scholarly journals Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions

2021 ◽  
Author(s):  
Junfeng Zhu ◽  
Kangming Chen ◽  
Jianping Peng ◽  
Yang Li ◽  
Chao Shen ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Leg Length ◽  
Surgical Hip Dislocation ◽  
Short Term ◽  
Term Outcome ◽  
Rotational Osteotomy ◽  
Patient Reported ◽  
Femoral Heads

Abstract In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.

scholarly journals Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach

2020 ◽  
Vol 14 (3) ◽  
pp. 190-200 ◽  
Author(s):  
Mostafa M. Baraka ◽  
Hany M. Hefny ◽  
Mootaz F. Thakeb ◽  
Tamer A. Fayyad ◽  
Haytham Abdelazim ◽  
...  
Keyword(s):  
Slipped Capital Femoral Epiphysis ◽  
Alpha Angle ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Functional Score ◽  
Surgical Hip Dislocation ◽  
Level Of Evidence ◽  
Surgical Dislocation ◽  
Imhauser Osteotomy ◽  
The Mean

Purpose Treatment of moderate to severe stable slipped capital femoral epiphysis (SCFE) remains a challenging problem. Open reduction by modified Dunn procedure carries a considerable risk of osteonecrosis (ON). Imhauser osteotomy is capable of realigning the deformity without the risk of ON, but the remaining metaphyseal bump is implicated with significant chondro-labral lesions and accelerated osteoarthritis. We conducted this study to evaluate the efficacy and safety of Imhauser osteotomy combined with osteochondroplasty (OCP) through the surgical hip dislocation (SHD) approach. Methods A prospective series of 23 patients with moderate-severe stable SCFE underwent Imhauser osteotomy and OCP through SHD. The mean age was 14.4 years (13 to 20) and the mean follow-up period was 45 months (24 to 66). The outcome measures included clinical and radiological parameters and Harris hip score (HHS) was used as a functional score. Results The mean HHS improved significantly from 65.39 to 93.3. The limb length discrepancy improved by a mean of 1.72 cm. The mean flexion and abduction arcs showed a significant improvement (mean increase of 37.5° and 18.5°, respectively). The mean internal rotation demonstrated the most significant improvement (mean increase of 38.5°). All the radiographic parameters improved significantly; including anterior and lateral slip angles (mean improvement 37.52° and 44.37°, respectively). The mean alpha angle decreased by 39.19°. The articulo-trochanteric distance significantly increased to a mean of 23.26 mm. No cases of ON or chondrolysis were identified. Conclusion Combined Imhauser osteotomy and OCP through the surgical dislocation approach provide a comprehensive and safe management of moderate to severe stable SCFE. Level of evidence IV

scholarly journals Capsular arthroplasty for neglected developmental dysplasia of hip

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877788 ◽  
Author(s):  
Saeed Ahmad ◽  
Irfan Qadir ◽  
Atiq uz Zaman ◽  
Chiragh Muhammad Khan ◽  
Shahzad Javed ◽  
...  
Keyword(s):  
Hip Dislocation ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Functional Evaluation ◽  
Short Term ◽  
Scoring Method ◽  
Developmental Dysplasia Of Hip ◽  
Femoral Shortening ◽  
Shelf Procedure

Introduction: Treatment of developmental dysplasia of hip (DDH) diagnosed after 10 years of age is extremely difficult because of the soft tissue and bone deformities. In this study, we evaluated short-term results of a single-stage procedure performed with surgical hip dislocation, femoral shortening and capsular arthroplasty. Patients and Methods: A retrospective review of charts of five patients with DDH, older than 10 years, who underwent capsular arthroplasty at Ghurki Trust Teaching Hospital between 2013 and 2015 was performed. Post-operative functional evaluation was performed using modified McKay’s scoring system and radiographic assessment using Severin’s scoring method at a minimum of 2-year follow-up. Results: We present results of five patients (six hips) with a mean age of 18.16 years. All patients had limping gait and International Hip dysplasia Institute classification (IHDI) class 4 hip dislocation. Harris hip score showed a significant improvement (53.13 vs 84.16; p = 0.0001). Femoral shortening of 2–2.5 cm was done. Additional shelf procedure was required in one patient. This patient persistently has post-operative hip subluxation. All patients had good to excellent outcomes according to McKay classification. Post-operative Severin classification was 1A in all patients. No case of avascular necrosis of the femoral head was noted during the follow-up. Conclusion: Capsular arthroplasty with subtrochanteric shortening is a useful procedure for neglected cases of DDH in patients older than 10 years.

scholarly journals Surgical hip dislocation versus hip arthroscopy for femoroacetabular impingement: clinical and morphological short-term results

2012 ◽  
Vol 133 (1) ◽  
pp. 69-79 ◽  
Author(s):  
Patrick O. Zingg ◽  
Erika J. Ulbrich ◽  
Tobias C. Buehler ◽  
Fabian Kalberer ◽  
Vaughan R. Poutawera ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Hip Dislocation ◽  
Surgical Hip Dislocation ◽  
Short Term

Short-Term Outcomes of Open Hip Preservation Surgery for Symptomatic Extraarticular Femoroacetabular Impingement

2017 ◽  
Vol 27 (6) ◽  
pp. 599-607 ◽  
Author(s):  
Benjamin F. Ricciardi ◽  
Kara G. Fields ◽  
Catherine Wentzel ◽  
Bryan T. Kelly ◽  
Ernest L. Sink
Keyword(s):  
Treatment Failure ◽  
Minimum Clinically Important Difference ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Short Term ◽  
Specific Patient ◽  
Patient Reported ◽  
Open Treatment ◽  
Outcome Tool

