Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles

Introduction: Herein, we describe and evaluate a curved periacetabular osteotomy (CPO) via an intermuscular approach (IM-CPO) between the sartorius and iliac muscles. Methods: Between January 2009 and January 2016, IM-CPO was performed in 17 joints (16 patients), and a traditional CPO was performed in 17 joints. The length of incision at wound closure, operative time, intraoperative blood loss, serum creatinine kinase (CK) level the day after surgery, correctional angle, walking ability assessed using the gait items of the Harris Hip Score (at 3 and 6 months after surgery), and perioperative complications were evaluated. Group differences were assessed using t-tests. Results: The IM-CPO and CPO groups did not differ in the mean operative time (130 minutes and 124 minutes, respectively), mean serum CK the day after surgery (349 IU/L and 425 IU/L, respectively), or mean correctional angle (24.9° and 24.6°, respectively). The mean incision length was significantly shorter in the IM-CPO group (8.3 cm) compared to that in the CPO group (9.5 cm). The mean walking ability was significantly higher in the IM-CPO group (24.2 points) compared to that in the CPO group (20.9 points) at 3 months after surgery, but not at 6 months after surgery (26.4 points and 24.9 points, respectively). No serious complications were observed in either group. Conclusion: In addition to demonstrating a similarly satisfactory correctional angle, IM-CPO is anticipated to enable early weight-bearing and recovery of walking ability. Thus, IM-CPO is considered a superior surgical technique.

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An outcome analysis of intertrochanteric fracture of femur managed with proximal femoral nail antirotation II

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192687 ◽

2019 ◽

Vol 5 (4) ◽

pp. 699

Author(s):

Hemeshwar Harshwardhan ◽

Shubhanshu Jain ◽

Manish Sharma

Keyword(s):

Blood Loss ◽

Intramedullary Nailing ◽

Operative Time ◽

Weight Bearing ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Time Duration ◽

Early Weight Bearing ◽

Pull Out ◽

The Mean

Background: Intertrochanteric fractures are common osteoporotic fractures in adults above 60 years with high mortality and morbidity. Common techniques for fixation of these fractures are sliding hip screw and plate or intramedullary nailing. Intramedullary nailing has advantage of short incision, less operative time, rapid rehabilition & thus decreased medical complications. PFNA II is newer intramedullary implant developed to obtain better fixation strength in osteoporotic bones. Biomechanical studies has demonstrated that PFNA II blade has a significance of higher cut out resistance than other commonly used screw systems.Methods: Prospective follow up study carried out at J.L.N. Medical College Ajmer from 1 March 2017 to 31st October 2018. 30 patients with unstable intertrochanteric fractures were included and operated on fracture table in supine position with PFNA2. We measured operative time, duration of hospital stay, modified Harris hip score and complications.Results: The mean age of the patients was 70.83 years of age. The mean time in surgery was 38.2 minutes. The mean amount of blood loss in surgery was 110.8 ml. In implant related complications, 2 patients had cut out and 1 patient had pull - out of the implant. Functional results according to modified Harris hip scores was found to be excellent in 8 (30%) patients, good in 12 (40%) patients, fair in 7 (20%) patients and poor in 3 (10%) patients.Conclusions: Elderly patients treated with PFNA2 has good outcome as less operative time, minimal blood loss, early weight bearing, less union time and very few cases of medial penetration and back out of spiral blade.

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A study of prospective analysis of unipolar versus bipolar hemiarthroplasty of hip joint in patients with fracture neck of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211621 ◽

2021 ◽

Vol 7 (3) ◽

pp. 629

Author(s):

Raja X. ◽

Arjun Sarvesh ◽

Karthikeyen M. ◽

A. E. Manoharan

Keyword(s):

Femoral Neck ◽

Weight Bearing ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Early Weight Bearing ◽

Group I ◽

Significant Difference ◽

Group Ii

Background: Femoral neck fractures occur most commonly in elderly females and are a major cause of morbidity and mortality in this age group and require immediate and appropriate management. Aim of the study was to compare the functional outcome of unipolar Austin Moore's prosthesis (AMP) hemiarthroplasty (HA) and bipolar (BHA) HA with femoral neck fractures using Harris hip score system.Methods: The study was conducted on 60 patients aged above 50 years with fractured neck of femur admitted in Vinayaka missions Kirupananda Variyar medical college and hospital from August 2017 to August 2019. Patients with femoral neck fracture were allocated randomly to have 30 cases of AMP.Results: Out of the 60 cases, the patients in the bipolar (nonmodular) HA group II showed better functional outcomes compared to unipolar (AMP) HA group I after six months follow-ups. At 12 months of follow-up, there was no significant difference between group I (AMP) and group II (BHA).Conclusions: Our study demonstrates, hemiarthroplasty of the hip for femoral neck fractures is a good option in elderly patients. The mortality and morbidity are not high, the operative procedure is simple, complications are less disabling, early weight-bearing and functional results are satisfactory and second surgery are less frequently required.

