Primary Coxarthrosis Research Articles

Gluteal tendinitis and primary coxarthrosis may lead to iliotibial band syndrome: a Mendelian randomization study

To analyze the causal relationship of gluteal tendinitis and primary coxarthrosis with the occurrence of iliotibial band syndrome using Mendelian randomization. The GWAS data of gluteal tendinitis, primary coxarthrosis and iliotibial band syndrome were screened for high correlation single-nucleotide polymorphisms (SNPs). Mendelian randomization analysis was performed using random-effects inverse variance weighting (IVW), MR-Egger regression, and weighted median method to determine whether gluteal tendinitis and primary coxarthrosis were causally related with iliotibial band syndrome. Heterogeneity test, multiple validity test and sensitivity analysis, and clinical data analysis were used to verify the reliability of the results. Both gluteal tendinitis [IVW: OR(95% CI)=1.32 (1.03-1.68), P=0.026] and primary coxarthrosis [IVW: OR (95% CI)=1.40 (1.06-1.84), P=0.017] was positively correlated with iliotibial band syndrome. Gluteal tendinitis and primary coxarthrosis may increase the risk of iliotibial band syndrome.

[Translated article] Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results

IntroductionOsteoarthritis is a disabling pathology characterised by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. Materials and methodsA retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. ResultsThe preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. ConclusionThe dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. Evidence levelIV. Retrospective observational case series study.

Artroplastia total de cadera con sistema de doble movilidad de segunda generación como tratamiento de coxartrosis primaria, resultados a mediano plazo

IntroductionOsteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. Materials and methodsA retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. ResultsThe preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. ConclusionThe dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. Evidence levelIV. Retrospective observational case series study.

Mechanical parameter assessment of fresh human cancellous bone of the femoral head in atraumatic femoral head necrosis and primary coxarthrosis

BackgroundAtraumatic femoral head necrosis is a rare pathological change of the femoral head. It is characterized by local necrosis of the cancellous bone as a result of reduced blood supply to the bone. Even today it remains unclear how to assess the hardness of the necrosis, whether it is soft tissue that is easily removed, or hard tissue that is difficult to resect. MethodsFemoral heads with primary coxarthrosis were selected as a comparison group. For this purpose, 49 femoral heads obtained during total hip arthroplasty surgery with either condition (23 femoral head necrosis, 26 coxarthrosis) were transferred to the testing laboratory in fresh condition. Cylindrical specimens were obtained using a tenon cutter along the main trabecular load direction in the subchondral region of the femoral head. Additionally, thin bone slices were extracted proximal and distal to the specimens for density measurements. Brass plates were glued to the circular surfaces of the specimens. After curing of the adhesive, the specimens were mounted in the testing machine and destructive uniaxial compression tests were conducted. FindingsThe recorded mean compressive strengths and elastic moduli were almost identical for both groups, but the necrosis group showed significantly higher data scattering and range regarding the elastic modulus. The mean density of the coxarthrosis specimens was significantly higher than that of the necrotic specimens. InterpretationThe mechanical properties of cancellous bone vary considerably in the presence of femoral head necrosis. The existence of hard necrosis implies a potential challenge regarding the clinical resection of these tissues.

INFLUENCE OF STEM FIXATION AND STEM TYPE ON REVISION AND MORTALITY RATES IN ELECTIVE TOTAL HIP ARTHROPLASTY PROCEDURES IN PATIENTS OVER 80 YEARS OF AGE

