Mean Postoperative Harris Hip Score Research Articles

Study on outcome of cemented total hip replacement by posterolateral approach to hip

In advanced osteoarthritis of the hip there will be painful gross limitation of movements incapacitating individual from his routine activities. The cemented total hip replacement is a boon to these patients by painless mobility of the joint. Cemented femoral component provides an immediate postoperative advantage (i.e. of intimate contact between the prosthesis cement and the bone, which permits dramatic early relief of pain and more weight – bearing). 40 patients with 49 diseased hips of various etiologies were treated with cemented total hip replacement by the posterolateral approach. The patients were assessed pre-operatively and post-operatively till minimum 6 months follow up using the Harris Hip Score. Minimum follow up period was 6 months which saw a count of 40 patients with 49 hips. There were 26 male and 14 females with the mean age being 53.43 years. Right sided injury was more common seen in 26 patients (65%) with AVN being the most common etiology. Superficial infection was the most common post-op complication seen in 2 patients while there were 1 patient each having complications of dislocation, DVT and foot drop. The mean Pre-operative Harris Hip Score was 52.29 and the mean Post-operative Harris Hip Score was 79.20 with 80% patients showing good outcome. Cemented THR by the posterolateral approach is a viable an excellent option in elderly patients suffering from hip disorders requiring replacement. However, further prospective randomized trials are warranted. Keywords: Total hip replacement, Cemented, Posterolateral approach to hip.

High Revision Rates of a Cementless Beta-Titanium Alloy Stem with Contamination-Free Roughened Surface in Primary Total Hip Arthroplasty.

Optimal osseointegration of cementless total hip arthroplasty is essential for high stability and long-term survival. The purpose of this follow-up study was to evaluate the clinical and radiological outcome, the complications, and survival rates of a beta-titanium alloy stem with a specific grit-blasted-free surface. In 192 patients (mean age of 64.4 years), 202 consecutive primary total hip arthroplasties were performed using a cementless Hipstar® stem (Stryker, Duisburg, DE). The Harris Hip Score (HHS) was assessed pre-operatively and post-operatively. Radiolucent lines were evaluated and the implant survival rate was calculated using Kaplan-Meier analysis. The mean follow-up was 7.71 years (range of 5.0–14.0 years). Overall, 15 revisions were performed. Early aseptic stem loosening was observed in six cases (2.97%). Radiolucent-lines adjacent to the stem were detected in 73 cases (83.02%), especially (70.46%) in the Gruen zones 1, 7, 8, and 14. The mean postoperative HHS was 92.65 points (range 42–100). The cumulative survival probability of the stem was 94.4% (95% CI 90.3 to 98.5%). Considering aseptic failure as an endpoint, the cumulative survival rate of the stem was 95.3% (95% CI 0.914 to 0.992) at six years of follow-up. Overall, an inferior mid-term implant survival was observed in comparison to well-established cementless stem designs.

Augmentation for Acetabular Deficiencies in Complex Total Hip Arthroplasty

Introduction:Complex and revision Total Hip Arthroplasty (THA) is a challenging prospect in patients with acetabular bone deficiencies. Augmentation using allograft and trabecular metal (TM) are among some of the options in these situations. This study report the outcomes of 14 cases of complex and revision THA using acetabular augments performed in our institution between 2015 and 2018Materials and Methods:In this retrospective study, data included demographic features, indication for THA, type of augments and clinical outcomes using the Harris hip score were collected for the to determine early results following THA.Results:The mean cohort age was 51.3 years. Gender distribution was equal with 7 male and female patients each. 7 THAs were augmented with allograft and 7 cases with TM augments. The average duration of follow-up was 16.9 months. Most patients (11 of 14) required complex primary THA following prior traumatic hip dislocations and its subsequent complications. The mean post-operative Harris hip score for functionality was 80.84 in our cohort at final follow-up (from an average of 33.8 pre-operatively). At present, there have been no reports of wound complications, infections or dislocations in this early cohort.Discussions:Complex/revision THA using allografts for acetabular augmentation have been used for decades with good and replicable results as shown in our series. TM is relatively new but current literatures show encouraging results. Both options have resulted in good outcomes in our cohort and further long term studies would be necessary before TM augments were to replace the need for allograft.Conclusions:Both allografts and TM acetabular augments showed good early results post-operatively in our cohort. With the improved flexibility of component selection and the lower risk of allograft infection, TM augments is currently our choice of acetabular augmentation and the early results are promising.

