Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up

Introduction: The aim of this retrospective case-control study is to evaluate clinical and radiographic results of short stems compared with traditional hip prostheses. Methods: 46 short stems (SS) and 50 traditional stems (TS) were selected. All the stems were implanted by the same surgeon using posterior approach because of primary osteoarthritis, post-traumatic osteoarthritis and avascular necrosis. All the patients were compared clinically by Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF-12F/M) and radiographically (offset, CD angle, limb length discrepancy, cup inclination, subsidence, osseointegration, heterotopic ossification). Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed (chi-square, t-test, Mann-Whitney). Results: At a mean follow-up of 30 months all the implanted stems were well-positioned and osseointegrated. In both groups there was a marked improvement in pain ( p < 0.001) with a statistically significant advantage in the SS group for WOMAC (90.8 vs. 87.5; p = 0.02) and in part for HHS (93 vs. 91.7; p = 0.18). The radiographic evaluations, with high concordance correlation between the 3 blinded surgeons (ICC consistently >0.80), showed no significant differences in the restoration of the articular geometry, with a reduction of cortical hypertrophy (2% SS vs. 7% TS) and periprosthetic stress-shielding ( p < 0.05) in the SS group. On the other hand, SS were more related to limb length discrepancy (61% vs. 33%; p < 0.05). No major complications were recorded in the 2 groups. Conclusion: Short stems were shown to be comparable or better than traditional implants at short-term follow-up.

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Reconstruction of Paprosky III defects with double-trabecular metal cups in acetabular revision at five-year follow-up

10.21203/rs.2.23126/v1 ◽

2020 ◽

Author(s):

Xianghong Zhang ◽

Jia Wan ◽

Wanchun Wang ◽

Fuming Li ◽

Libiao Qiu ◽

...

Keyword(s):

Los Angeles ◽

Bone Grafting ◽

Short Form ◽

Limb Length Discrepancy ◽

Acetabular Revision ◽

Harris Hip Score ◽

Trabecular Metal ◽

Modified Harris Hip Score ◽

Acetabular Defects

Abstract Background: Acetabular revision is often difficult to manage because of severe bone loss, especially for Paprosky type Ⅲ defects. Our present study aimed to assess the strategy of double-trabecular metal cups in acetabular revision.Methods: Fifteen patients (15 hips) underwent acetabular revision using double-cup technique alone or in combination with impacting bone grafting between January 2008 and May 2015. Preoperative and the latest follow-up clinical and radiographic scores were recorded and compared.Results: No patients were lost to follow up, and no patients underwent re-revision for loosening or any other reasons at the mean follow-up duration of 66 (range 55-105) months. We discovered 3 patients (3/15) with the early dislocation within the first year after the surgery and 2 patients (2/15) with delayed wound healing. The comparison between preoperative and the latest follow-up results showed the records of modified Harris Hip Score, University of California, Los Angeles activity score, Short Form 36, limb-length discrepancy and hip center of rotation were significantly improved.Conclusions: The application of double-cup technique alone or in combination with impacting bone grafting is an effective and reliable treatment option for Paprosky type Ⅲ acetabular defects without pelvic discontinuity.

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Efficacy of the “Eiffel tower” double titanium elastic nailing in combined management of congenital pseudarthrosis of the tibia: preliminary outcomes of 17 cases with review of literature

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04382-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiaoyu Wang ◽

Li Shi ◽

Rui Zhang ◽

Wenbo Wang ◽

Feng Wang ◽

...

Keyword(s):

Bone Grafting ◽

Limb Length Discrepancy ◽

Limb Length ◽

Bone Union ◽

Length Discrepancy ◽

Congenital Pseudarthrosis ◽

The Mean ◽

Primary Union ◽

Ilizarov Fixation

Abstract Background Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the “Eiffel Tower” double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN’s mechanical stability with the protection against refracture, Ilizarov’s high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed. Methods Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the “Eiffel Tower” double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months. Results The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6–141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01). Conclusions The “Eiffel Tower” double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery. Level of evidence Level IV.

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Trans-osseous intraoperative limb length measurement in hip replacement surgery

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204594 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1258

Author(s):

Anoop Pilar ◽

Srivatsa Nagaraj Rao ◽

Madan Mohan Muniswamy ◽

Sandesh G Manohar ◽

Rajkumar S. Amaravathi

Keyword(s):

Hip Replacement ◽

Intraoperative Imaging ◽

Weight Bearing ◽

Limb Length Discrepancy ◽

Limb Length ◽

Harris Hip Score ◽

Posterior View ◽

Replacement Surgery ◽

Hip Replacement Surgery ◽

Length Discrepancy

Background: Discrepancy of the limb length following total hip replacement is one of common complication. To reduce the occurrence, various modalities are used like pre-operative templating, navigation assisted measurements and intraoperative methods. This study was done using trans-osseous method of measurement using hip gauge which provides a faster, simpler assessment of limb length.Methods: A prospective study of 25 patients who underwent uncemented hip arthroplasty was taken in the study and the LLD was measured before and after the surgical procedure. Patient were re-assessed for limb length discrepancy after 6 months with functional Harris hip score and radiological analysis on weight bearing standard X-ray antero-posterior view of the pelvis with bilateral hip joint.Results: The results showed significant improvement in limb length discrepancy, and analysis of postoperative radiographs found the mean length difference of 2.44 mm and average Harris hip score was 95.5. No device related complications were reported, and none of them complained of the discomfort related to limb-length discrepancy after surgery. Conclusions: Trans-osseous fixed method using hip gauge provides a faster, reproducible and simpler method for the assessment of Limb length and aids with offset placement, acetabular anteversion for precise cup placement. This is a reliable method as it can be used both in the primary and revision hip surgery and most importantly doesn’t require any additional intraoperative imaging.

