Mean Postoperative Harris Hip Score Research Articles

COMPARATIVE STUDY OF REVISION HIP ARTHROPLASTY AFTER SHORT STEM VERSUS AFTER CONVENTIONAL STEM

AbstractObjectiveShort-stem total hip arthroplasty (THA) aims to preserve the proximal bone stock for future revisions, so that the first revision should resemble a primary intervention rather than a revision. This study aimed to compare the clinical and radiological outcomes in revision THA after failed short stem versus after failed conventional stem THA.MethodsThis study included forty-five patients with revision THA divided into three groups (15 each); group A: revision after short stem, group B: revision after conventional cementless stem and group C revision after conventional cemented stem. The studied groups were compared regarding 31 variables including demographic data, details of the primary and revision procedures, postoperative radiological subsidence, hospital stay, time for full weight bearing (FWB), preoperative and postoperative clinical scores.ResultsEarly stem subsidence (40%) was the main indication of revision in group A compared to peri-prosthetic femoral fractures (PFFs) (73.3%) and aseptic loosening (53.3%) in group B and C respectively (P=0.021). The mean time to revision was significantly shorter in group A (15 months) compared to 95.33 and 189.40 months in group B and C respectively. (P=0.005). Sixty % (9 patients) in group A were revised in the first year. The mean operative time, blood loss, postoperative blood transfusion and hospital stay were significantly lower in group A compared to group B and C (P<0.001, <0.001, 0.002 and 0.001 respectively). Revisions in group A were performed using either short stems (13.3%) or conventional stems (86.7%) whilst 80% of patients needed long stems and 20% of patients needed conventional stems in group B and C (P<0.001). The mean postoperative Harris Hip Score (HHS) at the latest follow up was 87.07, 87.53 and 85.47 in group A, B and C respectively. All PFFS had excellent results according to Beal's and Tower's criteria; all fractures healed and the implants were stable.ConclusionThe most common cause of failure of short stems is early stem subsidence. Short stem THA has specific indications and patient selection is very crucial. Preoperative templating for short stems and a detailed analysis of the individual patient anatomy in anteroposterior and lateral views are mandatory to predict the correct implant size more accurately. The use of intraoperative imaging can verify the sizing, implant position, and sufficient contact with the lateral cortex. Revision of short stem THA resembled the primary THA. If a standard implant can be used in a surgical revision instead of a longer revision stem, this can be considered as an advantage for the hip arthroplasty treatment concept. However, this only applies if the longevity of the first treatment with a short stem is comparable with that of a standard stem.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Outcomes of modular stem for the treatment of periprosthetic femoral fracture: a systematic review of the literature.

Periprosthetic femoral fractures (PFFs) are a frequent complication after total hip arthroplasty (THA). Both modular and non-modular tapered fluted titanium (TFT) stems could be used in total hip revisions (THRs). Nevertheless, the most appropriate femoral stem type is still under debate. The current systematic review aims to analyze the survival rate and all causes of stem revision, the overall complication rate and reason for reoperation, and patient reported outcome measures (PROMs) in THR for PFF using the modular tapered titanium stems (MTTS). A comprehensive search in four databases, PubMed, Scopus, Embase, and the Cochrane Database of Systematic Reviews databases, was performed, and following the PRISMA guidelines, a systematic review was conducted. Strict inclusion and exclusion criteria were applied, starting from 1,259 studies. The risk of bias was analyzed according to the MINORS tool system. Descriptive statistical analysis was performed for all data extracted. Eighteen clinical studies were included in the qualitative analysis for a total of 775 patients enrolled. A mean MINORS criteria score of 9.8 [8-12] was reported. The overall survival of MTTS for PFF treatment was 95.4%, with an overall reintervention rate of 10.3% at an average follow-up of 4.5 years. Despite the use of modular components, postoperative hip instability remains the most frequent complication and cause of reintervention in these patients. In addition, a mean postoperative Harris Hip Score (HHS) of 78.1 was reported, which was considered acceptable given the high mean age of 74.1 years at the time of the revision. Several therapeutic approaches and a wide variety of implants have been described in the literature for PFF management; however, no one solution has proven superior to others in the PFF treatment. MTTS has become a commonly used treatment option for Vancouver B2 and B3 fractures because they provide good clinical and radiological results with a reasonable survival rate. However, the complication rate of MTTS is still high.

