Degenerative Hip Disease Research Articles

Management of Unstable Intertrochanteric Fracture Femur using Long Stem Cementless Arthroplasty Single Armed Clinical Trial

Abstract Background fractures of trochanteric region of femur are common in elderly. Internal fixation of these fractures is a standard practice. But, Nowadays we encounter failures require reoperation. In fresh comminuted fracture through porotic bone in elderly with medical comorbidities or symptomatic ipsilateral degenerative hip disease, replacement preferred to allow early full weight bearing mobilization. arthroplasty using long-stem is a surgical method that helps patients relieve pain, facilitate early rehabilitation, limit long-term complications, and improve quality of life for patients. Hip fracture treatment in elderly patients remains challenging. Aim The aim of our study is to detect functional outcomes and complications after usage of cementless hip arthroplasty with long femoral stem for management of intertrochanteric femur fractures. Materials and Methods We followed 20 patients were treated with long-stem cementless arthroplasty due to intertrochanteric femur fractures. The mean age was 72.9±5.79 years and the mean follow-up period was 12.8 months. The patients underwent either bipolar or total hip arthroplasty. Outcomes were evaluated with the Harris hip score (HHS). Results At the last follow-up, the mean Harris hip score was 81.2points. There were no cases of osteolysis. All stems were stable without significant changes in alignment or progressive subsidence. Superficial Infection was observed in one patient and was treated medically. Implant loosening and periprosthetic fractures were not noted. Conclusion Primary cementless long stem arthroplasty is one of good choices in treatment unstable ITF in elderly patients, helped patients improve the quality of life.

Microsporidia (Encephalitozoon cuniculi) in Patients with Degenerative Hip and Knee Disease, Czech Republic.

Total joint arthroplasty is a commonly used surgical procedure in orthopedics. Revision surgeries are required in >10% of patients mainly because of prosthetic joint infection caused by bacteria or aseptic implant loosening caused by chronic inflammation. Encephalitozoon cuniculi is a microsporidium, an obligate intracellular parasite, capable of exploiting migrating proinflammatory immune cells for dissemination within the host. We used molecular detection methods to evaluate the incidence of E. cuniculi among patients who had total hip or knee arthroplasty revision. Out of 49 patients, E. cuniculi genotypes I, II, or III were confirmed in joint samples from 3 men and 2 women who had implant loosening. Understanding the risks associated with the presence of microsporidia in periprosthetic joint infections is essential for proper management of arthroplasty. Furthermore, E. cuniculi should be considered a potential contributing cause of joint inflammation and arthrosis.

Reducing the number of hip dislocations after total hip arthroplasty based on the study of the mechanisms of their development

Total hip arthroplasty is one of the most effective surgical interventions that improves quality of life, increases a range of motion, and reduces pain in patients with degenerative hip joint disease. Total hip arthroplasty allows patients to return to daily social and professional activities. Thus, it is currently the best approach to the treatment of several chronic conditions affecting the hip joint, including osteoarthritis, avascular necrosis of the femoral head, and traumatic injuries to the femoral head and neck. The purpose of this study was to show the mechanisms of hip dislocation in the presence of a hip endoprosthesis, associated risk factors and factors that reduce the risk of dislocation, as well as its consequences and methods for minimization. Hip dislocation is a common complication following total hip arthroplasty. It is the cause of 2 to 3 % of failures of primary replacements, increasing even to 10 % in extreme cases in patients highly predisposed to this condition. In general, technical errors during implant placement are the cause of dislocation. The measures taken to prevent complications include activities aimed to the correct implant insertion and selection of the most appropriate type of implant for the patient, depending on individual needs. This work summarized the current knowledge about hip dislocation to help surgeons understand the changes in the hip biomechanics after its replacement and the impact of each element involved. This knowledge may help a surgeon to choose the most favorable surgical method and the most appropriate implant to reduce the risk of its dislocation.

Does Order of Operation Matter in Patients Who Have Concomitant Hip and Spine Pathology?