Functional outcome of total hip arthroplasty in young adults: A retrospective study

Background: Management of end – stage hip in young adults (< 50 years) remains a challenge. Hip -preserving surgeries in the setting of advanced often do not provide adequate pain relief. The implications of total hip arthroplasty in young patients is a matter of concern regarding the outcome and durability of the prosthesis. Improved techniques and biomaterials have stimulated the demand for total hip arthroplasty in young and active individualsMaterials and Methods: A retrospective study of cases done between 2011 to 2015. A total of 225 patients, average age 35 (20 – 50) operated at Department of Orthopaedics, Vydehi Institute of Medical Sciences & Research Centre. Patients were followed up for a period of 3 years. Harris Hip score was used to evaluate the outcome and the Wilcoxin ranked T test was used to calculate p value. Results: An average follow up of 41 months (range 13 – 86) was done. The mean post-operative Harris hip score was significantly improved with p value

Debridement, Antibiotics and Implant Retention for Early Periprosthetic Infections of the Hip: Outcomes and Influencing Factors.

PurposeDebridement, antibiotics and implant retention (DAIR) is commonly performed and widely accepted for the treatment of acute infections following hip arthroplasty. The aims of this study were to: i) determine the DAIR success rate in treating acute postoperative and hematogenous periprosthetic infections of the hip at a tertiary hospital, ii) identify possible outcome predictors, and iii) analyze clinical and radiological outcomes.Materials and MethodsWe retrospectively reviewed cases of acute postoperative (≤3 months from index procedure) and hematogenous periprosthetic infections following total hip arthroplasty treated with DAIR at our hospital between 2004 and 2015. Overall, 26 hips (25 patients) were included in the study, with a mean age of 72.5 years (standard deviation [SD], 9.4). The mean follow-up was 48.5 months (SD, 43.7). Several variables (e.g., patient characteristics, infection type, surgery parameters) were examined to evaluate their influence on outcomes; functional and radiographic outcomes were assessed.ResultsThe overall success rate of DAIR was 26.9%. The male sex was associated with treatment failure (P=0.005) and debridement performed by a surgeon in hip unit with success (P=0.028). DAIR failure increased in patients with chronic pulmonary disease (P=0.059) and steroid therapy (P=0.062). Symptom duration of <11 days until DAIR yielded a better infection eradication rate (P=0.068). The mean postoperative Harris Hip Score was 74.2 (SD, 16.6).ConclusionDAIR, despite being used frequently, had a high failure rate in our series. Outcomes improved if an experienced hip arthroplasty surgeon performed the surgery. Patient comorbidities and symptom duration should be considered for decision-making.

Partial 2-Stage Exchange for Infected Total Hip Arthroplasty: An Updated Report

BackgroundManagement of an infected total hip arthroplasty (THA) is challenging. The eradication of infection as well as complications of component removal must all be considered. This study is an update on previous reports of treating periprosthetic infection of the hip with a partial 2-stage exchange with retention of the femoral component. MethodsA retrospective review of our practice’s arthroplasty registry from 2000 to 2018 revealed 41 hips with 2-year minimum follow-up that were treated with a 2-stage partial exchange for an infected THA. All first-stage procedures allowed an articulating construct with 1 of 3 variations: cemented constrained liner (13 hips), StageOne Hip Cement Spacer Mold (14 hips), or an antibiotic polymethylmethacrylate head molded from a bulb syringe (14 hips). Of 41 cases, 34 were culture positive, with 3 cases having methicillin-resistant Staphylococcus. ResultsMean follow-up was 5.5 years (range, 1.5-18.5 years). The second-stage reimplantation was accomplished in 39 of the 41 hips (95%) at a mean interval of 9.2 weeks (range, 5-9 weeks). Two patients underwent repeat radical debridement with removal of all components before reimplantation for persistent clinical evidence of infection. Thirty-three of the 41 hips (81%) were infection free at most recent follow-up. The mean postoperative Harris hip score at most recent evaluation was 63.6 (range, 24-100). ConclusionEradication of periprosthetic joint infections, while minimizing patient morbidity, continues to be a challenge. Partial 2-stage exchange may be considered in cases where removal of a well-fixed femoral component may result in significant bony destruction.

