Harris Hip Score Improvement Research Articles

Core decompression treatment of early-stage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency

BackgroundThe objective of this study was to explore the therapeutic effect of core decompression on different hemodynamics changes associated with osteonecrosis of the femoral head (ONFH). MethodsA total of 67 patients with 76 hips suffering from ONFH (Arco stage I–IIC) received core decompression surgical procedure. Radiographic, magnetic resonance imaging, and digital subtraction angiography examinations were performed before operation. Radiographic and magnetic resonance imaging follow-ups were also performed after 12, 24, and 60 mo of operation. Clinical follow-ups were performed using the Harris Hip Score (HHS) for an average period of 5 y postoperation. ResultsThe mean follow-up time ranged from 2–8 y with an average of 5 y. Two hips were lost during follow-up. Successful clinical efficacy (HHS ≥80) was achieved in 91.9% (68/74) of the hips. Six hips had conversion to total hip arthroplasty (THA), one hip had venous stasis, and five hips had both vein stasis and artery blood supply insufficiency. The mean HHS for the patients who did not have conversion to THA improved from 65 ± 3.5 to 89 ± 3.6 (mean ± standard deviation). Twenty-six stage I hips (100%), 22 of 23 stage IIA hips (95.7%), 13 of 15 stage IIB hips (86.7%), and 8 of 10 stage IIC hips (80%) had successful outcomes with no surgical complications. Kaplan–Meier survival analysis showed that 8-y survival rate was significantly different between stage I and stage IIC (THA as an end point; P < 0.001). ConclusionsIn patients with early-stage ONFH resulted from only venous stasis, core decompression led to a significant improvement in HHS and 8-y survival rate. However, the long-term efficacy for ONFH associated with artery blood supply insufficiency was not encouraging. Therefore, preoperative digital subtraction angiography is necessary before performing core decompression.

What is the Prognosis of Revision Total Hip Arthroplasty in Patients 55 Years and Younger?

Revision THAs are expected to increase; however, few studies have characterized the prognosis of revision THAs in younger patients. We performed a case-control study to evaluate intermediate-term survivorship, complications, and hip and activity scores after revision THAs in patients 55 years and younger, compared these outcomes with the results of primary THAs in a matched patient population, and evaluated risk factors for failed revisions. Ninety-three patients (103 hips) had a minimum of 4 years after revision THA, died, or had rerevision surgery. They were matched with 98 patients (103 hips) with primary THAs. Survivorship, complications, and clinical outcomes were compared between the groups using t-tests. Risk factors for failure also were assessed with chi-square analysis. At mean followup of 6.7 years, 71 revision THAs (69%) survived, compared with 102 (99%) primary THAs (odds ratio [OR], 45.9; 95% CI, 16.5-128.4; p < 0.001). Complications occurred in 29% of the revision group and 6% of the primary group (OR, 6.64; 95% CI, 4.14-10.67; p < 0.001). After revision THA, the average improvement in Harris hip score was 19.2 compared with 34.4 after primary THA (p < 0.001). The UCLA activity score improved by an average of 0.87 after revision compared with 2.36 after primary THA (p < 0.001). Conventional polyethylene was associated with failure after revision THA (OR, 2.98; 95% CI, 1.87-4.76; p = 0.004). At intermediate-term followup, young patients undergoing revision THAs had markedly higher failure and complication rates and more modest clinical improvements compared with patients in a matched cohort who had primary THAs. Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty). Preliminary report

PurposeThe purpose of this study was to evaluate clinical and radiological outcomes of autologous osteochondral transfer (OATS) for femoral head osteonecrosis.MethodsTwenty-one hips in 20 patients (one woman and 19 men), average patients' age at the time of surgery of 35.4 (range 20–56) years, were treated with OATS for osteonecrosis of the femoral head (ONFH). Seven patients at pre-collapse ARCO stages IIA and IIB were treated with OATS alone. Thirteen patients with large pre-collapse ARCO IIC and post-collapse ARCO III and IV were treated with OATS and morselised bone allografts (OATS/allograft). Harris hip score (HHS) was used for clinical evaluation of outcomes; X-rays were performed to examine the evolution of the disease. Kaplan-Meier survival curves were used to determine the failure of the procedures with conversion to THR defined as endpoint.ResultsFollow-up of patients treated with OATS alone was 46.14 (range 18–75) months with HHS improvement from a preoperative mean of 42 to 87.85 points at the latest follow-up examination. Only one patient in this group needed a revision operation with THR. The survival for this group of patients was 85.71 % at four years. Follow-up of patients treated with AOTS/allograft was 32.7 (range 7–84) months with HHS improvement from a preoperative mean of 35.2 to 65.7 points at the latest follow-up examination. One patient died six months after the surgery. There were five conversions to THR because of femoral head collapse in this group of patients with survival of 61.54 % at three years.ConclusionThe use of osteochondral grafts offers the possibility of successful treatment for ONFH at small and medium pre-collapse stages. The outcomes of large pre-collapse and post-collapse stages were below our expectations. OATS is a time buying procedure for young patients as it may defer total hip replacement.

Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients

Sickle cell disease (SCD) is the most common cause of avascular necrosis of femoral head (ANFH) in childhood. Advances in medical treatment led to improved life expectancy of such patients. SCD-related ANFH frequently progress to total collapse of the femoral head necessitating hip replacement. However, SCD patient are at more risk of intra- and post-operative complications and suboptimal outcome of total hip arthroplasty. Hence, it is imperative to preserve the femoral head as long as possible. Between September 1992 and June 2007, 94 core decompression procedures were done to SCD patients who had modified Ficat stage I, IIA and IIB ANFH. Sixty one patients underwent a classical 8-mm drilling and 33 patients underwent 3.2-mm diameter MD technique. Patients were followed up for minimum of 2years and were evaluated for clinical and Harris Hip Score improvement and for radiological progression. All 19 hips that had Ficat stage I had significant reduction of pain and improvement of Harris Hip Score. No patient has required further surgery. Among the 39 hips with Ficat IIA at time of procedure, 80% of hips which underwent CD and 78% of MD cases had significant reduction of pain and improvement of HHS. Those patients showed no radiographic progression of the disease. The remaining, 20% CD and 22% MD eventually progressed radiologically to grade III or grade IV and had HHS less than 75 at last visit. In the 36 cases with Ficat IIB, 52% CD and 52.8% MC had significant reduction of pain and improvement of HHS. The rest showed no improvement in pain and function, and progressed to stage IV; 11 of them underwent THA and one patient refused surgery. While multiple drilling is safer and less invasive than single coring in SCD, there is no statistically significant difference in outcome or complication rate between both procedures done for ANFH in patients with SCD.

Revision Hip Replacement in Patients 55 Years of Age and Younger

The purpose of this study was to assess the efficacy and complications associated with revision hip arthroplasty undertaken in patients under 55 years of age. A review of our revision hip database showed that 430 revision hip arthroplasties undertaken over the past 9 years had a minimum follow-up of 2 years. Of these, 84 (46 female, 38 male) patients were under 55 years of age. The index procedures were preformed at an average age of 46 years (range 15 years to 54 years). The etiology of failure was aseptic loosening (74%), followed by infection (8%) and recurrent dislocation (7%). In the majority of cases, uncemented implants were used at revision surgery (91% uncemented femoral stem, 100% uncemented acetabular cup). A form of bone graft was necessary in 39% of cases. At final follow-up satisfactory progress was noted in all cases with a statistically significant improvement in Harris hip score (p<0.05). Revision of hip arthroplasty in patients below 55 years of age is associated with significant improvement in function and patient satisfaction.

Results of uncemented distal locked prosthesis in revision hip arthroplasty with proximal femoral bone loss: A retrospective study

Introduction:Management of bone loss is a challenge in revision total hip arthroplasty (THA). A retrospective review was performed to study the use of uncemented distal locked prosthesis in cases with proximal femoral bone loss.Materials and Methods:Uncemented stems with distal interlocking were used in 65 hips during revision THAs with 38 hips having Paprosky IIIB/IV defects between January 1998 and February 2004. There were 48 males and 17 females in the study with an average age of 53 years (range 30-80 years). Radiographic and clinical outcome evaluation using the Harris hip score (HHS) were performed.Results:An improvement in HHS (mean: 33 points) was observed at final followup (mean: 9 years). Regeneration of proximal bone stock was observed without signs of loosening or subsidence and none of the stems were revised. Three patients developed recurrent dislocation while one had a stem subsidence of 1cm following removal of interlocking bolts.Conclusion:Uncemented distal locked prosthesis provide adequate stability in revision THA, aiding the reconstruction of bony deficiencies while avoiding the disadvantages of fully porous or cemented implants.