BackgroundIn patients, who have coexisting lumbar spine and degenerative hip disease, there remains uncertainty regarding whether hip or spine surgery should be performed first. We hypothesized that undergoing total hip arthroplasty (THA) would protect against subsequent lumbar spine surgery (LSS) in patients who have ‘hip-spine syndrome.’ MethodsA retrospective cohort study was performed from 2013 to 2021 on patients who had radiographically–confirmed hip osteoarthritis and degenerative lumbar spine pathology, evaluated separately in spine and arthroplasty clinics prior to surgical intervention. Included patients ultimately underwent THA and/or LSS. The primary outcome was survivorship free of LSS or THA after the other was initially performed. ResultsOf 256 patients, 206 (80.5%) underwent THA first. Only 14 of 206 (6.8%) who underwent THA required subsequent LSS, while 31 of 50 (62%) who underwent LSS required subsequent THA, (P < .001). At 5 years, there was 93.9% survivorship-free of LSS in the THA first group, compared to 44.7% survivorship-free of subsequent THA in the LSS group. Multivariate analyses showed that patients who had THA first had lower odds of undergoing subsequent surgery (odds ratio [OR]: 0.61, CI: 0.52-0.70, P < .001) compared to those who underwent LSS first. Additionally, those who have higher initial Kellgren-Lawrence grade hip osteoarthritis had lower odds (OR: 0.94, CI: 0.89-0.99, P = .04), and those who have progressive neurologic deficits (OR: 2.64, CI: 1.89-3.7, P < .001) and neurogenic claudication (OR: 1.15, CI: 1.06-1.24, P = .001) had increased odds of undergoing subsequent LSS. ConclusionPatients with ‘hip-spine syndrome’ may receive more initial benefit from undergoing THA, potentially reducing the subsequent need for LSS. The exceptions were those patients who had lower-severity hip osteoarthritis and symptoms of major spinal stenosis.

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

We present a case report of a total hip arthroplasty (THA) in a patient with ipsilateral knee arthrodesis. The direct anterior approach (DAA) was used, and to our knowledge, this has never been described previously in the literature. The purpose of this report is to highlight pre-, per-, and post-operative challenges using the DAA in these rare cases. This case report presents the case of a 77 year old female patient with degenerative hip disease in the presence of an ipsilateral arthrodesis of the knee. The patient was operated using the DAA. No complications were found and the patient had an excellent follow-up with a forgotten joint score of 93.75 at 1 year. The difficulty in this case consists in finding the correct stem anteversion with the altered knee anatomy. Using pre-operative templating on X-rays, intraoperative fluoroscopy and the posterior femoral neck the hip biomechanics could be restored. We believe that THA in presence of an ipsilateral knee arthrodesis can be safely performed through a DAA.

Frequency of Destructive Hip Disease Post Intra-Articular Cortecosteroid Hip Injection

Objective: This study aims to quantify the prevalence of destructive hip disease following intra-articular corticosteroid hip injections. Study design: A retrospective study Place and duration of study: Department of Orthopaedic, Khyber Teaching Hospital Peshawar during the period from January, 2022 to June, 2022. Methods: This study was conducted on two hundred cases of corticosteroid injection treatment. For finding the frequency of destructive hip disease, the radiological imaging was used. Patients were compared with their clinical, paraclinical, and demographic data. Observations of pain, joint mobility, and radiographic evaluation served as the foundation for the recently suggested clinico-radiological diagnostic criteria. The inter- and intraobserver reliability of the radiological grading system was evaluated. For statistical analysis, SPSS-20 was employed.. Results: From the total 200 cases, patients with POH were 80(40%), with RPOH were 20(10%), with femoral head avascular necrosis were 20(10%) and with secondary osteoarthritis of hip were 40(20%), patients went for THA were 90%. There were 30% males and 160% females with mean age of 53.9 ±3.3 and BMI &gt;32. The corticosteroidal injection of 40mg triamcinolone-acetonide with 4 mL 1% lidocaine was placed in 21(77.8%). Conclusion: An elevated chance of quickly degenerative hip disease can result from intra-articular corticosteroid hip injection. Hip injections with intra-articular corticosteroids are probably not as safe as we had believed. Hip injections should only be used when absolutely necessary, and their usage should be reduced. Before administering a large and repeated dose of corticosteroids, the patient should also be warned about the possibility of the condition progressing faster. Keywords: RDHD, intra-articular corticosteroid hip injection, frequency.

