Good Hip Function Research Articles

MID-TERM RESULTS OF AUTOLOGOUS MATRIX-INDUCED CHONDROGENESIS (AMIC) USED FOR LARGE CHONDRAL DEFECTS IN FEMOROACETABULAR IMPINGEMENT HIPS

Femoroacetabular impingement is a prearthritic deformity frequently associated with early chondral damage. Several techniques exist for restoring larger cartilage defects. While AMIC proved to be an effective treatment in knee and ankle, there are only short-term data available in hip. This study aimed to investigate the mid-term clinical outcome of patients with chondral lesions treated by AMIC and evaluate the quality of repair tissue via MRI.This retrospective, single center study includes 18 patients undergoing surgical hip dislocation for FAI between 2013 and 2016. Inclusion criteria were: cam or pincer-type FAI, femoral or acetabular chondral lesions > 1 cm2, (IRCS III-IV). Due to exclusion criteria and loss-to-follow-up 9 patients (10 hips) could be included. Patient reported outcome measures included Oxford Hip Score (OHS) & Core Outcome Measure Index (COMI)). MRIs were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score.None of the patients underwent revision surgery except screw removals from the greater trochanter. Followup data indicate a satisfactory to good hip function at 5 years: PROMS improved from pre- to postop at 5 years: OHS from 38.1 to 43.4, COMI from to 1.8 and UCLA from 4 to 8.1 respectively. MOCART score was 67.5 postoperatively. Subgrouping showed slightly better results for acetabular defects (Ø 69.4) compared femoral defects (Ø 60).Based on the reported mid-term results, we consider AMIC as a valuable treatment option for larger chondral defects of the hip.

Surgical Resection Combined with Adjuvant Radiotherapy and Non-Steroidal Anti-Inflammatory Drugs in the Treatment of Heterotopic Ossification Following Total Hip Arthroplasty.

Heterotopic ossification (HO) is a well-known complication following total hip arthroplasty (THA), with an average incidence of 30%. Patients are classified according to Brooker's staging system. In advanced stages (III and IV), HO may limit hip motion and cause intolerable pain. For these symptomatic stages, surgical excision is mandatory, usually combined with prophylaxis of recurrence with non-steroidal anti-inflammatory drugs (NSAIDs) and/or radiotherapy. We present the case of a 70-year-old woman who developed Stage IV HO after undergoing THA for left hip osteoarthritis. Surgical excision of the HO was performed eighteen months after THA, with adjuvant radiotherapy and indomethacin. After two years of follow-up, the patient had a good hip function with no recurrence of HO. Several authors have studied the effect of NSAIDs and radiotherapy in HO prophylaxis and in HO treatment but there is lack of reports concerning the combination of the two strategies with surgery in the postoperative period. We therefore report this successful case of post-THA HO treatment with surgical excision and post-operative radiotherapy and NSAIDs.

Hip Tuberculosis at Stage IV: Outcomes and Some Conditions for Total Hip Replacement

Background: Treatment of hip disorders during active hip tuberculosis has long been a controversial issue. Some authors have reported performing hip replacement with different strategies with very good outcomes. This study aimed to describe the surgical outcomes and necessary conditions for total hip replacement in active hip tuberculosis. Methods: We conducted a quasi-experimental study. The study enrolled 40 patients with 42 active tuberculosis hips at stage IV treated by total hip replacement from October 2016 to December 2019 at the National Lung Hospital. We followed up with the patients for at least 12 months, evaluated surgical outcomes, and investigated the factors associated with these outcomes by logistic regression analysis. Results: Surgical outcomes showed that 37 patients (88.1%) had excellent hip function, no abscesses, and no sinus tract formation. Four cases (9.5%) had sinus tract formations. One case (2.4%) had good hip function. Binary logistic regression models revealed that sinus tract formation was associated with preoperative tuberculosis infection syndrome. The average time to obtain antituberculosis drug treatment preoperatively was 4.6 weeks. Conclusion: Total hip replacement for active hip tuberculosis is a practical and promising treatment method. Surgeons should consider improving patients’ conditions before performing total hip replacement, administering antitubercular drugs, and arthrotomy to eliminate all abscesses, and decrease the risk of tuberculosis infection syndrome and the inflammatory response.