CEMENTLESS HIP ARTHROPLASTY AFTER PROXIMAL FEMORAL FRACTURES IN ELDERLY PATIENTS: A PROSPECTIVE CASE SERIES OF 26 PATIENTS.

Background: Fractures of the proximal femur in the elderly patients represent a challenge for the orthopedic surgeons due to osteoporosis and numerous illnesses that can aggravate the morbidity and complicate treatment. Internal fixation and arthroplasty are the two main options for the treatment. The optimal treatment remains controversial. Aim of the work: The present study aimed to evaluate the early clinical and functional outcomes of cementless hip replacement in elderly patients with Fractures of the proximal femur. Patients and methods: From January 2016 to March 2018 a prospective case series study was conducted on 24 participants (26 hips) with 2 year follow up and mean age 67.19 ± 8.38 years (60- 88 years). Twenty three cases (88 %) had fracture neck femur and three cases (12 %) had intertrochanteric fracture. Twenty cases (77 %) underwent cementless THA and six cases (23 %) had cementless bipolar hip arthroplasty. Modified lateral approach was used in all patients. Main criteria for clinical assessments were Harris hip score (HHS) and The Quality of Life Scale (QOLS). Results: HHS was used for clinical evaluation of patients, prefracture and postoperatively at 6 weeks, 6 months, 1 year and 2 years. The mean postoperative HHS for all patients in the last follow up (2 years) was 86.93 ± 11.62 (range, 71- 98). On the other hand, The QOLS was used for evaluation of patient’s satisfaction. The meanpostoperative QOLS at 2 year was 86.06 ± 11.13 (range, 55- 97) with no statistically significant difference between pre-fracture and postoperative. Conclusion: The results of this study suggest that cementless hemiarthroplasty and cementless THA offers good treatment option for displaced proximal femoral fractures in the elderly with overall good functional outcomes. It gives very satisfactory results that are comparable to published data. Longer follow up is needed toelaborate stronger clinical evidence. Level of evidence: (IV) a prospective case series trial.

Comparison of Wear Rate between Ceramic-on-Ceramic, Metal on Highly Cross-linked Polyethylene, and Metal-on-Metal Bearings.

Objective Currently, there is a lack of evidence on the medium-term follow-up of cementless total hip arthroplasty (THA) using metal on highly cross-linked polyethylene (MoP), ceramic-on-ceramic (CoC), and metal-on-metal (MoM) bearings. Our aim was to calculate the 5- to 10-year wear rate and the incidence rate of osteolysis for 3 types of bearings. Methods A total of 77 patients underwent MoP, 105 underwent ceramic CoC, and 55 underwent MoM THAs. The average patient age at the time of surgery was 64.7, 55.9, and 59.9 years old in the MoP, CoC, and MoM bearings, respectively. Clinical and radiologic measurements at a mean follow-up of 7.6 years were analyzed. Results The mean postoperative Harris hip scores showed no difference among the groups. The mean annual liner wear rates were 0.0160, 0.0040 and 0.0054 mm/year in MoP, CoC bearings, and MoM bearings, with that of CoC bearings being significantly lower than the others. Osteolysis (14.5%) among MoM bearings was significantly more frequently observed compared with the others. Kaplan-Meier survival at 10 years with implant loosening, or revision THA as the endpoint, was 96.1% (95% confidence interval [CI]: 88.4–98.7) for MoP, 98.6% (95% CI: 90.3–98.6) for CoC bearing, and 98.2% (95% CI: 88.0–99.7) for MoM bearings ( p = 0.360). Conclusion Excellent clinical and radiological outcomes were obtained for MoP and CoC bearings.

Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction: results in 126 patients with broad inclusion criteria.

Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants. Between 2010 and 2016, 126 patients underwent routine single-stage revision with cementless reconstruction with powdered vancomycin or imipenem poured into the medullary cavity and re-implantation of cementless components. For patients with a culture-negative hip, fungal infections, and multidrug-resistant organisms, a direct intra-articular infusion of pathogen-sensitive antibiotics was performed postoperatively. Recurrence of infection and clinical outcomes were evaluated. Three patients died and 12 patients (none with known recurrent infection) were lost to follow-up. There were 111 remaining patients (60 male, 51 female) with a mean age of 58.7 (sd 12.7; 20 to 79). Of these 111 patients, 99 (89.2%) were free of infection at a mean follow-up time of 58 months (24 to 107). A recurrent infection was observed in four of the 23 patients (17.4%) with culture-negative infected hip. The success rate in patients with multidrug-resistant organisms was 84.2% (16/19). The mean postoperative Harris hip score was 79.6 points (63 to 92) at the most recent assessment. Routine single-stage revision with cementless reconstruction can be a viable option for the treatment of chronically infected THA. The results of this study will add to the growing body of evidence supporting routine use of single-stage revision for the treatment of chronically infected THA. Cite this article: Bone Joint J 2019;101-B:396-402.

Does Proximally Coated Single-Wedge Cementless Stem Work Well in Dorr Type C Femurs? Minimum 10-year Followup.

Background:Total hip arthroplasty (THA) with a proximally coated single-wedge (PSW) cementless stem had been generally considered not to be suitable for Dorr Type C femurs. This study compares the long term outcomes of PSW stem according to the type of proximal femoral geometry.Materials and Methods:307 primary THAs in 247 patients were performed with PSW cementless stem and followed up for over 10 years in this retrospective study. According to Dorr's criteria, 89 femurs were classified as Type A, 156 as Type B, and 62 as Type C. They were followed up for an average of 13.2 years (range 10.0–17.3 years). All the hips were evaluated clinically and radiologically.Results:There was no significant difference in stem survivorship and clinical outcomes including the incidence of thigh pain and the mean postoperative Harris hip score (HHS) in all three groups. No significant differences were observed in osteolysis, pedestal formation, or cortical hypertrophy among the groups. Radiolucent lines <2 mm in thickness in Gruen zone 4 and 7 (P = 0.003 and P = 0.044, respectively), spot-weld (P < 0.001), and stress shielding (P = 0.010) of proximal femur were more pronounced in Dorr C type femora than in Type A or B. Fifty-six intraoperative fractures were identified among 307 hips with PSW stems. The incidence of intraoperative or postoperative femoral fractures was not significantly different among the groups.Conclusions:From over a 10-year followup, the PSW stem provided a recommendable option with satisfactory outcomes and excellent stem survivorship regardless of the Dorr type.

Results of periacetabular osteotomy in adolescent and young adult hip dysplasia

Background Dysplasia of the hip is one of the most common causes of secondary osteoarthritis because of its associated structural instability. The Bernese periacetabular osteotomy (PAO) now is the preferred and the gold standard procedure for the treatment of symptomatic acetabular dysplasia. Objective The primary aim of our study was to evaluate the results of PAO in the treatment of adolescent and young adult patients with symptomatic hip dysplasia. Patients and methods This prospective case series’ study included 22 patients (26 hips, 13 left hips, 13 right hips) with hip dysplasia after surgical reorientation of the acetabulum by PAO procedure. This study included three male patients and 19 female patients. The mean age of our patients was 23 years (13–40 years). The mean follow-up period was 15 months (6–24 months). Twenty-one hips had undergone isolated PAO, while five hips had undergone combined surgery with the PAO at the same time (three hips had proximal femoral varus osteotomy and two hips had arthrotomy and osteochondroplasty). Results Twenty-five hips had good clinical and radiographic outcomes with respect to hip function and radiographic parameters. One patient developed avascular necrosis (AVN) of the femoral head 6 months after PAO and was treated by total hip replacement 1 year after PAO. The mean lateral central edge angle was 10.57°±11.61° preoperatively and was corrected to a mean value of 31.96°±4.42° with a mean correction of 21.38°. The mean postoperative acetabular index was 7.57°±1.81°, with a mean correction of 15.34°. In our series, the mean postoperative Harris hip score was 91.36±4.14, and the mean improvement was 29.08. Conclusion The PAO is an effective and valuable method for preservation of the natural hip joint and should be learned in a specialized center before using it in clinical practice.