Current and Future Advanced Imaging Modalities for the Diagnosis of Early Osteoarthritis of the Hip.

Hip osteoarthritis (OA) can be idiopathic or develop secondary to structural joint abnormalities of the hip joint (alteration of normal anatomy) and/or due to a systemic condition with joint involvement. Early osteoarthritic changes to the hip can be completely asymptomatic or may cause the development hip symptomatology without evidence of OA on radiographs. Delaying the progression of hip OA is critical due to the significant impact of this condition on the patient’s quality of life. Pre-OA of the hip is a newly established term that is often described as the development of signs and symptoms of degenerative hip disease but no radiographic evidence of OA. Advanced imaging methods can help to diagnose pre-OA of the hip in patients with hip pain and normal radiographs or aid in the surveillance of asymptomatic patients with an underlying hip diagnosis that is known to increase the risk of early OA of the hip. These methods include the delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC), quantitative magnetic resonance imaging (qMRI- T1rho, T2, and T2* relaxation time mapping), 7-Tesla MRI, computed tomography (CT), and optical coherence tomography (OCT). dGEMRIC proved to be a reliable and accurate modality though it is limited by the significant time necessary for contrast washout between scans. This disadvantage is potentially overcome by T2 weighted MRIs, which do not require contrast. 7-Tesla MRI is a promising development for enhanced imaging resolution compared to 1.5 and 3T MRIs. This technique does require additional optimization and development prior to widespread clinical use. The purpose of this review was to summarize the results of translational and clinical studies investigating the utilization of the above-mentioned imaging modalities to diagnose hip pre-OA, with special focus on recent research evaluating their implementation into clinical practice.

The Effect of Hip Offset and Spinopelvic Abnormalities on the Risk of Dislocation Following Total Hip Arthroplasty.

Previous studies have demonstrated that patients with abnormal spinopelvic motion are at increased risk of dislocation. However, little is known about the effect of hip offset on dislocation risk following total hip arthroplasty (THA) in patients with abnormal spinopelvic motion. The purpose of this study is to investigate the prevalence of under-restored hip offset and spinopelvic abnormalities in a series of THA patients treated for recurrent instability. This is a retrospective review of consecutive patients treated for hip instability following primary THA (THA+I) from 2012 to 2020. Patient demographics, surgical variables, and radiographic parameters were recorded. THA+I patients were compared to an age-matched and gender-matched control THA population without hip instability (THA). Univariate analyses were performed to compare differences between groups. Thirty-three THA+I patients (44 hips) were compared to 44 THA patients (44 hips). THA+I patients had a higher prevalence of spinopelvic pathology (odds ratio [OR] 7.80, 95% confidence interval [CI] 2.59-23.50, P < .001). The majority of acetabular components were placed within the Lewinnek safe zone (86.4% THA+I vs 72.7% THA; P= .119). THA+I patients were at greater risk of markedly under-restored hip offset (Δoffset ≤ 3 mm; OR 6.34, 95% CI 2.20-18.30, P= .001) and small (<32 mm) femoral head diameter (OR 4.38, 95% CI 1.53-12.53, P= .006) compared to THA patients. Lumbar degenerative disease and under-restoration of hip offset were present in a high proportion of patients with hip instability. Although multiple factors may contribute to THA instability, these data suggest that restoration of offset is essential, particularly in patients with spinopelvic pathology, and may be more important than historically described acetabular targets. Level III.

Hip Resurfacing Arthroplasty Failure. Conversion to Total Hip is it a Favorable Solution with Satisfactory Outcomes?

Background: Hip resurfacing arthroplasty (HRA) had been utilized since the 1950s. The concept favoured for selected young active patients with degenerative hip disease owing to its proposed advantages. Revision rate in most national registries nearly 3.5%. Conversion to total hip replacement may be the correct option for old patients and those whose activity levels changed and the need for hip resurfacing no longer required.

