Resection Arthroplasty Of Hip Research Articles

Salvage Options for the Failed Total Hip Arthroplasty (THA)

AbstractTotal hip arthroplasty (THA) has been referred to as the operation of the century given its success and predictable improvement in quality of life. With the increase in number of THAs performed every year, there is a concomitant rise in the incidence of revision and re-revision surgeries. Failure of THA and revision hip arthroplasty may occur due to a variety of reasons, often in older patients with multiple comorbidities. Revision procedures in this setting are associated with worse outcomes as they are often complicated by limited bone stock and poor soft tissue and bone quality, making reconstruction more challenging. The purpose of this review is to discuss modern techniques for limb salvage following failed THA in the setting of significant bone loss. These include proximal femur replacement, total femur replacement, hip resection arthroplasty, and hip disarticulation.

Is hip resection arthroplasty a successful definitive treatment?

PurposeHip resection arthroplasty as a definitive treatment is an uncommon indication, although still in use selectively. This study evaluates a cohort of patients who have undergone hip resection arthroplasty surgery indicated as a definitive treatment, in order to assess the rate of re-operation, the rate of infection, and the mortality rates. MethodsWe conducted a retrospective, observational, descriptive analysis of a cohort of patients who had undergone a hip resection arthroplasty intended as a definitive treatment, in two University Hospitals from 1994 to 2020. The exclusion criteria were the implantation of a hip cement spacer, or a temporary hip resection arthroplasty in patients undergoing a two-staged surgical approach. We found 26 cases of hip resection arthroplasty. We recorded the indications for a definitive hip resection arthroplasty, the outcomes and complications, and analyzed the success of the hip resection arthroplasty as a definitive surgery using a Kaplan-Meier curve. ResultsSeven cases (26.9%) required a re-operation after the hip resection arthroplasty, four cases for persistent hip infection, and in the three remaining a conversion to a total hip arthroplasty was re-considered due to a good medical evolution and non-tolerance to the low functional outcome. The mortality rate was 61.5% (27 days–20 years), with a 19.2% mortality rate in the first 5 years. All the cases that required another surgery after the hip resection arthroplasty were re-operated within the first 18 months. ConclusionUnfortunately, hip resection arthroplasty continues to show elevated re-operation rate and early mortality rate, as well as low functional outcomes. Two-staged hip revision arthroplasty is the surgical treatment of choice in patients suffering from a periprosthetic joint infection, however we believe that hip resection arthroplasty should be considered in fragile patients, who have endured multiple revision surgeries, or their comorbidities make them unfit from further surgeries.

Hip resection arthroplasty for acute femoral neck fractures in the non-ambulator.

Objectives:Hemiarthroplasty (HA) is the current standard of care for displaced femoral neck fractures (FNFs) in non-ambulators. Despite excellent outcomes, arthroplasty-specific risks remain, including dislocation, implant failure, periprosthetic fracture and infection, and fat embolization syndrome. To eliminate the possibility of these complications, should non-ambulatory patients with acute, native hip FNFs be treated with simple hip resection arthroplasty (HRA) instead of HA?Design:Retrospective case series.Setting:Large, urban level-1 trauma center.Patients/Participants:Five non-ambulatory patients (6 hips) with acute, native hip FNF underwent femoral head and neck resection. Also, the most recent 10 FNFs treated with HA were also identified for comparison purposes.Intervention:HRA was performed via a Smith-Peterson approach with an oscillating saw or osteotome to complete the fracture or perform a fresh neck cut.Main Outcome Measurements:Outcomes included postoperative vs preoperative VAS pain scores and narcotics usage, and return to baseline functional status (sit up in bed or a chair postoperatively). Procedure time for HRA was compared with the 10 most recent patients with FNF treated with HA.Results:HRA resulted in decreased postoperative vs preoperative VAS pain scores (7.7 vs 3.3, P = .002), and decreased operative times (59.2 minutes for HRA, 111.8 minutes for HA, P < .001). All HRA patients had immediate return of baseline function.Conclusion:HRA offers shorter operative times when compared with HA, decreased postoperative VAS pain scores, and immediate return to functional baseline status without possibility of arthroplasty-specific complications. HRA may be an acceptable treatment option for FNFs in the non-ambulator.Level of evidence: IV

Analysis of perioperative outcomes in hip resection arthroplasty.