Function, sarcopenia and osteoporosis 10 years after a femoral neck fracture in patients younger than 70 years

Background and purposeA femoral neck fracture (FNF) may have long-term effects on the patient's function, also in patients younger than 70 years. These long-term effects are not well described, since most studies have short follow-ups. The aim of this study was to investigate clinical outcome by performance-based functional tests, hand grip strength, and hip function in different subgroups. The secondary aim was to study surgical complications, bone mineral density (BMD) and occurrence of sarcopenia 10 years after a FNF. Patients and methodsA prospective multicenter study with a 10-year follow-up of patients aged 20–69 years with a FNF treated with internal fixation (IF). Five-times sit-to-stand test (5TSST), 4-m walking speed test, hand grip strength (HGS) and Harris Hip Score (HHS) were performed.A radiographic examination of the hip was performed and re-operations were registered. Bone mineral density (BMD) at the hip, spine and total body composition were assessed with dual energy x-ray absorptiometry (DXA). Present sarcopenia was determined by the combination of reduced functional performance and low fat-free mass index (FFMI). ResultsA total of 58 patients were included. 5TSTS was normal in 45% of the patients and old age was associated with poorer performance (p<0.001). 76% of the study population had a normal speed gait and likewise, old age (p = 0.005) and walking aids (p = 0.001) were associated with poor performance. HGS was normal in 82% of the men and 64% of the women. HHS showed that 85% had a good/excellent function. A major re-operation was performed in 34% of the patients with displaced FNF and in 20% of patients with non-displaced FNF. 74% displayed osteopenia and 12% osteoporosis. 17% of the men and 38% of the women had sarcopenia. InterpretationThe majority of patients less than 70 years of age with a FNF treated with IF, had normal functional tests, muscle strength and a good hip function ten years post-operatively. However, one in ten had osteoporosis, and one third was sarcopenic which indicate the importance of encouraging regular muscle preserving resistance training after hip fracture.

Total Hip Arthroplasty for Hip Fracture: Clinical Results and Mid-Term Survivorship.

AimThe purpose of this study is to report the clinical results and mid-term survivorship for total hip arthroplasty (THA) performed to treat displaced intracapsular hip fracture.MethodsBetween January 2005 and December 2019, 414 patients underwent THA for acute displaced intracapsular hip fracture. The mean age of patients was 73.2±8.0. Out of the total patients, 89.6% received a cemented THA. Kaplan-Meier analysis was performed with implant survivorship and dislocation as separate endpoints. Complications and modified Harris Hip Score (HHS) at the latest follow-up were also reported.ResultsThere was a total of nine revisions, six were performed for dislocation and three for infection. Kaplan-Meier implant survivorship was 99.0% at five years and 97.7% at ten years. Twenty (4.8%) patients suffered at least one dislocation and 11 suffered more than one, so following a first dislocation, the chance of one or more further dislocations was 11/20 (55%). Kaplan-Meier analysis with dislocation as the endpoint showed the risk of dislocation of 2.9, 4.4, and 5.2% at one, five, and ten years respectively. Three (0.7%) patients suffered late periprosthetic fractures and 22 (5.3%) contralateral hip fractures. The mean modified HHS at the latest follow-up was 86.3±18.9.ConclusionIn conclusion, the present study shows excellent implant survivorship, good hip function, and moderate risk of dislocation and contralateral hip fracture following THA for displaced intracapsular hip fracture. Our study shows favourable results for THA treatment in a selected group of patients with hip fractures.