The early revision rate in elective Total Hip Arthroplasty (THA) three years after surgery in elderly patients over 80 years is significantly lower for cemented stems in the German Arthroplasty Register (EPRD): cemented 3,1% (3.0 – 3.2) vs. uncemented 4.2% (4.1 – 4.3; p < 0.001). However, the mortality rate in elderly patients is elevated for cemented fixation. This study presents a detailed analysis of the influence of stem type and fixation on revision and mortality rate in this patient cohort.Elective primary THA cases for primary Coxarthrosis using uncemented cups from the EPRD data base were analysed (n0= 37,183). Four stem type groups were compared: cementless, cementless with collar, cementless short, and cemented. Stems with at least 300 cases at risk three years after surgery were analysed individually. The reference stem was determined as the stem with the lowest revision rate and at least 1000 cases under surveillance 3 years after surgery (n3 = 28,637).The revision rate for cemented stems (2.5% [2.2–1.81] was lower than for uncemented (4.5% [4.2–4.9]; p<0.001) and uncemented short stems (4.2% [3.1–5.7]; p=0.002). The revision rate of uncemented collared stems (2.3% [1.5–3.6]) was similar to cemented stems (p=0.89) and lower than for uncemented stems (p=0.02). One year mortality showed no sig. differences between the groups (p>0.17): cemented 3.2% [2.9–3.6], uncemented 3.4% [3.1–3.7], uncemented short 3.5% [2.5–4.9], uncemented collar 2.0% [1.2–3.2].“Cementless” and “cementless short” stems should not be used in patients over 80 years due to the higher revision risk. If cementing should be avoided, “cementless collared” stems seem to be a good alternative combined with a tendency for a lower one year mortality rate.

Psychological comorbidities in osteoarthritis in Germany

Osteoarthritis is a degenerative joint disease associated with pain, loss of function and reduced quality of life. Concomitant psychological disorders can significantly influence treatment outcomes. Therefore, we aimed to answer the following research questions: (1) How has the incidence of primary coxarthrosis and gonarthrosis developed over the last decade? (2) How high is the prevalence of osteoarthritis patients with concomitant psychological diagnoses? (3) Which psychological comorbidities are most prevalent in coxarthrosis and gonarthrosis patients, respectively? For this cross-sectional study, a dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes “M16.1” and “M17.1”, unilateral primary coxarthrosis and unilateral primary gonarthrosis, were quantified. Prevalence rates of secondary diagnoses of the chapter F of the ICD-10 were determined. Incidences were 230.7/100,000 inhabitants for coxarthrosis and 224.2/100,000 inhabitants for gonarthrosis. Patients with psychological comorbidities constituted 9.0% of coxarthrosis cases and 8.9% of gonarthrosis cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant “F” diagnoses of the ICD-10 increased by + 37.8% for coxarthrosis and by 17.9% for gonarthrosis. The most prevalent secondary diagnoses were affective disorders (F3), whereby numbers increased over the years. Increasing psychological comorbidities advocate for the implementation of screening tools, prevention strategies, interdisciplinary approaches and psychological support in the treatment of osteoarthritis.

The effects of shoulder and hip widths on the acetabular angle in hip arthroplasty performed in the lateral decubitus position. Trochanter/shoulder ratio effect on postop inclination

Objectives This study aimed to determine the effects of the soft tissue and bone widths of the patient's hip and shoulder region on the patient's position and postoperative acetabular inclination angles in the lateral decubitus position during hip replacement procedures. Materials and Methods Seventy-three patients with primary coxarthrosis who underwent primary hip arthroplasty by a single experienced surgeon using a water gauge assisted inclinometer in lateral decubitus position were retrospectively studied. Soft tissue and bone widths of the shoulder, ASIS (Anterior superior iliac spine), and trochanter levels measured from the preoperative radiographs of the patients and shoulder/hip (ASIS-trochanter) ratios were calculated and made statistical comparisons with postoperative acetabular inclination angle. Results Postoperative inclination angle had a strong negative correlation with trochanter/shoulder soft tissue ratio, a moderate negative correlation with ASIS/shoulder soft tissue ratio, and a weak negative correlation with trochanter and ASIS/shoulder bone ratios. When patients are grouped by trochanter/shoulder ratio, the postoperative inclination value is 43.04 (38-47) degrees in the group with the ratio < 0.85, the postoperative inclination value is 38.67 (33-45) degrees in the group with the ratio of 0.85-1, and the mean postoperative inclination value in the group with the ratio > 1 was found to be 35.60 (30-38) degrees. (p < 0.001) As for the postoperative inclination values, the mean trochanter/shoulder and ASIS/shoulder values in the group with ≤ 40 degrees were 0.99 and 0.94, respectively, while these values in the group with > 40 degrees were 0.83 and 0.79, respectively. (p < 0.001). Conclusions Soft tissue widths in the shoulder and hip regions may affect the surgical position and postoperative acetabular inclination angle. Knowing the relationship between the patient's preoperative hip and shoulder distance can influence the expected clinical outcome after hip arthroplasty. Therefore, surgeons should consider these effects when planning hip arthroplasty surgery.