Combined Tantalum Implant with Bone Grafting for the Treatment of Osteonecrosis of the Femoral Head

ABSTRACTBackground: The purpose of this study was to evaluate the short-term clinical outcome of using a tantalum implant in combination with bone grafting for the treatment of osteonecrosis of the femoral head. Methods: Sixty-nine patients with 94 osteonecrotic hips were treated with this method from March 2006 to March 2011. All the patients were treated with tantalum rod implantation in combination with bone grafting, and were followed for an average 35.4 months. Harris hip score and the survival rate were analyzed according to stage, etiology, and osteonecrosis part. Results: Patients with stage I and stage II diseases had significant greater Harris hip score improvement than patients having stage III disease (p < .05). The survival rate was also significantly higher in patients with stage I and stage II diseases than in patients having stage III disease (p < .05). Patients with type A and type B necrotic lesions had better recovery than patients with type C1 and type C2 having lateral column lesions (p < .05). No significant differences were detected in the clinical outcome among patients with different etiologies. Conclusion: Combined tantalum implant with bone grafting provided good short-term clinical outcomes for early stage I and stage II patients with type A and type B necrotic lesions. However, this treatment modality was not so effective for patients with stage III or type C1 and type C2 necrotic lesions.

Mid-term results of large diameter heads on cross-linked polyethylene liners in total hip replacement.

Highly cross-linked polyethylene liners in total hip replacement (THR) have allowed the use of larger diameter femoral heads. Larger heads allow for increased range of motion, decreased implant impingement, and protection against dislocation. The purpose of this study is to assess the clinical and radiographic outcomes of patients with large femoral heads THR at 4 years postop. Study includes 28 patients who had a primary THR with a 36mm larger femoral head were retrospectively for minimum 4 years follow-up. All patients received a cementless acetabular shell and a highly cross-linked polyethylene liner with an inner diameter of 36mm. The median radiographic follow-up was 4 years (range 2.0-6.0), and patients were assessed clinically by Harris hip score. The mean follow-up is minimum 4 years (range 2-6 years) results in all operated patients showed marked improvement in Harris hip score from preoperative mean 49.1 to 89.9 at 4 years or more follow-up. The complications include superficial infection (n=2). No dislocation, or no osteolysis was seen in the pelvis or proximal femur, and no components failed due to aseptic loosening. There was no evidence of cup migration, screw breakage, or eccentric wear on the liner. The mid-term results in this series of patients with LDH using 36 mm femoral head articulating with highly cross linked polyethylene showed excellent clinical, and radiological results, in terms of, joint restoration that replicates the natural anatomy, optimized range of motion without impingement & reduced opportunity for postoperative dislocation.

Crowe Type I and II Ddh Managed by Large Diameter Metal-on-Metal Total Hip Arthroplasty

Large bearing metal-on-metal (MOM) total hip arthroplasty (THA) may offer advantages relating to stability and range of motion in patients with Crowe Type I and II developmental dysplasia of the hip (DDH). The purpose of this study was to provide an analysis of the clinical and radiological results of MOM THA in this context and compare the results with a cohort of patients treated with metal-on-polyethylene (MOP) bearing surfaces. 75 hips in 65 patients were treated with cementless MOM THA using large femoral heads (36-56 mm). The mean age of the patients was 47.4 years (29 to 59) and 54 were female. A group of 47 hips (41 patients) treated with conventional THA (screwed cup-polyethylene insert-28 mm head) was used for comparison. The study group was followed up for a mean of 62.1 months (32 to 76). No difference was found between the two groups in relation to improvement in Harris hip score (HHS) (43.1 to 90.3 points in the study group, 42.6 to 89.5 points in the control group, p>0.05). Although the preoperative range of motion in all planes were similar in both groups, the large head group demonstrated greater motion in all planes postoperatively, which was significant (all p=0.001). Additionally, there was a significant difference between groups in relation to the necessity for acetabular structural graft (8% and 31.9%, respectively; p=0.001). No major complications or adverse reactions to metal debris (ARMD) were observed in the study group. The results of large head MOM THA in young and active patients with DDH are similar to conventional THA at early follow-up, but the former offers the advantages of secure acetabular fixation without screws, greater range of motion, and lower risk of dislocation.

