIB.
 The structural features of these implants, made of tantalum in a carbon skeleton with uniform porosity, similar to the structure of bone tissue, provide an increased coefficient of friction, thereby contributing to the rapid growth of bone tissue in the implant structure.
 Results. The average follow-up period was 14 months. The average preoperative assessment of the hip joint by Harris Hip Score (HHS) was 43 points (from 14 to 86). After surgery, the average HHS improved to 88.7(69 to 100). 1 patient had hemorrhagic discharge after surgery. On the 7th day an audit was performed. In 2 cases, paresis of the peroneal portion of the sciatic nerve developed after surgery. There were no cases of recurrent dislocations, deep infection, pulmonary embolism or death as a result of operations.
 Conclusion. Taking into account the mechanical properties, tantalum implants allow to achieve a stable primary fixation with the restoration of the center of rotation of the hip joint and eliminate the risks associated with the use of allografts.

Cementless Primary Total Hip Arthroplasty with a Trabecular Titanium Implant: Results at Short-to-Medium-Term Follow-Up

AbstractOver the last two decades, cementless hip prostheses gained increasing popularity. Highly porous, trabecular coatings and their promising bone-friendly properties also came to a wider diffusion. As a consequence, this study was aimed to evaluate clinical and radiographic results at short-to-medium term of cementless prosthetic implants with trabecular titanium cup and titanium femoral metaphyseal stem highly porous coatings. From September 2012 to June 2015 213, cementless total hip arthroplasties were performed in 200 patients. All patients received a cementless Accolade II stem and Tritanium cup with UHMWPE Trident X3 Bearing Technology polyethylene liner. All surgeries were performed using a tissue-sparing modified posterolateral approach. All patients underwent prophylaxis for heterotopic ossifications. For every patient, the following data were collected: age, gender, height, weight, body mass index, blood loss, preoperative and postoperative hemoglobin, surgical time, and complications. Harris Hip Score was obtained for every patient. Radiographic measurements were performed using a freeware software (TraumaCAD 2.0). The computed parameters were inclination and anteversion of acetabular cup and presence of heterotopic ossification. The mean follow-up was 37.7 months from surgery. Data were analyzed by SPSS software v 24.0. The postoperative average Harris Hip Score was 87.4 points (range, 40.5–95.7) and 91 patients scored excellent results, with more than 90 points (52.4%). Heterotopic ossifications were seen in 12 patients (6.9%) and correlated to patient weight, surgical timing, and hemoglobin values. There were three cases of dislocation (1.7%) that significantly correlated with cup inclination (R 2 = 17.9; p = 0.018). One cup underwent early revision because of undersizing of the component and subsequent lack of integration, thus leading to an overall survivorship of 99.4%. In conclusion, excellent medium-term functional outcome, patient satisfaction, and low complications rate were observed for the studied implant. A higher incidence of heterotopic ossifications was significantly correlated to patient weight, surgical time, blood loss, and transfusions. Also, inclination of the acetabular cup proved to be correlated to hip dislocation.

Evaluation of clinical results and complications of internal fixation of intertrochanteric femur fracture with proximal femoral nail antirotation

<p class="abstract"><strong>Background:</strong> The purpose of the present study was to evaluate the theoretical advantages of the proximal femoral nail antirotation in cases of intertrochanteric fractures and also whether it actually alters the eventual functional outcome of the patient.</p><p class="abstract"><strong>Methods:</strong> The present study includes a total 30 patients with intertrochanteric femur fractures managed with proximal femoral nail antirotation between December 2014 to November 2016. In all patients similar standard physical rehabilitation therapy were followed. All complications including intra and postoperative were assessed and recorded. The patients were followed up for over 24 months. Functional outcome was assessed using the Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> All of 30 cases of intertrochanteric fracture got united with good anatomical position and average time of fracture union was 14 weeks. Postoperative complications included 2 degree varus deformity (n=1, 3%), calcification at tip of greater trochanter (n=4, 13%), sensitivity over TFL (n=2, 7%), medial thigh pain (n=3, 10%). 10 patients developed femoral shortness (mean=0.22 cm, range from 0-1 cm). Average harris hip score at the end of study showed mean value of 87, ranged from 65 to 94 with almost 22 (73%) patients showing excellent or good outcome.</p><p class="abstract"><strong>Conclusions:</strong> Proximal femoral nail antirotation (PFNA) represents a significant treatment option in management of intertrochanteric fractures with low complication rate.</p>