Fixation of intertrochanteric femur fractures using the SIGN intramedullary nail augmented by a lateral plate in a resource-limited setting without intraoperative fluoroscopy: assessment of functional outcomes at one-year follow-up at Juba Teaching Hospital.

Objectives:The incidence of hip fracture is high and increasing globally due to an aging population. Morbidity and mortality from these injuries are high at baseline and worse without prompt surgical treatment to facilitate early mobilization. Due to resource constraints, surgeons in low-income countries often must adapt available materials to meet these surgical needs. The objective of this study is to assess functional outcomes after surgical fixation of intertrochanteric femur fractures with the Surgical Implant Generation Network (SIGN) intramedullary nail augmented by a lateral SIGN plate.Design:Prospective case seriesSetting:Juba Teaching Hospital, Tertiary Referral Hospital for South SudanParticipants:Adult patients with intertrochanteric hip fracturesIntervention:SIGN nail augmented by a lateral plateMain Outcome Measurements:Primary outcome was hip function as measured by a modified Harris Hip Score (mHHS) at 1-year after surgery. Secondary endpoints were the occurrence of reoperation or infection at 1-year after surgery.Results:Thirty patients were included, 16 (53%) men and 14 (47%) women, with a mean age of 62 years. Fractures were classified as AO/OTA Type 31A1 in 12 (40%) patients, 31A2 in 15 (50%) patients, and 31A3 in 3 (10%) patients. Mean mHHS at 1-year was 75.10 ± 21.2 with 76% categorized as excellent or good scores. There was 1 (3%) infection and 2 (7%) reoperations.Conclusions:The SIGN nail augmented by a lateral plate achieved good or excellent hip function in the majority of patients with intertrochanteric hip fractures. This may be a suitable alternative to conventional implants for hip fracture patients in low-resource settings to allow mobilization.

Long-term survival of CLS Spotorno femoral stem: a systematic review of literature

CLS Spotorno is a time-tested femoral stem design with excellent early results; the present review was designed to assess the published evidence on CLS Spotorno stem in the literature to evaluate its long-term outcomes and compare it to two other popular stem designs the uncemented Corail™ and the cemented Exeter™ stems. Do CLS Spotorno stems provide adequate long-term rates of survival in terms of revisions and functional outcomes? Medline, EMBASE and SCOPUS databases were searched for relevant articles and a total number of 670 hits were obtained, out of which 14 relevant studies were included in this review. Pooled analysis of revisions rates, subsidence and Harris Hip scores (HHS) were done. All the 14 studies were retrospective in design but had sufficiently large follow-up periods (12.3-27years, mean 17.1years). Of the 2459 hips reviewed, the documented revision rate was only 6.2%, with aseptic loosening reported in 3.1% and subsidence > 2mm in 2.6% cases. The overall survival was similar to reported smaller cohorts of Corail (95% at 12years) and Exeter stems (100% at 17years). Varus malposition was seen in 10.6% cases, but it did not show any influence on implant survival or revision rates. Distal pedestal formation was seen in 172 of 805 hips across seven studies, while distal cortical hypertrophy was seen in 70 cases out of 398 hips; these were not related with stem malposition. The overall functional outcome was good, with mean HHS of 88.65 (95% CI = 86.08-91.23, p < 0.01). The improvement in scores from preoperative values (of 43.9 points) were comparable to Corail (43.8) and Exeter (45) stems. Thigh pain was seen in only 41 cases out of 1097 hips. Despite the limitations due to high heterogeneity of the cumulative data, the review suggests that CLS Spotorno femoral stems provides excellent long-term survival and good hip function. These outcomes are comparable to other commonly utilized femoral stems like the Corail and Exeter. IV.

Metal ion levels in the blood of patients with metal-on-metal hip prostheses.

