Efficacy Of Total Hip Arthroplasty Research Articles

Medium- to long-term clinical efficacy of total hip arthroplasty with structural bone grafting for dysplasia of the hip.

Patients with dysplasia of the hip (DDH) have different degrees of bone defects above and outside the acetabulum, and anatomically reconstructing the acetabular centre of rotation is difficult in primary total hip arthroplasty (THA). From April 2012 to December 2022, 64 patients (64 hips) with DDH treated with THA with structural bone graft in the superolateral acetabulum were selected. The Oxford hip score(OHS), Barthel index (BI), leg length discrepancy, Wibegr central edge-angle(CE), gluteus medius muscle strength, vertical and horizontal distance of the hip rotation center, coverage rate of the bone graft and complications were used to evaluate the clinical effectiveness of the patients. All patients were followed up for an average of 7.3±1.9 years. The OHS improved significantly after the operation (P<0.001). The postoperative BI was significantly greater than that before operation (P<0.001). The postoperative leg length discrepancy was significantly lower than that before the operation (P<0.001). Postoperative bedside photography revealed that the height and horizontal distance to the hip rotation center were significantly lower after surgery than before surgery (P<0.001). The postoperative CE was significantly greater than that before surgery (P<0.001). No acetabular component loosening or bone graft resorption was found during the postoperative imaging examination. The use of biological acetabular cup combined with structural bone graft in the superolateral acetabulum in THA for DDH can obtain satisfactory medium and long-term clinical and radiological results.

The Effect of Limb Length Discrepancy and Anteversion on The Post-Operational Efficacy of Total Hip Arthroplasty

The Effect of Limb Length Discrepancy and Anteversion on The Post-Operational Efficacy of Total Hip Arthroplasty

Virtual and Augmented Surgical Skills in Total Hip Arthroplasty.

A surgical treatment called arthroplasty can be used to rehabilitate the function of joints. Hip arthroplasty is the surgical replacement of a hip joint. It is the procedure in which the joint surface can be replaced, retreated, or readjusted. It is useful when medical treatment cannot overcome long-lasting joint pain. Arthroplasty in patients significantly increases quality of life, activity level, and joint pain. The most commonly performed arthroplasty is of hip and knee joints. During any surgical treatment, complications occur. Some common complications during arthroplasty are hemorrhage, septicemia, mass in the legs and lungs, and loosening of prosthetic parts. This method's proponents point out that quicker recovery periods, decreased pain levels, higher patient satisfaction, and immediate return to function are the highlighted indicators. Many techniques have been created and used for preoperative planning for a hip replacement with varying degrees of effectiveness. It mainly includes digital templating, which has allegedly improved the accuracy of prosthetic implant size prediction and increased the efficacy of total hip arthroplasty (THA). Surgical training for hip replacement includes teaching, practice, treatment, and techniques performed during arthroplasty. Preoperative education also plays a vital role in surgical training as it is a major surgical procedure that is physically and mentally stressful for the patient. The resources in surgical training of hip arthroplasty contribute to rapid progress in surgical training worldwide with increasing occurrence of THA. This article's focus is to draw outcomes from the surgical treatment of hip arthroplasty by comparing and concluding about virtual and surgical treatment.

Total hip arthroplasty for treatment of femoral neck fracture due to hypophosphatemic osteomalacia: a retrospective case series with mean follow-up of fiveyears.

To retrospectively characterize the clinical characteristics and efficacy of total hip arthroplasty and the important factors needing attention in hypophosphatemic osteomalacia (HO) patients with hip involvement. We performed a review of seven patients (two women and five men) referred to our clinic with a final diagnosis of HO who received total hip arthroplasty between 2010 and 2018. Five patients (Group 1) received proper medical management with or without aetiologic therapy, while the other two patients (Group 2) did not receive due to misdiagnosis. The mean follow-up duration was 5.1 ± 2.0years. The patients in Group 1 had significant relief of pain and improved laboratory results. The mean Harris Hip Score of Group 1 increased from 44.2 ± 6.0 to 94.0 ± 3.0, and the mean VAS score decreased from 8.8 ± 0.4 to 1.8 ± 0.7. However, the progressive extensive pain score in Group 2 had no obvious improvement, with the Harris Hip Score increasing from 45.5 ± 0.5 to 60 ± 28.0 and the VAS score decreasing from 9.0 ± 1.0 to 6.5 ± 2.5. THA appears to be an effective method for hip arthritis or joint deformities resulting from hypophosphatemic osteomalacia. A satisfactory outcome of the surgery depends on the early etiological identification, the treatment of hypophosphatemia, a careful operation, and the operative strategies, as well as proper medical treatment.