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Sports activity participation after curved periacetabular osteotomy for acetabular dysplasia

10.21203/rs.3.rs-22059/v4 ◽

2020 ◽

Author(s):

Yoshiki Takahashi ◽

Naonobu Takahira ◽

Katsufumi Uchiyama ◽

Kensuke Fukushima ◽

Mitsutoshi Moriya ◽

...

Keyword(s):

Physical Function ◽

Acetabular Dysplasia ◽

Periacetabular Osteotomy ◽

Weight Bearing ◽

Activity Participation ◽

Full Weight Bearing ◽

Sports Activity ◽

Before And After ◽

Curved Periacetabular Osteotomy ◽

Sports Activities

Abstract Background: Curved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO.Methods: A total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO.Results: The pre- and post-operative sports activity participation rates were 55.8% and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier.Conclusions: Among acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.

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Iliac intramedullary stabilization for Type IIIA fragility fractures of the pelvis

Scientific Reports ◽

10.1038/s41598-020-77560-7 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Shingo Okazaki ◽

Masahiro Shirahama ◽

Ryuki Hashida ◽

Mitsuhiro Matsuura ◽

Shiro Yoshida ◽

...

Keyword(s):

Internal Fixation ◽

Weight Bearing ◽

Fragility Fractures ◽

Full Weight Bearing ◽

Walking Ability ◽

Less Invasive ◽

Type Iiia ◽

Iliac Screws ◽

Intramedullary Stabilization ◽

The Mean

AbstractThere have been few reports on fixation of Rommens classification Type IIIA fragility fractures of the pelvis (FFPs). Here, we present our less invasive surgical technique, called iliac intramedullary stabilization (ILIS), for the internal fixation of Type IIIA FFPs. The technique involves a closed reduction, termed the femur internal rotation reduction method (FIRM), whereby the fracture fragments are repositioned using lateral rotators by internally rotating the femur while the patient is in the prone position. Two iliac screws are inserted on the ilium bilaterally via the supra-acetabular bone canal during FIRM and connected with two transverse rods and two cross connectors. We refer to this internal fixation procedure as ILIS. We retrospectively recruited patients with Type IIIA fractures, treated using this procedure, at our institute between October 2017 and October 2019. We evaluated operative and post-operative outcomes. We enrolled 10 patients (9 women and 1 man; mean age, 85.2 years) who were followed up for over 6 months. All patients suffered FFPs after falling from a standing position. The mean operative time was 145.1 (range, 94–217) minutes, and the mean blood loss was 258.5 (range, 100–684) ml. All patients were allowed full weight bearing from post-operative day 1. All patients achieved bone union and regained their pre-injury walking ability at 6 months after surgery without evident secondary displacement. In conclusion, our ILIS technique allows less invasive internal fixation of Type IIIA FFPs with adequate stability for full weight bearing from post-operative day 1.

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Management of Recurrent Posterior Hip Dislocation in a Down Syndrome Patient with Dysplastic Hip Using Ganz Periacetabular Osteotomy: Follow Up After 4 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00036 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0003

Author(s):

Ismail H. Dilogo ◽

Jessica Fiolin

Keyword(s):

