Harris Hip Rating Research Articles

Management of fracture neck femur treated with bipolar hemiarthroplasty in the elderly population

Background: Hip fractures are common and comprise about 20% of the operative workload of an orthopedic trauma unit. As life expectancy is increasing all over the world Geriatric population sustaining the Fracture neck of femur are also increasing resulting in Great burden to health of society which can be better managed with Hemiarthroplasty. The goal of the current study is to assess the functional outcome and quality of life in terms of pain, mobility, stability using Harris Hip Score Aims and objective of the study: To study the results of bipolar prosthesis with respect to pain, mobility and stability and to analyze the complications per-operative and post operative like infection, DVT, acetabular erosion, loosening and dislocation. Materials and methods: The prospective study included thirty patients with intracapsular femoral neck fractures referred to the Department of Orthopaedics, Ashwini Hospital, Gulbarga were selected for this study. Patients with intracapsular femoral neck fractures and aged above 55 years were considered. Discussion: We have excellent results in 10 cases (33.33%), good in 11cases (36.67%), fair in 7 cases (22.33%) and poor in two cases (6.67%) according to the Harris hip rating system. We got excellent to good results in 70% of the cases at a mean follow up period of six months. We analysed pain at 6 weeks, 3 months and 6 months follow up according to Visual analogue scale (VAS) in all patients. At 6 months follow up period, 70% patients had no pain (0), 20% had mild pain (1-4), 6.67% moderate pain (5-8) and 3.33% severe pain (>8). Early assisted ambulation was begun on second post operative day in our study, which probably accelerated better functional recovery. At 6 months follow up period, 70% patients were ambulatory without assistance, 23.33% patients were ambulatory with assistance (with cane). Conclusion: We came to a conclusion after treating 30 patients of intracapsular fracture neck of femur, with Bipolar prosthesis, that it has better advantage in terms of stability, mobility, range of motion, and functional outcome as per Harris hip score.

Drehmann Sign and Femoro-acetabular Impingement in SCFE

Drehmann sign is a characteristic clinical feature in slipped capital femoral epiphysis (SCFE). The presence of SCFE indicates an anatomic change of the proximal femur, which induces obligatory hip external rotation with hip flexion. In contrast, a cam-type femoro-acetabular impingement (FAI) is well known as sequelae of SCFE. The purpose of this study was to clarify the relationship between Drehmann sign and radiologic FAI. We studied 92 hips of 80 SCFE patients who had been treated with in situ fixation. The occurrence rate of Drehmann sign was analyzed according to the degree of remodeling (the Jones classification) and the radiologic α-angle measured in each class at the final follow-up. At a mean 12.2 years after the final follow-up, the patients' present condition was clinically investigated with a questionnaire using a part of the Harris Hip Rating Scale (HHRS). In addition, 3-dimensional computed tomography analysis was performed to clarify the anatomic relationship between the femoral head and the acetabulum during testing for Drehmann sign. Among the 92 hips in the study, 60 were well remodeled (Jones type A), 24 were type B, and 8 were type C, with 6.5 years of mean follow-up. The mean of the modified α-angles for the 3 groups (A, B, and C) were 61.8, 84.7, and 119.4, respectively (P < 0.05); 25%, 75%, and 100% of the hips in the 3 groups, respectively, exhibited Drehmann sign. The set of hips (n = 41) with a positive Drehmann sign had a mean α-angle of 85.6 versus 63.0 degrees for the set of hips (n = 51) with a negative Drehmann sign (P < 0.05). Seven (13.5%) of 52 patients responding to the questionnaire reported hip pain and/or limp in the positive Drehmann sign group, but no patient in the negative sign group complained of either. Three-dimensional computed tomography delineated FAI at 2 different positions during testing for Drehmann sign. Drehmann sign is highly valuable for clinically evaluating the existence of FAI and for following up with observation or realignment to prevent early osteoarthritis.