Early postoperative results analysis of standard and mini-incision posterolateral approach in total hip arthroplasty

Background/Aim. Total hip arthroplasty is the replacement of the hip joint with an artificial one. Standard surgical procedures involve a long skin incision and extensive dissection of healthy tissue. Mini-incision surgery is a modification of standard operative approaches. In addition to a significantly smaller skin incision, the main difference is based on much less damage to soft tissues, especially the muscles that move the hip. The aim of this study was to compare the early results of the mini-incision and a standard approach in total hip arthroplasty and to determine the advantages and disadvantages of the mini-incision surgical technique. Methods. A retrospective study analyzed data based on 63 patients who underwent total hip arthroplasty with a mini-incision and standard approach at the Institute of Orthopaedic Surgery ?Banjica?, Belgrade from 2004 to 2010. All the patients suffered from primary coxarthrosis. All operations were carried out by the same surgical team. All patients were clinically evaluated before and after the surgery using the Harris Hip Score (HHS). Results. The group of patients operated on with the mini-incision approach included 32 patients, while 31 patients made up the group of patients operated on with the standard approach. Comparing these groups did not reveal a statistically significant difference in age, body mass index, surgery duration, and HHS before the surgery. A statistically significant difference was determined by comparing intraoperative blood loss, the amount of drainage fluid after the surgery, and the HHS after the surgery. Conclusion. The mini-incision posterolateral approach, compared to the standard approach, apart from an esthetically more acceptable scar, achieves significantly less intraoperative blood loss and better hip function with almost the same risk of complications.

Patient safety during endoprosthetic training : Does the training of surgeons in primary hip arthroplasty at certified endoprosthesis centres lead to increased complications?

HintergrundZiel der Studie war die Untersuchung, ob sich das perioperative Outcome und operationsspezifische Prozessgrößen bei Patienten mit Hüftgelenksersatz signifikant verschlechtern, wenn die Operation durch einen unerfahrenen Operateur, assistiert durch einen erfahrenen Operateur, im Kontext eines zertifizierten Endoprothesenzentrums durchgeführt wird.Material und MethodenEs wurden 1480 Patienten eingeschlossen, die zwischen 2013 und 2016 bei primärer Koxarthrose mit einer primären zementfreien Hüfttotalendoprothese (HTEP) versorgt wurden. Die relevanten Daten wurden retrospektiv aus dem Krankenhausinformationssystem, dem Entlassungsbrief und aus dem EndoCert-Bogen dokumentiert. Die Operateure wurden nach ihrer Qualifikation in erfahrene (Senior, > 50 HTEP pro Jahr) und unerfahrene Operateure (Junior, < 50 HTEP pro Jahr) unterteilt. Anschließend erfolgte der Vergleich der erhobenen Daten anhand dieser Unterteilung.ResultateEs zeigte sich bei unerfahrenen Operateuren eine signifikante Verlängerung der Operationsdauer um 20,7 min (Senior 62,6 ± 20,4 min; Junior 83,3 ± 19,5 min; p ≤ 0,001), der Krankenhausverweildauer um 0,25 Tage (Senior 8,8 ± 0,9 d; Junior 9,0 ± 0,9 d; p ≤ 0,001) und eine Erhöhung der Transfusionshäufigkeit von Erythrozytenkonzentraten (Senior 0,6 ± 1,1 Stk.; Junior 0,9 ± 1,4 Stk.; p ≤ 0,001). Dagegen zeigte sich kein Unterschied bei perioperativen Komplikationen (p = 0,682) und beim perioperativen Blutverlust (Senior 1,3 ± 0,5 l; Junior 1,3 ± 0,5 l; p = 0,097). Zwischen Operationsdauer und Blutverlust bestand allerdings eine positive Korrelation (Senior r = 0,183; Junior r = 0,214; jeweils p ≤ 0,01).SchlussfolgerungDie Ausbildung von unerfahrenen Operateuren an einem zertifizierten Endoprothesenzentrum führt bei Assistenz durch erfahrene Operateure nicht zur Reduktion der Patientensicherheit mit vermehrten Komplikationen. Aufgrund der Operationszeitverlängerung kommt es allerdings zu einer Mehrbelastung der Kliniken im Wettbewerb mit nichtausbildenden Kliniken, die nicht im DRG-System abgebildet ist.

