scholarly journals The fate of femoral head autograft in acetabular reconstruction in dysplastic hips at midterm

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095710
Author(s):  
Arif Jan Hamrayev ◽  
Mehmet Ozbey Buyukkuscu ◽  
Abdulhamit Misir ◽  
Sukru Sarper Gursu
Keyword(s):  
Femoral Head ◽  
Acetabular Component ◽  
Hip Dislocation ◽  
Hip Osteoarthritis ◽  
Acetabular Reconstruction ◽  
Acetabular Coverage ◽  
Acetabular Cup ◽  
Developmental Hip Dysplasia ◽  
The Mean

Purpose: To evaluate the acetabular cup and graft survival in patients who underwent total hip arthroplasty (THA) with the diagnosis of dysplastic hip osteoarthritis and received a femoral head autograft due to acetabular coverage deficiency. Methods: Between January 2005 and December 2016, 83 hip prostheses of 80 patients who underwent THA using femoral head autografts and were followed up for at least 2 years were retrospectively evaluated. Seventy-four hips of the remaining 71 patients (57 female (80%)) were included. Mean patient age at surgery was 51 ± 16 (range 18–76) years. The mean follow-up duration was 76 ± 25 (range 25–161) months. Acetabular inclination and graft thickness, contact length, percentage of coverage, and graft resorption were examined on postoperative and final follow-up radiographs. The presence of a radiolucent area around the acetabular and femoral components indicating loosening was also evaluated. Results: The mean postoperative acetabular component inclination was 44 ± 5.1° (range 30–48°) with mean graft coverage of 34 ± 4.8% (range 24–46%). In all patients, autograft union with the pelvis was seen and the lateral overflow was remodeled. Fifteen patients (20%) underwent revision surgery due to aseptic acetabular component loosening in four, nontraumatic recurrent dislocations in eight, periprosthetic infection in one, acetabular component protrusion in one, and traumatic hip dislocation in one. Conclusion: In patients with osteoarthritis secondary to developmental hip dysplasia, the use of femoral head autografts to eliminate acetabular coverage deficiency during THA achieves acceptable midterm postoperative radiological outcomes. Increased acetabular bone stock may be beneficial in possible future revision surgeries.

Analysis of Outcomes of Total Cementless Hip Joint Arthroplasty in the Treatment of Advanced Hip Osteoarthritis Following Childhood Perthes’ Disease

2020 ◽  
Vol 22 (5) ◽  
pp. 333-342
Author(s):  
Marek Drobniewski ◽  
Magdalena Krasińska ◽  
Andrzej Grzegorzewski ◽  
Marek Synder ◽  
Andrzej Borowski
Keyword(s):  
Hip Joint ◽  
Hip Osteoarthritis ◽  
Joint Arthroplasty ◽  
Perthes Disease ◽  
Acetabular Cup ◽  
Kaplan Meier ◽  
Long Term Follow Up ◽  
The Mean ◽  
Joint Arthroplasties

Background. The aim of this study is to analyse the outcomes of total cementless hip joint arthroplasty in the treatment of advanced hip osteoarthritis following Perthes’ disease in childhood. Material and methods. The study enrolled 56 patients (15 women and 41 men) who underwent a total of 61 hip joint arthroplasties for coxarthrosis following Perthes’ disease. The mean age of the patients at surgery was 46.7 years (range 21-67 years). The mean follow-up period was 13.7 years. Results. Pre-operative Merle d’Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 25 cases, good in 16, satisfactory in 16 and poor in 9 cases. Poor results were always related to loosening of the acetabular cup. Heterotopic ossification was noted in 7 cases. According to the Kaplan-Meier estimator, 10 years’ survival probability was 85.24% for the whole implant and 100% for the stem. Conclusions. 1. Total cementless hip joint arthroplasty is an effective method in the treatment of advanced hip osteoarthritis following Perthes’ disease in childhood. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the patients’ young age, there may be more cases of loosening over time, requiring regular long-term follow-up.

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

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.

Advanced wear of an Oxinium™ femoral head implant following polyethylene liner dislocation

2013 ◽  
Vol 95 (8) ◽  
pp. e4-e6 ◽  
Author(s):  
H Tribe ◽  
S Malek ◽  
J Stammers ◽  
V Ranawat ◽  
JA Skinner
Keyword(s):  
Femoral Head ◽  
Surface Coating ◽  
Hip Dislocation ◽  
Acetabular Cup ◽  
Revision Procedure ◽  
Wear Rates ◽  
Soft Metal ◽  
Low Wear

Oxinium™ (Smith & Nephew, Memphis, TN, US) has been used in hip arthroplasty since 2003. The surface coating is hard and provides low wear rates but if this surface coating is damaged, the soft metal core is at risk of accelerated wear. Previous reports have described accelerated wear following intra and postoperative hip dislocation. We report a case of advanced wear of an in situ Oxinium™ femoral head implant following a cracked acetabular liner. The liner had disengaged from the titanium shell, allowing the Oxinium™ head to articulate directly with the shell. The disengaged liner led to dislocation of the Oxinium™ head, with associated pronounced wear of the head and the acetabular cup. The patient had a successful revision procedure. We advise close follow-up of patients with Oxinium™ implants, especially if associated with dislocation and closed reduction.