The Results of Hip Arthroplasty with Hydroxyapatite Coated Anatomical Profile® Femoral Stem: Result After 5-Years to 10-years Follow up

Purpose: To report the results of hip arthroplasty using an uncemented hydroxyapatite (HA) coated anatomical Profilefemoral stem during a follow-up period of five to ten years. Materials and Methods: Eighty-eight patients, ninety-nine cases of hip arthroplasty, who underwent surgery from May 1993 to February 1998, were reviewed clinically and radiographically. Results: The mean Harris hip rating score was 54.4 preoperatively, which improved to 88.2 at the last follow up postoperatively. The radiographic evaluations revealed that endosteal new bone formation developed at Gruen zone 1 and 7 in all cases (100%) between 6 month and one year after surgery. Approximately 20 cases (20%) showed proximal osteoporosis due to profound stress shielding, and 83 cases (83.8%) showed distal cortical hypertrophy (zone 2, 6). These femoral remodelings correlated with the clinical results statistically. There was no aseptic loosening, but the polyethylene liner was changed only in one hip due to severe liner wear. Conclusion: This study indicate that the anatomical Profile femoral stem can provide excellent initial stability and osseointegration. However, profound proximal bone loss was noted secondary to distal cortical hypertrophy in the long-term follow up. Therefore, other design concepts are needed, in which the femoral strain transfers more proximally rather than distally.

Total Hip Arthroplasty for the Treatment of Osseous Ankylosed Hips

The long-term results of total hip prostheses in 86 patients (87 hips) who had either primary cemented or cementless total hip arthroplasty after fusion take-down were analyzed. Thirty-eight patients (38 hips) had a surgical fusion and 48 patients (49 hips) had a spontaneous fusion. The mean age of patients was slightly older in the cemented group (49.8 years) than in the cementless group (43.8 years). Twenty-six of 42 patients (62%) in the cemented group and 32 of 44 patients (73%) in the cementless group were younger than 50 years. Clinical (Harris hip rating system) and radiographic evaluations were done preoperatively and at 6 weeks, at 3, 6, and 12 months, and yearly thereafter. The average followup was 10.2 years (range, 8-18 years) in the cemented group and 9.8 years (range, 8-17 years) in the cementless group. The revision rates were 16% in the patients who had surgical fusion and 18% in the patients who had spontaneous fusion. The revision rates were 17% in the cemented group and 18% in the cementless group. The average linear wear rate of polyethylene per year was 0.24 mm in the cemented group and 0.32 mm in the cementless group. The incidence of osteolysis was 52% in the cemented group and was 58% in the cementless group.

Our Experience with the SL-Plus Cementless Stem: Mid-Term Results

The authors reviewed the mid-term results of 474 SL-Plus stems performed on 342 patients with primary and secondary osteoarthritis. The average age at the time of operation was 60.5 years (range, 17 to 81 years) and the average duration of follow-up was 60 months (range 25 to 96 months). The average Harris hip rating was 44 points (range, 30 to 58 points) before and 85 points (range, 72 to 94 points) after the operation. Good or excellent outcomes were observed in more than 90 per cent of the hips, with an average pain score of 43 points and average function score of 45 points. Two incomplete intra-operative fractures of the proximal femur were successfully treated by cerclage fixation. Five fractures of the greater trochanter were encountered. Dislocation occurred in five hips, one of which required revision to a captive polyethylene insert. Late infection with loosening of the femoral component occurred in one case. Radiological assessment identified one loose stem, but the patient refused surgical revision. Lower values for metaphyseal and diaphyseal fill observed in 31 cases had no correlation with implant stability and outcome. No progressive subsidence was detected except for one loose femoral component. Seventy-four hips revealed radiolucent lines at the bone cement interface. These were always less than 2mm. These mid-term results seem promising and authors hope that the long-term outcomes will be equally gratifying.

Total hip arthroplasty in patients with deficient bone stock and small femoral canals

Total hip arthroplasty in patients requiring very small femoral stems is a challenge because frequently deformity and inadequate bone stock, especially of the acetabulum, are also present. An analysis of 34 consecutive cases managed with a 9-mm distal diameter noncemented stem was performed. The mean patient age was 42.6 years and mean follow-up time was 7.8 years. Two patients were lost to follow-up at 4 and 6 years, and 1 patient had a fracture below the stem immediately after surgery, necessitating revision. These patients were excluded from analysis. Of the remaining 31 patients, 1 underwent revision for distal osteolysis leading to fracture. The Harris hip ratings for these patients were 58.1% excellent, 22.6% good, 16.1% fair, and 3.2% poor. Complications experienced included 1 femoral component that fractured but remains asymptomatic. Polyethylene wear of the very small acetabular components in 31% of cases is a cause for concern; 2 of these patients have required revision for this reason. The acetabular component was subsequently modified to allow thicker polyethylene. Copyright 2003, Elsevier Science (USA). All rights reserved.