Bone remodelling, around an anatomical hip stem: A one year prospective study using DEXA

IntroductionThe loss of bone mass, as a consequence of bone remodelling, in the proximal third of the femur, is a factor that contributes to the failure of hip prostheses in the medium to long term. This periprosthetic remodelling occurs mainly during the first 12 months after the operation.The aim is to evaluate the behaviour at one year of a new anatomical stem, the ANATO® stem (2015-Stryker®), which is a redesign of its predecessor (ABG-II®—Stryker stem) by means of bone densitometry. MethodProspective, controlled study in which the changes in bone mineral density (BMD) observed around the 7 areas of Gruen in a group of 61 patients affected by primary coxarthrosis, in whom an ANATO® stem was implanted, are analysed densitometrically. The healthy hip was taken as the control group. The existence of differences in the remodelling pattern according to sex, age and body mass index (BMI) was compared. The follow-up was during the first year after the intervention. ResultsAfter one year of follow-up, decreases of bone mineral density in zone 7 of −5.9% were observed, being this decrease statistically significant. No differences were found in the remodeling pattern according to age, sex and body mass index. ConclusionThe ANATO® stem allows an efficient transmission of loads from the stem to the proximal femur. Only in zone 7 significant bone atrophy is observed. Differences in age, BMI and sex do not seem to influence the bone remodelling around this new stem.

Estudio prospectivo del remodelado óseo femoral alrededor de un vástago anatómico de cadera: un año de seguimiento densitométrico

IntroductionThe loss of bone mass, as a consequence of bone remodelling, in the proximal third of the femur, is a factor that contributes to the failure of hip prostheses in the medium to long term. This periprosthetic remodelling occurs mainly during the first 12 months after the operation.The aim is to evaluate the behaviour at one year of a new anatomical stem, the ANATO® stem (2015-Stryker®), which is a redesign of its predecessor (ABG-ii®-Stryker stem) by means of bone densitometry. MethodProspective, controlled study in which the changes in bone mineral density (BMD) observed around the seven areas of Gruen in a group of 61 patients affected by primary coxarthrosis, in whom an ANATO® stem was implanted, are analysed densitometrically. The healthy hip was taken as the control group. The existence of differences in the remodelling pattern according to sex, age and body mass index (BMI) was compared. The follow-up was during the first year after the intervention. ResultsAfter one year of follow-up, decreases of bone mineral density in zone seven of -5.9% were observed, being this decrease statistically significant. No differences were found in the remodelling pattern according to age, sex and body mass index. ConclusionThe ANATO® stem allows an efficient transmission of loads from the stem to the proximal femur. Only in zone seven significant bone atrophy is observed. Differences in age, BMI and sex do not seem to influence the bone remodelling around this new stem.