The impact of obesity on weight change and outcomes at 12 months in patients undergoing total hip arthroplasty

To establish the rate of clinically significant weight change after 12 months in patients who have had a primary total hip arthroplasty (THA); to identify patient characteristics that predicted weight loss or gain; and to compare clinical and functional outcomes between obese and non-obese patients. Prospective study of 471 patients who underwent THA between 2006 and 2007 at St Vincent's Hospital, Melbourne, a university-affiliated tertiary referral centre. Patients were classified as non-obese, obese and morbidly obese, and were assessed using the Harris Hip Score (HHS) and 12-item Short Form Health Survey (SF-12). Incidence of weight loss or gain 12 months after surgery; preoperative patient variables predictive of weight change; functional and quality-of-life outcomes and rate of adverse events at 12 months; differences in outcomes between obese and non-obese patients. 194 patients (41%) were obese or morbidly obese. At 12-month follow-up, 18 obese or morbidly obese patients (9%) had lost >or= 5% of their preoperative weight and 118 patients (25%) had gained >or= 5% of their preoperative weight. No preoperative predictor of weight loss was identified, but weight gain was associated with lower preoperative SF-12 mental health scores (odds ratio [OR], 0.98 [95% CI, 0.96-0.99]; P = 0.04). There were no significant differences between obesity groups in improvement in HHS or SF-12 physical health scores. Improvement in SF-12 mental health scores was greater in obese (+ 3.6 [SD, 12.2]) and morbidly obese (+ 3.7 [SD, 9.4]) patients than in non-obese patients (- 0.1 [SD, 11.7]) (P = 0.01). Compared with non-obese patients, the odds of a postoperative complication were significantly greater in obese patients (OR, 1.81 [95% CI, 1.05-3.11]) and morbidly obese patients (OR, 5.77 [95% CI, 2.10-15.86]). Clinically significant weight loss in obese patients after THA is uncommon. Obese and morbidly obese patients experience comparable reduction in pain and improvement in function after THA, but the risk of complications in the first 12 months after surgery is significantly greater than the risk in non-obese patients.

Primary cemented total hip arthroplasty: 10 years follow-up.

Background:Primary cemented total hip arthroplasty is a procedure for non-traumatic and traumatic affections of the hip. Long term follow-up is required to assess the longevity of the implant and establish the procedure. Indo-Asian literature on long term result of total hip arthroplasty is sparse. We present a 10-year follow-up of our patients of primary cemented total hip arthroplasty.Materials and Methods:We operated 31 hips in 30 patients with primary cemented total hip arthroplasty. We followed the cases for a minimum period of 10 years with a mean follow-up period of 12.7 years. The mean age of the patients was 60.7 years (range 37–82 yrs) male to female ratio was 2:1. The clinical diagnoses included - avascular necrosis of femoral head (n=15), sero positive rheumatoid arthritis (n=5), seronegative spondylo-arthropathy (n=4), neglected femoral neck fractures (n=3), healed tubercular arthritis (n=2) and post traumatic osteoarthritis of hip (n=2). The prostheses used were cemented Charnley’s total hip (n=12) and cemented modular prosthesis (n=19). The results were assessed according to Harris hip score and radiographs taken at yearly intervals.Results:The mean follow-up is 12.7 yrs (range 11-16 yrs) Results in all operated patients showed marked improvement in Harris hip score from preoperative mean 29.2 to 79.9 at 10 years or more followup. However, the non-inflammatory group showed more sustained long term improvement as compared to the inflammatory group, as revealed by the Harris hip score. Mean blood loss was 450ml (±3.7 ml), mean transfusion rate was 1.2 units (±.3). The complications were hypotension (n=7), shortening >1.5 cm (n=9), superficial infection (n=2) and malposition of prosthesis (n=1).Conclusion:The needs of Indian Asian patients, vary from what is discussed in literature. The pain tolerance is greater than western population and financial constraints are high. Thus revision surgery among Indian-Asian patients is less compared to western yard sticks.