Comparison of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position

To compare the clinical efficacy of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position. From February 2017 to January 2019, 67 patients underwent hip arthroplasty due to hip diseases, including 21 patients in the minimally invasive group, 12 males and 9 females;there were 10 cases of femoral neck fracture, 5 cases of aseptic necrosis of femoral head and 6 cases of hip osteoarthritis. In the traditional group, 46 cases were treated by traditional posterolateral approach, including 28 males and 18 females;there were 24 cases of femoral neck fracture, 12 cases of aseptic necrosis of femoral head and 10 cases of hip osteoarthritis. All patientsused biological ceramic artificial joint prosthesis. The operation time, intraoperative bleeding, incision length, preoperative and postoperative creatine kinase (CK-NAC), underground activity time, hospital stay, abduction angle and anteversion angle of prosthesis were observed and compared between two groups. Harris scores before operation and 12 months after operation were compared between two groups. All cases were followed up for 14 to 26(18.4±3.6) months. There was no significant difference in intraoperative bleeding, postoperative anteversion and abduction angle between two groups (P>0.05). There were significant differences in operation time, incision length, postoperative creatine kinase, underground time and hospital stay between two groups (P<0.05). There was no significant difference in Harris function score between two groups before operation and 12 months after operation(P>0.05). The two approaches of total hip arthroplasty can obtain satisfactory results.OCM approach has less damage and rapid postoperative recovery. It is a reliable surgical approach and can be popularized and used.

A comparative study of MAKO robotic arm assisted total hip arthroplasty and traditional total hip arthroplasty through posterolateral approach

To investigate the efficacy of total hip arthroplasty (THA) assisted by the MAKO robotic arm via posterolateral approach. The clinical data of 70 patients treated with THA via posterolateral approach between March 2017 and March 2019 who met the selection criteria were retrospectively analyzed. According to different treatment methods, the patients were divided into two groups, 35 were treated with MAKO robotic arm assisted THA (MAKO group) and 35 with traditional THA (THA group). There was no significant difference in gender, age, body mass index, disease duration, etiology, perioperative time, preoperative activity of daily living (ADL) scale index, American Society of Anesthesiologists (ASA) classification, walking ability, comorbidities, hemoglobin, and other general data between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stay, postoperative acetabular abduction and anteversion angles, postoperative length difference of bilateral lower limbs, and proportions of intraoperative blood transfusion, immediate postoperative loading, wound drainage time more than 2 days, and complications were recorded and compared between the two groups. According to the X-ray films at 6 months after operation, the reduction quality was judged. The forgotten joint score, Harris score, and proportions of independent walking and ADL index increased were used to evaluate the function recovery of patients. Patients in both groups were followed up 6-18 months, with an average of 8 months. There was no significant difference ( P>0.05) between the two groups in operation time, intraoperative blood loss, hospital stay, acetabular abduction and anteversion angles, and length difference of both lower limbs at 6 months after operation. There was no significant difference in the proportions of intraoperative blood transfusion, immediate postoperative loading, and wound drainage time more than 2 days between the two group ( P>0.05). X-ray reexamination at 6 months after operation showed that there was no significant difference in the reduction quality between the two groups ( Z=4.191, P=0.123). Postoperative complications occurred in 7 patients (20.0%) in the MAKO group and 10 patients (28.6%) in the THA group, showing no significant difference in the incidence of complications between the two groups ( χ 2=2.121, P=0.224). Two patients (5.7%) in the MAKO group and 4 patients (11.4%) in the THA group underwent revision within 6 months, showing no significant difference in the revision rate between the two groups ( χ 2=0.729, P=0.673). At 3 and 6 months after operation, the proportions of independent walking and ADL index increased showed no significant difference between the two groups ( P>0.05). Harris scores in both groups improved significantly when compared with preoperative scores ( P<0.05); there was no significant difference in the forgotten joint scores and Harris scores between the two groups ( P>0.05). Compared with traditional THA, MAKO robotic arm assisted THA has longer operation time and more intraoperative blood loss, but it has the advantages of accurate positioning and simple operation, and there is no significant difference in short-term postoperative function recovery.