A BHR (Birmingham hip resurfacing) prosthesis was implanted in 445people in Norway. Adverse reactions can arise as a result of the release of metal ions from metal-on-metal joint surfaces made from cobalt-chromium alloy. The aim of the study was to analyse the release of metal ions during the first five years after surgery in patients with a BHR prosthesis and to investigate whether this was linked to clinical complications. Forty-four male patients (median age 53 years) implanted with a BHR prosthesis at the Coastal Hospital at Hagevik in the period October 2009 to May 2013 were monitored by means of blood samples before implantation and three months, one year, three years and five years afterwards. Analyses of cobalt and chromium in whole blood were performed. Function scoring was used to clinically assess the prosthetic joint. Metal ion concentrations increased between the surgery date and one year later (p < 0.001), and subsequently remained stable. After five years, the median concentrations (min.- max.) of cobalt and chromium were 1.1 µg/L (0.4-6.3 µg/L) and 1.4 µg/L (0.4-11.7 µg/L) respectively for unilateral prostheses (n = 36), and 2.3 µg/L (1.6-28.5 µg/L) and 2.6 µg/L (1.7-14.1 µg/L) respectively for bilateral prostheses (n = 8). Five patients underwent revision surgery, while other patients had good hip function. Patients with a BHR prosthesis had a significant increase in cobalt and chromium in their blood one to five years after surgery, but the median levels were still well below the threshold value of 7 μg/L, which indicates an increased risk of complications.

Acetabular roof lesions in children: a descriptive study and literature review

BackgroundAcetabular roof lesions (ARLs) in children are uncommon and may involve a variety of diseases. The acetabular roof is the main weight-bearing area of the hip joint, and lesions affecting the acetabular roof lead to fluid accumulation in the hip joint, causing hip pain and claudication. Methods for diagnosing and treating ARLs and the prognosis after treatment are rarely reported. We present our experience in a group of children and teenagers with ARLs to retrospectively explore the clinical and imaging features and histopathological diagnosis and report the treatment methods and follow-up observations.MethodsPatients with ARLs admitted to the Children’s Hospital of Chongqing Medical University from April 2011 to September 2018 were selected retrospectively. We collected the basic information of patients (name, sex, age), main symptoms and signs, results of various laboratory tests, treatment methods, and intraoperative observations through the hospital medical record system. We collected X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and pathological examination data through the Picture Archiving and Communications System. Follow-up data were collected through an outpatient medical record system, telephone, and chat software (such as WeChat). We used descriptive methods to analyze the lesion structure and destruction mode based on the imaging findings and histopathological diagnosis.ResultsThere were 14 ARL patients, including 6 with eosinophilic granuloma (EG), 5 with chronic osteomyelitis, 2 with bone cyst, and 1 with tuberculosis. One patient underwent percutaneous needle biopsy, 2 underwent open biopsy, and 11 underwent curettage; among them, 5 patients also underwent bone grafting. These lesions had no characteristic imaging findings, and the diagnosis was mainly based on histopathological examination. Most patients showed complete symptom resolution and good hip function at the 1-year follow-up.ConclusionARLs are not common in children. The types of lesions are diverse and mostly benign, with EG being most common. Malignant tumors may also occur, such as Ewing’s sarcoma, non-Hodgkin’s lymphoma, metastases and neuroblastoma. CT and MRI can be helpful in diagnosing certain cases, but incisional biopsy is required in most cases.