Mid- and long-term effects and related factors of metal-on-metal hip resurfacing arthroplasty

Objective To investigate the mid- and long-term effects of metal-on-metal hip resurfacing arthroplasty(HRA), and to analyze its related factors. Methods A total of 64 patients (81 hips) who underwent metal-on-metal HRA from June 2005 to January 2013 were recruited in the present study. There were 35 males (44 hips) and 29 females (37 hips) with the mean age of 48.26±10.45 years (20-65 years), including 47 unilateral and 17 bilateral HRAs. The cohort consisted of osteoarthritis secondary to the developmental dysplasia of the hip (23 cases, 29 hips), necrosis of the femoral head (19 cases, 22 hips), osteoarthritis (8 cases, 10 hips), rheumatoid arthritis (5 cases, 9 hips), ankylosing spondylitis (6 cases, 8 hips), pigmented villonodular synovitis (2 cases, 2 hips) and Otto's disease (1 case, 1 hip). During the follow-up duration, radiographic features, including acetabular inclination angle, stem-femoral shaft angle, component loosening, osteolysis, femoral neck narrowing and heterotopic ossification, were evaluated by hip X-rays in straight and froglike position. The size and type of pseudotumor were assessed by MRI and ultrasonography. Clinical efficacy was evaluated by Harris hip score and the University of California at Los Angeles (UCLA) hip score. Considering revision surgery as the end point, the component survivorship was calculated. Results The mean follow-up was 7.98±2.21 years, ranging from 5.0 to 12.8 years. The mean postoperative Harris hip score (92.01±5.69) was higher than the preoperative score (41.93±9.09). The mean postoperative UCLA pain, walking, function, activity scores (9.37±0.86, 9.14±1.01, 8.77±1.09, 6.47±1.27, respectively) were improved when compared with the preoperative UCLA scores (3.57±1.23, 5.99±1.30, 5.00±1.01, 3.84±1.41, respectively). The postoperative flexion, abduction and adduction, medial and lateral rotation of the hip was larger than the preoperative ones. Complications occurred in 10 hips (12.3%, 10/81). Seven patients (8 hips) experienced early and intermediate complications, including one intraoperative femoral nerve injury, one deep femoral artery and saphenous nerve injuries during the same surgery, one unexplained pain of hip, one femoral neck fracture, three hips of heterotopic ossification, and one pseudotumour. There were mid- and long-term complications in two hips, including one narrowing of the neck and one pseudotumour which was occurred at 9 years. There was one patient (2 hips) underwent revision surgery twice at 5 months and 9 years. The former cause of revision was femoral neck fracture and the latter one was pseudotumour. The Kaplan-Meier survivorship was98.8% at five years, and 95.0% at ten years. Conclusion Patients who underwent metal-on-metal HRA could obtain good mid- and long-term results. Pseudotumour and unexplained pain of the hip are critical factors which can affect the mid- and long-term results and survivorship of metal-on-metal HRA. Key words: Arthroplasty, replacement, hip; Postoperative complications; Treatment outcome

The Utilization of Metal Augments Allows Better Biomechanical Reconstruction of the Hip in Revision Total Hip Arthroplasty With Severe Acetabular Defects: A Comparative Study

BackgroundReconstructing the normal hip biomechanics is important for a successful revision total hip arthroplasty (THA). Little is known about whether using metal augments in revision THA is biomechanically superior to traditional techniques. MethodsA retrospective review was conducted on 74 consecutive THAs revised using metal augments with a cementless hemispherical cup and 77 consecutive THAs revised using the jumbo cup, all with a minimum 2-year follow-up. Biomechanical parameters were measured before and immediately after the revision. Radiological and clinical outcomes at follow-ups were also evaluated. ResultsThe metal augment group had a reconstructed center of rotation (COR) that was 6.5 mm closer to the anatomic COR in height (P < .001), had 3.6 m smaller cup size (P < .001), and had 5.7 mm less head-cup difference (P < .001). Moreover, there was a reconstructed COR that was much closer to the anatomic COR (vertical distance: 1.8 vs 14.1 mm, P < .001; horizontal distance: −2.1 vs 7.9 mm, P = .013), had 4.1 mm greater femoral offset (P = .006), and had 8 mm less leg length discrepancy (P = .035) in the subgroup of Paprosky type III bone defects when compared to the jumbo cup group. All cup-augment constructs were radiologically stable with a higher mean postoperative Harris Hip Score (P = .012). One jumbo cup was radiologically unstable. ConclusionIn revision THA, utilizing metal augments helps to restore the COR position more precisely, avoid using a larger cup, reduce head-cup difference, rebuild femoral offset, and decrease leg length discrepancy, particularly with Paprosky type III bone defects. Moreover, it provides satisfactory radiological and clinical outcomes in the short term.