Single stage bilateral total hip arthroplasty - 10 years of experience

Background/Aim. Coxarthrosis is a chronic degenerative joint disorder which occurs in approximately 4% of population, and bilateral occurrence is estimated at 42%. Patients with bilateral coxarthrosis can undergo bilateral hip replacement in one or two stage procedure. Aim of this article was to present our experience in simultaneous bilateral hip arthroplasty, and to recommend it in patients with adequate indications. Methods. We processed data for 113 patients of both genders, operated at the Clinic for Orthopedic Surgery and Traumatology of the Military Medical Academy in Belgrade, Serbia from 2005 until 2015 where single stage bilateral hip arthroplasty was performed. Identical operative technique was applied in all patients as well as standard antibiotic and thromboprophylactic treatment. Follow-up period was 30 days postoperatively. Results. Mean age of patients was 56 ? 10.2 years, whereby 45 (39.8%) of them were males and 68 (60.2%) females. Primary coxarthrosis was etiologic factor for the majority of patients, 69 (61.1%). Postoperative hospitalization duration was 10.3 days on average (range from 3 to 34 days). We noticed the following complications: one luxation of the endoprosthesis, one deep infection and one thrombosis of the leg. There was no mortality. Majority of operated patients were grouped as the American Society of Anesthesiologists (ASA) scores 1-3. Mean blood transfusion was 1,275 mL (range from 300 to 2,830 mL). Conclusion. One stage bilateral hip arthroplasty can be performed routinely and safely in facilities with possibility for interdisciplinary approach and adequate selection of patients. Data from our study which indicate significantly increased need for blood substitution, emphasize the need to introduce contemporary perioperative blood loss management principles. The rate of complications observed in our study was within rates published in the literature concerning hip arthroplasty.

Management of patients in the post-operative period after the hip joint replacement accessed by low-invasive access

Up to 1.5 million total hip arthroplasty is performed annually in the world. In Russia, at least 300 thousand patients a year need hip replacement surgery. High tissue invasiveness during surgical approaches presents special requirements for the rehabilitation process in the early postoperative period. Accelerating and making it more efficient is possible with the use of the least traumatic operating access. The purpose of the study is a comparative analysis of two models of the organization of rehabilitation in the postoperative period after hip arthroplasty: using standard Harding surgical access and the minimally invasive Rottinger access. Material of the study - patients operated on with standard Harding access (group I, n = 227) and front-external Rottinger access (group II, n = 266). Criteria for inclusion of patients in both groups are primary coxarthrosis without previous surgical interventions, exclusion criteria are connective tissue diseases, severe comorbidity. Group I patients underwent postoperative rehabilitation according to the standard protocol, group II - according to the rehabilitation concept "ERAS, fast-track". To assess the effectiveness of the rehabilitation at all stages in both groups, the rehabilitation potential was assessed on the rehabilitation routing scale (SRM), the dynamics of the pain syndrome on the visual analogue pain scale (VAS), the verticalization period was taken into account, the main assessment scales of the patient's motor functions and psychological status were used in hip arthroplasty: Harris scale, quality of life questionnaire (EQ - 5D), modified Rankin scale. Results and discussion. The proportion of hip arthroplasty using MIS access in the total number of operations increased from 0.7% in 2015 to 10.1% in 2018. The studied groups are comparable in terms of the ratio of men and women, average age, number of observations, BMI and the volume of blood loss. The surgeon duration and the duration of the stationary phase in group I exceeded the similar parameters of the II group. The modified Rankin scale at admission and discharge in all patients showed moderate disability, starting indicators and results after 3 months were more prosperous in group II. Both groups had an equivalent score on the Harris scale before surgery and after 3 months after it, more pronounced positive dynamics of the quality of life on the EQ-5D scale ("thermometer") was noted in group II. A decrease in pain after surgery compared with baseline, with regression to 0.8-1.0 points by 3 months after surgery, was noted in all patients. The assessment on the rehabilitation routing scale did not differ in both groups. At the stationary stage, group I patients walked with additional support on crutches (100%), group II - on a cane (92.5%). On long days 4-6, 82.8% of patients of group I and 91.7% of patients of group II passed long distances. At the end of stage I rehabilitation, 83.7% of group I patients and 92.5% of group II were sent to the outpatient rehabilitation stage, the rest were transferred to stage II of rehabilitation in a 24 - hour hospital. The third stage of rehabilitation, all patients went on an outpatient basis at the place of residence. At the follow-up stage, the data of a telephone survey of group II were analyzed (n = 68, 25.6% of the respondents). By 3 months, the Harris score exceeds 90 points, satisfaction with the operation is 97%. As a result of the use of surgical MIS access for hip arthroplasty, all patients had good rehabilitation indicators. Conclusions. The general approach to managing patients after hip arthroplasty is similar for all types of surgical access, however, MIS-access creates the most favorable conditions for the rehabilitation of patients in the early postoperative period: a positive attitude of the patient, reduced blood loss, reduced surgical incision, the possibility of early activation and transition to the general regime for 6-7 days. The results of the study showed the advantages of a model for the organization of rehabilitation in the postoperative period after hip arthroplasty using mini-invasive access over standard surgical access. Group II patients (MIS access) had a higher level of physical activity and a low level of pain in the early postoperative period.