Hip resurfacing arthroplasty as an alternative to total hip arthroplasty in patients aged under 40 years.

The aims of the study were to report for a cohort aged younger than 40 years: 1) indications for HRA; 2) patient-reported outcomes in terms of the modified Harris Hip Score (HHS); 3) dislocation rate; and 4) revision rate. This retrospective analysis identified 267 hips from 224 patients who underwent an hip resurfacing arthroplasty (HRA) from a single fellowship-trained surgeon using the direct lateral approach between 2007 and 2019. Inclusion criteria was minimum two-year follow-up, and age younger than 40 years. Patients were followed using a prospectively maintained institutional database. A total of 217 hips (81%) were included for follow-up analysis at a mean of 3.8 years. Of the 23 females who underwent HRA, none were revised, and the median head size was 46 mm (compared to 50 mm for males). The most common indication for HRA was femoroacetabular impingement syndrome (n = 133), and avascular necrosis ( (n = 53). Mean postoperative HHS was 100 at two and five years. No dislocations occurred. A total of four hips (1.8%) required reoperation for resection of heterotopic ossification, removal of components for infection, and subsidence with loosening. The overall revision rate was 0.9%. For younger patients with higher functional expectations and increased lifetime risk for revision, HRA is an excellent bone preserving intervention carrying low complication rates, revision rates, and excellent patient outcomes without lifetime restrictions allowing these patients to return to activity and sport. Thus, in younger male patients with end-stage hip disease and higher demands, referral to a high-volume HRA surgeon should be considered.

Patient-Reported Outcomes and Factors Impacting Success of the Periacetabular Osteotomy.

Hip dysplasia is a condition affecting both infants and adults, characterized by a shallow acetabulum that does not sufficiently cover the head of the femur. This leads to instability of the hip and elevated levels of mechanical stress around the acetabular rim. A popular procedure for the correction of hip dysplasia is the periacetabular osteotomy (PAO), in which fluoroscopically guided osteotomies around the pelvis are made to allow for repositioning of the acetabulum to fit properly on the femoral head. This systematic review aims to analyze patient factors that impact outcomes, as well as patient-reported outcomes such as the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The patients in this review did not undergo any prior intervention for acetabular hip dysplasia, allowing for an unbiased reporting of outcomes from all included studies. Of studies reporting HHS, the mean preoperative HHS was 68.92 and the mean postoperative HHS was 89.1. Of the study that reported mHHS, the mean preoperative mHHS was 70, and the mean postoperative mHHS was 91. Of the studies reporting WOMAC, the mean preoperative WOMAC was 66, and the mean postoperative WOMAC was 63. Key findings of this review are that of the seven included studies, six achieved a minimally important clinical difference (MCID) based on patient-reported outcomes, and factors impacting outcome are preoperative Tönnis osteoarthritis (OA) grade, pre and postoperative lateral-center edge angle (LCEA), preoperative hip joint congruency, postoperative Tönnis angle, and age. In patients with no prior intervention for hip dysplasia, the PAO is a successful procedure with significant improvement in postoperative patient-reported outcomes. Despite the reported success of the PAO, proper patient selection is vital to avoid early conversions to total hip arthroplasty (THA) and prolonged pain. However, further investigation is prompted regarding the long-term survivorship of the PAO in patients with no prior intervention for hip dysplasia.

Intussusception Allograft Prosthetic Composites in Total Hip Arthroplasty: A Salvage Operation for Extensive Femoral Bone Loss

BackgroundAllograft prosthetic composites (APCs) have been used to perform revision total hip arthroplasty (THA) for massive femoral bone loss or deformity. Intussusception, or “telescoping”, APC techniques have been proposed to enhance the contact area of this interface and provide superior mechanical fixation over conventional methods. The purpose of this study is to present to our knowledge, the largest series of telescoping APC THAs, along with surgical technique details and midterm (average 5-10 years) clinical results. MethodsBetween 1994 and 2015, 46 revision THAs performed with proximal femoral telescoping APCs were retrospectively reviewed at a single institution. Overall survival, reoperation-free survival, and construct survival rates were calculated via Kaplan-Meier methods. In addition, radiographic analyses were performed to evaluate for component loosening, union at the APC-host interface, and resorption of the allograft. ResultsAt 10 years, the overall patient survival was 58%, reoperation-free survival was 76%, and construct survival was 95%. Reoperation was performed in 20% (n = 9) and only 2 constructs required resection. Radiographic analyses performed at latest follow-up revealed no instances of radiographic femoral stem loosening, an 86% union rate at the APC-host site, 23% with signs of some allograft resorption, and a 54% trochanteric union. The mean postoperative Harris hip score was 71 points (range, 46-100). ConclusionTelescoping APCs are technically demanding, but provide reliable mechanical fixation for the reconstructing of large proximal femoral bone deficits in revision THA with excellent construct survivorship, acceptable reoperation rates, and good clinical outcomes. Level of EvidenceIV.