Revision hip arthroplasty by Waldemar Link custom-made total hip prosthesis

The number of patients undergoing hip arthroplasty revision is constantly growing. Especially, complex problem is extensive loss of bone stock and pelvic discontinuity that requires reconstruction. The paper presented a 50-year old patient, who ten years ago underwent a total cement artrhroplasty of the left hip. A year after the primary operation the patient had difficulties in walking without crutches. Problems intensified in the last five years, the patient had severe pain, totally limited movement in the left hip and could not walk at all. Radiographically, we found loose femoral component, massive loss of bone stock of proximal femur, acetabular protrusion and a consequent pelvic discontinuity. Clinically, a completely disfunctional left hip joint was registered (Harris hip score--7.1). We performed total rearthroplasty by a custom-made Waldemar Link total hip prosthesis with acetabular antiprotrusio cage and compensation of bone defects with a graft from the bone bank. A year after the operation, we found clinically an extreme improvement in Harris hip score--87.8. Radiographically, we found stability of implanted components, a complete graft integration and bone bridging across the site of pelvic discontinuity. Pelvic discontinuity and massive loss of proximal femoral bone stock is a challenging and complex entity. Conventional prostheses cannot provide an adequate fixation and stability of the hip. Application of custom-made prosthesis (measured specificaly for a patient) and additional alografting bone defects is a good method in revision surgery after unsuccessful hip arthroplasty with extensive bone defects.

Structural Augmentation with Biomaterial-Loaded Allograft Threaded Cage for the Treatment of Femoral Head Osteonecrosis

Seventy-six patients with femoral head necrosis were allocated to a program of either core decompression (control group) or core decompression and implantation of a biomaterial-loaded allograft threaded cage (treatment group). All patients were followed up prospectively clinically and radiographically. In the control group, no significant improvement in Harris hip score was found, and 13 of the 22 hips had deteriorated to stage III. In the treatment group, the mean Harris hip score was improved from 62.8 to 81.6; the clinical success rate at 36 months postoperatively was 91%. Collapse was seen in 1 hip, and another 3 hips exhibited progressive collapse. The procedure is attractive as a minimally invasive and salvage procedure, which shows encouraging success rates and early clinical results in patients with Steinberg stage I-II osteonecrosis.

Periacetabular Osteotomy for Acetabular Dysplasia in Patients Older than 40 Years: A Preliminary Study

The functional outcomes of periacetabular osteotomy (PAO) and factors predicting outcome in the older patient with acetabular dysplasia are not well understood. We therefore retrospectively determined the functional outcome of 70 patients (87 hips) over age 40 treated with PAO in three institutions; we also determined whether preoperative factors, particularly the presence of osteoarthritis, influenced the survival of the hip or time to total hip arthroplasty after PAO. The average age at surgery was 43.6 years. The minimum followup was 2 years (mean, 4.9 years; range, 2-13 years). Twenty-one hips (24%) had undergone total hip arthroplasty (THA), at a mean of 5.2 years after PAO (range, 1.9-7.6 years). Surviving hips had a mean improvement in Harris hip score from 60.7 to 90.3 and in total WOMAC pain score from 8.7 to 3. We observed no differences in preoperative or postoperative radiographic measurements or preoperative clinical function scores (HHS, WOMAC) in hips surviving and hips having THA. The risk of THA at 5 years after PAO was 12% in hips with preoperative Tönnis Grade 0 or 1 and 27% for Tönnis Grade 2. Our preliminary study suggests that PAO will give satisfactory functional and pain scores in patients over age 40 having dysplastic hips with mild or no arthrosis.

Hip Arthroscopy for Labral Pathology: Prospective Analysis With 10-Year Follow-up

The purpose of this study was to investigate the results of arthroscopic treatment of acetabular labral tears (the most common indication for hip arthroscopy) in a consecutive series of patients with 10-year follow-up. Since 1993, all of our patients undergoing hip arthroscopy have been prospectively assessed by use of a modified Harris Hip Score preoperatively and postoperatively at 3, 12, 24, 60, and 120 months. Variables recorded include age, sex, diagnosis, duration of symptoms, onset of symptoms, center-edge angle, Workers' compensation status, and pending litigation. From a cohort of 52 procedures performed on 50 patients who had achieved 10-year follow-up, 29 patients (31 hips) were treated for a tear of the acetabular labrum and represent the substance of this study. There was 100% follow-up, excluding 3 patients (5 hips) who died before their 10-year assessment. The mean age was 46 years (range, 17 to 84 years); there were 13 male and 13 female patients. The median Harris Hip Score improvement was 29 points (from 52 points preoperatively to 81 points postoperatively). Among 18 patients without arthritis, 15 (83%) continued to show substantial improvement (>or=18 points) at 10-year follow-up. Among 8 patients with associated arthritis, 7 (88%) were converted to total hip arthroplasty at a mean of 63 months. Two patients underwent repeat arthroscopy, which did not preclude a successful outcome at 10-year follow-up. There were no complications. Selective debridement of symptomatic tears can result in favorable long-term results. The presence of clinical findings of arthritis at the time of the index procedure is a poor prognostic indicator, with uniformly poor results at 10 years. Level IV, therapeutic case series.

Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting.

Background:Femoral head-preserving core decompression and bone grafting have shown excellent result in preventing collapse. The use of vascularized grafts have shown better clinical results. The vascular pedicle bone graft is an easy to perform operation and does not require special equipment. We analyzed and report a series of patients of osteonecrosis of femoral head treated by core decompression and vascular pedicle grafting of part of iliac crest based on deep circumflex iliac vessels.Materials and Methods:The article comprises of the retrospective study of 31 patients of osteonecrosis of femoral head in stage II and III treated with core decompression and vascular pedicle grafting by using part of iliac crest with deep circumflex iliac vessels from January 1990 to December 2005. The young patients with a mean age 32 years (18–52 years) with a minimum follow-up of five years were included for analysis. Sixteen patients had osteonecrosis following alcohol abuse, 12 patients following corticosteroid consumption, 3 patients had idiopathic osteonecrosis. Nine patients were stage IIB, and 22 patients were stage IIIC according to ARCO's system. The core decompression and vascular pedicle grafting was performed by anterior approach by using part of iliac crest with deep circumflex iliac vessels.Results:Digital subtraction arteriography performed in 9 patients at the end of 12 weeks showed the patency of deep circumflex artery in all cases, and bone scan performed in 6 other patients showed high uptake in the grafted area of the femoral head proving the efficacy of the operative procedure. Out of 31 patients, only one patient progressed to collapse and total joint replacement was advised. At the final follow up period of 5–8 years, Harris Hip Score improved mean ± SD of 28.2 ± 6.4 (p < 0.05). Forty-eight percent of patients had an improvement in Harris Hip Score of more that 28 points.Conclusion:The core decompression and vascular pedicle grafting reduces the intraosseous tension to achieve early revascularization of ischemic femoral head. The high percentage of marrow and osteogenic cells survive within a vascularized pedicle graft, which helps in early vascularization and we have been able to achieve good outcome.

Short-term outcome after posterior versus lateral surgical approach for total hip arthroplasty - a randomized clinical trial*

PurposeCurrently, total hip replacement (THR) is most commonly performed via a posterior or a direct lateral approach, but the impact of the latter on the invention's outcome has yet not been quantified.MethodsWe compared the short-term outcome of cementless THR using the both approaches in a prospective, randomized controlled trial. 60 patients with unilateral osteoarthritis were included. Outcome assessment was performed one day before surgery and one week, four weeks, six weeks and 12 weeks after surgery, respectively, using the Harris Hip score as primary objective.ResultsWe found no significant difference in the intraindividual Harris Hip Score improvement at the pre-and three months post-operative assessments between both treatment groups (p = 0.115). However, Harris Hip scores and most functional and psychometric secondary endpoints showed a consistent tendency of a slightly better three months result in patients implanted via the posterior approach. In contrast a significant shorter operating time of the direct lateral approach was recorded (67 minutes versus 76 minutes, p < 0.001).ConclusionIn our opinion this slightly better short-term functional outcome after posterior approach is not clinical relevant. However, to make definitive conclusions all clinical relevant factors (i.e. mid- to long-term function, satisfaction, complication rates and long-term survival) have to be taken into account. Level of evidence: I - therapeutic

Varus Proximal Femoral Osteotomy for hip Dysplasia in Adults

A retrospective study was carried out to evaluate the role of varus proximal femoral osteotomy in relieving symptoms and improving function in adults affected by hip dysplasia. A group of 24 patients were identified that underwent 26 varus proximal femoral osteotomies between the period May 1979 and January 2001. All were investigated by dynamic hip arthrography to confirm restoration of congruency in the abducted position and the position of ''best fit''. The mean age of the patients at the time of operation was 26 years (range 16 to 47) and the median duration of follow-up was 5.1 years (range 1.6 to 23.1 years). Clinical improvement was evaluated by determining the Harris Hip Score at the time of admission with a further assessment at the most recent follow-up. Additionally, radiological change was evaluated by measuring acetabular femoral head index, the centre-edge angle of Wiberg and the Tonnis grade of osteoarthritis. The results revealed an improvement in Harris hip score from a mean of 72.1 pre-operatively (range 58.8 to 88.53) to 96.83 at the most recent follow-up (range 85.1 to 100). The centre edge angle and acetabular head index also increased in all patients. The results were statistically significant (p value <0.05). The procedure was found to reduce discomfort and improve function in patients affected by hip dysplasia. No patients required further intervention to alter disease progression during the follow-up period. The best results were found when the operation was performed for long leg dysplasia. Only one patient required surgery for non-union at the osteotomy site. Varus proximal femoral osteotomy appears to be a good treatment option in young adults with hip dysplasia, even when early degenerative change is present.