Using Tantalum Augments for Major Acetabular Bone Defects in Revision Hip Surgery

Abstract Aim. The purpose of the study was to follow up the clinical and functional results of the patients with major acetabular bone defects in revision hip surgery. Materials and methods. The study was retrospective, over a period of six years (from January 2014 to January 2019), and included all the patients with hip replacement, with major acetabular bone defects, who needed Tantalum blocks substitution. 11 patients were included in the study (8 men and 3 women). The average age was 71 years (between 64 and 78 years old). The average follow up period was 23 months (between 11 and 36 months). Paprosky radiological classification was used for the preoperatory evaluation of the bone defects. In 9 cases, the bone defect was of type 2B Paprosky and in 2 cases, of type 3A. Harris score was determined preoperatory and postoperatory for the appreciation of functional results. Results. 6 patients were underwent replacement for coxarthrosis secondary to dysplasia, 2 patients for coxarthrosis secondary to aseptic necrosis and 3 patients for primary coxarthrosis. The average time elapsed from the moment of primary arthroplasty to the need of revision surgery was on average of 13 years (between 7 and 16 years). The postoperatory radiological evaluation showed an improvement of the hip rotation center from an average postoperative vertical position of 3.1 cm (between 1.2 and 4.6 cm) at an average postoperatory position of 1.1 cm (between 0.5 and 2.3). The average result of Harris score postoperatively was 36 (between 39 and 96). During the follow up period, no early loosening, infection or prosthesis dislocation was registered. Conclusions. The Tantalum Augments used in major acetabular bone defects in revision surgery represent a good option, correcting the hip rotation center, thus considerably improving the functional score.

Anesthesia type have the effect of extremity length award in patients with total hip artroplasty?

Aim: Leg length discrepancy (LLD), instability and periprosthetic infection are most common reasons patient complaint after total hip replacement (THR) surgery. Degree of soft tissue release in operating room may mislead us about LLD. The objective of this study is to report the effect of the anesthesia type on leg lengthening amount. Material and Method: In this study, 36 primary coxarthrosis patients who underwent THR surgery in two different medical centers under different types of anesthesia during2016-2017 were enrolled retrospectively. Patients are divided into two groups. Group 1 (n:18) who underwent general anesthesia, group 2 (n:18) who underwent regional anesthesia. Distance between greater trochanter-ischial tuberocity (GT-IT) is measured radiologically for leg lengthening, umbilicus-medial malleolus distance is measured clinically for LLD. Harris hip score (HHS) is measured for functional scoring. Results: The average follow-up time was 13 months (12-15 months). No deep infection or neurovascular damage were seen in patients. According to GT-IT distance, leg lengthening was 19.76±9.83 mm in group 1 and 3.2±3.96 in group 2 (p:0.000*). According to 12 month umbilicus-medial malleolus distance, 9 patients experienced leg lengthening (<2cm) and 9 patients had no LLD in group 1 where 3 patients experienced leg shorthening (<1cm), 5 patients experienced leg lengthening (<1cm) and 11 patients had no LLD in group 2. Average HHS was 77.17±4.4 in group 1 where 78.64±5.73 in group 2 (p:0.410). When all patients were considered 12 patients (33%) experienced 1-10 mm lengthening, 4 patients (11%) experienced 10-20 mm lengthening. HHS was 79.62 in patients with no LLD, 77.41 in 1-10 mm LLD, 75.21 in 10-20 mm LLD (p:0.140) Conclusion: In THR surgery, leg lengthening is seen in patients whom underwent general anesthesia more than regional anesthesia patients. We think that this is because soft tissue relaxation is more significant after general anesthesia.