The Role of Hip Arthroscopy in the Management of Acute Arthritis of Hip

Septic arthritis of hip is an orthopaedic emergency requiring early diagnosis and prompt surgical treatment to avoid grave complications like avascular necrosis and chondrolysis and post-infectious arthrosis.This is a retrospective review of 9 patients who underwent hip arthroscopy for suspected septic arthritis of hip from 2012 to 2018. Medical charts were reviewed to determine the efficacy of the use of hip arthroscopy in the diagnosis and treatment of acute hip arthritis.The age of patients ranged from 9 to 82. The mean follow-up was 29 months (1 to 49). All presented with hip pain and effusion in imaging by CT scan or ultrasonography. Fever was present in 5 out of 9 patients. Hip arthroscopy with 2 portals technique and joint lavage +/- debridement was done. Two patients had whitish suspension in the joint fluid and pathology confirmed pseudogout of hip. The remaining 7 patients were diagnosed and treated as septic hip arthritis. Only 3 had positive culture, probably related to the prior use of antibiotics. All except one responds well to arthroscopic debridement and lavage with infection eradicated, good hip motion and hip function. One patient of delayed treatment (2 weeks after onset of hip pain) had ongoing infection, requiring further arthrotomy and Girdlestone operation for uncontrolled hip infection with intramuscular abscess of vastus lateralis.Hip arthroscopy is a useful diagnostic tool in acute hip arthritis. Besides septic arthritis, monoarticular attack of psuedogout is an important differential diagnosis of acute hip pain in elderly. Early hip arthroscopy can result in rapid postoperative recovery. Arthroscopic lavage and debridement is safe and a good alternative to open arthrotomy in hip septic arthritis.

3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

BackgroundFemoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity.Patients and methodsBetween 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented.ResultsTwelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1).ConclusionsThe 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications.Trial registrationWe register our research at http://www.researchregistry.com. The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847.

Avascular necrosis post unstable slipped capital femoral epiphysis: a treatment algorithm with staged hinged hip distraction: mid-term results.

Management of avascular necrosis (AVN) of the femoral head in slipped capital femoral epiphysis (SCFE) is difficult. We proposed to ascertain if staged hip distraction could prevent collapse and recover the femoral head. A retrospective review of the hip database retrieved 16 children with unstable SCFE and AVN. All underwent capital realignment by surgical dislocation followed by 2nd-stage hinged hip distraction. Patient demographics and radiographic parameters of deformity, AVN and arthritis were collected. The patients scored their hip function both before and after intervention and at follow-up using the modified Harris Hip Score and Nonarthritic Hip score. 7 boys and 9 girls formed the study group (n = 16). The average age at surgery was 12.7 years (9-16 years). 8 rights hips and 8 left hips were involved. The average follow-up was 45 months (33-66 months). Group A (n = 7) had hip distraction only if the follow-up radiographs showed AVN changes and collapse. Based on the observations in Group A, the protocol was changed for Group B. Group B (n = 9) underwent hip distraction at 6 weeks of capital realignment for avascularity of the femoral head. In Group A, all patients had further collapse and advanced arthritis at follow-up. In Group B all patients had hip joint space restored and good hip function without pain at follow-up. Pre-emptive application of hip distractor for those children with proven lack of blood flow to the femoral head is a potential option to stall the progression of AVN and to help recover useful hip function.

Comparative functional analysis of intertrochanteric fractures of femur treated with dynamic hip screw with that of proximal femoral nailing

The intertrochanteric fractures are the most common hip fractures in the elderly in whole world. These factors affect the hip function and stability. A well aligned and stable fixation is the prime goal of treatment of all operative fixation methods. It helps to restore and preserve good hip function following operative fixation. Anatomical restoration of proximal femur, maintenance of mechanical axis and restoration of hip function can be achieved. Both stable and unstable fractures are fixed now-a-days by various fixation methods. Complex anatomical features, associated complications, patients general condition all have bearing on early surgical management of these fractures. The study includes 20 patients all of whom were adults. It includes all four types of intertrochanteric fractures < Boyd and Griffin Classification > fixed either with dynamic hip screw fixation and proximal femoral nailing fixation.