Varus proximal femoral osteotomy for hip dysplasia in adults

A retrospective study was carried out to evaluate the role of varus proximal femoral osteotomy in relieving symptoms and improving function in adults affected by hip dysplasia. A group of 24 patients were identified that underwent 26 varus proximal femoral osteotomies between the period May 1979 and January 2001. All were investigated by dynamic hip arthrography to confirm restoration of congruency in the abducted position and the position of ''best fit''. The mean age of the patients at the time of operation was 26 years (range 16 to 47) and the median duration of follow-up was 5.1 years (range 1.6 to 23.1 years). Clinical improvement was evaluated by determining the Harris Hip Score at the time of admission with a further assessment at the most recent follow-up. Additionally, radiological change was evaluated by measuring acetabular femoral head index, the centre-edge angle of Wiberg and the Tonnis grade of osteoarthritis. The results revealed an improvement in Harris hip score from a mean of 72.1 pre-operatively (range 58.8 to 88.53) to 96.83 at the most recent follow-up (range 85.1 to 100). The centre edge angle and acetabular head index also increased in all patients. The results were statistically significant (p value <0.05). The procedure was found to reduce discomfort and improve function in patients affected by hip dysplasia. No patients required further intervention to alter disease progression during the follow-up period. The best results were found when the operation was performed for long leg dysplasia. Only one patient required surgery for non-union at the osteotomy site. Varus proximal femoral osteotomy appears to be a good treatment option in young adults with hip dysplasia, even when early degenerative change is present.

The tantalum screw for treating femoral head necrosis: rationale and results

Femoral head necrosis (FHN) is a progressive pathology due to the failure of blood supply to the proximal femoral epiphysis, with consequent necrosis of the sub-chondral bone and collapse of the articular cartilage and loss of congruity between the head and the acetabulum. Borrowing the biological and mechanical principles from the vascularized fibular graft technique for the femoral neck, the tantalum screws have been introduced. They show an extraordinary porosity, osteoconductivity, biocompatibility and very good osteoinductivity. Vitreous tantalum can be processed to take the form of a screw, with a round medial extremity and a 25 mm threaded lateral extremity that can be inserted into the neck of the femur, thereby supporting the articular cartilage, stimulating the repair process, interrupting the interface between necrotic and healthy tissue and favoring local vascularization. We have drawn up a treatment protocol for early-stage FHN, based on the insertion of a tantalum screw into the femoral neck. The implant has a cylindrical shape, with a 10 mm diameter in the smooth part and 15 mm in the threaded part. It is available in different sizes from 70 to 130 mm, with 5 mm increments. The aim of the study is to describe the clinical and instrumental results of the tantalum screw for FHN. From June 2004 to June 2006 we performed 15 implants. The tantalum screw was inserted with an incision on the trochanteric region with traction and under X-ray control. For the clinical evaluation of the hip, we used the Harris hip score (HHS). For diagnosis and staging we used standard X-rays in two views and/or MRI, using the Steinberg classification (J Bone Joint Surg Br 77:34-41, 1995) and CT. In all cases, the osteonecrosis extended to not more than 30% of the joint surface and the cartilage was intact with no collapse. To assess the results, we compared the pre-operative and the post-operative HHS, calculated the percentage differences between the two. We then compared X-rays, CT scans and MRI before and some time after the operation to assess whether the problem had been addressed, taking into account the intracancellous edema and the possible extension of necrosis. After an average follow-up period of 15.43 +/- 5.41 months, ten implants (seven patients out of ten) were examined and all but one patient showed a marked improvement in HHS (the average increase was 127.9%), with no further progression of the disease. We believe that this procedure can be suitable for young patients with limited first or second stage osteonecrosis. The objective for the foreseeable future is to resolve the pain, improve the quality of life and prevent or at least postpone arthroplasty.