Surgical Treatment of Type 31-A1 Two-part Intertrochanteric Femur Fractures: Is Proximal Femoral Nail Superior to Dynamic Hip Screw Fixation?

IntroductionThe implant of choice for two-part intertrochanteric femur fracture is still under debate. This study was done to compare the operative parameters and functional outcome of two-part intertrochanteric fractures treated by dynamic hip screw (DHS) and proximal femur nail (PFN).MethodsFifty-four operated cases of two-part intertrochanteric (AO 31A1) were analysed and divided into two groups based on implant used (PFN 30, DHS 24). Operative details, which include blood loss and duration of surgery, were obtained from hospital records. All patients were followed up for six months and assessed for radiographic and functional outcome. The functional outcome was calculated with modified Harris hip score and Parker mobility score.ResultsThere was no significant difference in the operative parameters (p > 0.05) between DHS and PFN. The average blood loss for DHS and PFN was 202.5 ml and 198 ml respectively while operative duration was 136 min and 126 min, respectively. All patients had good functional outcome at the end of six months with average Harris hip score of 69.7 and Parker score of 8. No difference was found between the two surgeries in terms of functional outcome as well (p > 0.05).ConclusionThere is no conclusive evidence to show that PFN is superior to DHS in the treatment of two-part intertrochanteric (31A1) fracture. Both DHS and PFN are equally effective in treatment of such fractures.

Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis.

Presently, unstable intertrochanteric femur fractures are treated commonly with intramedullary nailing devices. Various designs of intramedullary nail are introduced. The conventional Proximal Femoral Nail has given diverse outcome. Complications have also been noted with this implant. Newer designs like Proximal Femoral Nail Antirotation-2 have been introduced for Asian population. The aim of our study was to compare the radiological and functional outcome of unstable intertrochanteric femur fracture treated with conventional Proximal Femoral Nail and Proximal Femoral Nail Antirotation-2 in osteoporotic patients. Patients presenting with unstable intertrochanteric femur fracture (AO classification) and Singh's index ≤ 3 were included. Patients were assigned to the groups based on the implant used for treatment (PFN and PFNA2 group). Post-operative radiographs were used to assess the quality of reduction, by calculating neck shaft angle. The quality of fixation was assessed, by calculating tip apex distance and Cleveland index. The duration of surgery, blood loss, number of fluoroscopic images taken and length of hospital stay were noted. Patients were followed up for 6months, and complications were noted. The functional outcome was compared using modified Harris hip score. The data analysis was done using Student's unpaired t test/Mann-Whitney U test and Chi-square test/Fisher's exact test. A p value less than 0.05 was considered significant. Seventy-eight patients with unstable intertrochanteric fractures and Singh's index < 3 were included. Thirty-seven were treated with PFNA2 and 41 with PFN. The average age in PFNA2 group was 69.51, and PFN group was 70.804. Nine patients in PFNA2 group and 10 patients in PFN group had tip apex distance more than 25mm. Twelve patients in PFNA2 group and 14 Patients in PFN group had sub-optimal implant position as per Cleveland index. The difference in neck shaft angle between uninjured and operated side was more than 10° in four patients of PFNA2 group and seven patients of PFN group. The average Harris hip score was 74.55 for PFNA2 group and 69.88 for PFN group. Four complications were seen in PFNA2 group and 5 in PFN group. The functional outcome (p = 0.102) achieved with both the implants was similar. Good functional outcome can be achieved, when the radiological parameters are restored, i.e. TAD < 25mm, Cleveland index in centre-centre position and neck shaft angle difference < 5°. The overall complications, in the set-up of osteoporosis, seen with both the implants were similar (p = 0.44). PFNA2 group showed better results in terms of perioperative morbidity.