scholarly journals Multiple Acetabular Revisions in THA - Poor Outcome Despite Maximum Effort

2012 ◽  
Vol 6 (1) ◽  
pp. 488-494 ◽  
Author(s):  
O Bischel ◽  
JB Seeger ◽  
M Krüge ◽  
BG Bitsch
Keyword(s):  
Acetabular Component ◽  
Rank Test ◽  
Acetabular Reconstruction ◽  
Consecutive Series ◽  
Worst Case ◽  
Cumulative Survival ◽  
Number Of Patients ◽  
Maximum Effort ◽  
The Mean

A consecutive series of 52 acetabular revisions was evaluated retrospectively. Inclusion criteria for all patients were at least one former exchange of the acetabular component. Reconstruction was performed with reliable techniques and implants other than extensively porous coated device (e.g. tantalum). The mean follow up was 5.63 (0.01-14.05) years. Cumulative survival at 14.05 years with removal of the acetabular component due to aseptic loosening or the worst case criterion (removal of the acetabular component for any cause and/or lost to follow-up) as the end point was 66.38 (95 % C.-I.: 47.80-84.96) % and 58.42 (95 % C.-I.: 41.01-75.83) %, respectively. The cumulative survival rate with mechanical failure of the acetabular reconstruction as the endpoint was significantly lower in patients with two or more previous revisions in comparison to those with only one former procedure (log rank test: p=0,0112 respectively). The mean Merle d’Aubignée-score improved from 7.3 (0-14) preoperatively to 10.6 (0-17) points at latest follow up examination.Survival of acetabular reconstructions with common techniques and implants is decreasing with the number of previous revisions. This may cause major concerns with regard to the rising number of patients needing repeated revisions. Maximizing durability of primary THA, precise preoperative planning as well as improved techniques and implants for revision may decrease this problem in the long term.

Analysis of the Results of Hip Arthroplasty with the Use of Khanuja Group 6 stems

2021 ◽  
Vol 23 (5) ◽  
pp. 361-374
Author(s):  
Marek Drobniewski ◽  
Magdalena Krasińska ◽  
Marek Synder ◽  
Andrzej Borowski
Keyword(s):  
Hip Joint ◽  
Hip Osteoarthritis ◽  
Functional Results ◽  
Joint Arthroplasty ◽  
Implantation Technique ◽  
Acetabular Cup ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
The Mean

Background. Total cementless hip joint arthroplasty is universally recognized as a method of treatment of ad­vanced hip osteoarthritis. Multifaceted research by a wide group of implant specialists has led to the development of special implants that fulfill their purpose even in the most severe deformities of the hip joint. The aim of the study is to present and analyse the results of hip joint arthroplasty with the Antega anatomical stem. Materials and methods. The study enrolled 533 patients (342 women and 191 men) who underwent a total of 595 hip joint arthroplasties with the Antega anatomical stem. The mean age of the patients at surgery was 56.2 years (range: 20-87 years). The mean follow-up period was 7.3 years (range: 5-15.5 years). Results. Pre-operative Merle d’Aubigne-Postel scores (modified by Charnley) were poor in all patients. Mean post-operative improvement was 6.1 points. The outcomes were classified as excellent in 419 cases (70.4%), good in 102 cases (17.1%), satisfactory in 39 (6.6%) and poor in 34 cases. Poor results were usually associated with loosening of one of the prosthetic components. Heterotopic ossification was noted in 37 cases (6.2%). According to the Kaplan-Meier estimator, 10 years’ survival probability was 89.9% for the whole implant and 96.1% for the stem alone. Conclusions. 1. Our follow-up data (from a mean follow-up period of more than 10 years) indicate that the Antega anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Modification of the Antega stem implantation technique significantly reduces the risk of so-called unexplained thigh pain, which sometimes occurs following hip replacement surgery. 4. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

Our Experience with Alumina on Alumina Weight Bearing in Everyday Orthopedic Practice

2014 ◽  
Vol 614 ◽  
pp. 212-217
Author(s):  
Dan Grecu ◽  
Dan Tarnita ◽  
Daniela Tarniţă ◽  
D.R. Nita
Keyword(s):  
Femoral Head ◽  
Hip Prosthesis ◽  
Weight Bearing ◽  
Lateral Wall ◽  
Acetabular Cup ◽  
Ceramic Bearing ◽  
The Mean ◽  
Almost All ◽  
Mid Term Results