The efficacy of total hip arthroplasty on locomotive syndrome and its related physical function in patients with hip osteoarthritis

BackgroundLocomotive syndrome (LS) is a predictive factor of future motor dysfunction. Our aim was to evaluate the change in the total LS grade and, its the association with the Japanese Orthopaedic Association (JOA) hip score after total hip arthroplasty (THA) among patients with hip osteoarthritis. MethodsThis was a prospective case–control study of 72 patients who underwent primary THA. The functional outcomes were measured before, and at 6 and 12 months after THA. LS was evaluated using the following tests: stand-up test, 2-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). In addition, factors affecting the improvement of LS grade were examined. ResultsPrior to THA, 7% and 93% of patients were classified as LS grades 1 and 2. At 6 months after THA, an improvement in the total LS grade was observed in 57% of patients, with this percentage further increasing to 65% at 1 year. Only the preoperative GLFS-25 was correlated with the preoperative JOA hip scores. The postoperative GLFS-25 and the two-step test were correlated with the postoperative JOA hip scores. The preoperative functional reach test (FRT) was significantly correlated with the total LS grade improvement. ConclusionsTHA can improve the total LS grade in 65% of patients at 1 year postoperatively. Improvement was largely achieved in the first 6 months after THA, with a change from LS grade 2 to grade 1. FRT could be used an indicator of the total LS grade improvement.

Efficacy of total hip arthroplasty for the treatment of patients with femoral head avascular necrosis: A protocol for systematic review and meta-analysis.

Background:Femoral head avascular necrosis (FHAN) is a very common condition among elderly population. Previous studies have reported that total hip arthroplasty (THAP) can benefit patients with such condition. However, no study systematically addressed this topic. Thus, this study will systematically explore the efficacy and safety of THAP for the treatment of patients with FHAN.Methods:We will search the following electronic bibliographic databases from inception to the February 29, 2020: MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Scientific Journal Database. Randomized controlled trials of THAP for the treatment of patients with FHAN will be included, which were reported in any language. All process of study selection, data collection, and study quality assessment will be performed independently by 2 authors independently. Any divergences will be solved by discussion with another author. RevMan 5.3 software will be carried out for data synthesis and analysis.Results:This study will provide a detailed summary of current evidence related to the efficacy and safety of THAP for the treatment of patients with FHAN through assessing pain intensity of hip or knee joints, function and limitation of attacked femoral head, health-related quality of life, and complications.Conclusion:The findings of this study may provide helpful guidance of THAP for the treatment of patients with FHAN.Systematic review registration:INPLASY202040067.

Efficacy of total hip arthroplasty after operatively treated acetabular fracture.

We evaluated the clinical and radiological outcomes of patients following total hip arthroplasty (THA) for acetabular fracture. This was a retrospective cohort study in a single center. The medical records of patients who underwent THA from March 2002 to March 2017 were reviewed. Inclusion criteria were THA and a history of open reduction and internal fixation of acetabular fractures. Thirty-seven patients with a mean age of 56.2years were enrolled. The Harris hip score (HHS), acetabular fracture classification, time interval between acetabular fracture and THA, cause of THA, surgical approach, implant type, complications, radiographic results, and Kaplan-Meier survival curves were analyzed. All patients were followed up for an average of 6.6years. The mean preoperative HHS of 42.5 had improved to 83.5 at the final follow-up (p < 0.05). There were 29 cases of post-traumatic arthritis, 6 cases of avascular necrosis, and 4 cases of non-union. The average interval from injury to THA was 58months (range 4-336months). The re-admission rate was 18.9%. Patients who underwent conversion to THA due to post-traumatic arthritis combined with non-union acetabular fracture developed clinical failure more frequently than patients with post-traumatic arthritis (p = 0.037). At 12years, 83.4% of patients were free from revision of femoral and acetabular components. THA secondary to an operatively treated acetabular fracture provides good symptomatic relief, but shows relatively inferior survival rates, and clinical failure was related to post-traumatic arthritis with acetabular non-union.