Does isolated greater trochanter implication affect hip abducent strength and functions in intertrochanteric fracture?

BackgroundA fracture in the isolated greater trochanter is an infrequent type of femoral intertrochanteric fracture. The gluteus medius and gluteus minimus are abducent muscle groups with attachments located on the greater trochanter. Thus, a fracture of the greater trochanter could cause avulsion injury of these attachment points and eventually affect the abducent function of the hip joint and cause chronic pain. Despite these prospects, the impact of a greater trochanter fracture on abducent strength and hip joint function have yet to be investigated.MethodsPatients who were diagnosed with an isolated greater trochanter fracture (via computed tomography scan and X-ray) and underwent conservative treatment from June 2013 to October 2016 were included in the present study. Magnetic resonance imaging (MRI) was used to verify the morbidity of recessive fractures. Patients’ Harris Hip Scores were determined at 3 months, 6 months, and 12 months and the abducent strength and range of motion of the hip joint on the injured side were analyzed and compared to those on the healthy side.ResultAmong 32 patients, there were 7 individuals diagnosed with isolated greater trochanter fractures by MRI, and 25 individuals whose fractures were found to have extended into the intertrochanteric region, wherein the recessive intertrochanteric region fractures had no relationship with patients’ age, gender, or weight. After 12 months of conservative treatment, 7 patients still complained of pain in the hip joint. The average Harris Hip Score was 87.84 ± 4.83, and the abducent range of the hip joint on the injured side (42.02 ± 13.93°) was not significantly different from that of the healthy side (46.24 ± 7.93°). The abducent strength of the hip joint of the injured side was 121.32 ± 41.06 N which was significantly lower than that of healthy side (137.44 ± 42.21 N).ConclusionResults from this investigation suggest that an isolated greater trochanter fracture attenuates the abducent strength of the hip joint, which may be related to injuries of the ligaments and muscles around the greater trochanter. The surgical skills and methods of addressing isolated greater trochanter fractures merit further investigation.

Cementless hip arthroplasty and transverse shortening femoral osteotomy with the S-ROM stem for Crowe type IV developmental dysplasia

The aim of this study has been to present outcomes after cementless arthroplasty for developmental dysplasia Crowe type IV of the hip, with transverse subtrochanteric shortening osteotomy and using the S-ROM stem. We evaluated radiographs, functional scores and complications in a consecutive series of 23 patients (28 hips) with high dislocation of the hip. The average age of patients at surgery was 49.9 (range 22-68) years. The operations were performed between 2007 and 2013. Patients were assessed retrospectively-clinically and radiographically during the year 2018. The mean follow-up period was 94 (range 60-134) months. The average Harris hip score improved from 39.9 to 84.0. The mean leg length discrepancy decreased from 5cm preoperatively to 1.4cm at the final follow-up. All acetabular components were implanted into the true acetabulum, and all prostheses were stable at the latest examination. No neurovascular damage was recorded. We have identified specific complications in seven hips (25%) in total: Intraoperative femoral fracture required fixation in four hips; three hips (10.7%) needed revision: Recurrent dislocation, with the need for cup reorientation, occurred in two hips (in one of them, this was followed by the subsequent need for resection of heterotopic ossification); there was one aseptic stem loosening with the need of one-stage revision. All the osteotomies healed within 8months. Hip arthroplasty with transverse shortening femoral osteotomy, using S-ROM stem, is an acceptable, but not complication-free treatment method in patients with Crowe type IV developmental hip dysplasia, in the midterm.

