Hip abductor repair improves patient outcome, function, and satisfaction in patients without and with total hip arthroplasty

Obturator hip dislocations are rare, typically resulting from high-energy trauma in native hips. These types of dislocations are treated with closed reduction under sedation. Open reduction and internal fixation may be performed in the presence of associated fractures. Still rarer are obturator hip dislocations that penetrate through the obturator foramen itself. These types of dislocations have only been reported three other times in the literature, all within native hips. To date, there have been no reports of foraminal obturator dislocations after total hip arthroplasty. We report of the first periprosthetic foraminal obturator hip dislocation, which was caused iatrogenically during attempts at closed reduction of a posterior hip dislocation in the setting of a chronic greater trochanter fracture. Altered joint biomechanics stemming from a weak hip abductor mechanism rendered the patient vulnerable to this specific dislocation subtype, which ultimately required open surgical intervention. An early assessment and identification of this dislocation prevented excessive closed reduction maneuvers, which otherwise could have had detrimental consequences including damage to vital intrapelvic structures. This case report raises awareness to this very rare, yet potential complication after total hip arthroplasty.

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Hip abductor strength following total hip arthroplasty: A prospective comparison of the posterior and lateral approach in 100 patients

Acta Orthopaedica Scandinavica ◽

10.1080/00016470152846501 ◽

2001 ◽

Vol 72 (3) ◽

pp. 215-220 ◽

Cited By ~ 95

Author(s):

Nicholas D Downing ◽

David I Clark ◽

James W Hutchinson ◽

Karen Colclough ◽

Peter W Howard

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lateral Approach ◽

Total Hip ◽

Prospective Comparison ◽

Hip Abductor ◽

Abductor Strength

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Primary Total Hip Arthroplasty (THA) in Patients with Incomplete Hip Abductor Tears: Does Hip Abductor Repair Improve Outcome?

Hip International ◽

10.5301/hipint.5000133 ◽

2014 ◽

Vol 24 (4) ◽

pp. 399-404 ◽

Cited By ~ 6

Author(s):

Michael Betz ◽

Patrick O. Zingg ◽

Anna Hirschmann ◽

Amin Alireza ◽

Claudio Dora

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Improve Outcome ◽

Total Hip ◽

Hip Abductor ◽

Primary Total Hip Arthroplasty

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Key performance and training parameters in primary total hip arthroplasty – an expert consensus using the Delphi technique

Hip International ◽

10.1177/11207000211056864 ◽

2021 ◽

pp. 112070002110568

Author(s):

Daniel Howgate ◽

Patrick Garfjeld Roberts ◽

Ben Kendrick ◽

Jonathan Rees

Keyword(s):

Patient Outcome ◽

Total Hip Arthroplasty ◽

Surgical Training ◽

Hip Arthroplasty ◽

Delphi Technique ◽

Expert Consensus ◽

Substantial Impact ◽

Total Hip ◽

Key Steps ◽

Primary Total Hip Arthroplasty

Aims: Primary total hip arthroplasty (THA) is a commonly performed and successful operation which orthopaedic trainees must demonstrate competence in prior to completion of surgical training. An assessment of agreement between surgical trainers regarding the critical steps of a primary THA has never been undertaken. The aim of this study was to define and rank the key steps of a primary THA regards ease of teaching and their importance in achieving the best patient outcome. Materials and methods: The Delphi technique with 3 iterative rounds was used to establish expert group consensus. The benchmark for consensus was set at an 80% agreement in any category for each step of a THR. The intra-class correlation coefficient (ICC) was used to report on the inter- and intra-rater reliabilities between and within participants responses respectively in rounds 2 and 3. Results: 50 consultant orthopaedic hip surgeons completed round 2, and 28 completed round 3. Overall, 27 steps (54 parameters) were identified, with 16 parameters achieving consensus agreement for their impact on patient outcome, and 17 for ease of teaching. The inter-rater ICC for patient outcome parameters was 0.89 and 0.92 in rounds 2 and 3 respectively while for teaching parameters it was 0.82 and 0.73. 50% of surgeons agreed that acetabular reaming, assessing and accurately restoring leg length, and acetabular cup anteversion were the 3 most difficult steps to teach trainees, while 90% agreed these 3 steps were substantially important to patient outcome. Another 5 steps achieved consensus for their substantial impact on patient outcome but failed to achieve consensus for ease of teaching. Conclusions: The results of this expert consensus have produced a rank-order list of the key steps in primary THA, which may be used for orthopaedic curriculum development and guiding focused improvements for surgical training in primary THR including simulation.

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