Total hip arthroplasty by direct anterior approach in the lateral position for the treatment of ankylosed hips.

To investigate the clinical efficacy of total hip arthroplasty (THA) via the direct anterior approach (DAA) for the treatment of hip ankylosis in the lateral position. A retrospective analysis was performed on the clinical data of 24 patients (39 hips) who underwent THA via the DAA in the lateral position for the treatment of hip ankylosis between January 2016 and December 2018. We performed bilateral THA for fifteen patients and unilateral THA for nine patients. Operation time, intraoperative blood loss, length of incisions, straight leg-raising time, length of postoperative hospital stay, operation-related complication, prosthesis position, radiological outcomes, postoperative pain relief (evaluated by VAS) and functional rehabilitation [evaluated by Harris hip score and range of motion (ROM)] were analyzed to determine clinical efficacy. These clinical data were compared and statistically analyzed with the clinical data of another 23 patients (28 hips) who underwent THA via the posterolateral approach (PLA) for the treatment of hip ankylosis in the lateral position. Follow-up was performed at 12-15months. The incision length in the DAA group and the PLA group was (11.12 ± 1.69 vs. 14.36 ± 3.42)cm, the intraoperative blood loss was (371.25 ± 120.55 vs. 396.80 ± 101.21)ml, the operation time was (122.47 ± 25.40 vs. 138.47 ± 24.45)min, the postoperative hospital stay was (9.59 ± 4.62 vs. 12.08 ± 3.58)days, and the straight leg elevation time was (9.20 ± 2.12 vs. 12.34 ± 3.25)days, respectively. The prosthesis of the two groups was in a good position: The average angle of cup anteversion in the DAA group and the PLA group was (10.76 ± 2.84 vs. 15.36 ± 3.42)°, and the average angle of cup abduction in the DAA group and the PLA group was (40.00 ± 3.45 vs. 41.21 ± 2.85)° (P > 0.05). The VAS score, ROM and Harris score at different follow-up time points were significantly improved in the two groups compared with those before surgery. In the first 3months after surgery, the VAS score, ROM and Harris score of the DAA group were significantly better than those of the PLA group (P < 0.05), but with the extension of the follow-up time, there was no significant difference in the above indicators between the two groups (P > 0.05). One case of greater trochanteric fracture occurred in the DAA group. Two cases of hip posterior dislocations occurred in the PLA group, and no dislocations occurred after manual closed reduction and hip fixation in bed for 1month to the last follow-up. No complications such as infection, deep vein thrombosis, fat embolism, prosthesis loosening, limb length inequality or joint dislocation were reported. THA via the DAA for the treatment of hip ankylosis in the lateral position was safe and effective and had the advantage of reduced trauma, quicker recovery of hip function, lower incidence of postoperative dislocation and ability to expose the acetabulum fully and fit the prosthesis properly, providing satisfactory clinical efficacy.