Hip resection arthroplasty (HRA) is a salvage surgical technique for the management of complex hip conditions wherein arthroplasty may be contraindicated. The purpose of this study was to review modern-day indications for HRA and compare outcomes between patients undergoing HRA and revision total hip arthroplasty (RTHA). The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was used to identify patients undergoing HRA or RTHA between 2012 and 2017. Patient demographics, risk factors, and perioperative complications were analyzed. Multivariate regression was used to determine predictors of early postoperative complications. Propensity score matching (PSM) was performed to compare relative risks (RR) of complications in HRA compared to RTHA. 290 patients underwent HRA between 2012 and 2017. Infection was the most common indication for HRA (39.8%), followed by femoral neck fracture or malunion/nonunion (26%) and prosthetic instability (12.2%). Increased body mass index (BMI) (p = 0.012) and chronic obstructive pulmonary disease (COPD) (p = 0.007) were associated with increased risk of complication in HRA. There were no significant differences in short-term complication risks between RTHA and HRA. HRA was associated with short-term complication rates comparable to RTHA. These findings may help in surgical decision-making and appropriate indications in the present day. III.

Resection Arthroplasty Treatment Possibility for a Patient with Fibrous Dysplasia, Chronic Osteomyelitis, and Recurrent Periprosthetic Hip Joint Infection: A Case Report.

Introduction:Fibrous dysplasia (FD) is a rare congenital abnormality, in which parts of bone are replaced with fibrous stroma and woven bone, making it susceptible to pathological fractures. Osteomyelitis following intramedullary nailing of such fractures of the femur and periprosthetic joint infection (PJI) after hip arthroplasty is one of the most devastating complications and a true challenge for the orthopedic surgeon. To the best of our knowledge, this is the 1st time, such complications are reported in a patient with monostotic FD.Case Report:We present a 30-year-old male patient with FD of the left femur, chronic osteomyelitis, recurrent periprosthetic hip joint infection after multiple revision arthroplasties, and two episodes of axillary vein thrombosis. Due to the severe structural changes and a large medial wall defect in the proximal femur with impairment of a large soft tissue zone, it was decided during operation not to put any other implants in the hip joint and perform only a resection hip arthroplasty procedure.Conclusion:Managing a recurrent PJI in a patient with poor bone quality, severe bone defects, soft tissue compromise, and thromboembolic events is challenging even for the most experienced orthopedic surgeon. Resection arthroplasty is a salvage treatment option that should be considered in such complex cases.

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

AbstractHip resection arthroplasty (HRA) is a relatively uncommon, yet viable surgical procedure originally developed by Girdlestone for osteomyelitis of the proximal femur. Currently, HRA is primarily indicated as a salvage procedure after a failed total hip arthroplasty. Despite a continuous rise in the rates of primary and revision hip arthroplasty, there is a lack of published evidence regarding the extent of HRA's current use and its recent trends. We sought to provide an epidemiological description of the recent utilization patterns of HRA in the United States. A level of evidence IV, retrospective case series review of the entire Medicare files between 2005 and 2012 was conducted through the use of current procedural terminology codes and International Classification of Disease ninth edition codes. Linear regressions and chi-square tests were used for analysis. Subgroup analysis was performed by patient age. The total number of HRAs performed between 2005 and 2012 significantly decreased from 4,248 to 3,872 (p = 0.025). There was a significant increase in the annual incidence of HRA among patients younger than 65 years (p = 0.027; 9% increase) and patients 65 to 69 years old (p = 0.007; 22% increase), constituting 43% of the total patients. There was a significant decrease in HRA incidence among patients 80 to 84 years old (p = 0.001; 32% decrease) and patients 85 years old and over (p = 0.002; 24% decrease). Geographic analysis demonstrated the most HRA procedures were performed in the South, whereas gender focused analysis demonstrated a statistically significant decrease in HRA incidence for females (p = 0.003; 6% decrease) and a significant increase in incidence for males (p = 0.003; 7% increase). The overall annual incidence of HRA performed in the Medicare patient population has significantly decreased in recent years. However, this conceals an increased incidence among the relatively younger patient population. Potential causes for these opposing trends include changes in rates of revision surgery, alternative indications for surgery, advances in hardware, and surgeon expertise. This was a level of evidence IV, retrospective case series study.

Femoral Neck Stress Shielding after Birmingham Mid Head Resection Hip Arthroplasty – Case Report and Literature Review

We describe the presentation of substantial neck thinning due to stress shielding about a well-fixed Birmingham Mid Head Resection femoral implant. Despite significant resorption of proximal periarticular bone adjacent to the modular femoral head, secondary bone remodeling about the implant stem and proximal femur has occurred and stress shielding has appeared to stabilize, resulting in a satisfactory clinical outcome to date. For total hip arthroplasty utilizing short femoral implants we recommend consideration of alternative design stems to reduce the risk of stress shielding.