Sports Activity and Patient-Related Outcomes after Cementless Total Hip Arthroplasty in Patients Younger than 40 Years.

Background: The management of degenerative hip diseases in young patients remains a challenge. Despite the improvement of hip-preserving procedures, total hip arthroplasty (THA) may be required in some instances. In addition, young patients undergoing THA have high expectations concerning their postoperative level of activity. Purpose: (1) to define the sports activity level and the return to sports after THA, (2) to describe the modification or initiation of new sports disciplines, and (3) to report the clinically meaningful outcomes after THA in patients younger than 40 years. Methods: A total of 36 patients (40 hips) were prospectively analyzed at a midterm follow-up of 3.9 years. The modified Harris Hip Score (mHHS); the Visual Analog Scale (VAS) for pain; the University of California, Los Angeles (UCLA) activity scale; and sports and recreational activity levels were assessed via questionnaire. The minimal clinically important difference (MCID) was determined by calculating half of the standard deviation, and the substantial clinical benefit (SCB) as well as patient acceptable symptomatic state (PASS), were calculated by the anchor method for the mHHS. Results: At the final follow-up, there was a significant improvement in mHHS (34.1 to 92.6; p < 0.0001), UCLA (3.2 to 7.6; p < 0.0001), and VAS for pain (8 to 1; p < 0.0001). More patients were active in sports at follow-up than before surgery (44% to 92%, p < 0.0001). In addition, the duration and frequency of sports activities showed a significant increase (p < 0.0001). The MCID, SCB and PASS for mHHS were 89% and 58%, respectively. No revision surgery had to be performed. Conclusion: This study showed that a large proportion of patients under 40 years of age who underwent THA increased their physical activity. Eighty-six percent of the patients were highly active, with a UCLA score ≥ 7. Furthermore, the reported MCID, SCB, and PASS for mHHS were achieved by more than 80% of patients.

Functional outcomes, complications and revision rate of hip arthroplasty in patients with sequelae of slipped capital femoral epiphysis: a systematic review.

Background: Slipped capital femoral epiphysis (SCFE) results in alterations to femoral head anatomy, predisposing patients to degenerative hip disease at a young age. Total hip arthroplasty (THA) is performed to relieve symptoms and improve function. However, it can be associated with a variable outcomes and little evidence exists on the functional outcomes, complications and revision rate following such procedures.Purpose: The aim of this systematic review is to determine the safety and effectiveness of performing hip arthroplasty in patients with degenerative hips secondary to SCFE.Methodology: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature review was conducted of MEDLINE and Embase. Both single-arm and comparative studies were included. The outcomes of interest were functional scores, post-operative complications and revision rate.Results: Six studies fit the inclusion criteria. Of these, five were retrospective single-arm studies and one was a retrospective comparative study based on registry data.All studies reported significant improvement in hip function and quality of life after THA. An overall revision rate of 11.9% was reported, occurring at a mean of 6.5 years (0.75–18.7 years).THA in patients after SCFE leads to improved functional outcomes that are comparable to patients receiving THA for osteoarthritis. The revision rate appears to be higher than is reported in patients undergoing THA for osteoarthritis at mid-term follow-up. Further prospective comparative studies are needed to evaluate the efficacy of the treatment in more detail.Cite this article: EFORT Open Rev 2021;6:539-544. DOI: 10.1302/2058-5241.6.200038

Chronic pain and gait analysis in dogs with degenerative hip joint disease treated with repeated intra-articular injections of platelet-rich plasma or allogeneic adipose-derived stem cells.