Down Syndrome ◽

Periacetabular Osteotomy ◽

Weight Bearing ◽

Hip Dislocation ◽

Harris Hip Score ◽

Syndrome Patient ◽

Down Syndrome Patient ◽

Dysplastic Hip ◽

Posterior Hip Dislocation

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status and the dysplastic hip forces limited option as a treatment. This is the first case world wide reporting 4 year follow up of dysplastic hip with Down Syndrome treated successfully with PAO technique. Methods: An eighteen years old female with history of Down Syndrome had multiple posterior hip dislocation episodes since 3 years prior. Several attempts of close reduction and hip spica applications were performed upon dislocation despite no successful retaining of reduction. Acetabular index of right hip were 550 and epiphyseal plate hasclosed. PatientwasperformedopenreductionusingSouthern-Mooreposteriorapproachand osteotomy of ischium, continued with capsulorrhaphy followed with Smith-Peterson anterior approach and osteotomy of superior ramus pubis and iliac bone. Then, derotation maneuver was performed under image intensifier to obtain adequate coveragefollowedwithbonegraftandfixationusing2cannulatedscrewandhipspica castapplication. Results: Within four years after surgery, the hip has never been dislocated again, patient could sit without pain and walk with full weight bearing although Harris Hip Score could not be performed due to Down Syndrome. Leg length discrepancy was negligible,fracture has fully united and acetabularin dex was300. Conclusions: Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological ou tcome

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Assessment of the outcome of fracture intertrochanteric femur treated by trochanteric fixation nail in the elderly population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205573 ◽

2020 ◽

Vol 7 (1) ◽

pp. 125

Author(s):

Vipin Tyagi ◽

Rahul Kakran ◽

Amit Dwivedi ◽

Fenil Shah

Keyword(s):

Elderly Population ◽

The Elderly ◽

Early Rehabilitation ◽

Harris Hip Score ◽

High Morbidity ◽

Intertrochanteric Fractures ◽

Early Weight Bearing ◽

Duration Of Surgery ◽

The Mean ◽

Trochanteric Fixation Nail

Background: Intertrochanteric fractures femur in elderly population are more commonly forbidden high morbidity. The surgical stabilization together with early rehabilitation is the main challenge. The elderly population have poor bone mass quality and also the chances of complications like nonunion or implant failure are more with conventional procedures. Stable fixation and early rehabilitation is the main aim in intertrochanteric fractures. The aim is to assess the functional outcome of intertrochanteric fractures femur managed by trochanteric fixation nail (TFN) in the elderly population.Methods: The study includes 40 patients, 30 male and 10 female, with fracture intertrochanteric femur treated with TFN from September 2018 to May 2019 at Yashoda Superspeciality Hospital, Nehrunagar, Ghaziabad. The patients were evaluated at 4, 8, 12 weeks postoperatively and assessed by the Modified Harris hip score. Classification used is AO classification.Results: The mean age of patients was 64 years. The mean duration of surgery was 48±10 min. The Harris hip score was 96.90±4.60, which is better than scores from other implants used for intertrochanteric fractures femur.Conclusions: In this study, we conclude that TFN is a good choice in managing the intertrochanteric fractures, having higher bone union rate and less union time. The period of immobilization is decreased, early weight bearing and less complications.

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A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214188 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1194

Author(s):

S. F. Kammar ◽

Karthik B. ◽

V. K. Bhasme ◽

Suryakanth Kalluraya

Keyword(s):

Clinical Outcomes ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Lateral View ◽

Successful Outcome ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

The Mean

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

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Sports activity participation after curved periacetabular osteotomy for acetabular dysplasia

10.21203/rs.3.rs-22059/v1 ◽

2020 ◽

Author(s):

Yoshiki Takahashi ◽

Naonobu Takahira ◽

Katsufumi Uchiyama ◽

Kensuke Fukushima ◽

Mitsutoshi Moriya ◽

...

Keyword(s):

Physical Function ◽

Acetabular Dysplasia ◽

Clinical Decision Making ◽

Periacetabular Osteotomy ◽

Weight Bearing ◽

Activity Participation ◽

Full Weight Bearing ◽

Sports Activity ◽

Curved Periacetabular Osteotomy ◽

Sports Activities

Abstract Background: Curved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO. Methods: A total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO. Results: The pre- and post-operative sports activity participation rates were 55.8% and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively returned to full weight-bearing earlier. Conclusions: Among acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings are important for clinical decision-making for CPO and should be communicated to patients.

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The Early Outcome Of the Bernese Periacetabular Osteotomy For Hip Dysplasia In Multiple Epiphyseal Dysplasia

10.21203/rs.3.rs-691751/v1 ◽

2021 ◽

Author(s):

Yao-Yuan Chang ◽

Chia-Che Lee ◽

Sheng-Chieh Lin ◽

Ken N Kuo ◽

Kuan-Wen Wu ◽

...