Interlocking Triple Pelvic Osteotomy in Severe Legg-Calvé-Perthes Disease

The authors reviewed 21 patients who underwent triple pelvic osteotomy for severe Legg-Calvé-Perthes disease to evaluate their clinical, functional, and radiologic results. The mean age at presentation was 7 years 7 months (range 5-11 years). Seventeen hips were Herring group C and 5 were group B. All of them had "at risk" radiologic signs. A new technique of interlocking iliac osteotomy was used to provide extra stability, allow early weight bearing, and prevent inadvertent retroversion. The average period of follow-up was 30 months (range 1-5 years). The average gain in Harris score was 34.3 (range 4-55). The average gain in acetabular head index was 18% and that in center-edge angle was 22 degrees, more than reported for any other single surgical procedure for containment of the subluxed femoral head. Average gains in abduction, internal rotation, and flexion were 17 degrees, 12 degrees, and 28 degrees respectively. Longer follow-up is required to see the results at maturity, but the early results are promising.

Total hip replacement with a cementless acetabular component and a cemented femoral component in patients younger than fifty years of age.

We have been using hybrid total hip arthroplasty (a cementless acetabular component and a cemented stem) in young patients. The purpose of this study was to determine the prevalence of aseptic loosening, polyethylene wear, and osteolysis after the use of this technique. We studied a prospective consecutive series of sixty-four primary hybrid total hip replacements in fifty-five patients younger than fifty years old. There were forty-three men and twelve women; the average age at the time of the index operation was 43.4 years. The average duration of follow-up was 9.4 years. We used a cementless acetabular component without screw-holes and a cemented femoral component with a 22-mm head in all hips. Clinical follow-up with use of Harris hip ratings and radiographic follow-up were performed at six weeks; at three, six, and twelve months; and yearly thereafter. The sequential annual linear and volumetric wear rates were measured, and bone-remodeling and osteolysis were assessed. The mean preoperative Harris hip score was 44 points, which increased to 95 points at the time of final follow-up. No hip had aseptic loosening. One hip (2%) was revised because of late infection. The average linear wear (and standard deviation) was 0.96 +/- 0.066 mm, with an average annual rate of 0.096 +/- 0.013 mm. The average volumetric wear was 364.7 +/- 25.2 mm (3), with an average annual rate of 43.4 +/- 3.5 mm (3). Six hips (9%) had an osteolytic lesion of <1 cm in diameter in the calcar femorale (zone 7). Our results show that a hybrid arthroplasty with a cementless acetabular component and a smooth cemented femoral component (Ra, 0.6 mm) is effective for primary total hip replacement in young patients. Although there was no aseptic loosening and a low prevalence of osteolysis at the latest follow-up evaluation, the high rates of linear and volumetric wear of the polyethylene liner in these young patients remain a concern.

Treatment of congenital dislocated hip by arthroplasty with femoral shortening.

This was a retrospective study of 15 hips in 11 patients with complete congenital dislocation of the hip treated by total hip arthroplasty and femoral shortening with a subtrochanteric double chevron derotation osteotomy. The mean age at the time of surgery was 51 years (range, 21-74 years), and the mean followup was 5.5 years (range, 2-8.5 years). Functional evaluation using the modified Harris hip rating system showed an excellent result in five hips and a good result in seven hips (80% success rate). The location of the hip center was lowered by a mean of 8.3 cm (range, 5.7-10.4 cm). Leg length discrepancy in seven patients with unilateral involvement was reduced from a mean of 3.9 cm (range, 1.7-8.2 cm) before surgery to a mean of 1.4 cm at the latest followup (range, 0-4 cm). The Trendelenburg sign was assessed in 10 of 15 hips and was corrected from a positive preoperative status to a negative postoperative status in eight of these 10 hips. There were no cases of nonunion, dislocation, nerve palsy, or radiographic loosening. The only complications were a supracondylar fracture below the femoral component in a patient with severe osteoporosis 6 months after surgery and loosening of the cemented titanium metal backed acetabular component in the same patient 1.5 years after surgery. The current series showed that total hip arthroplasty in combination with a subtrochanteric double chevron derotation osteotomy has promising short to midterm results in the treatment of complete congenital dislocation of the hip in adults.