This prospective, comparative, randomized, horizontal, and double-blind clinical study investigated the clinical efficacy of leucocyte-poor platelet-rich plasma (PRP, n=8) or allogeneic adipose-derived stem cells (ADSC, n=8) in dogs with bilateral degenerative hip joint disease (DHJD). Sixteen dogs were treated with two intra-articular injections of PRP or ADSCs, within a 30-day interval. The Canine Brief Pain Inventory (CBPI), the Helsinki Chronic Pain Index (HCPI), and Visual Analogue Scales for pain (VAS-pain) and locomotion (VAS-loc) were assessed by the dog owners. Analysis-of-gait using a force plate, response to palpation (VAS-palp), and the descriptive numerical scale for pain (DNS) were measured by a veterinarian. The assessments were performed before (baseline), 30 and 60 days after the first treatment. Data were analyzed using the unpaired t test, paired Wilcoxon test, Fisher’s exact test, and Mann-Whitney and Friedman tests (P<0.05). Compared with baseline HCPI, CBPI, VAS-pain, and VAS-palp scores reduced 41%, 52%, 51%, and 48% (P=0.0001–0.03) at 60 days in the ADSC group. In PRP-treated dogs, CBPI, VAS-loc, and DNS scores decreased by 43%, 43%, and 33% at 60 days, respectively (P=0.0003–0.011). Based on CBPI data, the rate of success at 60 days was 75% and 25% in the ADSC and PRP groups (P=0.13), respectively. Both therapies were apparently safe and effective to reduce chronic pain in dogs with bilateral DHJD during a 60-day period. However, a trend towards greater improvement was provided by the ADSC treatment.

Primer Total Kalça Protezi Uygulanmış Hastaların Peroperatif Komplikasyonları ve Postoperatif Dizilim Problemleri

INTRODUCTION: The application of hip joint arthroplasty in hip joint degenerative diseases improves joint pain. The lower elastic modulus of titanium alloy prostheses in hip prostheses than stainless steel elastic modulus ensures higher bone "bone ingrowing" in titanium alloy prostheses. However, malaligment applications during surgery shorten the life of the prosthesis. The aim of this study is to investigate post-operative alignment and to examine perioperative complications in patients undergoing total hip prosthesis. METHODS: In this study, 122 patients who underwent total hip arthroplasty for degenerative hip joint disease and elderly collum femoris fractures between 2013-2017 were evaluated. Perioperative complications in total hip prostheses and early complications of prosthesis alignment in retrospective early follow-up. RESULTS: 78 of these patients were female, 44 of them were male, the mean age was 66 years (42-87), the mean follow-up period was 27 months (6-48). Intraoperatively, femoral calcar fractures developed in 2 patients while 1.5% femoral component was placed. Malaligment was placed at an average of 6 degrees (3-9 degrees) in 9% valgus position in 11 patients. Intraoperative blood loss was observed on average 855 ml (460-1250 ml) DISCUSSION AND CONCLUSION: The results of the implants produced in our country show similar clinical and radiological results with the results stated in the literature. It is considered to be advantageous in terms of both the contribution to the country's economy and the contribution to the patient's health and being easily available.

Adolescent hip dysplasia: what are the symptoms and how to diagnose it.

Adolescent and young adult hip dysplasia is a cause of hip pain which can lead to early hip osteoarthritis. This may result in early hip osteoarthrosis and possible total hip arthroplasty if dysplasia is not recognized and treated. Hip dysplasia in this population can be difficult to diagnose. It is important for primary care providers and pediatricians to recognize the symptoms, physical examination findings, and radiographic findings associated with adolescent hip dysplasia so that the patient can be referred to an orthopedist specializing in hip disorder. The current review includes the most up-to-date literature on the diagnosis of adolescent hip dysplasia. Recent studies have shown that most patients presenting with symptomatic hip dysplasia present with insidious onset hip pain localized to either the groin or lateral aspect of the hip in a C-shape distribution around the inguinal crease. Patients most commonly see several different providers and have pain for a long period prior to accurate diagnosis. There are myriad radiographic measurements of hip dysplasia, many of which are described below that are helpful in initial diagnosis. Adolescent and young adult hip dysplasia can be a cause of early, progressive hip osteoarthritis. Hip dysplasia is a term that represents a spectrum of disorder due to abnormal formation of the hip joint, resulting in an acetabulum that does not sufficiently cover the femoral head. The ability to recognize symptoms, physical examination findings, and radiographic evidence of adolescent hip dysplasia is critical so that the patient can be referred to the appropriate provider and receive timely treatment prior to the onset of degenerative hip disease. This article will focus mainly on the diagnosis of adolescent hip dysplasia. The standard for treatment of acetabular dysplasia in skeletally mature patients is the periacetabular osteotomy; however, nonoperative management and occasionally arthroscopic surgery can also be considered in cases of symptomatic borderline dysplasia.