Hip Resection Arthroplasty.

Rubin, Lee E. MD1,a; Murgo, Kenneth T. BS1; Ritterman, Scott A. MD1; McClure, Philip K. MD1 Author Information

Resection hip arthroplasty as a feasible surgical procedure for periacetabular tumors of the pelvis

AimsSurgical treatment of periacetabular tumors remains one of the most challenging problems in musculoskeletal oncology. The purpose of this study was to review the clinical and functional outcomes of resection hip arthroplasty and analyze its feasibility. MethodsThis study assesses twenty-seven patients with periacetabular tumors treated by resection hip arthroplasty between 1999 and 2010. The tumors were excised with wide margins and the residual intact femoral head placed underneath the resected ilium. Clinical, functional and oncological outcomes as well as complications were carefully evaluated. ResultsThe average follow-up time was 55 months (range, 3–118) and the mean surgical time 170 min (range, 120–350) with an average blood loss 1200 ml (range, 600–2200). Six patients died in 6–33 months postoperatively; no other local recurrences or deaths occurred. The 1-year, 5-year, and 10-year disease-free survival rates were 96.3%, 77.8% and 77.8% respectively. The mean limb-length discrepancy was 5 cm (range, 2–7.5) and all patients required custom-made shoes with their heels heightened by 2–5 cm. At the last follow-up, the mean functional score was 75.6%. Twenty patients recovered normal ambulation function with custom-made shoes and seven had to walk with crutches. Wound healing problems were observed in nine patients and deep or superficial infection in none. ConclusionsResection hip arthroplasty is recommended as a feasible surgical protocol for periacetabular tumors because it has few complications, good functional results, short surgical time and little blood loss.

Birmingham Mid-Head Resection Hip Arthroplasty in a Young Man with Gigantism

The Birmingham Mid-Head Resection (Smith & Nephew Ltd, Warwick, United Kingdom) arthroplasty is a new bone-conserving procedure that, like hip resurfacing, is used in younger, active patients. We present the case of a young man with Sotos syndrome (cerebral gigantism) with associated extraordinary stature (height, 2.16 m; weight, 157 kg) who underwent Birmingham Mid-Head Resection arthroplasty. The large stature of this patient required a custom manufactured prosthesis (a femoral head 68 mm in diameter with an acetabular cup 76 mm in diameter). We believe this to be the largest metal-on-metal resurfacing articulation and hip arthroplasty reported to date.

Group B streptococcal prosthetic joint infections: a retrospective study of 30 cases

To describe the epidemiological, clinical, and laboratory characteristics of patients with group B streptococcal (GBS) prosthetic joint infections, their diagnoses, treatment, and long-term outcomes. We conducted a retrospective cohort study including all patients hospitalized from January 1994 through May 2006 for a GBS prosthetic joint infection. The study included 30 patients, aged 35-87 (median 74) years with prosthetic hip (24) or knee (6) infections, 20 with at least one underlying disease. The route of infection was presumed to be hematogenous in 27 patients, and a portal of entry was identified in 9 (genitourinary tract 4, skin 2, gastrointestinal tract 2, oropharynx 1). All patients underwent surgery (6 debridement-synovectomy, 9 1-stage exchange arthroplasty, 8 2-stage exchange arthroplasty, 6 hip resection arthroplasty, and 1 knee arthrodesis) and received prolonged intravenous antibiotics. Four patients relapsed. One patient developed 2 other infections on her knee prosthesis. Two deaths were infection-related, and one was treatment-related. Nineteen patients followed for >/=2 years were cured. One patient was lost to follow-up and 3 died of causes unrelated to infection or treatment within 2 years. GBS prosthetic joint infections are mostly acute hematogenous infections that require prompt management for satisfactory outcome. Despite high antibiotic susceptibility, treatment failure is frequent because of the severity of the infection and patients' advanced age, underlying diseases, and relapses.

Usefulness of Histological Analysis for Predicting the Presence of Microorganisms at the Time of Reimplantation After Hip Resection Arthroplasty for the Treatment of Infection