One-stage revision using intra-articular carbapenem infusion effectively treats chronic periprosthetic joint infection caused by Gram-negative organisms.

Gram-negative periprosthetic joint infection (PJI) has been poorly studied despite its rapidly increasing incidence. Treatment with one-stage revision using intra-articular (IA) infusion of antibiotics may offer a reasonable alternative with a distinct advantage of providing a means of delivering the drug in high concentrations. Carbapenems are regarded as the last line of defense against severe Gram-negative or polymicrobial infection. This study presents the results of one-stage revision using intra-articular carbapenem infusion for treating Gram-negative PJI, and analyzes the characteristics of bacteria distribution and drug sensitivity. We retrospectively reviewed 32 patients (22 hips and 11 knees) who underwent single-stage revision combined with IA carbapenem infusion between November 2013 and March 2020. The IA and intravenous (IV) carbapenem infusions were administered for a single Gram-negative infection, and IV vancomycin combined with IA carbapenems and vancomycin was applied for polymicrobial infection including Gram-negative bacteria. The bacterial community distribution, drug sensitivity, infection control rate, functional recovery, and complications were evaluated. Reinfection or death caused by PJI was regarded as a treatment failure. Gram-negative PJI was mainly caused by Escherichia coli (8/34), Enterobacter cloacae (7/34), and Klebsiella pneumoniae (5/34). Seven cases (7/32) involved polymicrobial PJIs. The resistance rates of penicillin, cephalosporin, quinolones, and sulfonamides were > 10%, and all penicillin and partial cephalosporins (first and second generation) were > 30%. Of 32 cases, treatment failed to eradicate infection in only three cases (9.4%), at a mean follow-up of 55.1 months (SD 25 to 90). The mean postoperative Harris Hip Score and Hospital for Special Surgery knee score at the most recent follow-up were 81 (62 to 91) and 79 (56 to 89), respectively. One patient developed a fistula, and another presented with a local rash on an infected joint. The use of IA carbapenem delivered alongside one-stage revision effectively controlled Gram-negative infection and obtained acceptable clinical outcomes with few complications. Notably, first- and second-generation cephalosporins and penicillin should be administrated with caution, due to a high incidence of resistance.

POSITIONING OF ACETABULAR AND FEMORAL COMPONENT IN PRIMARY TOTAL HIP ARTHROPLASTY USING CT EVALUATED PATIENT NATIVE ANATOMY

In total hip arthroplasty, component orientation is an important task for stability. Acetabular and femoral component orientation is the key factor for outcome of total hip arthroplasty. The aim of this study is to assess the clinical and radiological effectiveness of positioning of acetabulum and femoral components in primary total hip replacement using CT evaluated patient native anatomy. Subjects of this study were 36 patients with nonunion neck of femur fractures or arthritic hip based on inclusion and exclusion criteria and treated with cemented or uncemented total hip arthroplasty. Pre operative CT scan with 3D reconstruction was done for all patients and the acetabular inclination and version was measured in coronal and axial planes. Femoral anteversion was measured in mid axial image. Transverse acetabular notch (TAN) and anterior acetabular notch (AAN) were identied intra operatively to reproduce the pre operative angles. Post operatively CT scan was done and all angles were measured as before. All patients were followed up and analyzed using Harris Hip Score. The mean preoperative Harris Hip Score is 34.5. The mean postoperative Harris Hip Score is 88.19. Mean acetabular cup inclination is 39.80°, Mean cup anteversion is 15.1° and mean femoral anteversion is 14.75°. No Dislocation was noted during follow up. No hips show clinical and radiological evidence of femoral and acetabular component loosening. All Postoperative CT measurements of angles are within the safe zone by Lewinnek et al. Preoperative CT guided parameters, intra operative anatomical landmarks (TAN&AAN) and the digital protractor device can aid better positioning of the acetabular and femoral component of THA and is independent of the position of the patient. It also provides a precise planning for component placement resulting in less intra operative time thereby reducing the chances of infection and decreases the dislocation rate and wear and tear and improves the functional outcome