Effectiveness analysis of surgical treatment of ipsilateral femoral neck fracture and subtrochanteric fracture

To discuss the effectiveness of intramedullary nail fixation with selective cable wiring in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture. Between June 2012 and December 2015, a total of 19 patients with ipsilateral femoral neck fracture and subtrochanteric fracture underwent closed reduction of femoral neck fracture and intramedullary nail fixation combined with selective cable wiring. There were 5 males and 14 females with a median age of 52 years (range, 35-77 years). The cause of injury included traffic accident injury in 17 cases and falling injury in 2 cases. According to Garden classification for femoral neck fractures, 7 cases were rated as type Ⅱ, 8 as type Ⅲ, and 4 as type Ⅳ. Femoral subtrochanteric fractures were classified by Seinsheimer classification, with 9 cases as type Ⅱ, 5 as type Ⅲ, 3 as type Ⅳ, and 2 as type V. The interval from injury to operation ranged from 2 to 7 days with an average of 3.7 days. The operation time was 58-125 minutes (mean, 82.4 minutes) and the intraoperative blood loss was 225-725 mL (mean, 289.5 mL). All incisions achieved healing by first intention and no early complication such as infection was observed. All patients were followed up 12-18 months (mean, 13.9 months). At 1 month after operation, the tip apex distance was 9-23 mm (mean, 15.2 mm). All patients achieved bone union with the healing time of 18-42 weeks (mean, 27.4 weeks). One case of hip varus and femoral neck re-displacement (femoral neck shaft angle was 122°) occurred at 3 months after operation, which achieved bone union at 42 weeks after operation. Five patients complained of postoperative pain with the visual analogue scale (VAS) score of 1-3 (mean, 1.8), which did not influence normal life. A total of 16 patients recovered preoperative hip function. During follow-up, no fracture nonunion, femoral head necrosis, implant failure, screw cut-out, and loosening of cable wiring was observed. The Harris hip score (HSS) was 72-92 (mean, 82.8) at last follow-up and 15 patients (78.9%) achieved good hip function. Intramedullary nail fixation combined with selective cable wiring was effective in the treatment of ipsilateral femoral neck fracture and subtrochanteric fracture.

Combined anteversion technique in total hip arthroplasty for Crowe IV developmental dysplasia of the hip.

A high rate of postoperative dislocation in total hip arthroplasty (THA) for Crowe IV developmental dysplasia of the hip (DDH) has been reported, 1 of the main reasons being higher true acetabular anteversion. If the cup is fixed with normal anteversion, the anterior rim will be excessively exposed, which reduces the contact areas of the cup and bone, affects prosthesis stability, and leads to iliopsoas tendinitis and persistent hip pain after THA. The aim of this study was to demonstrate that when cup anteversion is larger, adjusting femoral anteversion to bring the combined anteversion (CA) into the "safe zone" might prevent dislocation. After having fixed the cup in the acetabulum according to the patients' native acetabular anteversion, we shortened and rotated the proximal femur to reduce femoral anteversion, adjusting the CA into the "safe zone". The Harris Hip Score (HHS) was used to evaluate hip joint function. Computerised tomography scanning was used to measure the anteversion angles. All patients were followed up without any dislocation. Preoperative and 12 months after surgery, the mean HHS were 43.3 ± 2.6 (38-47) and 88.1 ± 3.3 (78-92) respectively. Pre- and post-operation, the mean CA angles were 88.6° ± 9.4° (80.3°-119.4°) and 49.2° ± 2.6° (43.4°-54.4°) respectively. The bone healing time of femoral osteotomy ranged from 4 to 14 months, with a mean time of 7.5 months. This CA technique in THA for Crowe IV DDH can effectively prevent postoperative dislocation and provide good hip function.

Hemiarthroplasty (HA) with a Two-Step Osteotomy in Unstable Intertrochanteric Osteoporotic Fractures of Senile Patients (A Report of 65 Cases)