Outcome of short- to medium-term migration analysis of a cementless short stem total hip arthroplasty using EBRA-FCA: a radiological and clinical study.

Stress shielding may lead to aseptic loosening which is a common reason for implant failure. An established method to identify implants with risk of implant failure caused by aseptic loosening is to measure early migration of the stem with the "Ein Bild Roentgen Analyse" femoral component analysis (EBRA-FCA). Therefore, the aim of this study was to measure the migration of a cementless short stem prosthesis via EBRA-FCA to predict the future performance. A total collective of 71 patients were treated with a cementless short hip stem prosthesis. Indications for surgery were primary coxarthrosis, dysplasia coxarthrosis or femoral head necrosis. After surgery, the patients were followed-up immediately after 3, 6, 12, 24, 36, and 48months and X-ray images for EBRA-FCA measurements were taken. Axial caudal migration as well as the varus/valgus tilting of the prosthesis was determined. Possible influencing factors like BMI, age, diagnosis, gender or Harris Hip Score (HHS) on the migration of the stem were assessed. HHS increased significantly direct postoperatively (p < 0.001). At the second follow-up the average caudal migration was 0.42 ± 0.52mm (range: 0.00-2.85mm) (p < 0.001). A total of 14 patients underwent a caudal migration greater than 1.5mm until 48months. The initial varus and valgus tilts within the first 3months were significant (p < 0.001). No correlations between BMI, age, diagnosis, gender or HHS and the migration as well as the tilting of the cementless short hip stem prosthesis were found. Although initial axial caudal migration as well as tilting tendencies in varus or valgus position can be detected, there is no marked migration of the examined prosthesis after the first 48months. Likewise, no aseptic early loosening was detected throughout the study period, which indicates good osseointegration of the short stem prosthesis.

Inter and Intra Operator Reliability of Motor and Palpation Evaluation in Fascial Manipulation in individuals with coxarthrosis

ABSTRACT Objective An inter and intra rater reliability (INTERR and INTRAR) study was designed. Methods 71 subjects, with primary hip coxarthrosis, were included and randomly divided in a study group (SG= 36) and a control group (CG= 35) to assess the efficacy of the Fascial Manipulation® (FM®) method. The primary objective was the assessment of INTERR and INTRAR about movement verification (MV) and palpation verification (PV) of FM® performed by two physiotherapists (PtA and PtB). The secondary objective was evaluate the efficacy of FM® through MV, PV and pain score. Pain was assessed using the Numeric Rating Scale (NRS). SG received three weekly sessions of FM® byPtA. PtB re-evaluated all the subjects at the end of the study. Results Results of the INTERR analysis showed for SG: MV (ICC= 0.92, k= 72.7%); PV (ICC= 0.91, k= 75.7%). For CG : MV (ICC= 0.95, k= 84.2%); PV (ICC= 0.90, k= 75%). Results of the INTRAR analysis for SG reported: MV (ICC= 0.82, k= 74,8%); PV (ICC= 0.60, k= 46.8%); for CG: MV (ICC= 0.93, k= 78.7%); PV (ICC= 0.84, k= 53.3%). Statistical significance were reported in NRS (p = 0.001), MV (p = 0.0003) and PV (p < 0.0001) with better results for SG using “Intention To Treat” method. Discussion This study demonstrates that FM® assessment procedures have a high reliability even if applied by practitioners with basic experience. Furthermore FM® treatment can improve pain and ROM in individuals with primary coxarthrosis

Influência da artroplastia total de quadril sobre o equilíbrio sagital lombopélvico: avaliação dos parâmetros radiográficos