Total hip arthroplasty with femoral osteotomy and modular prosthesis for proximal femoral deformity

BackgroundSevere anatomical abnormalities exist in proximal femoral deformities (PFDs). Total hip arthroplasty (THA) is associated with drawbacks such as high surgical complexity, long operation time, requirement for high surgical skills, high incidences of postoperative complications, and poor efficacy.ObjectiveThis study aimed to investigate the short-term efficacy of THA with femoral osteotomy and modular prosthesis implantation for femoral fixation and reconstruction in patients with PFD.MethodsA total of 15 patients (15 hips) with rotational PFD treated with THA with femoral osteotomy and modular prosthesis between August 2012 and September 2014 were included. There were 10 male (10 hips) and 5 female (5 hips) patients. Preoperative limb shortening, intraoperative osteotomy length, and postoperative limb length were recorded. The Harris hip score was adopted for assessing the clinical results. Postoperative radiography was performed to observe the prosthesis position, as well as the presence or absence of abnormalities such as osteolysis, loosening, and subsidence of the prosthesis.ResultsAll 15 patients were followed up postoperatively, with a mean follow-up duration of 62.5 (range 20–85) months. The postoperative limb-length discrepancy (1.0 ± 0.5 cm) was significantly less than the preoperative discrepancy (3.2 ± 1.2 cm) (t = − 2.501, P = 0.002). The Harris hip score significantly improved from a mean of 47.2 ± 9.9 points preoperatively to 89.7 ± 3.9 points during the last follow-up visit (t = 21.31, P = 0.001). Immediate postoperative radiographs showed restoration of limb alignment after femoral osteotomy, excellent initial press-fit fixation of the S-ROM prosthesis, and good canal filling. According to Engh’s criteria, all 15 hips were graded as ingrown bones. No infection, prosthesis loosening, periprosthetic fracture, or other complications occurred.ConclusionIn patients with femoral deformities treated with THA, precise osteotomy, good coaptation of the osteotomy surfaces, and correct choice of modular S-ROM prostheses for femoral reconstruction and fixation remain the key factors for surgical success.

Safety and efficacy of total hip arthroplasty following failed internal fixation of intertrochanteric fractures

To evaluate the safety and efficacy of total hip arthroplasty (THA) following failed internal fixation of intertrochanteric fractures. Between January 2007 and January 2016, THAs were performed in 32 patients (33 hips) for failed internal fixation of intertrochanteric fractures. There were 15 males and 17 females, with mean age of 74.0 years old (range, 65-87 years). There were 3 hips of Evans-Jensen type Ⅱ, 10 hips of type Ⅲ, 8 hips of type Ⅳ, and 12 hips of type Ⅴ. The fractures were fixed with dynamic hip screw in 18 hips, proximal femoral nail antirotation in 9 hips, locking plate in 5 hips, and hollow screw in 1 hip. The internal fixation failure caused by fracture displacement and nonunion in 22 patients, traumatic arthritis in 6 patients, fracture nonunion and infection in 3 patients, and avascular necrosis of the femoral head in 2 patients. The mean interval from initial fracture fixation to THA was 20 months (range, 2-48 months). The safety evaluation indicators included operation time, amount of operative bleeding and postoperative drainage, blood transfusion, and perioperative complications. The efficacy indexes included the hip Harris score, the range of motion (ROM), visual analogue scale (VAS) score, and the length difference between both legs; the X- ray films were taken to assess the prosthesis survival condition. The average operation time was 92 minutes (range, 55-135 minutes). The average amount of operative bleeding and postoperative drainage were 480 mL (range, 360-620 mL) and 350 mL (range, 220-520 mL), respectively. Intraoperative proximal femur fissure fracture occurred in 2 hips. After operation, 10 cases received allogeneic blood transfusion, 1 case occurred cerebral infarction, 2 hips experienced dislocation, 1 hip occurred greater trochanter re-fracture and dislocation because of spraining, and 1 case died of myocardial infarction. Twenty-nine patients (30 hips) were followed up 2-10 years (mean, 4.9 years). At last follow-up, there was no infection recurrence in 3 infected hips, and there was no prosthesis loosening, subsidence, or rupture in all cases. The Harris score, ROM, VAS score, and the length difference between both legs were significantly superior to preoperative ones ( P<0.05). THA is an effective salvage procedure after failed internal fixation of intertrochanteric fracture. But its perioperative risks and complications are pretty high. Adequate preoperative evaluation, elaborate and individualized perioperative management are keys to make sure the patient can safely survive the perioperative period.