The research for an ideal hip prosthesis has led to the development of several durable materials that have been tested very intensly during the past decades, both clinically and mechanically. Alumina on alumina bearing has proven to be a very reliable bearing and is used more and more often. Nevertheless, because of the lack of ductility of alumina ceramic, concerns have been raised regarding its risk of fracture. The purpose of our study is to evaluate the mid-term results (78 months follow-up) of alumina on alumina prosthesis and the complications that have appeared regarding to the properties of the implant. We have reviewed retrospectively 89 THA performed in our clinic during October 2005 – October 2013 on a follow-up period of maximum 78 months. The mean age of the patients included was 49,60 years for men and 48,44 years for women. It was used a single kind of implant with same type of alumina parts, applied only on a postero-lateral surgical approach. The survival rate of ceramic-on-ceramic bearing surface by itself was 98.87% (88 out of 89). The most frequent complication was the dislocation of the prosthesis that happened in 7 cases, mainly due to a malposition of the acetabular cup, without any damage done to the ceramic bearing surfaces. In the failed case we have encountered a cracked femoral head that has been previously resterilized by steam. We could conclude that the alumina on alumina prosthesis is a very reliable prosthesis regarding its durability and strength. It requires a very precise surgical technique when implanted, since almost all the complications were due to a malposition of the acetabular component. A postero-lateral wall of the liner might decrease the rate of dislocations and ceramic wear. Also, we might debate that the steam sterilization is not suitable for alumina implants, since the fractured femoral head was resterilized.

scholarly journals A case report of femoral head fracture with osteochondral lesion treated by osteosynthesis and biomimetic scaffold: 2-year clinical and radiological follow-up

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Alessandro Casiraghi ◽  
Claudio Galante ◽  
Marco Domenicucci ◽  
Stefano Cattaneo ◽  
Andrea Achille Spreafico ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Articular Surface ◽  
Osteochondral Lesion ◽  
Hip Dislocation ◽  
Fracture Dislocation ◽  
Osteochondral Lesions ◽  
Femoral Head Fracture ◽  
Osteochondral Scaffold

AbstractThe aim of the present study was to present clinical and radiological outcome of a hip fracture-dislocation of the femoral head treated with biomimetic osteochondral scaffold.An 18-year-old male was admitted to the hospital after a motorcycle-accident. He presented with an obturator hip dislocation with a type IVA femoral head fracture according to Brumback classification system. The patient underwent surgery 5 days after accident. The largest osteochondral fragment was reduced and stabilized with 2 screws, and the small fragments were removed. The residual osteochondral area was replaced by a biomimetic nanostructured osteochondral scaffold. At 1-year follow-up the patient did not complain of hip pain and could walk without limp. At 2-year follow-up he was able to run with no pain and he returned to practice sports. Repeated radiographs and magnetic resonance imaging studies of the hip showed no signs of osteoarthritis or evidence of avascular necrosis. A hyaline-like signal on the surface of the scaffold was observed with restoration of the articular surface and progressive decrease of the subchondral edema.The results of the present study showed that the biomimetic nanostructured osteochondral scaffold could be a promising and safe option for the treatment of traumatic osteochondral lesions of the femoral head.Study Design: Case report.

scholarly journals Salvage Arthrodesis with Femoral Head Allograft for Failed Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0032
Author(s):  
Hong S. Lee ◽  
Kiwon Young ◽  
Tae-Hoon Park ◽  
Hong Seop Lee
Keyword(s):  
Femoral Head ◽  
Subjective Assessment ◽  
Total Ankle Arthroplasty ◽  
Bone Block ◽  
Ankle Arthroplasty ◽  
Pain Scores ◽  
Walking Aids ◽  
The Mean ◽  
Final Followup

Category: Ankle Introduction/Purpose: Failed total ankle arthroplasty (TAA) often results in significant bone loss and requires salvage arthrodesis. The aim of this study was to investigate the outcomes of Salvage arthrodesis with allo-bone block for failed TAA. Methods: This study included 8 patients who underwent salvage arthrodesis with femoral head allograft for failed TAA from August 2012 to March 2018 because of loosing of TAA implant. The mean age of the patients was 71 years (range, 54-81 years), and the mean follow-up period was 32 months (range, 12 to 84 months). Allograft problem and alignment of joint were evaluated radiographically. American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and visual analogue scale (VAS) pain scores were recorded preoperatively and at the time of final followup. Functional questionnaires were used to assess the duration for which the patient could walk continuously, use of walking aids, consumption of pain medication, and the patient’s subjective assessment of the percentage of overall improvement compared with before the salvage arthrodesis. Results: The allograft was retained without collapse for a mean of 24 months (range, 12 to 36 months) in four patients. Collapse of the allograft was observed in four patients at a mean of 11 months (range, 9 to 16 months), 1 of 4 patients were conserved to retrograde intramedullary nail at postoperative 12 months because of with implant failure and nonunion. The mean AOFAS and VAS pain scores improved from 12 (range, 8 to 40) preoperatively to 63 (range, 38 to 75) postoperatively (p = 0.001) and from 7 (range, 6 to 10 to 3 (range, 2 to 8) (p = 0.001), respectively. At the final follow-up evaluation, 6 of 8 patients were able to walk continuously at least 30 minutes with walking aid. Conclusion: The successful rate of salvage arthrodesis with femoral head allograft was 75% (Six of total 8 patients). The incidence rate of allograft collapse was 50% (Four of total 8 patients).

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