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Hip arthroplasty - study correlating intra operative stable range of motion with postoperative functional activity

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204595 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1263

Author(s):

Tushar Singhi ◽

Udit Kapoor ◽

Ashith Rao

Keyword(s):

Range Of Motion ◽

Hip Arthroplasty ◽

Posterior Approach ◽

Short Form ◽

Limb Length Discrepancy ◽

Harris Hip Score ◽

Stable Range ◽

High Flexion ◽

One Year

Background: Squatting and sitting cross-legged is a part of lifestyle both for employment and for daily ablutions. When these activities can be allowed after hip arthroplasty is not documented. The aim of this study is to identify if patients having good intra-operative stability with the posterior approach, can start high flexion activities early.Methods: In this retrospective study, all hip arthroplasty patients done from 2013-2017 were considered for inclusion. Patients were evaluated for intra-operative stable range of motion and patients who were stable were encouraged to do cross-legged sitting from 2 weeks after surgery and squatting from 6 weeks after surgery. The follow-up visits were at 6-weeks, 3-months and 1-year after surgery. Parameters assessed were Harris hip score, short form survey-12 (SF-12) score, limb length discrepancy, range of motion and ability to sit cross-legged and squat. All the patients were again called for a follow-up visit and the parameters were reassessed.Results: Sixty patients were included in the study. Mean follow-up was 2 years 3 months. Mean Harris hip score and SF-12 showed improvement from 64.8 and 19.5 at 3 months to 88.3 and 37.8 respectively at last follow-up. At the end of 3 months, 85% patients could sit cross-legged and 50% could squat. At one year, the corresponding figures were 85% and 70%.Conclusions: If intra-operative range of motion testing is satisfactory, early initiation of high flexion hip activities is safe.

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Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9124104 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4104

Author(s):

Lukas Zak ◽

Thomas Manfred Tiefenboeck ◽

Gerald Eliot Wozasek

Keyword(s):

Hip Dysplasia ◽

Young Patients ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Limb Length ◽

Hip Surgery ◽

Bone Lengthening ◽

Safe Procedure ◽

Length Discrepancy ◽

Healing Index

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

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Clinical results of the Metha short hip stem: a perspective for younger patients?

Orthopedic Reviews ◽

10.4081/or.2013.e34 ◽

2013 ◽

Vol 5 (4) ◽

pp. 34 ◽

Cited By ~ 30

Author(s):

Fritz Thorey ◽

Claudia Hoefer ◽

Nima Abdi-Tabari ◽

Matthias Lerch ◽

Stefan Budde ◽

...

Keyword(s):

Bone Ingrowth ◽

Long Term Results ◽

Harris Hip Score ◽

Femoral Revision ◽

Term Survival ◽

Younger Patients ◽

The Mean ◽

Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

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Outcomes of Hip Arthroscopic Surgery in Adolescents With a Subanalysis on Return to Sport: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546519875131 ◽

2019 ◽

Vol 48 (6) ◽

pp. 1526-1534

Author(s):

Sarah L. Chen ◽

David R. Maldonado ◽

Cammille C. Go ◽

Cynthia Kyin ◽

Ajay C. Lall ◽

...

Keyword(s):

Systematic Review ◽

Short Form ◽

Adult Population ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Functional Improvement ◽

Harris Hip Score ◽

Patient Reported ◽

The Mean

Background: There is a plethora of literature on outcomes after hip arthroscopic surgery in the adult population; however, outcomes in the adolescent population have not been as widely reported. Additionally, as adolescents represent a very active population, it is imperative to understand their athletic activity and return to sport after hip arthroscopic surgery. Purpose: To analyze patient-reported outcomes (PROs) after hip arthroscopic surgery in adolescents (aged 10-19 years) and present a return-to-sport analysis in the athletic adolescent subgroup. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, Embase, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify articles that reported PROs after hip arthroscopic surgery in adolescents. The standardized mean difference was calculated to compare the effect size of hip arthroscopic surgery on various PROs. For the athletic subgroup, a return-to-sport summary was also provided. Results: Ten studies, with 618 adolescent hips and a collective study period of December 2004 to February 2015, were included in this systematic review. Across all studies, the mean age was 15.8 years (range, 11.0-19.9 years), and female patients composed approximately 56.7% of the entire cohort. The mean follow-up was 34.5 months (range, 12-120 months). The modified Harris Hip Score (mHHS) was reported in 9 studies, and at latest follow-up, scores were excellent in 4 studies (range, 90-95) and good in the remaining 5 studies (range, 82.1-89.6). All adolescents also showed significant improvement on the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL), the HOS–Sport-Specific Subscale (HOS-SSS), the physical component of the 12-Item Short Form Health Survey (SF-12P), a visual analog scale for pain (VAS), and both versions of the International Hip Outcome Tool (iHOT-12 and iHOT-33) at latest follow-up ( P < .05). Further, mean improvements reported in all studies surpassed reported values of the minimal clinically important difference and patient acceptable symptomatic state for the mHHS, HOS-ADL, HOS-SSS, and iHOT-33. Finally, the collective return-to-sport rate among athletic adolescents was 84.9%. Conclusion: In the setting of labral tears and femoroacetabular impingement, hip arthroscopic surgery can safely be performed in adolescents and leads to significant functional improvement. Furthermore, athletic adolescents return to sport at high levels after hip arthroscopic surgery.

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