Selection of spinal surgery and hip replacement sequence in patients with both degenerative scoliosis and hip disease.

ObjectiveTo discuss how the sequence of spinal surgery and hip replacement is determined for patients with both degenerative scoliosis and hip disease.MethodsTwenty-six patients treated for both degenerative scoliosis and hip disease from June 2012 to June 2015 were retrospectively studied. Eleven patients underwent hip replacement followed by lumbar surgery (Group A), and 15 patients underwent lumbar surgery followed by hip replacement (Group B). The average follow-up duration was 1.5 years. Related indicators were assessed preoperatively and postoperatively.ResultsThe parameters showing significant differences between Groups A and B after surgery were acetabular anteversion, the Oswestry functional disability score, and the Harris hip score. Postoperatively, five patients in Group A had unequal shoulder heights and inclination of the trunk to one side. After lumbar surgery and before total hip arthroplasty in Group B, eight patients could not walk, and the limitation was more severe than that preoperatively.ConclusionSpinal surgery may be performed first to resolve lumbar nerve symptoms and restore sagittal balance of the spine; hip replacement may then be performed to simplify hip replacement difficulties and resolve the imbalance after spinal surgery. Severely limited range of motion exists after lumbar surgery and before total hip arthroplasty.

Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease

Background and purposeThe purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. MethodsThis a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011.Each subject completed three questionnaires at final follow- up: “Hip "Outcome Score-Activities of Daily Living" (HOS-ADL), "Hip Outcome Score-Sport" (HOS-S) and " Modified Harris Hip Score “(m-HHS). ResultsThirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months).Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores.Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores.No major complication was observed. Only four patients had minor complications.Mean survival time was 97.1 months (95% CI, 85.1–109.1 months), with a survival at 8 years of 69% (95% CI, 53%–85%). ConclusionsOur findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. Level of evidenceLevel IV. Case series.

Midterm Results of a Contemporary, Porous-Coated Acetabular System in Patients Undergoing Primary Total Hip Replacement for Degenerative Hip Disease: A Prospective, Multicenter Study

BackgroundA contemporary, porous-coated acetabular implant designed for uncemented insertion was introduced in Europe and Australia in 2007. A similar previous acetabular system was found in several studies at 10 to 15-year follow-up to demonstrate accelerated polyethylene wear, osteolysis, and early failure. The current study was conducted to determine the midterm safety and effectiveness of this contemporary acetabular system using highly crosslinked polyethylene and ceramic liners at 5-year follow-up. MethodsA prospective, nonrandomized study was conducted at 8 sites in Canada and the United States. All 148 study participants received a contemporary acetabular shell with proprietary porous coating. The primary outcome was the requirement for revision surgery at 5 years postoperatively. Secondary outcomes included a survival analysis, patient-reported outcome measures, radiographic failure, and postoperative adverse events. ResultsAt 5-year follow-up there was 1 cup revised for deep infection. No cups were revised for loosening and none were found to be radiographically loose. The overall survival rate with reoperation for any reason was 97.1%. The success rate was 96.8% for polyethylene and 100% for ceramic with no difference in the success rate between either bearing surface (P = 1.0). The mean patient-reported outcome measures all improved significantly between preoperative and 5-year postoperative scores (P < .001). ConclusionResults from this 5-year, multicenter, prospective study indicate excellent survivorship for this acetabular system when used with crosslinked polyethylene or ceramic bearing surfaces.

Simultaneous Bilateral Minimally Invasive Direct Anterior Approach Total Hip Arthroplasty with fast track Protocol.