Total hip arthroplasty for the treatment of bony ankylosis in patients with ankylosing spondylitis

To evaluate the efficacy of total hip arthroplasty for the treatment of bony ankylosis in patients with ankylosing spondylitis. From January 2008 to January 2012, 12 patients (24 hips) with ankylosing spondylitis combined with hip ankylosis were treated with total hip arthroplasty, including 11 males and 1 females, ranging in age from 27 to 62 years old. The course of diseases ranged from 5 to 32 years old. Preoperative and postoperative hip mobility and Harris function score, intraoperative and postoperative complications were analyzed. All the patients were followed up, and the duration ranged from 60 to 96 months, with an average of 72.6 months. The Harris hip scores of all patients were improved. Three patients got an excellent result, 6 good and 3 fair. One case had heterotopic ossification of Brooker I without clinical symptoms. One patient with severe flexion deformity underwent femoral nerve traction injury after operation, and recovered after 1 year of follow-up. No prosthesis subsidence or cup loosening, no joint dislocation, acute infection or deep venous thrombosis occurred during the latest follow-up. Total hip arthroplasty is an effective method for the treatment of ankylosing spondylitis with hip ankylosis at the advanced stage.

Safety and efficacy of total hip arthroplasty in patients with end stage renal disease

To evaluate the safety and efficacy of total hip arthroplasty (THA) in patients with end stage renal disease (ESRD). Between December 2009 and May 2016, 30 THAs were performed in 28 patients with dialysis-dependent renal failure (18 patients) or renal transplantation (10 patients). A retrospective case control study was carried out to compare these 28 ESRD patients (ESRD group) with a matched cohort of 28 nonrenal patients (control group). There was no significant difference in gender, age, hip side, American Society of Anesthesiology (ASA) classification, comorbidities, and preoperative Harris score and hemoglobin (Hb) level between 2 groups ( P>0.05). The complications during hospitalization, Hb level changes, perioperative transfusion rate, hospital stay, and hospitalization costs in 2 groups were evaluated; and the creatinine changes of dialysis patients in ESRD group were evaluated. During the follow-up period, 90 days readmissions, periprosthetic infection, prosthesis loosening, hip Harris score, and deaths were recorded. There was no loss of follow-up. The mean postoperative follow-up of ESRD group was 3.4 years (range, 1.0-7.4 years) and control group was 3.5 years (range, 1.0-7.4 years). Differences in hospital stay and the drop of Hb was not significant between 2 groups ( P>0.05). The hospitalization costs and perioperative transfusion rate were significantly higher in ESRD group than in control group ( P<0.05). There was no significant difference in creatinine value of dialysis patients in ESRD group between pre- and post-operation ( t=1.804, P=0.089). At last follow-up, the Harris score was significantly higher than preoperative score in both groups ( P<0.05); however, there was no significant difference in Harris score between groups ( t=1.278, P=0.207). In ESRD group, 5 patients presented complications, 1 patient was readmitted to hospital, and 2 patients died during the follow-up. In control group, 1 patient presented complications, and there was no 90 days readmission and no death. During the follow-up period, there was no loosening or revision in 2 groups and the prosthesis was in good position. THA can improve joint function and life quality of ESRD patients, but the risks of operation, perioperative complications, transfusion rate, and cost are high. Correct perioperative evaluation and management can help ESRD patients safely go through the perioperative period.

Total hip arthroplasty in patients with Psoriatic arthritis

Objective: To evaluate the clinical efficacy of Total hip arthroplasty (THA) in treating the hip joint involvement of Psoriatic arthritis (PsA). Methods: From January 2005 to December 2016, a total of 15 PsA patients (20 hip joints) underwent THA in Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. All the patients had obvious restriction in daily life before operation. The mean Harris score was 25.2 averagely and the mean total range of the hip joint movement was 39.6° before surgery. All the prosthesis were biotype and ceramic to ceramic. Results: All patients were followed up with an average of 35.7 months and could take care of themselves. The Harris score of hip joint was 83.2 averagely, including 15 hips excellent, 3 good, and 2 passable, with an excellent and good rate of 90%. The mean total range of the hip joint movement was 175° after surgery. There was no infection, nerve injury or loosening of the prosthesis. 1 hip appeared avulsion fracture of greater trochanter of femur, and the joint function was satisfying at the last time of follow-up. Conclusion: THA is an effective method in treating affected hip joint of PsA. It can restore the hip function and improve the life quality of the PsA patients.