A Review of Total Joint Replacement in Active Duty Soldiers

Thirty-two active duty soldiers (36 total joint replacements) were followed from 9 months and 18 years (average 4.1 years) to evaluate the outcome of total joint replacement in active duty soldiers. Follow-up consisted of clinical assessment and radiographic evaluation at 6 weeks, 3 months, 6 months, 1 year, and yearly thereafter. A Harris hip rating (HHR) was also completed at each clinic visit. There were 30 total hip arthroplasties in 27 patients with an average age at surgery of 40.8 years (range 31-58) and an average follow-up of 4.1 years. The HHR averaged 93 on latest evaluation. There were three revisions (average 7.2 years). Of the 27 patients, 18 were retained on active duty and 9 were separated from service. Of the senior enlisted (E7 or above) and officers (O4 or above), 16 of 17 (94%) were retained on active duty, whereas only 2 of 10 (20%) of the junior enlisted (E6 or below) were retained on active duty. There were 6 total knee arthroplasties in 5 patients with an average age at surgery of 49.8 years (range 33-58) and an average follow-up of 3.0 years (9 months to 4 years). There were no revisions, and all 5 soldiers were retained on active duty. Preliminary results from this study reveal that a high percentage of soldiers undergoing total joint replacement are retained on active duty (72%) and are able to continue active lives. Rank or seniority also appears to be a significant factor for retention on active duty. The revision rate (10%) and the rate of osteolysis (19%) are comparable with reported rates.

Total hip arthroplasty with femoral osteotomy for proximal femoral deformity.

Thirty-one total hip arthroplasties, 20 primary and 11 revision, combined with femoral osteotomy in 28 patients for a major proximal femoral deformity were reviewed an average of 4.6 years after surgery. The type of femoral osteotomy used was a uniplanar wedge in 19 cases, biplanar in 4, and step cut in 8. The Harris hip rating score improved from an average of 51 to 77 points in primary cases and from an average of 35 to 73 points in revision case. The average time until union of the osteotomy was 35 weeks. Complications included intraoperative femoral fracture in 7 cases, osteotomy nonunion in 4, instability in 4, aseptic femoral loosening in 4, osteolysis in 1, and deep infection in 1. Ten reoperations (32%) were performed in 8 patients. Total hip arthroplasty with concurrent femoral osteotomy is a technically demanding procedure. Stable initial fixation of the osteotomy is recommended to avoid osteotomy nonunion and failure.

Cementless Total Hip Arthroplasty With Autologous Bone Grafting for Hip Dysplasia

The fate of autologous femoral head bone grafts in acetabular roof reconstruction for severely dysplastic hips was investigated in 25 patients (25 cementless total hip arthroplasties). Twenty patients were women and 5 were men, whose average age was 55 years old; their average followup was 58 months. The average Harris Hip Rating improved from a preoperative value of 49 points to a postoperative value of 85 points. Radiographic measurements did not indicate any vertical or horizontal socket migration >2 mm. The grafted bone was incorporated by an average time of 7 months, and the acetabular sclerosis had disappeared in 23 hips by 9.4 months. One year after operation, the grafted bone was reduced in size significantly. Radionuclide uptake at the site of the bone graft remained high for as long as 18 months after the operation, then normalized. The autologous acetabular bone grafts were incorporated completely and remodeled 18 months after surgery.

Allograft Epiphysiodesis for Slipped Capital Femoral Epiphysis

During this retrospective investigation, use of freeze-dried irradiated allograft for achieving epiphysiodesis in patients with Grade I or Grade II slipped capital femoral epiphyses was evaluated. The study reviewed 40 grafting procedures in 33 patients: 20 patients were boys and 13 were girls, whose average age was 13 years old. The group included 31 Grade I slips and 9 Grade II slips. Six were unstable and 34 were stable. Procedure time averaged 1 hour 57 minutes and blood loss averaged 360 ml. The average time to complete physeal closure was 28 weeks. An incomplete bony physeal bridge, apparent at an average 11 weeks, may impart earlier stability. Thirty-eight cases had followup averaging 3 years 6 months. At most recent evaluation, according to the Harris hip rating system, 35 hips had excellent ratings, 1 had a good rating, and 2 had fair ratings. Six patients were identified with major postoperative complications, including 1 case each of segmental avascular necrosis, chondrolysis, femoral neck fracture, subtrochanteric hip fracture, bilateral progressive coxa vara deformities requiring corrective osteotomies, and a unilateral progressive coxa vara deformity. The senior author (TLS) currently uses a fluoroscopically guided percutaneous lateral approach, a cannulated reaming system, and freeze-dried irradiated cortical allograft. The procedure promotes premature physeal closure. Allograft epiphysiodesis is an alternative operating technique for treating patients with a slipped capital femoral epiphysis.