Appropriate interpretation of a frozen section has a relatively high specificity and sensitivity for the diagnosis of infection when septic loosening of a prosthesis is suspected. However, its usefulness for predicting the presence of microorganisms at the time of reimplantation after hip resection arthroplasty for the treatment of infection is not well defined. The aim of the present study was to evaluate the usefulness of histological analysis in this situation. From January 2002 to February 2006, a total of twenty-one patients underwent reimplantation after hip resection arthroplasty for the treatment of infection. Histological studies and cultures of specimens of periprosthetic tissue that had been obtained at the time of reimplantation were retrospectively reviewed. The results of culture were considered positive when the same microorganism was isolated in at least two samples. Two histological criteria were used to diagnose infection: (1) Criterion A (the Feldman criterion), defined as the presence of at least five neutrophils per high-power field (x400) in at least five separate microscopic fields and (2) Criterion B (the Athanasou criterion), defined as the presence of at least one neutrophil per high-power field (x400), on average, after examination of ten microscopic fields. The sensitivity, specificity, positive predictive value, and negative predictive value of each of these criteria were calculated with use of microbiological results as the gold standard for defining infection. Seven of the twenty-one patients had a positive result on culture, and the most common microorganism was coagulase-negative staphylococcus. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen-section analysis were 28.5%, 100%, 100%, and 73.6%, respectively, according to the Feldman criterion and 71.4%, 64.2%, 50%, and 81.8%, respectively, according to the Athanasou criterion. The numbers of lymphocytes and plasma cells did not help in the diagnosis of infection. Fibrosis was more common in patients without an infection. The probability of infection is high when at least five neutrophils per high-power field are found in the periprosthetic tissue, but it is not possible to rule out infection when the number of neutrophils is less than five. Diagnostic Level I.

Usefulness of Histological Analysis for Predicting the Presence of Microorganisms at the Time of Reimplantation After Hip Resection Arthroplasty for the Treatment of Infection

Background: Appropriate interpretation of a frozen section has a relatively high specificity and sensitivity for the diagnosis of infection when septic loosening of a prosthesis is suspected. However, its usefulness for predicting the presence of microorganisms at the time of reimplantation after hip resection arthroplasty for the treatment of infection is not well defined. The aim of the present study was to evaluate the usefulness of histological analysis in this situation. Methods: From January 2002 to February 2006, a total of twenty-one patients underwent reimplantation after hip resection arthroplasty for the treatment of infection. Histological studies and cultures of specimens of periprosthetic tissue that had been obtained at the time of reimplantation were retrospectively reviewed. The results of culture were considered positive when the same microorganism was isolated in at least two samples. Two histological criteria were used to diagnose infection: (1) Criterion A (the Feldman criterion), defined as the presence of at least five neutrophils per high-power field (×400) in at least five separate microscopic fields and (2) Criterion B (the Athanasou criterion), defined as the presence of at least one neutrophil per high-power field (×400), on average, after examination of ten microscopic fields. The sensitivity, specificity, positive predictive value, and negative predictive value of each of these criteria were calculated with use of microbiological results as the gold standard for defining infection. Results: Seven of the twenty-one patients had a positive result on culture, and the most common microorganism was coagulase-negative staphylococcus. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen-section analysis were 28.5%, 100%, 100%, and 73.6%, respectively, according to the Feldman criterion and 71.4%, 64.2%, 50%, and 81.8%, respectively, according to the Athanasou criterion. The numbers of lymphocytes and plasma cells did not help in the diagnosis of infection. Fibrosis was more common in patients without an infection. Conclusions: The probability of infection is high when at least five neutrophils per high-power field are found in the periprosthetic tissue, but it is not possible to rule out infection when the number of neutrophils is less than five. Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.

The Energy Cost of Walking with Arthritis of the Hip and Knee

The physiologic energy expenditure of walking was measured in patients with severe arthritis. Nine patients were tested following Girdlestone hip resection arthroplasty, six patients prior to total knee arthroplasty (TKA) for unilateral osteoarthritis of the knee, and 49 rheumatoid arthritis patients prior to unilateral TKA; 27 were retested after operation. The results were compared with previously published pre- and postoperative data for total hip arthroplasty (THA) following primary osteoarthritis. There were severe energetic penalties caused by rheumatoid or osteoarthritis involving the hip or knee or following Girdlestone arthroplasty. Walking speed was severely reduced in all groups (range, 33-46 m/minute). The rate of oxygen consumption was not significantly greater than the mean rate of oxygen uptake for normal subjects; however, the oxygen cost per meter travelled was elevated because of the slow walking speed. The heart rate was significantly elevated in all patient groups. The elevated cardiac response can be accounted for on the basis of deconditioning resulting from the patients' pain, limited ambulatory activities, and the systemic effects of rheumatoid disease. In addition, the elevated cardiac response may be caused by added physical exertion by the arms in patients on crutches or walkers. The improvements in speed and energy cost were the same for the group of rheumatoid patients tested after unilateral TKA as in the group of patients tested before and after THA. The clinician can anticipate the same magnitude of improvement from surgery in a rheumatoid patient as in an osteoarthritis patient if the primary joint disease is restricted to a single joint.