Advanced degenerative hip joint disease is bilateral in approximately 20% of cases, prompting questions of whether it is necessary to perform two separate surgical procedures, whether simultaneous bilateral hip replacement makes the surgical treatment too extensive, and whether it significantly affects the postoperative course. The study analysed the duration of hospitalisation, perioperative complications, and the need for blood transfusion in 30 patients (27 men and 3 women) with bilateral hip osteoarthritis who underwent simultaneous bilateral total hip replacement from a minimally invasive direct anterior approach followed by a fast track protocol for optimisation of perioperative management between 2014 and 2017. The mean age of patients was 60.2 years (range 43 to 77 years) and the mean follow-up period was 28 months (range 18 to 48 months). Mean duration of hospitalisation was 4.5 days (range 3 to 9 days). A total of 4 patients (13%) required allogeneic blood transfusion. No patient developed thromboembolic or infectious complications or implant dislocation after surgery. Apart from one case where the acetabulum was not selected correctly, which resulted in postoperative loosening, there were no other significant medical events potentially related to the surgical treatment. Simultaneous bilateral total hip arthroplasty using a minimally invasive direct approach and a fast track protocol for optimisation of perioperative management does not increase the need for perioperative blood transfusion or the number of surgical complications and constitutes a safe, effective, and recommendable method of treatment in patients with advanced bilateral degenerative disease of the hip joints.

Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes.

Subchondral insufficiency fractures of the femoral head (SIFFH) are a cause of femoral head collapse leading to degenerative hip disease. SIFFH is often mistaken for osteonecrosis given similar clinical and radiographic features. These similarities often lead to missed or delayed diagnosis which can often delay or change management. The purpose of this article is to systematically review the spectrum of demographics, diagnostic and treatment options, including hip preservation in young patient populations. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All related peer-reviewed publications from January 1999 to January 2019 were reviewed using the following databases: Medline, EMBASE, Scopus and Web of Science. The systematic review identified 54 articles, encompassing 482 patients (504 hips) diagnosed with SIFFH. One hundred and seventy-six (35%) males and 306 (63%) females were included, with a mean age of 53.6 ± 17.5 years and mean body mass index of 23.4 ± 4.0 kg/m2. Mean follow-up was 23.4 ± 15.9 months. Treatment decisions were 256 (55%) non-operative, 157 (34%) total hip arthroplasty (THA), 24 (5%) transtrochanteric anterior rotational osteotomy, 9 (2%) hip arthroscopy, 7 (2%) hip resurfacing, 3 (1%) bone grafting, 3 (1%) hemiarthroplasty and 1 (1%) tantalum rod insertion. Overall, 35% of SIFFH hips were converted to THA at latest follow-up. A majority of SIFFH patients had symptom resolution with non-operative management. Failure most often resulted in THA. In younger patients, hip preservation techniques have shown promising early results and should be considered as an alternative.

CAM Impingement: Surgical Management

CAM-type femoroacetabular impingement is increasingly recognized as a source of activity-limiting symptom and a contributor to degenerative hip disease. Hip arthroscopy is an effective treatment option for repairing the resulting acetabular chondrolabral junction injury and reshaping the pathologic bony morphology to limit further joint degeneration. Recent randomized controlled trials have confirmed the advantages of surgical management of femoroacetabular impingement with hip arthroscopy over conservative management. Standard technique utilizes 3 portals, anterolateral, mid-anterior, and distal anterolateral accessory. Interportal capsulotomy allows access to the central compartment to resect a concomitant pincer lesion, refixate a torn labrum, and treat articular cartilage injury. The mid-anterior portal is used for arthroscopic visualization, while suture anchors are placed through the distal anterolateral accessory portal and the anterolateral portal is a working portal. T-capsulotomy provides extensile exposure of the entire CAM lesion, and viewing from the mid-anterior portal further improves arthroscopic visualization. Fluoroscopy is essential for intraoperative mapping of the CAM lesion and to confirm appropriate resection. Capsular closure is performed routinely to repair both the T-capsulotomy and the interportal capsulotomy. This review provides a comprehensive description of the surgical technique for CAM impingement, as well as the postoperative rehabilitation and outcomes.