A preliminary evaluation of raising the center of rotation in total hip arthroplasty for the patients with developmental dysplasia of the hip

Background: Total hip arthroplasty is an effective treatment for developmental dysplasia of the hip (DDH). However, there are still debated issues in total hip arthroplasty (THA) for DDH patients. Placing the acetabular cup according to the anatomic center of rotation (COR) in THA is not always the perfect choice for the DDH patients. We raised the COR in THA in order to get better press fit and coverage for the acetabular cup. This study aims to evaluate the clinical results of raising the COR in total hip arthroplasty for the patients with developmental dysplasia of the hip. Methods: A retrospective analysis was carried out in 16 DDH patients (19 hips) who received THA in our department from March 2015 to January 2016. The COR was raised in THA for all the 19 hips. We evaluated the vertical distance between COR of acetabular cup and anatomic COR, horizontal distance between COR of acetabular cup and anatomic COR, coverage for acetabular cup, preoperative Harris hip score and postoperative Harris hip score. Results: The mean follow-up time of 16 cases (19 hips) DDH was 16 months (range, 4–22 months). The mean vertical distance between COR of acetabular cup and anatomic COR was 1.07±0.26 cm (range, 0.68–1.48 cm). The mean horizontal distance between COR of acetabular cup and anatomic COR was 0.24±0.11 cm (range, 0.10–0.51 cm). The mean coverage for acetabular cup was 88.3% (range, 79.8–97.7%). The mean preoperative Harris hip score was 51.9±13.9 (range, 36.4–75.8), and the mean postoperative Harris hip score was 85.5±6.5 (range, 75.6–95.8), and there is significant difference between the two groups (P Conclusions: Raising the COR in THA for DDH patients is a feasible option when the coverage for acetabular cup was poor. A detailed preoperative plan is the crucial step to get good coverage for acetabular cup and minor limb length discrepancy.

Clinical Performance of Ultra-Short Anatomic Cementless Versus Fourth-Generation Cemented Femoral Stems for Hip Replacement in Octogenarians

The aim of this study was to determine how ultra-short anatomic cementless vs cemented femoral stems affect the survival of primary total hip arthroplasties in octogenarians. Specifically, the authors investigated whether ultra-short anatomic cementless and cemented femoral components would have similar (1) functional results, (2) radiographic results, (3) revision and survival rates, and (4) complication rates in octogenarians. The authors evaluated 93 consecutive octogenarians (98 hips) in the ultra-short stem group (mean age, 86.5±5.3 years) and 78 consecutive octogenarians (92 hips) in the cemented stem group (mean age, 85.7±5.8 years). The average follow-up was 8.1 years (range, 5-12 years) in the ultra-short anatomic cementless stem group and 7.8 years (range, 5-11 years) in the cemented stem group. Mean preoperative (39 vs 37 points) and postoperative (81 vs 83 points) Harris hip scores were similar in the 2 groups (P=.131 and .128, respectively). The incidence of thigh pain was 0% in both groups. At final follow-up, mean Western Ontario and McMaster Universities Osteoarthritis Index scores (18 vs 14 points) and University of California, Los Angeles activity scores (4.3 vs 4.5 points) were similar in the 2 groups. The revision rate was 3% (3 hips) in the ultra-short stem group and 3% (3 hips) in the cemented stem group. Survivorship of the femoral stem was 97.3% at 8.1 years in the ultra-short stem group and 97.9% at 7.8 years in the cemented stem group (P=.136). Ultra-short anatomic cementless and cemented stems obtained rigid fixation in octogenarians. However, the incidence of undisplaced periprosthetic calcar fracture intraoperatively was significantly higher (P=.003) in the cemented stem group. [Orthopedics. 2018; 41(4):e470-e478.].