Keyword(s):

Femoral Head ◽

Statistical Significance ◽

Periacetabular Osteotomy ◽

Hip Osteoarthritis ◽

Multiple Epiphyseal Dysplasia ◽

Harris Hip Score ◽

Joint Preserving Surgery ◽

The Mean ◽

Epiphyseal Dysplasia

Abstract Background:Multiple epiphyseal dysplasia (MED) is a rare congenital bone dysplasia. Patients with MED develop secondary hip osteoarthritis as early as third to the fourth decade. Currently, there is no consensus on how to prevent or slow the process of secondary hip osteoarthritis.The Bernese periacetabular osteotomy is a joint preserving surgery to reshape acetabulum and extend coverage for the hip, however, there is no established evidence of the effectiveness for the MED hips.Patients and methods:A retrospective series of 6 hips in 3 patients with multiple epiphyseal dysplasia treated with the Bernese periacetabular osteotomy were reviewed. The average age at the time of surgery was 14.3 years (range: 11.4 to 17.2 y). Radiographic parameters were analyzed preoperatively and 1-year postoperatively. The hip function was evaluated by the Harris Hip Score (HHS) before and after surgery. Results:The mean follow-up time was 1.7 years. The mean LCEA increased from 3.8° to 47.1° (p = .02), ACEA increased from 7.3° to 35.1° (p = .02), and AI decreased from 27.8° to 14.6° (p=.04). The femoral head coverage ratio increased from 66.8% to 100% (p= .02). The procedure achieved femoral head medialization by decreasing central head distance from 86.7mm preoperatively to 82.7mm postoperatively, however, without statistical significance. (p = .699). The improvement of clinical outcomes by mean HHS was significant from 67.3 preoperatively to 86.7 postoperatively (p=0.05).Conclusion:Bernese PAO is a feasible option for treatment of the hip problems in MED patients. It reshapes acetabular and femoral morphology 3-dimensionally. In our study, the short-term follow-up results showed obvious functional and radiographic improvement. A long-term follow-up is necessary in the future.

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Outcome of proximal femoral nail antirotation in peritrochanteric fractures: A prospective study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i8.36401 ◽

2021 ◽

Vol 12 (8) ◽

pp. 125-129

Author(s):

Pratyenta Raj Onta ◽

Dilip C Agarwal ◽

Upendra Jung Thapa ◽

Pabin Thapa ◽

Krishna Wahegoankar ◽

...

Keyword(s):

Blood Loss ◽

Weight Bearing ◽

Invasive Procedure ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Femoral Nail ◽

The Mean ◽

Proximal Femoral Nail Antirotation ◽

A Prospective Study

Background: The incidence of peritrochanteric fractures are increasing worldwide. Early mobilization in these fractures prevents from other medical complications. There are many methods of treatment but the ideal method should be less invasive procedure, intramedullary device and stable fixation of fracture. Proximal femoral nail antirotation (PFNA) is biomechanically considered one of the most effective methods of treatment with promising results. Aims and Objectives: The aim of our study was to evaluate the clinical and radiological outcomes in patient who were treated with PFNA in peritrochanteric fracture. Materials and Methods: This study was a prospective study which included 37 patients, conducted in Manipal Teaching Hospital from 1st October 2019 to 30th September 2020. All the patients were clinically evaluated and detail history was obtained. After the anaesthesia clearance the patients were operated. Operating time, intraoperative blood loss and complications were noted. Postoperatively the duration of hospital stay, time of partial and full weight bearing, time for radiological union and complications were noted. At the final follow up Harris Hip Score was used for functional outcome. Results: The mean age of the patient in this study was 64 years (45-88 years). The average time to complete the surgery was 62.49 minutes (45-75 minutes) and the average blood loss was 129.32 ml (65-210 ml). Partial weight bearing was started at the mean time of 8.57 weeks (6-12 weeks) whereas full weight bearing was done at the mean of 14.43 weeks (10-20 weeks). Fracture union was seen at the average of 11.41 weeks (8-18 weeks). The mean Harris Hip score at final follow up was 84.73 (65.8-95.0) with the functional status of 35.1% excellent result, 45.9% good, 13.5% fair and 5.4% poor. Conclusion: Proximal femoral nail antirotation in peritrochanteric fracture is a good method of fixation. The procedure is easy with reduced operative time and radiation exposure. Since this is minimally invasive procedure the blood loss is very less compared to DHS or plate fixation. The patient could be mobilized early from the bed that reduced the complication of immobilization. So we strongly recommend using PFNA for fixation of peritrochanteric fracture of hip.

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