Surgical outcome of total hip arthroplasty in bony ankylosed hips in ankylosing spondylosis —Systematic review

Incidence of bony ankylosis in hip joint with AS is approximately 40%. Bony ankylosis of hips joints comes with very unique management challenges. There is no specific review article in the literature only for total hip replacement in bony ankylosed hips. We run a literature review to evaluate surgical outcomes and postoperative complications of Total Hip Arthroplasty in Bony ankylosing hip joints. Total five studies, which satisfied inclusion criteria, selected for this review process. Outcome measures like HHS, VAS, ROM and complications were noted and compared. Total number of hips included in this study were 220 in 136 patients. Average patient age was 35.74 years. The mean post-operative Harris Hip Score was 84.9 which was improved from pre-operative HHS 31.1. All studies reported an improvement in hip Range of motion (ROM). Complications were heterotopic ossification, femur fracture, nerve injury, infection, dislocation. Heterotopic ossification (HO) occurred in total 25 hips in 4 studies except Kanniyan et al study. This literature review put forward that total hip arthroplasty of bony ankylosed hips in AS brings improvements in functional outcome measures such as Harris Hip Score, range of motion and ambulatory status.

OUR RESULTS OF TOTAL HIP ARTROPLASTY WITH ANTEROLATERAL APPROACH

Aim: It was aimed to compare the clinical and radiological results of total hip arthroplasty performed with the anterolateral approach with the literature. Material and Method: 65 patients who underwent total hip arthroplasty with anterolateral approach between 2016-2021 were included. Preoperative and postoperative functional status evaluations of the patients were performed using the Harris hip score. In the clinical evaluation of the patients, thigh pain, wound infection, length of hospital stay, body mass index, duration of surgery and complications were also evaluated. In the radiological evaluation, the acetabular and femoral relaxation zones, the presence and amount of vertical and horizontal migration of the acetabular component, the presence and amount of femoral vertical migration, the position of the femoral component, the femoral dorr classification, the angle of inclination of the acetabular component and the presence of heterotrophic ossification were examined. Results: Of the patients, 29 (44.6%) were male and 36 (55.4%) were female. The mean age of the patients was 61.65 and the mean follow-up period was 40.2 months. Considering the diagnoses of the patients, THA was applied to 51 (70.8%) patients for coxarthrosis, 14 (19.4%) for avascular necrosis, 5 (6.9%) patients for fractures, and 2 (2.8%) patients for septic arthritis. The mean preoperative Harris Hip Score of the patients was 34.2 (18.1-59.9). The mean postoperative Harris Hip score was 88.5 (68.8-96). When the postoperative Harris Hip Score of the patients was evaluated, 53 (73.6%) were evaluated as excellent results, 18 (25%) as very good results, and 1 (1.4%) as good result. Findings: In our study, the results of total hip arthroplasty performed with the anterolateral approach were found to be a successful and satisfactory surgery when performed with appropriate indications and planning.

Adult Proximal Humeral Locking Plate Is a Good Alternative Option in the Treatment of Adolescent Subtrochanteric Femur Fractures: A Case Series and Literature Review.

Management of pediatric subtrochanteric femur fractures (SFFs) is difficult. The aim of this study was to evaluate the outcomes of adolescent SFFs treated with adult proximal humeral locking plates (PHLPs). A retrospective analysis of 18 adolescents (11 male, 7 female) with a diagnosis of SFF who underwent internal fixation with a PHLP was conducted. Data regarding injury mechanism, fracture pattern, and time to union were recorded for all patients. In addition, a clinical and functional evaluation of patients was performed using the Harris hip score (HHS), Iowa hip score (IHS), modified Merle d'Aubigne-Postel score (MMAPS), Flynn criteria, and hip range of motion (ROM). The mean age of the patients was 12.72±2.05 years (range, 10-16 years). Radiological observation was performed for evaluation of five different injury mechanisms and different fracture patterns in patients. The mean postoperative HHS was 92.27±5.61, the mean IHS was 90.88±6.46, and the mean MMAPS was 17.22±0.94. According to the Flynn criteria, excellent results were achieved in 14 cases and satisfactory results were obtained in four cases. Measurements of the patients' mean hip ROM values were as follows: 17.77±3.52° in extension, 115.27±6.74° in flexion, 43.05±3.48° in abduction, 27.50±4.28° in adduction, 42.22±4.60° in internal rotation, and 42.22±3.91° in external rotation. Surgery performed on adolescent patients using an adult PHLP showed good, safe results. Therefore, it should be considered as an alternative option.

Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection : a mean seven years' follow-up.

Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection represent a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion in treating this condition. A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single-stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had undergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two-stage revision, and four had a failed one-stage revision before their single-stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated. A total of 68 patients (87.1%) were free of infection at a mean follow-up time of 85 months (24 to 133). The seven-year infection-free survival was 87.6% (95% confidence interval (CI) 79.4 to 95.8). No significant difference in infection-free survival was observed between hip and knee PJIs (91.5% (95% CI 79.9 to 100) vs 84.7% (95% CI 73.1 to 96.3); p = 0.648). The mean postoperative Harris Hip Score was 76.1 points (63.2 to 92.4) and Hospital for Special Surgery score was 78. 2 (63.2 to 92.4) at the most recent assessment. Polymicrobial and fungal infections accounted for 14.1% (11/78) and 9.0% (7/78) of all cases, respectively. Single-stage revision with intra-articular antibiotic infusion can provide high antibiotic concentration in synovial fluid, thereby overcoming reduced vascular supply and biofilm formation. This supplementary route of administration may be a viable option in treating PJI after multiple failed prior surgeries for reinfection. Cite this article: Bone Joint J2022;104-B(7):867-874.

Management of Early Avascular necrosis of femoral head with Core Decompression and Platelet Rich Plasma infiltration

Various modalities available for the treatment of AVN range from conservative modalities like observation and non-weight-bearing mobilization, various pharmacological agents like Bisphosphonates, Enoxaparin are shown to be useful in some studies, Hyperbaric oxygen therapy to Surgical modalities like femoral head preserving procedures (core decompression with or without additional procedure, i.e. bone grafting, biologic adjuvants – Platelet Rich Plasma, Stem cells etc. and rotational osteotomies) and replacement surgeries. 20 patients of Early AVN who met inclusion criteria and operated with core decompression and PRP infiltration were included in this study. Out of 20 patients, 2 patients (10%) had superficial infections which healed on its own without any intervention, 5 patients (25%) had restriction of movements and 3 patients (15%) required replacement surgery. The mean pre-operative Harris Hip Score of our study was 64.3, and the mean post-operative Harris hip score of our study was 80.2. Out of 20 cases, 6 patients (30%) showed limitation of the progression of the disease, 3 (15%) patients progressed to the further stages of the disease and 11 patients (55%) had remission of the disease. The final outcome, on the basis of Harris Hip Score in 5 patients (25%), was excellent, 7 patients (35%) was good, 5 patients (25%) was fair, and in 3 patients (15%) was poor. Our study concludes that Core decompression along with PRP infiltration can be used as a good alternative for or in addition with traditionally performed core decompression and bone grafting.

Megaprosthesis Reconstruction of the Proximal Femur following Bone Tumour Resection: When Do We Need the Cup?

PurposeReconstruction of the proximal femur after tumour resection can be performed with proximal femoral endopros-theses (PFE). Many studies have reported that bipolar hemiarthroplasty (BHA) reduce the risk of dislocation after oncological resections. However, progressive cotyloiditis which might require acetabular resurfacing (total hip arthroplasty [THA]) has been reported. The aim of this study is to compare the results of BHA and THA after proximal femur resection.Materials and MethodsA total of 104 consecutive patients affected by primary (n=52) and metastatic (n=52) bone tumours were included. Ninety patients underwent BHA and 14 patients underwent THA. Complications were recorded and classified according to the Henderson classification. At final follow-up, patients with the implant in site were functionally evaluated with modified Harris hip score (HHS).ResultsThe mean follow-up was 50 months (range, 2–171 months). Twenty-four (23.1%) patients developed major complications. Eleven (12.2%) BHA required acetabular resurfacing. Patients affected by primary bone tumours showed an increased risk of THA conversion (P=0.042). A reduced risk was observed in patients younger than 35 years (P=0.043) and in those older than 65 years (P=0.033). Dislocation occurred in four case (3.8%), in particular after THA (P=0.021). At final follow-up, 93 patients had the prosthesis in site (80 BHA and 13 THA). Mean postoperative HHS was 70 (range, 30–90).ConclusionThe risk of dislocation is lower for bipolar endoprosthesis compared to THA. However cotyloiditis and acetabular resurfacing might occurred.

