MRI findings of ischiofemoral impingement after total hip arthroplasty are associated with increased femoral antetorsion

2021 ◽  
pp. 028418512110210
Author(s):  
Tim Fischer ◽  
Christoph Stern ◽  
Benjamin Fritz ◽  
Patrick O Zingg ◽  
Christian WA Pfirrmann ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Statistical Significance ◽  
Fatty Infiltration ◽  
Imaging Features ◽  
Mri Findings ◽  
Total Hip ◽  
Femoris Muscle ◽  
Ischiofemoral Impingement ◽  
Quadratus Femoris

Background Ischiofemoral impingement (IFI) is a known complication after total hip arthroplasty (THA). Purpose To assess if increased postoperative (FA) is associated with magnetic resonance imaging (MRI) findings of IFI. Material and Methods In 221 patients with THA, two independent readers measured FA, ischiofemoral space (IFS), quadratus femoris space (QFS), edema, and fatty infiltration of quadratus femoris muscle. Three sets of IFI-imaging features were defined: acute IFI (set 1): IFS ≤15 mm or QFS ≤10 mm and edema in the quadratus femoris muscle; chronic IFI (set 2): IFS ≤15 mm or QFS ≤10 mm and fatty infiltration of quadratus femoris muscle Goutallier grade ≥2; acute and chronic IFI (set 3) with both criteria applicable. For each set, FA angles were compared between positive findings of IFI and negative findings of IFI. The t-test for independent samples tested statistical significance. Results In 7.2% (16/221) of patients, findings of IFI (IFS ≤15 mm or QFS ≤10 mm and edema, n = 1; fatty infiltration, n = 9; or both, n = 6) were observed. In women, 11.4% (14/123) exhibited findings of IFI compared to 2.0% (2/98) in men. Comparison in set 1 (n = 7): mean antetorsion of 23.9° ± 9.8° (findings of acute IFI) compared to 14.4° ± 9.7° ( P = 0.01). Comparison in set 2 (n = 15): mean antetorsion of 16.2° ± 6.3° (findings of chronic IFI) compared to 14.5° ± 9.9° ( P = 0.49). Comparison in set 3 (n = 6): mean antetorsion of 20.4° ± 3.8° (findings of acute and chronic IFI) compared to 14.5° ± 9.9° ( P = 0.01). Conclusion After THA, high postoperative FA is associated with MRI findings of acute as well as acute and chronic IFI. Findings of IFI were commonly seen in women.

Primary Total Hip Arthroplasty Using Modified Posterior Approach through Quadratus Femoris Flap Osteotomy; Comparison with Conventional Posterior Approach

2016 ◽  
Vol 26 (6) ◽  
pp. 543-549 ◽  
Author(s):  
Se-Won Lee ◽  
Weon-Yoo Kim ◽  
Min-Sung Kang
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Conventional Group ◽  
Harris Hip Score ◽  
Muscle Area ◽  
Total Hip ◽  
Femoris Muscle ◽  
Quadratus Femoris ◽  
Primary Total Hip Arthroplasty

Introduction The quadratus femoris muscle has not attracted attention as a structure for surgical exposure during posterior hip approaches. We sought to introduce a modified posterior approach through the quadratus femoris muscle area only, by flap osteotomy, which we have named the quadratus femoris osteotomy (QFO) approach. We compare this with the conventional posterior approach to determine the effectiveness of the new technique. Methods We retrospectively reviewed the medical records of 329 patients (383 hips) who had undergone primary total hip arthroplasty (THA) between March 2006 and January 2013 by a single hip surgeon. The conventional group consisted of consecutive 118 patients (138 hips) who had undergone THA using the conventional posterior approach. The QFO group consisted of consecutive 101 patients (120 hips) who were treated with THA using the QFO approach. Results The 2-year postoperative average Harris hip score were 88.8 ± 6.6 in the conventional group and 93.1 ± 6.9 in the QFO group. The 2-year postoperative average WOMAC scores were 20.8 ± 6.7 in the conventional group and 14.1 ± 6.6 in the QFO group. Complications in the conventional group were 2 deep vein thrombosis (DVT)s, 1 intraoperative fracture, and 6 posterior dislocations; the QFO group experienced 1 DVT and 3 intraoperative fracture. No dislocation was noted within 2 years after surgery. Conclusions Although further studies are needed to confirm the validity of our findings, a modified posterior approach using a quadratus femoris flap osteotomy could be an option worth considering among the variants of posterior approaches in THA.