Background: Although Hemi Arthroplasty (HA) remains controversial, it has been the supplement in the treatment of unstable intertrochanteric osteoporotic fractures in senile patients. A newly designed two-step osteotomy with hemiarthroplasty was introduced in this study. Methods: Sixty five consecutive patients (aged from 75 to 92 years with a mean of 81 years old) with unstable intertrochanteric fractures including 21 male cases (21 hips) and 44 female cases (44 hips) were treated in our hospital from August 2006 to October 2015 (Evans type III in 20 casesi¼ŒEvans type â…£ in 45 cases) with a newly designed two-step osteotomy technique with bipolar hemiarthroplasty by a senior orthopedic surgeon through posterior approach under general anesthesia. All cases were evaluated by Zuckerman functional recovery score (FRS) [1] and operative risk assessment software 1 (ORAS1), based on the Possum and P-Possum score system [2]. The duration and blood loss have been recorded. All prostheses consisted of Link SP II femoral stem and bipolar femoral head and were followed up for more than 1 year. Results: The average pre-injured FRSi¼Œpredictive value of operative morbidity and mortality were 82.7 (8 1.6—84.9), 9.2%(7.1%--14.9%) and 3.4%(2.1%--4.3%), respectively. The average operation time was 50 minutes with a mean intra operative blood loss of 310 m1. There were no operative or anesthetic complications or deaths within 30 days after operation. Sitting up was permitted 3 to 4 days, and partial weight beating was allowed 5 to 7 days after operation. The average FRS was 78.3 at 30 days and 83.9 at 1 year postoperatively. Eleven patients died of unrelated causes (Five due to myocardial infarction and the others due to cerebral hemorrhage during at least one-year follow-up) (table 1)i¼Ž Conclusion: Bipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fractures in the senile patients is a good choice for early ambulation and good hip function. Internal fixation (IF), especially with intramedullary nail, has been the gold standard in the treatment of unstable intertrochanteric osteoporotic fractures in senile patients. However, high internal fixation failure rate because of severe osteoporosis, coxa vara, displaced greater and lesser trochanters, makes orthopedic surgeon puzzled in the decision making. Although it remains controversial, hemiarthroplasty (HA) has been the supplement in the treatment, because bipolar hemiarthroplasty can not only achieve early mobilization but also get good hip function. But because of difficult anatomical reduction, poor bone quality, local complicated anatomical structure and many comorbidities, The surgical technique remains challenging to orthopedic surgeon. The purpose of this study was to introduce bipolar hemiarthroplasty with a newly-designed two-step osteotomy technique and observe its clinical result for unstable intertrochanteric fractures in senile patients. Keywords: Hemiarthroplasty, Osteoporosis, Intertrochanteric Fracture

Residual hip dysplasia at 1 year after treatment for neonatal hip instability is not related to degenerative joint disease in young adulthood: a 21-year follow-up study including dGEMRIC

Developmental dysplasia of the hip (DDH) is associated with an increased risk of early hip osteoarthritis (OA). We aimed to examine the outcome at the completion of growth in a cohort of children who had residual acetabular dysplasia at age 1 year following early treatment for neonatal instability of the hip (NIH). We examined 21 of 30 subjects who had been treated with the von Rosen splint neonatally for NIH and had residual acetabular dysplasia at age 1 year. Mean follow-up time was 21 years (range 17-24). Signs of OA and acetabular dysplasia were assessed by radiography. Cartilage quality was assessed by delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC), a tool for molecular imaging of cartilage quality, at 1.5 T. Patient reported outcome (PRO) was assessed by the 12-item WOMAC score. No study participant had radiographic OA (defined as Kellgren-Lawrence grade ≥2) or minimum joint space width (JSW) ≤2 mm. The mean dGEMRIC index was 630 ms (95% CI: 600-666, range: 516-825) suggesting good cartilage quality. The mean 12-item WOMAC score was 1.2. Two of three radiographic measurements of DDH correlated positively to the dGEMRIC index. Children treated neonatally for NIH have good hip function and no signs of cartilage degeneration at 21-year follow-up, despite residual dysplasia at age 1 year. Unexpectedly, radiographic signs of dysplasia were associated with better cartilage quality, as assessed with dGEMRIC. This may indicate cartilage adaptation to increased mechanical stress in mild hip dysplasia.

Bipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fracture in senile patients

ObjectiveTo introduce bipolar hemiarthroplasty with a two-step osteotomy technique and observe its clinical result for unstable intertrochanteric fractures in senile patients. MethodsFifteen consecutive patients with unstable intertrochanteric fractures aged from 81 to 92years with a mean of 85years were treated in our hospital from August 2006 to October 2011 (Evans type III in 4 cases, Evans type IV in 11 cases), who received bipolar hemiarthroplasty with a two-step osteotomy technique performed by a senior orthopedic surgeon through posterior approach under general anesthesia. All cases were evaluated by Zuckerman functional recovery score (FRS) and operative risk assessment software 1, based on the patients’ physical and laboratory examinations preoperatively. The duration and blood loss have been recorded. There were 4 male cases (4 hips) and 11 female cases (11 hips). All prostheses consisted of Link SP II femoral stem and bipolar femoral head. All patients were followed up for more than 1year. ResultsThe average preoperative FRS, predictive value of operative morbidity and mortality were 83.7 (81.7-85.9), 9.3% (7.3%-15.0%) and 3.5% (2.3%-4.2%), respectively. The average operation time was 50minutes with a mean intraoperative blood loss of 310ml. There were no operative or anesthetic complications or deaths within 30days after operation. Sitting up was permitted 3 to 4days, and partial weight bearing was allowed 5 to 7days after operation. The average FRS was 79.3 at 30days and 84.9 at 1year postoperatively. Three patients died of unrelated causes (one due to myocardial infarction and the others due to cerebral hemorrhage during at least one-year follow-up). ConclusionBipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fractures in the senile patients is a good choice for early ambulation and good hip function.

Uncemented hip arthroplasty for failed internal fixation of peritrochanteric fracture

Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture. Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study. The patients aged 67.2 years(range, 41-80 years) composed 6 males and 11 females. There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture. The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients. Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation. Harris score was used for evaluation of the results of hip arthroplasty. Preoperative Harris score was (32.6±6.8)points. Results All the patients were followed up for 6 to 48 months. One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery. One patient had secondary subsidence of the femoral stem without pain and limitation of motion. One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation. Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening. Harris hip score significantly improved to (79.2±15.9)points at the final follow-up (P<0.01). Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture. The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability, and avoids the complications of bone cement use. Key words: Arthroplasty, replacement, hip; Hip fractures; Treatment failure

Total hip arthroplasty for postoperative ankylosis in patients with hip peripheral fracture

Objective To discussion the feasibility and effect of total hip arthroplasty (THA) of postoperative ankylosis in patients with hip peripheral fracture. Methods From January 2008 to October 2013, cementless THA was performed in 23 patients with ankylosis after internal fixation of hip peripheral fracture. There were 16 males and 7 females, aged 23 to 67 years (mean, 43 years). Interval between internal fixation and THA was 12 to 73 months (mean, 38 months). Results Mean follow-up was 28 months (range, 3 to 60 months). All patients presented good press-fit prostheses with mean acetabular valgus of 43.3°, mean acetabular anteversion of 22.5°, and mean femoral anteversion of 16.4°. Primary wound healing was detected with no occurrence of infection, prosthetic loosening or dislocation, and periprosthetic fracture. Femoral vein incomplete embolism was diagnosed in one patient with limb swelling 2 months after operation, but swelling subsided after 3 months of bed rest, elevation of the affected limb and anticoagulant therapy. Length of the bilateral limbs was almost equal in 19 patients with the difference within 0.5 cm, but the affected limb was 0.8-1.4 cm shorter in 3 patients and was 0.8 cm longer in 1 patient. Harris hip score improved from (42.16 ± 3.03)points before operation to (93.08±5.23)points at the last follow-up (P<0.05). Conclusion THA is associated with good hip function recovery and improved quality of life during the treatment of postoperative ankylosis in patients with hip peripheral fracture. Key words: Ankylosis; Hip fractures; Arthroplasty, replacement, hip