ObjectiveTo prospectively analyze the radiographic variables of lumbosacral sagittal balance in the pre‐ and postoperative period of patients submitted to total hip arthroplasty. MethodsA prospective, observational, comparative study that evaluated pre‐ and postoperative radiographic parameters of 71 patients, submitted to 72 total hip arthroplasties in a three‐year period (2014–2017) for primary coxarthrosis, of whom 28 performed late postoperative control (six months) through the Surgimap Spine program. Statistical analysis was performed using Student's t‐test, the analysis of covariance (ANCOVA) model, and the Kolmogorov‐Smirnov test. The data were analyzed using the IBM SPSS Statistics program, v. 20.0. p‐value < 0.05 indicated statistical significance. ResultsSeventy‐two cases presented a mean age of 57.9 years, predominantly females (60.6%) and patients older than 50 years (71.8%). There was an overall decrease in lumbar lordosis values in the immediate postoperative period, without major global changes in late evolution. It was found that patients with a pelvic incidence greater than or equal to 60° tended to have their other sagittal balance parameters elevated. ConclusionThere was no significant difference between the radiographic variables of sagittal lumbopelvic balance in the evaluated periods. Lumbar lordosis and pelvic incidence were the main modifying factors. Improvement of low back pain after total hip arthroplasty, without changes in parameters, suggests different pathology mechanisms still to be clarified.

Factors affecting the return to work of total hip arthroplasty due to of developmental hip dysplasia in in young patients

IntroductionThe aim of this study was to examine the factors affecting return to work after Total hip arthroplasty (THA) applied for coxarthrosis due to developmental hip dysplasia (DDH). MethodsThe study included 51 patients aged <60 years in the period 2004–2010. The demographic information was recorded for all patients and the pre-postoperative Modified Harris score, EQ-5D, EQ-5D VAS and Grimby activity score. With an evaluation of the current employment status at the final follow-up examination. ResultsPreoperatively, 21 patients were employed, 16 were unemployed and 14 were housewives, none of whom were able to perform housework tasks. Postoperatively, 30 patients were employed and 10 were unemployed. One of the previously employed patients decided preoperatively to retire and was therefore not employed postoperatively. Of the 14 housewives, 9 were able to undertake the housework themselves postoperatively. The mean time of return to work was 13.4 weeks. Factors affecting finding work postoperatively were determined to be body mass index, National Occupational Level, whether or not osteotomy was applied and the preoperative duration of unemployment. ConclusionsAs coxarthrosis associated with DDH develops earlier than primary coxarthrosis, these patients undergo surgery at a younger age and the vast majority are of working age. THA applied for coxarthrosis on the basis of DDH enables most patients to return to their preoperative work and offers the opportunity of finding work to some of those who were unemployed. This increases the contribution of these patients to the national economy.

Adaptive Bone Remodeling With New Design of the ABG Stem. Densitometric Study

To establish the pattern of bone remodeling caused by a cementless, anatomic implant, we intend to evaluate the changes in bone mineral density observed after surgery in the Gruen zones. A controlled, prospective study was carried out, in which a group of 37 patients with primary coxarthrosis were densitrometrically analyzed over the 1 year period following the implant of an ANATO stem (Stryker). The patient's healthy hip was taken as the control. Any differences in the remodeling pattern were compared according to age, body mass index, and implant size. Decreases in bone mineral density were observed after 3 months in all of the zones studied. However, this bone mineral density loss was recovered in all zones by the end of the study, except in zone 7 where a decrease of 7.2% in bone mass was observed. In zones 2 and 6, where more loads are transmitted, bone mass preservation, in accordance with Wolff's law, can be seen. No differences were found in the remodeling pattern in relation to age and body mass index. There were also no differences related to stem size except in zones 1 and 7. The ANATO stem achieves an efficient transmission of loads between the stem and the proximal femur, providing enough mechanical loads for bone preservation. It is only in zone 7 where significant bone atrophy can be observed, attributable to the damage that this area suffers during the surgical process and the subsequent stress-shielding caused by the implant design.