Acetabular Reconstruction Using Bipolar Endoprosthesis and Bone Grafting in Patients With Severe Bone Deficiency

Eighty-one patients who had hip reconstruction with bone grafting and bipolar endoprosthesis for severe acetabular deficiency were reviewed retrospectively at 3 to 8 years postoperatively. Failed total hip arthroplasty was the most common indication for operation. Bone grafts were fixed bone blocks, morselized cancellous bone, and wafer-type grafts used singly or in combination. The average Harris hip rating score was 49.9 points preoperatively, 81.4 points at 1 year, and 70.8 points at latest followup examination. The 35 unsuccessful procedures included 25 reoperations for implant removal (resection arthroplasty or revision) and 10 cases pending revision. At latest followup examination, 54.7% of patients considered themselves improved and 62.7% had no or mild pain. Eighty-five percent of cases had radiographic evidence of component migration that was superior and medial in direction. Overall probability of implant survival was 96% at 1 year, but only 47% at 6.5 years postoperatively. Because of the high failure rate, this procedure has a limited role in hip reconstruction, but may be a reasonable part of a staged reconstruction for patients with massive bone loss or in certain revision cases where instability is a concern.

Reliability, Validity, and Responsiveness of Functional Tests in Patients With Total Joint Replacement

High-quality measurements are needed to develop meaningful clinical practice databases to assess the effectiveness of physical therapy. This study determined the reliability, validity, and responsiveness of measurements obtained with five functional tests graded with the newly developed Iowa Level of Assistance Scale. Eighty-six patients with total hip or knee replacements were tested at various time periods during their hospitalization. Patients were tested for five functional activities by four therapists to establish the reliability and test responsiveness. The Harris Hip Rating Scale was administered to assess the validity of the functional score. The weighted Kappa statistic supported good intratester (K = .79-.90) and moderate intertester (K = .48-.78) reliability. The correlation between the Harris Hip Rating Scale scores and the total functional scores was high (r = -.86). The total functional score was responsive to 4 days of therapy postoperatively. The assessment of function using the Iowa Level of Assistance Scale was shown to be highly reliable, valid, and responsive in patients following total hip or knee replacements.

Acetabular fractures: long-term follow-up of open reduction and internal fixation.

Eight-seven acetabular fractures in eighty-seven patients underwent open reduction and internal fixation at Vanderbilt University Hospital from 1984 to 1989. Fifty-six were treated by orthopaedic traumatologists. Fifty-six patients returned for long-term follow-up (range 24-80 months, average 43). Harris hip ratings were used to clinically grade the results. Poor results were found in 43%. Eighty-three percent of the patients with poor results had satisfactory surgical reductions with < 3 mm of residual displacement. Factors other than surgical reduction contributed significantly to the poor results. These included hip dislocation associated with the fracture, class III or IV heterotopic ossification, development of avascular necrosis, and age > 40 years. These factors in addition to adequacy of surgical reduction allow us to better counsel patients as to long-term prognosis.

Prospective Analysis of Uncemented and Hybrid Primary Porous Coated Anatomic Total Hip ArthropIasties in a Community Setting

One hundred thirty-four consecutive primary total hip arthroplasties, with 100 uncemented and 34 hybrid cemented femoral components, were performed in 119 patients in a community hospital setting, and the patients were followed for between 2 and 4 years. Two-year followup mean Harris hip ratings were 88 for the hybrid group and 90 for the porous coated group. The pain score was 43 for both groups. The incidence of thigh pain was 9% at 1 year, 6% at 2 years, and 5% at 3 years in the porous coated group; none of the pain was disabling. A persistent limp was noted in 19% of patients: 18% of the porous coated group and 22% of the hybrid group. Limp was believed to be related to the number of prior hip surgeries, preoperative leg length discrepancy greater than 2.7 cm, and comorbid musculoskeletal diseases, and not to utilization of the modified direct lateral approach. Radiographic zonal analysis revealed that 99 of the porous coated femoral components had a stable implant fixation with bone ingrowth; one component was stabilized by fibrous ingrowth. The average femoral size used was two sizes larger than those used elsewhere, when the same prosthesis was used during the same time interval. These results obtained in a community hospital setting using either modern cemented or porous-coated insertion techniques are similar to those achieved in major medical centers.