Direct anterior approach for total hip arthroplasty with a novel mobile traction table -a prospective cohort study

BackgroundThe purpose of this prospective cohort study was to clarify the safety and efficacy of total hip arthroplasty via the direct anterior approach in the supine position with a novel mobile traction table.MethodsThe first experience of consecutive surgeries by a single surgeon using the direct anterior approach with a traction table is described with a two-year follow-up period. Of 121 patients, 100 patients without previous hip surgeries, severe deformity, or cemented implants were divided into two groups comprising the first 50 patients and the second 50 patients.ResultsThe implant survival rate was 99% at the two-year follow-up. Revision surgery was required for periprosthetic femoral fracture in one patient. The complication rate possibly related to the traction table was 5% (5 patients): three anterior dislocations, one periprosthetic femoral fracture, and one intraoperative perforation caused by femoral rasping. The complication rate tended to decrease in the second group compared to the first group (4% versus 6%). Mean surgical time (72.0 minutes versus 82.5 min, p = 0.027), rate of allogeneic blood transfusion (2% versus 24%, p = 0.001), and cup alignment in the safe zone (100% versus 88%, p = 0.027) were significantly improved in the second group compared to the first group.ConclusionThe direct anterior approach with a novel mobile traction table showed a positive learning curve for surgical time, rate of allogeneic blood transfusion, and cup alignment in the safe zone.

Complications of total hip arthroplasty following solid organ transplantation.

Solid organ transplants (SOT) continue to increase with recipients living longer than ever before. The lifelong immunosuppression in these patients also may place them at increased risk for postoperative complications. The efficacy of total hip arthroplasty (THA) in this patient population is undisputed but previous studies investigating the complication profiles in these patients often are underpowered to identify rare complications as well as make comparisons between individual organs. The purpose of this study was to use a large database to compare complications of a combined SOT cohort as well as each individual organ to a control population. A search of the entire Medicare database from 2005 to 2011 was performed using International Classification of Disease version 9 (ICD-9) codes to identify patients who underwent THA after one or more solid organ transplants. A large cohort of patients served as a control with minimum 2-year follow-up. Post-operative complications at 30-day, 90-day, and overall time points were investigated. Transplant patients carry more medical comorbidities and are prone to increased medical complications, dislocations (OR 1.45, p<0.001), need for irrigation and debridement (OR 1.90, p<0.001), and periprosthetic infection (OR 1.69, p<0.001) compared to patients without SOT. Total hip arthroplasty after renal transplantation has the worst complication profile of the individual organs whereas lung and pancreas transplants were no different than control with regard to overall surgical complications. The complications of THA after SOT vary by individual organ and these results may aid in patient selection and perioperative patient counseling.

The efficacy of modified direct lateral versus posterior approach on gait function and hip muscle strength after primary total hip arthroplasty at 12 months follow-up. An explorative randomised controlled trial

BackgroundThe lateral and the posterior approach are the most commonly used procedures for total hip arthroplasty. Due to the detachment of the hip abductors, lateral approach is claimed to cause reduced hip muscle strength and altered gait pattern. However, this has not been investigated in a randomised controlled trial. The aim was to compare the efficacy of total hip arthroplasty performed by lateral or posterior approach on gait function and hip muscle strength up to 12months post-operatively. We hypothesised that posterior approach would be superior to lateral approach. MethodsForty-seven patients with primary hip osteoarthritis were randomised to total hip arthroplasty with either posterior or lateral approach and evaluated pre-operatively, 3 and 12months post-operatively using 3-dimensional gait analyses as objective measures of gait function, including Gait Deviation Index, temporo–spatial parameters and range of motion. Isometric maximal hip muscle strength in abduction, flexion and extension was also tested. FindingsPost-operatively, no between-group difference in gait function was observed. However, both hip abductor and flexor muscle strength improved more in the posterior approach group: −0.20(Nm/kg)[95%CI:−0.4 to 0.0] and −0.20(Nm/kg)[95%CI:−0.4 to 0.0], respectively. InterpretationContrary to our first hypothesis, the overall gait function in the posterior approach group did not improve more than in the lateral approach group. However, in agreement with our second hypothesis, patients in the posterior approach group improved more in hip abductor and flexor muscle strength at 12months. Further investigation of the effect of reduced maximal hip muscle strength on functional capacity is needed.ClinicalTrials.gov. No.: NCT01616667