Total hip replacement in sickle cell disorder: A preliminary report of challenges and early outcome of 21 consecutive patients

The aim of this study is to describe the pattern of presentation osteoarthritic patients with sickle cell disorder (SCD) in our environment, determine the implant sizes taking the peculiar nature of the pathology and our operating environment into consideration, highlight the challenges and technical difficulties encountered during the procedure, measure the functional outcome and observe complications of treatment, recommend ways of improving outcome. Between November 2008 and November 2012, 29 consecutive primary total hip replacements (THRs) were performed on 21 patients with avascular necrosis of the head of femur secondary to SCD. Patients' evaluation was performed at two different times of follow-up (1 and 5 years, respectively). Twenty-one patients were available at 1 year as well as 5-year follow-up. The mean preoperative Harris Hip Score was 20.17 ± 11. The mean postoperative Harris Hip Score was 92.25 ± 13 (P < 0.001) at 1 year and 88.75 ± 10 (P < 0.001) at 5 years. Eighteen patients had regional anesthesia while three had general anesthesia. The average cup size used was 49.43 with a range of 46-54. The average liner size was 49.43 with a range of 46-54. The head size used in all patients was 28. The average stem size was 6.57 with a range of 6-8. The offset used in all the patients was standard All the patients had 1-2 screw fixation of the acetabular shell. Four patients had complications as follows: periprosthetic fracture 1, superficial wound infection 1, pulmonary complication 1, and abdominal crisis 1. THR is a veritable means of treatment of patients with avascular necrosis of the femoral head arising from SCDs. The challenges encountered during the surgery are related to the quality of bone of the affected patient. Arthroplasty Surgeons in our environment must be fully prepared for the challenges by ensuring a preoperative plan that will take care of the technical problems such as recreating femoral canals, wiring of intraoperative fractures as well as treatment of acetabular defects. A detailed planned total hip arthroplasty can be performed in patients with SCD in younger patients with good clinical benefits.

Clinical research of free vascularized fibular grafting for osteonecrosis of femoral head

Objective To evaluate the clinical results of free vascularized fibular grafting (FVFG) for the treatment of osteonecrosis of the femoral head (ONFH). Methods From July, 2009 to January, 2013, 85 cases (120 hips) of ONFH were treated with free vascularized fibular grafting. These cases included 61 males (87 hips) and 24 females (33 hips) with an average age of 36.5 years (22-51 years) ; 7 hips (ⅠA 2 hips, ⅠB 3 hips, ⅠC 2 hips) were at stage Ⅰ, 98 hips (ⅡA 24 hips, ⅡB 39 hips, ⅡC 35 hips) at stage Ⅱ and 15 hips (ⅢA 9 hips, ⅢB 4 hips, ⅢC 2 hips) at stage Ⅲ according to the classification system of Association Research Circulation Osseous (ARCO). The mean preoperative Harris hip score was (60.21±6.85) points (42-71 points) , The follow-up items included the X-ray examination, the Harris scores of the hip, and the evaluation of the complications. Results Eighty-three cases (117 hips) were followed up. The average duration of follow-up was 25 months (range from 12 months to 42 months). The mean postoperative Harris hip score was increased to (81.26±5.84) points (67-91 points) by the end of the follow-up, compared with the preoperation, the score improved significantly, the difference was statistically significant (P<0.05). Comparing with postoperative X-ray, 101 hips (86.3%) were improved, 12 hips (10.3%) had no significant changes and deterioration occurred in 4 hips (3.4%). Conclusion The free vascularized fibular grafting is an effective method for treating osteonecrosis of and preventing the collapse of the femoral head. Key words: Osteonecrosis of the femoral head; Free vascularized fibular grafting; Harris scores; Micro-surgical technique

Mid-term Results of Total Hip and Total Knee Arthroplasty in Patients With Human Immunodeficiency Virus.