The Open Triradiate Cartilage: How Young Is Too Young for Total Hip Arthroplasty?

There is, to our knowledge, no published literature regarding primary total hip arthroplasty (THA) in pediatric patients with an open triradiate cartilage. The purpose of this study was to report the outcomes following primary THA in pediatric patients with open triradiate cartilage at a single intuition. Using a single institution's Total Joint Registry, 12 patients (13 hips) were identified as having undergone primary THA with open triradiate cartilage between the years of 2000 and 2019. The mean age and body mass index of this group were 13.1 years and 25.5 kg/m2, respectively. The cohort was composed of 10 males, and the mean follow up was 5.5 years. Indications for surgery, functional outcomes, and radiographic signs of stable fixation were analyzed. The most common indication for surgery was avascular necrosis secondary to corticosteroid use (31%), followed by avascular necrosis after operative management of slipped capital femoral epiphysis (23%). The proportion of patients able to achieve independent, gait-aid free, ambulation improved from 23% to 100%. Mean postoperative Harris Hip Score was 92.3. All constructs were cementless, and bearing surfaces included ceramic-on-ceramic in 62% and ceramic on highly crosslinked polyethylene bearings in the remainder. Radiographic review at final follow up demonstrated osseointegration in 12 of 13 (92%) acetabular components. Although 1 patient experienced both acetabular component loosening and instability, on separate occasions, there were no incidences of infection, wound dehiscence, thromboembolic events, or failure secondary to wear. In this study, THA in patients with an open triradiate cartilage yielded significant clinical improvement, low complication rates and good initial implant survivorship at early follow up. Awaiting closure of the triradiate cartilage for concerns of decreased fixation and implant survivorship may be unnecessary. Level IV-case series.

مقایسه ی میزان جوش خوردگی در بیماران با شکستگی اینترتروکانتریک با گاما نیل کوتاه قفل و غیر قفل؛ یک مطالعه مقطعی

Introduction: Intertrochanteric fractures, which are one type of hip fracture, have been considered as a major public health issue in many nations. This study was carried out with the aim of comparing the rate of fusion between patients with intertrochanteric fractures treated with short sliding and non-sliding Gamma nail implants. Methods: This is a retrospective cross-sectional study performed in 2018 and 2019, and 47 patients with intertrochanteric fractures, who referred to Imam Hussein Hospital, and were treated using either sliding or non-sliding gamma nail implants were compared. The rates of bone fusion, fused union, and bone repairments were all assessed using radiography 1, 3, 7 and 12 months after the operation. Results: In the current survey, 68.6% of cases were treated with non-sliding gamma nail implants, while 31.4% were treated with sliding gamma nail implants. The mean period of bone fusion was 4.5 months in patients with non-sliding gamma nail implants and 5.5 months in patients with sliding gamma nail implants. In patients treated with sliding gamma nail implants, treatment of 28.5% of patients failed, and in the group of patients treated with non-sliding gamma nail, treatment failure was reported in 12.5% of patients. In addition, mean postoperative Harris Hip Score (HHS) in the group treated with non-sliding gamma nail implants was significantly higher than the group treated with sliding gamma nail implants (P = 0.002). Conclusion: Based on the findings of the present study, it seems that treatment with short non-sliding gamma nail implants is a better method compared to treatment with sliding gamma nail implants.