Assessment of total hip arthroplasty as a predisposing factor for ischiofemoral impingement

2015 ◽  
Vol 44 (12) ◽  
pp. 1755-1760 ◽  
Author(s):  
Adriana L. Oliveira ◽  
Debora C. Azevedo ◽  
Alireza Eajazi ◽  
William E. Palmer ◽  
Young-Min Kwon ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Predisposing Factor ◽  
Total Hip ◽  
Ischiofemoral Impingement

Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty?

2019 ◽  
Vol 44 (2) ◽  
pp. 275-282 ◽  
Author(s):  
Antonio Pasquale Vadalà ◽  
Daniele Mazza ◽  
Davide Desideri ◽  
Raffaele Iorio ◽  
Gianluca Fedeli ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Fatty Infiltration ◽  
Gluteus Medius ◽  
Tendon Degeneration ◽  
Total Hip

scholarly journals Identification of risk factors for treatment failure of closed reduction and abduction bracing after first-time total hip arthroplasty dislocation

2021 ◽  
Author(s):  
Viktor Janz ◽  
Georgi Wassilew ◽  
Michael Putzier ◽  
Geraldine Kath ◽  
Carsten Perka
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Conservative Treatment ◽  
Hip Arthroplasty ◽  
Closed Reduction ◽  
Conservative Therapy ◽  
Statistical Significance ◽  
Total Hip ◽  
First Time ◽  
Cup Position

IntroductionAfter a first-time total hip arthroplasty (THA) dislocation, a closed reduction followed by partial immobilization in an abduction brace is the recommended therapy. Despite modern abduction braces the success rate of conservative therapy is limited and evidence is scarce. The aim of this study was to identify risk factors for failure of conservative treatment after THA dislocation.Material and methodsEighty-seven patients, with conservative treatment of a first-time dislocation of a primary or revision THA, were included in this retrospective cohort study. Success was defined as a stable THA for a minimum of six months. Re-dislocation, open reduction or revision was defined as failure. The following risk factors were analyzed: gender, age, body mass index (BMI), ASA (American Society of Anesthesiologists) score, time of dislocation, head size, cup orientation, leg length, center of rotation and offset.ResultsSixty-seven percent of all patients experienced a re-dislocation, despite standardized conservative therapy. A BMI ≥ 25, early THA dislocation, and low cup anteversion were associated with a statistically significantly higher risk for re-dislocation. None of the other risk-factors achieved statistical significance. A multifactorial risk-factor analysis was performed to assess whether a cup position outside of Lewinnek’s safe zone in combination with gender, BMI and time to dislocation showed statistical significance for re-dislocation. Both BMI ≥ 25 and early dislocation showed a statistically higher failure rate. Cup position and gender were not significant.ConclusionsBMI ≥ 25, early THA dislocation and low cup anteversion were identified as significant risk factors for failure of conservative treatment with an abduction brace for first-time THA dislocation.

Recovery of Muscle Atrophy and Fatty Infiltration in Patients With Acetabular Dysplasia After Total Hip Arthroplasty

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Takumi Kawano ◽  
Manabu Nankaku ◽  
Masanobu Murao ◽  
Ryota Hamada ◽  
Koji Goto ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Muscle Atrophy ◽  
Hip Arthroplasty ◽  
Acetabular Dysplasia ◽  
Fatty Infiltration ◽  
Total Hip

scholarly journals The Prevention of Periprosthetic Joint Infection in Primary Total Hip Arthroplasty Using Pre-Operative Chlorhexidine Bathing

2021 ◽  
Vol 10 (3) ◽  
pp. 434
Author(s):  
Wen-Chi Su ◽  
Yu-Chin Lai ◽  
Cheng-Hung Lee ◽  
Cheng-Min Shih ◽  
Chao-Ping Chen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Statistical Significance ◽  
Joint Infection ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Skin Preparation ◽  
Total Hip ◽  
Chlorhexidine Bathing

Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a devastating complication. The aim of this study was to investigate whether preoperative bathing using chlorhexidine gluconate (CHG) before THA can effectively reduce the postoperative PJI rate. A total of 933 primary THA patients, with the majority being female (54.4%) were included in the study. Primary THA patients who performed preoperative chlorhexidine bathing were assigned to the CHG group (190 subjects), and those who did not have preoperative chlorhexidine bathing were in the control group (743 subjects). The effects of chlorhexidine bathing on the prevention of PJI incidence rates were investigated. Differences in age, sex, and the operated side between the two groups were not statistically significant. Postoperative PJI occurred in four subjects, indicating an infection rate of 0.43% (4/933). All four infected subjects belonged to the control group. Although the PJI cases were significantly more in the control group than in the CHG group, statistical analysis revealed no statistical significance in the risk of PJI occurrence between the two groups (p = 0.588). Preoperative skin preparation by bathing with a 2% chlorhexidine gluconate cleanser did not produce significant effects on the prevention of postoperative PJI in primary THA.

scholarly journals Imageless computer assisted navigation in ceramic-on-ceramic total hip arthroplasty vs. manual approach: a single-centre retrospective study

10.29007/9gpf ◽  
2019 ◽  
Author(s):  
John McLoughlin ◽  
Mo Mathew ◽  
Stephen Grant
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Patient Reported Outcomes ◽  
Statistical Significance ◽  
Computer Assisted ◽  
Total Hip ◽  
Patient Reported ◽  
Cup Positioning

Background: Acetabular cup positioning is vital to the long-term survivorship of total hip arthroplasty (THA). Malalignment has been linked to dislocation, wear and osteolysis. Although there are many studies demonstrating the reduction in variability of cup positioning with computer-assisted techniques, there are relatively few reporting long-term patient reported outcomes and revision rates. Aim: The aim of this study was to review whether those patients who underwent navigated THA had better long-term survivorship or better patient reported outcomes. Methods: We compared revision rates and Oxford hip scores of 152 THAs (47 navigated and 105 non-navigated) performed at a single site between 2003 and 2008, with a minimum follow-up of 10 years. Results: 9 of the non-navigated and none of the navigated hips were revised at 10 year follow-up (p=0.057). There were no observable differences in 10-year Oxford hip scores between the navigated and non-navigated hips, 44.82 and 43.38 respectively. Conclusion: With respect to the rate of revision, although statistical significance was not achieved, it can be shown from our data that there was a clinically significant reduction in revision rates with navigated vs. non-navigated techniques. More data with higher patient numbers in the navigated cohort may be required to validate the results of our study.

Hip Abductor Deficiency after Total Hip Arthroplasty: Diagnostic and Therapeutic Methods

2021 ◽  
Author(s):  
David Richard Krüger ◽  
Karl-Dieter Heller
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fatty Infiltration ◽  
Gluteus Maximus ◽  
Gluteus Medius ◽  
Anatomical Reconstruction ◽  
Vastus Lateralis Muscle ◽  
Low Grade ◽  
Total Hip ◽  
Reconstruction Methods

AbstractAbductor deficiency after total hip arthroplasty is a severe complication with functional limitations and a significant reduction in the patientʼs quality of life. Common causes are degenerative ruptures or approach-related iatrogenic damage to the gluteus medius and minimus muscle and the inferior gluteal nerve, fractures of the greater trochanter and incorrect reconstruction of leg length and femoroacetabular offset. With a standardised diagnosis consisting of a clinical examination, conventional X-ray and MRI, the causes of the functional problems can often be reliably determined. Therapy of abductor deficiency is challenging for both patients and physicians and is often tedious. However, with a clear diagnostic and therapeutic algorithm and straightforward patient education, good treatment results can be achieved even in this challenging condition. Conservative therapy with eccentric stretching and muscle strengthening are the basis of the treatment. In cases of progression of complaints despite intensive conservative treatment, various anatomical and extra-anatomical surgical reconstruction methods are available to relieve pain and improve function. Anatomical reconstruction of the gluteal tendon insertion is an option in cases of low-grade fatty infiltration and moderate retraction of the gluteal muscles. In situations with advanced degenerative changes in the gluteus medius and minimus muscles and an intact gluteus maximus muscle, transfer of the anterior portion of the gluteus maximus according to Whiteside is an option. For high-grade defects of the soft tissue, there is also the option of an isolated or combined transfer of the vastus lateralis muscle.

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