Introduction The purposes of this study were to describe: (i) short-term disease-specific patient-reported outcome scores (PROMs); and (ii) factors associated with reoperation or treatment failure in patients undergoing open hip preservation surgery for symptomatic extraarticular FAI. Methods Patients undergoing open hip preservation surgery for symptomatic extraarticular FAI were identified from a prospective, single-centre hip preservation registry (n = 51 patients; median clinical follow-up 24 [range 11-49] months). Hip-specific PROMs were assessed preoperatively, 6 months, and each year subsequently. Patients undergoing reoperation or treatment failure (<10 point improvement in iHOT-33 postoperatively) over the study period were identified. Preoperative associated factors were explored on a univariate basis. Results International Hip Outcome Tool-33 (iHOT-33) improved from 33 (standard deviation [SD] 18) to 62 (26) at most recent follow-up and 76% of patients improved by minimum clinically important difference (MCID). Harris Hip Score improved from 53 (15) to 75 (17) at most recent follow-up and 79% of patients improved by MCID. Hip Outcome Score (HOS) Sport improved from 45 (26) to 66 (28) at most recent follow-up and 60% of patients improved by MCID. Continued improvements in mean follow-up scores were seen from 1 year to 2 years. Overall, 7 patients underwent reoperation and 9 patients failed to improve by MCID. Preoperative HOS Sport was higher in patients experiencing reoperation or treatment failure (58 [SD 19] vs. 40 [SD 27] respectively; p = 0.03). No other associated demographic, physical examination, or radiographic factors were found. Conclusions Open treatment of extraarticular FAI results in short-term improvements in hip-specific PROMs in most patients. Higher HOS Sport scores were associated with reoperation or treatment failure. Longer-term follow-up is necessary to define maximum improvements in this challenging patient population.

scholarly journals A review of outcomes of the surgical management of femoroacetabular impingement

2014 ◽  
Vol 96 (5) ◽  
pp. 331-338 ◽  
Author(s):  
RJ MacFarlane ◽  
S Konan ◽  
M El-Huseinny ◽  
FS Haddad
Keyword(s):  
Outcome Measures ◽  
Femoroacetabular Impingement ◽  
Hip Dislocation ◽  
Outcome Data ◽  
Acetabular Labrum ◽  
Short Term ◽  
Term Outcome ◽  
Search Terms ◽  
Methods Of Treatment ◽  
Mini Open

Introduction Femoroacetabular impingement (FAI) resulting from abnormal contact between the acetabulum and femur has been studied extensively in recent years owing to its association with acetabular labrum tears and possible contribution to the development of osteoarthritis. Methods A comprehensive PubMed, MEDLINE® and Embase™ literature search was conducted. Search terms included ‘femoroacetabular impingement’, ‘pathophysiology’, ‘diagnosis’, ‘dGEMRIC’, ‘arthroscopic’, ‘open’, ‘mini-open’ and ‘outcome measure’. Results A range of radiographic features have been described, and computed tomography and magnetic resonance imaging are both commonly used in the diagnosis of the bony abnormalities in FAI. Treatment of FAI is surgical with methods of treatment ranging from open surgical hip dislocation to arthroscopic osteochondroplasty. Conclusions In recent years, a trend towards the use of arthroscopic treatment for FAI has been seen, with promising results from a range of studies. However, only short-term outcome data are available and a range of different outcome measures have been used in studies to date. We present an overview of the outcomes for a range of surgical treatment methods for FAI and discuss the outcome measures used.

scholarly journals Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

2022 ◽  
Author(s):  
Xuefeng Zhou ◽  
Sichao Gu ◽  
Li Li ◽  
Lei Xu ◽  
Xujin Wang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Clinical Efficacy ◽  
Weight Bearing ◽  
Operation Time ◽  
Femoral Neck Fractures ◽  
Teaching Hospitals ◽  
Harris Hip Score ◽  
Clinical Report ◽  
Short Term

Abstract Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 73-77
Author(s):  
Loris Perticarini ◽  
Mario Mosconi ◽  
Marta Medetti ◽  
Laura Caliogna ◽  
Francesco M Benazzo
Keyword(s):  
Revision Surgery ◽  
Developmental Dysplasia ◽  
Modular System ◽  
Harris Hip Score ◽  
Metastatic Tumour ◽  
Leg Length ◽  
Short Term ◽  
Femoral Shortening ◽  
The Mean

Background: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36’) in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. Aim: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. Methods: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17–94; standard deviation [SD] 21.9) years. Results: The mean body mass index of the patients was 24.6 (17–34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8–40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35–58) preoperatively to 87 (range 75–94). Leg length discrepancy was found in 10% of cases but never >1 cm. Conclusions: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.

scholarly journals Independent assessment and outcomes of 196 short-tapered stems short-term follow-up and review of the literature

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901881223 ◽  
Author(s):  
Sam Nahas ◽  
Akash Patel ◽  
Nicola Blucher ◽  
Vikas Vedi
Keyword(s):  
Outcome Measures ◽  
Case Series ◽  
Outcome Data ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Short Term ◽  
Safe Alternative ◽  
Term Outcome ◽  
Patient Reported

Background: Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless ‘Microplasty Taperloc’ (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening. Methods: Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs. Results: One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative peri-prosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre- to post-operatively). There were no signs of radiographic loosening. Conclusion: The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.

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