Use of a modular hip dual-mobility articulation in patients with high risk of dislocation: a relatively small-sized acetabulum in Asian patients may limit its use

BackgroundDual-mobility hip component is widely used in Europe and North America, because it effectively reduces hip dislocation in primary and revision total hip arthroplasties. However, reports were limited on the use of dual-mobility articulation in Asian populations.PurposeThe aim of this retrospective study was to review the use of modular dual-mobility hip articulation in Asian patients with the high risk factor for hip dislocation. We also discussed the potential concern on the use of dual-mobility articulation in Asian patients.MethodsFrom Jan 2018 to June 2019, 17 patients were included in this study. The mean age of the patients was (73.8 ± 9.5) years (range: 57–88 years). The mean size of acetabular cup and modular DM liner were (49.5 ± 3.4) mm (range, 46–58 mm) and (40.7 ± 3.4) mm (range, 38–48 mm), respectively. The mean follow-up period was (15.8 ± 3.9) months (range, 11–24 months). The primary outcome was the rate of hip dislocation. The secondary outcomes included the Harris Hip Score. Differences were considered statistically significant at p < 0.05.ResultsHip dislocation, loosening, peri-prosthetic fractures, or intra-prosthetic dislocation was not found in the series. The mean preoperative and postoperative Harris Hip Scores were 42.2 ± 17.2 (range, 15–80) and 74.7 ± 13.5 (range, 52–97), respectively, giving a mean improvement of 32.5 ± 17.2 (range, 4–72). The improvement was statistically significant (p < 0.05).ConclusionsIn Asian patients with high risk of hip dislocation, the use of modular dual-mobility hip component produces promising outcomes without hip dislocation, but the relatively small-sized acetabulum may limit it widespread application in other populations worldwide.Trial registrationHKUCTR-2913.

Functional and radiological outcomes of impaction grafts and cemented cup for the treatment of acetabular bone deficiency in total hip arthroplasty

Background and Aim Acetabular bone defects are one of the most difficult problems in both primary and revision total hip replacements. Many techniques have been described to deal with acetabular bone defects in total hip replacement, including the use of cement with or without cages and rings, structural bone grafting, and impaction bone grafts with cementless or cemented cups. The aim of this study was to asses short-term to midterm clinical and radiological outcomes of acetabular reconstruction by impaction bone grafts and cemented cups in both primary and revision cases indicated for total hip arthroplasty (THA) with acetabular bone deficiency. Patients and methods This is a retrospective study that included 26 patients with total hip arthroplasty (THA) who underwent acetabular bone defect reconstructions with grafting and cemented cups between December 2014 and January 2019. The mean age at operation was 45.3 years. Among the procedures, 12 were primary THAs, whereas 14 procedures were revision THAs. The morselized grafts were used in eight cases only, along with combined strut graft and morselized grafts in five cases, acetabular rim mesh and morselized grafts in 12 cases, and Kerboul cross-ring with morselized grafts in one case. All cases were clinically evaluated by Harris hip score in addition to radiological evaluation. Results All the patients except one showed clinical improvement, where the mean postoperative Harris hip score became 84. Radiograph follow-up for all the cases showed graft incorporation without loosening or any significant cup migration, except one case, which was revised owing to loosening around the cup. Conclusion The use of impaction graft and cemented cups is safe and reproductive even in young patients. Moreover, this technique reconstitutes bone and gives a stable platform of bone stock for further revision, especially in young population.

Development of modified Ilizarov hip reconstruction surgery for hip dysfunction treatment in adolescent and young adults