Porous-coated total hip arthroplasty in rheumatoid arthritis

Thirty-five porous-coated total hip arthroplasties were implanted in 25 patients with juvenile-onset or adult-onset rheumatoid arthritis and prospectively followed for a mean of 4.5 years (range, 3–6.5 years). Using the Harris hip rating, the mean hip score at the final follow-up evaluation was 91, and 86% of the hips had a good or excellent result. Thirty-one hips had no hip or thigh pain, while four had occasional slight pain. After surgery, 10 patients were employed and the remainder were ambulatory. There were no early or late deep infections. There was one reoperation for recurrent dislocation of the hip, but the components were not removed. Radiographic evaluation of the acetabular component showed that only one component had a complete radiolucent line in all three zones. Three femoral components had nonprogressive subsidence. At this intermediate-term follow-up period, porous-coated total hip arthroplasty is a promising technique that is likely to be successful in young patients with rheumatoid arthritis.

Hip Arthroplasty for Osteonecrosis After Renal Transplantation

The treatment of osteonecrosis in renal-transplant patients with hip arthroplasty was reviewed. From 1972 to 1988, the surgical treatment evolved from the use of cemented total hip arthroplasty (THA) to uncemented bipolar hemiarthroplasty to, most recently, porous-ingrowth THA. During this period, 46 patients had 77 hip arthroplasties. Cemented replacement was used in 32 hips, uncemented bipolar replacement in 32, and porous-ingrowth arthroplasty in 13. At the two- to 18-year follow-up evaluations, the average Harris hip rating was 89 points. Ratings averaged 82 points at 8.7 years in cemented hips, 91 points at six years in bipolar hips, and 90 points at 3.1 years in uncemented hips. Loosening occurred in 46% of hips with cemented total hip prostheses, 9% of hips with bipolar prostheses, and in no hips with porous-ingrowth components. Aseptic revision rates were 31%, 12.5%, and 0% respectively. Infection rates were 0%, 9%, and 10% respectively. Although the follow-up period was shorter for bipolar and uncemented THAs, uncemented bipolar hemiarthroplasty and porous-ingrowth THA may be reasonable alternatives for the renal-transplant patient with osteonecrosis rather than cemented THA, which has a high long-term failure rate. The early results of porous-coated hip arthroplasty are satisfactory in patients with a functioning renal transplant.

Evaluation of Uncemented Total Hip Arthroplasty in Patients With Avascular Necrosis of the Femoral Head

Thirty-seven uncemented primary porous coated anatomic (PCA) total hip arthroplasties (THA) that were performed in 33 patients for the diagnosis of avascular necrosis (AVN) between June 1984 and December 1986 were reexamined at four- to six-year follow-up periods. Final clinical evaluation showed an 86-point average Harris hip rating (range, 47-100 points), which had improved from an average preoperative rating of 42 points (range, 20-61 points). Thigh pain, which was usually not functionally limiting, occurred in 11 patients (25%), and seven patients (16%) had a moderate or severe limp. Nine patients (20%) required the use of a cane. Long-term radiographic evaluation in 37 hips demonstrated acetabular cup migration in one hip, acetabular lucencies in four hips (11%), and acetabular bead loosening in ten hips (27%). Femoral subsidence occurred in five hips (14%) and femoral bead loosening in 11 hips (30%). Thirty hips (81%) demonstrated radiographic evidence of stable bony ingrowth. No revisions were performed for aseptic loosening, but two prostheses were removed for infection. These results of uncemented THA in patients with AVN appear to be as good or better than the results reported for cemented arthroplasty in AVN at this interval of a follow-up period. This study supports the use of uncemented devices, especially with the newer designs and increasing surgical experience in this difficult patient population.