With antiretroviral therapy, patients who are human immunodeficiency virus (HIV)-positive are increasingly becoming candidates for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Prior reports focus on perioperative complications, but longer-term outcomes remain unclear. The authors specifically analyzed clinical outcomes, perioperative complications, and survivorship free of periprosthetic joint infection (PJI) of THAs and TKAs in HIV-positive patients who had extended follow-up. A total of 21 HIV-positive patients who underwent 29 primary arthroplasties (14 THAs, 15 TKAs) from 1992 to 2012 were retrospectively reviewed. Mean age was 43 years and mean follow-up was 8 years. Mean perioperative CD4 cell count was 450 cells/mL; only 2 patients had perioperative CD4 cell counts less than 200 cells/mL. At mid-term follow-up, THAs and TKAs were reliable in improving function (mean postoperative Harris Hip Score: 87, P<.01; mean postoperative Knee Society Score: 83, P<.01). The rate of perioperative complications was high (17%). Patients with both hemophilia and HIV were at particular risk for complications at 33% (P=.04). Survivorship free of deep PJI was 100% in THAs at 10 years and 93% in TKAs at 10 years. Only 1 (7%) patient (1 TKA), who had a perioperative CD4 cell count of less than 200 cells/mL, was revised for deep PJI. In HIV-positive patients, both THAs and TKAs are reliable in alleviating pain and improving clinical function at mid-term follow-up. However, HIV-positive patients are at substantial risk of perioperative complications, especially with comorbid hemophilia. With antiretroviral therapy and maintained CD4 cell counts above 200 cells/mL, survivorship free of deep PJI approaches 100%. [Orthopedics. 2017; 40(4):e699-e702.].

Midterm Outcomes of Revision Total Hip Arthroplasty With the Use of a Multihole Highly-Porous Titanium Shell

BackgroundWe are reporting on the minimum 5-year outcomes of patients who underwent revision total hip arthroplasty (THA) using a specific highly-porous titanium shell. We assessed (1) aseptic and all-cause survivorship; (2) functional outcomes; (3) complications; and (4) radiographic outcomes. MethodsTwo hospital databases were evaluated for patients who underwent revision THA due to component instability or aseptic loosening using a cementless highly-porous titanium shell between September 2006 and December 2011. This yielded 35 patients who had a mean age of 61 years (range 14-88 years). Patients had a mean follow-up of 6 years (minimum 5 years). All-cause and aseptic survivorship of the shell was calculated. Functional outcomes were assessed using the Harris Hip Score. We determined the incidence of postoperative complications and performed radiographic evaluation of pelvic radiographs from regular office visits. ResultThe aseptic survivorship of the acetabular component was 97% (95% confidence interval; 8.1-9.5). The all-cause survivorship of the acetabular component was 91% (95% confidence interval; 7.3-8.1). One patient had an aseptic failure and 2 patients had septic failures. The mean postoperative Harris Hip Score was 76 points (range, 61-91 points). Excluding the aseptic and septic failures, there was no osteolysis or progressive radiolucencies present on radiographic evaluation at final follow-up. ConclusionAt a minimum of 5-year follow-up, the highly-porous titanium acetabular revision shell has excellent survivorship and functional outcomes. Although long-term follow-up is needed to further monitor these implants, the results are promising and demonstrate that this prosthesis may be an excellent option for patients undergoing revision THA.

Single-Stage Revision for Chronic Fungal Periprosthetic Joint Infection: An Average of 5 Years of Follow-Up

BackgroundPeriprosthetic infections caused by fungal pathogens are a rare entity, and there exist no definite guidelines according to which these infections can be successfully managed. In these situations, we wondered whether patients could be treated successfully for their fungal infections with single-stage revision. MethodsA retrospective analysis between January 2004 and October 2014 included 11 patients (4 hips and 7 knees) with chronic fungal periprosthetic joint infection who underwent single-stage revision, including aggressive soft-tissue debridement, thorough removal of infected components and cement, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungus-sensitive antibiotics, and a reasonable combination of antifungal agents and antibacterial medications. Recurrence of infection and clinical outcomes were evaluated. The average follow-up was 5 years (range, 2-10 years). ResultsThere were 3 failures during the study period; 1 patient died during the perioperative period because of acute heart failure on the eighth postoperative day. Of the 11 patients, 7 patients had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The mean postoperative Harris hip score and Hospital for Special Surgery knee score was 77 points (67-88 points; P < .05) and 78 points (73-84 points; P < .05), respectively, at the most recent assessment. ConclusionTreatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes, which indicated that this may be a feasible alternative strategy in selected patients.