Background/objectiveHip dysfunction in young population caused by developmental dysplasia of the hip, congenital hip deformity or femur head necrosis severely affect the quality of life of young patients, and total hip replacement is the current widely accepted standard therapy for hip function reconstruction in adults, but not for young patients. Alternative safe and effective surgical method for hip function preservation/reconstruction for young patients is lacking. Ilizarov hip reconstruction osteotomy was an alternative method for preserving hip function but the surgical procedures were rather complicated using discomforting ring fixation at the hip region that prevents its wider acceptance and application. Here we reported a modified Ilizarov hip reconstruction surgery for hip dysfunction/deformity correction in adolescent and young adults using femoral shaft osteotomy and simplified unilateral external fixation configuration at the hip region with satisfactory clinical outcomes.MethodsThis is a retrospective study with five male and twelve female patients aged from 10 to 34 years old (mean 20.6 years) including 11 developmental dislocations of the hip and 6 femoral head necrosis. Modified Ilizarov hip reconstruction y surgery was performed using single-arm triangular configuration, threaded half pins on the femur and multiple drill hole guide for osteotomy. The mechanical axis and limb length were corrected spontaneously during the subsequent limb lengthening process in all patients. Preoperative and postoperative gross appearance, radiography of the hip and hip function assessment scores were recorded and compared during the follow-up period.ResultsThe mean follow-up period was 64.3 months (12–87 months). Satisfactory hip appearance, hip and knee functions were achieved in all patients, none resulted in hip replacement surgery at the follow-up period. The mean preoperative and postoperative Harris hip scores were 45.92 ​± ​19.41 and 87.16 ​± ​5.31, respectively (p ​< ​0.01). Pin-track infections occurred in four patients, treated successfully with wound dressing care and oral antibiotics. Restricted range of motion of the knee was observed in eight patients, all gradually overcome by active functional exercises. Osteotomy site fracture of the middle femurs after removing external devices occurred in two patients due to unexpected fall, and complete healing was achieved after plaster fixation. Complications such as fixation device failure, knee dislocation, vessel or nerve impairments did not occur.ConclusionsModified Ilizarov hip reconstruction surgery significantly reduced the surgery time and discomforts to patients, avoided the disturbance of blood supply at the osteotomy sites. This modified method is a useful alternative for correction of hip deformities and reconstruction hip function in adolescent and young adults who are not suitable for conventional pelvis support surgery or hip replacement surgery.Translational potential statementThe modified Ilizarov hip reconstruction surgery provides an alternative for hip replacement surgery with satisfactory clinical outcomes. This procedure is minimally invasive, safe and simple, with few complications compared to conventional pelvis support surgery, and it may be the first choice of surgery for the management of hip dysfunction in adolescent and young adults.

Treatment of secondary hip arthritis from shell fragment and gunshot injury in the Syrian civil war

BackgroundIn gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. Individuals injured in the Syrian civil war were frequently transferred to the authors’ institution in neighboring city. Orthopedic trauma exposures were determined in approximately 30% of these patients. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty.MethodsThis retrospective study reviewed 26 patients (24 males, 2 females) who underwent hip arthroplasty due to prior gunshot and shell fragment injuries from November 2013 to January 2019. For all patients, the Harris Hip Score (HHS) was evaluated preoperatively and after surgery.ResultsMean age was 31.5 (range, 19–48) years. The mean preoperative HHS was 52.95 points, and the mean postoperative HHS was 79.92 points at the final follow-up after surgery. Patients with shell fragment injuries to the hip joint had higher infection rates, but it is not statistically significant.ConclusionsAn anatomic reduction of the fracture may not be possible in these cases as a result of significant bone and/or cartilage loss. Total hip arthroplasty can be done after gunshot- and shell fragment-related posttraumatic arthritis. It is an effective treatment choice to reduce pain and improve function, but the surgeon must be very careful because of high rate of infection.

Revision Hip Arthroplasty Using a Porous-coated or Taper ZMR Implant: Minimum 10-year Follow-up of Implant Survivorship.

The Zimmer Modular Revision hip (ZMR) system is available in two stem options, a porous-coated cylindrical (PCM) and a taper (TM) stem. Several concerns have been reported regarding modular implants. Specifically, because of early junctional fractures, the ZMR system was redesigned with a wider modular interface. As such, we designed a study assessing long-term ZMR survivorship and functional and radiographic outcomes. A search of our institutional research database was performed. A minimum 10-year follow-up was selected. The following two cohorts were created: PCM and TM stems. The Kaplan-Meier survival analysis was performed, and causes of stem failure requiring revision surgery were collected. Functional outcomes as per the Harris Hip Score and radiographic stem stability were assessed as per the Engh classification. A total of 146 patients meeting the inclusion criteria were available for follow-up (PCM = 68, TM = 78). The mean follow-up was 13.4 years clinically and 11.1 years radiographically for the PCM cohort. Similarly, the TM cohort had a follow-up of 11.1 years clinically and 10.5 years radiographically. The Kaplan-Meier survivorships were 87.1% and 87.8% at 15 years for the PCM and TM cohorts, respectively. The most common cause of failure requiring revision surgery overall was aseptic loosening (PCM = 1.4%, TM = 5.6%). The mean postoperative Harris Hip Score was as follows: PCM = 71.2 and TM = 64.7. Engh type I or II stem ingrowth was as follows: PCM = 85% and TM = 68%. Good survivorship using the ZMR stem system can be expected at up to 15 years. Aseptic loosening remains the most commonly encountered problem for both PCM and TM stems. Previously identified modular junctional weakness seem to have been addressed.