Treatment of Slipped Capital Femoral Epiphysis With the Modified Dunn Procedure: A Multicenter Study.

Treatment of moderate to severe slipped capital femoral epiphysis (SCFE) is controversial. Over the last years, 3 institutions in Argentina adopted the modified Dunn procedure for capital realignment in selected cases of SCFE. Our aim in this study was to evaluate the clinical outcome and the rate of complications of patients who had undergone surgical hip dislocation and capital realignment. A multicenter retrospective cohort study of patients who received the modified Dunn procedure from January 2009 to 2013 was performed. Data concerning clinical features, surgical technique, intraoperative findings, and postoperative complications were obtained from all available medical records. The operative results were evaluated on clinical and radiographic criteria. Twenty patients (21 hips) with a mean of 40.4 months (range, 12 to 84 mo) of follow-up were evaluated. The average Harris Hip score was 76.3 points (range, 40 to 100 points). Seven patients had excellent results, 6 good, 2 fair, and 5 poor. Mean slip angle improved from a preoperative value of 59.1±11.2 degrees to 5.4±2.5 degrees (P=0.001). The mean postoperative alpha angle and neck-shaft angle were 40.8±2 degrees and 131±9.9 degrees, respectively. One patient had a superficial infection that was resolved with oral antibiotics. Six patients had complete osteonecrosis with severe involvement and 4 partial femoral head necrosis with minimal deformity. No patients developed chondrolysis, infection, deep venous thrombosis, heterotopic ossification, nonunion, or nerve palsies. Modified Dunn procedure for treating hip SCFE is a technically demanding surgery with wide variations in the reported outcomes. Although in this series 65% of patients had good or excellent functional results, a high rate of complications was observed. This may be related, among other factors, to the learning curve of the procedure. Level IV-therapeutic study.

Management of pelvic discontinuity in revision arthroplasty : Cementless acetabular cup with iliac stem and cranial strap.

Pelvic discontinuity causes severe destruction of the acetabular bony walls and is particularly difficult to manage. This article reports the short-term results and complications encountered in the management of loosening of the acetabular cup with pelvic discontinuity using an acetabular cup with an intramedullary iliac stem combined with an extramedullary iliac plate. As part of this monocentric retrospective case analysis all patients who underwent acetabular revision surgery after THR due to loosening of the acetabular cup with pelvic discontinuity in this clinic from January 2016 to June 2017 were identified (n = 16). All patients underwent routine clinical and radiological follow-up. In addition, the Harris hip score (HHS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were evaluated as part of a1-year follow-up. All patients were treated with an acetabular revision cup of appropriate size with intramedullary iliac stem combined with an anatomical extramedullary iliac plate. On clinical follow-up at 1 year (median follow-up time 14.5 ± 3.3months), the average HHS was 69.3 ± 14.1 and the average WOMAC was 79.3 ± 11.7. Complications were registered in 7 out of the 16patients whereby 1 showed aseptic loosening of the revision cup, dislocations were reported in 4cases and infections in 2cases. In the case of the two patients with infections aGirdlestone resection arthroplasty had to be performed. The overall complications and postoperative outcome in revision surgery after THR reported in the literature were compared to the results of this study. Compared to the results of salvage procedures using large or bipolar heads and Girdlestone resection arthroplasty, satisfactory results were obtained using the acetabular cup with an intramedullary iliac stem combined with an extramedullary iliac plate.

Arthroscopic treatment of iliopsoas impingement syndrome after hip arthroplasty.