Total hip arthroplasty with no femoral shortening osteotomy for unilateral Crowe IV developmental dysplasia of the hip

Objective To evaluate the clinical efficacy of total hip arthroplasty （THA） with no femoral shortening osteotomy for unilateral Croweiv developmental dysplasia of hip. Methods From October 2007 to January 2010, 32 patients with Croweiv developmental dysplasia of hip in one side underwent THA, including 20 females and 12 males, with an average age of 49.4±9.7 years （range, 23-60 years）. There were 15 cases as normal and 17 as mild developmental dysplasia of hip in the other side. The THA were performed with requisite soft tissue release and direct leverage using an elevator but with no femoral shortening osteotomy. The patients＇ satisfaction, Harris hip score, bilateral leg-length discrepancy and pelvic obliquity was used to assess the clinical results. Results All of patient were followed up for 1-6 years, average 4.0±1.5 years. No loosening or failure of component occurred by the end of follow-up. The Harris hip score was improved from preoperative 36.5±10.3 （20-63） to 89.8± 4.9 （80-97）, and the excellent and good rate was 100% （excellent 16 cases, good 16 cases）. The satisfactory rate was 93.8% （30/32）. The leg-length discrepancy of the bilateral sides and the pelvic obliquity was corrected gradually and the gait returns to normal. Nine cases have valgus knee after THA and 4 cases of them felt uncomfortable after long-distance walk. Femoral nerve injury occurred in 2 cases. All of cases recovered after 1 and 3 months respectively. No infection and dislocation occurred. Conclusion THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral Crowe Ⅳ developmental dysplasia of hip. The discrepancy of leg-length will be diminished with the correction for pelvic obliquity. Key words: Hip dislocation, congenital; Arthropalsty, replacement, hip; Acetabulum; Adult

Total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe IV developmental dysplasia of the hip

Objective To evaluate the clinical efficacy of total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe IV developmental dysplasia of the hip. Methods From September 2003 to September 2012, 21 patients （24 hips） underwent total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe IV developmental dysplasia of the hip in our hospital. There were 3 males and 18 females, aged from 28 to 71 years （average, 54±10 years）. The ceramic- polyethylene articulation was used in 17 patients （20 hips）, and metal-polyethylene articulation in 4 patients （4 hips）. The osteoto- my site was treated with autologous bone graft in 18 patients （21 hips） and allogeneic bone graft in 3 patients （3 hips）. The Harris hip score was used to assess the clinical results. Results A total of 18 patients were followed up for 0.5 to 9 years （average, 3.5 years）. The Harris hip score was improved from preoperative 47.9±9.1 to 88.4±3.5 at 6 months postoperatively. For most patients, hip pain relieved significantly; range of motion of the hip was improved, and the gait returned to normal. Sciatic nerve palsy occurred in 1 patient. There was no wound infection. X-rays 6 months after operation showed that the position of prostheses was satisfactory, without loosening of prostheses and bone block resorption. Conclusion Total hip arthroplasty with subtrochanteric femoral shortening osteotomy can achieve good clinical effect in Crowe IV developmental dysplasia of the hip. Moreover, it can improve leg length discrepancy and decrease the risk of sciatic nerve injury. Key words: Hip dislocation, congenital; Acetabulum; Arthroplasty, replacement, hip