Background and aim of the Work: Groin pain after hip arthroplasty (HA) ranges from 0.4% to 18.3%. Defining the cause of groin pain after HA can be difficult. Iliopsoas impingement (IPI) has been reported to be the underlying cause of groin pain in up to 4.4% of cases. The purpose of this study is to present arthroscopic surgical outcomes in the treatment of IPI after HA. Methods: Between September 2013 and March 2018, 13 patients, 11 total hip arthroplasty (THA), 1 hip endoprosthesis and 1 total hip resurfacing affected by groin pain due to unceasing iliopsoas tendinopathy for impingement after HA were treated arthroscopically. The patients underwent to physical examination, blood analysis, hip X-rays, bone scintigraphy and CT assessment. We performed the arthroscopic OUT-IN access to hip joint in all patients. VAS scale, Harris Hip Score (HHS) and Medical Research Council (MRC) scale were performed before surgery and during follow up at 1-3-6-12 months. Results: After 10 months of mean follow-up, average HHS and MRC scale improved significantly from preoperatively to postoperatively. No complications arose in our case series. Conclusions: Hip arthroscopy after hip arthroplasty is supported in the literature for a variety of indications. Hip arthroscopy is a viable and reproducible technique in treatment of IPI, being less invasive than the classic open technique. This simple arthroscopic release provides satisfactory results and preserves HA function. Moreover an arthroscopic OUT-IN access proves good clinical outcomes, few complications and iatrogenic lesions. (www.actabiomedica.it)

Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips.

This series assessed the clinical and radiographic outcomes of total hip arthroplasty (THA) with femoral shortening osteotomy for the management of patients with Crowe type IV hip dysplasia. Only patients with Crowe type IV hip dysplasia who underwent primary THA combined with a subtrochanteric transverse osteotomy with an uncemented monoblock conical stem were included. The clinical and radiographic evaluations were performed before and immediately after surgery, and at last follow-up. The hip function was assessed with the Harris Hip Score (HHS). Seventy-four patients (102 hips) with a mean age of 53.9 (range, 20-83) were evaluated at an average follow-up of 11.3years (range, 5-25). Stem revision occurred in two (1.9%) cases, with a survivorship of 95.9% (95%IC, 91.9-99.9%) at tenyears. The average HHS increased from 44 (range, 15-78) pre-operatively to 90.3 (range, 62-100) at last follow-up (p < 0.001). Osteotomy site non-union and early dislocation were observed in 3.9 and 3.8%, respectively. No cases of nerve palsy were reported. THA with a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patients with Crowe IV hip dysplasia.

Midterm Results of Conversion from Failed Bipolar Hemiarthroplasty to Total Hip Arthroplasty.

Background:Conversion from failed bipolar hemiarthroplasty (HA) to total hip arthroplasty (THA) presents a great challenge to orthopedic surgeons for bipolar head removal and cup placement with or without change of femoral stem. Conversion THA after failed bipolar arthroplasty is known to offer both symptomatic and functional improvement. This study evaluates the midterm functional outcome and complications, especially dislocation associated with femoral head diameter, after conversion THA.Materials and Methods:Forty eight hips with the conversion of bipolar HA to THA were followed up for an average 6.2 years (range 2.0–11.5 years). Twenty one hips had conversion surgery to THA using metal-on-metal articulation (28 or 32 mm head). Nine hips used ceramic-on-ceramic (28–40 mm) and eighteen hips used large head metal-on-metal bearing (>40 mm). Outcome was evaluated using Harris Hip Score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of osteolysis and/or loosening. The complications were evaluated, especially dislocation with different femoral head diameter.Results:Average HHS significantly improved from 42 preoperatively to 86 postoperatively and the average WOMAC score also significantly improved from 47 to 22 postoperatively. Radiological evaluation showed all the femoral components were stable. There was one acetabular component loosening, which required revision 9 years after conversion to THA. One dislocation and one recurrent dislocation were recorded in isolated acetabular revision hip; whereas one dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations occurred in hips with a femoral head size of 28 mm (P = 0.052). The cup and femoral head interval length was the most significant factor contributing to dislocation (P = 0.013).Conclusions:Conversion THA after failed bipolar HA offers a reliable pain relief and functional improvement. To prevent dislocation, it is highly recommended to use a larger diameter femoral head, especially where the cup size is big.