scholarly journals Preventing postoperative prosthetic joint dislocation by repairing obturator externus in total hip arthroplasty performed via the posterior approach

Arthroplasty ◽  
2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Hideki Fujii ◽  
Takuya Otani ◽  
Yasuhiko Kawaguchi ◽  
Tetsuo Hayama ◽  
Toshiomi Abe ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Soft Tissues ◽  
Joint Dislocation ◽  
Total Hip ◽  
Obturator Externus ◽  
Prosthetic Joint ◽  
Repair Group

Abstract Background In total hip arthroplasty performed via the posterior approach, repairing the posterior soft tissues is a conventional method for preventing postoperative prosthetic joint dislocation. The aim of this study was to verify whether obturator externus repair played the main role and what was the mechanism of the repair preventing the dislocation. Methods Included were 188 patients who underwent primary cementless total hip arthroplasty via the posterior approach. The patients were divided into a repair group (n = 94) and a non-repair group (n = 94). Patients of repair group received additional obturator externus repair while patients of non-repair group did not. The range of motion of hip joint was assessed before and after operation. Data were compared between the two groups. A p value < 0.05 was considered statistically significant. Results Before operation and under anesthesia, with regard to internal rotation of hip joint, the mean values of repair and non-repair groups were 24° ± 16/28° ± 15 (p = 0.2933). The mean values of the groups were 13° ± 8/15° ± 9 immediately after repair (p = 0.5672). Range of internal rotation 1 year after operation were 15° ± 8/19° ± 9 (p = 0.0139). Specifically, the values in repair group were lower than those in non-repair group. During a 5-year period of postoperative follow-up, hip joint dislocation occurred in one patient of non-repair group. No dislocation was observed in repair group. Conclusion When THA is performed via the posterior approach, repairing the obturator externus may decrease the risk of postoperative prosthetic joint dislocation by reinforcing the posterior soft tissues of the hip joint. Level of evidence Therapeutic study, Level IVa.

scholarly journals Diagnosis, preoperative evaluation, classification and total hip arthroplasty in patients with long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bo Liu ◽  
Zhaoke Wu ◽  
Zhikun Zhuang ◽  
Sikai Liu ◽  
Huijie Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Surgical Procedures ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Type A ◽  
Secondary Osteoarthritis ◽  
Joint Dislocation ◽  
Total Hip ◽  
Type C

Abstract Background Neglected long-term unreduced hip joint dislocation with secondary osteoarthritis and pseudoarthrosis poses a great challenge to hip surgeons. However, as this is an uncommon injury, few studies have systematically investigated these patients. Methods We retrospectively reviewed 16 patients from 2010 to 2017. The diagnostic values of three different types of common radiological examinations were evaluated. We evaluated the bone conditions of the original acetabulum and classified the patients into three types (four subtypes). The surgical procedures and prognosis of the patients were also investigated. Results With the combined application of X-ray, CT scans and 3D reconstruction, 93.8% of these patients (sensitivity = 93.8%, Youden’s index = 0.93, intraclass correlation coefficient = 0.95) could be diagnosed correctly. There were 6/16 (37.5%) type A patients, 4/16 (25.0%) type B1 patients, 5/16 (31.3%) type B2 patients and 1/16 (6.3%) type C patient. For patients with type A injury, the surgical procedures for total hip arthroplasty were similar to “standard” total hip arthroplasty. For patients with type B injury, due to atrophy or partial bone deficiency of the original acetabulum, the surgical procedure for total hip arthroplasty was probably similar to those for patients with developmental dysplasia of the hip. For patients with type C injury, the situation was similar to that of revision surgery. The average Harris hip score postoperatively was 89.94 ± 5.78 points (range: 79–98 points). Conclusions The new classification system could help surgeons estimate potential difficulties during total hip arthroplasty. The prognosis of most patients after total hip arthroplasty is expected to be excellent or good.

scholarly journals Study of hip joint dislocation after total hip arthroplasty

2005 ◽  
Vol 30 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Toshinori Masaoka ◽  
Kengo Yamamoto ◽  
Takaaki Shishido ◽  
Yoichi Katori ◽  
Tatsuro Mizoue ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Joint Dislocation ◽  
Total Hip

scholarly journals Diagnosis, Preoperative Evaluation, Classification and Total Hip Arthroplasty in Patients with Long-Term Unreduced Hip Joint Dislocation, Secondary Osteoarthritis and Pseudoarthrosis

2020 ◽  
Author(s):  
Bo Liu ◽  
Zhaoke Wu ◽  
Zhikun Zhuang ◽  
Sikai Liu ◽  
Huijie Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Surgical Procedures ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Type A ◽  
Secondary Osteoarthritis ◽  
Joint Dislocation ◽  
Total Hip ◽  
Type C

Abstract Background Neglected long-term unreduced hip joint dislocation with secondary osteoarthritis and pseudoarthrosis poses a great challenge to hip surgeons. However, as this is an uncommon injury, few studies have systematically investigated these patients.Methods We retrospectively reviewed 16 patients from 2010 to 2017. The diagnostic value of three different kinds of common radiological examinations were evaluated. We evaluated the bone conditions of the original acetabulum and classified the patients into three types (four subtypes). The surgical procedures and prognosis of the patients were also investigated.Results With the combined application of X-ray, CT scans and 3D reconstruction, 93.8% of these patients (sensitivity = 93.8%, Youden’s index = 0.93, intraclass correlation coefficient = 0.95) could be diagnosed correctly. There were 6/16 (37.5%) type A patients, 4/16 (25.0%) type B1 patients, 5/16 (31.3%) type B2 patients and 1/16 (6.3%) type C patient. For patients with type A injury, the surgical procedures for total hip arthroplasty were similar to “standard” total hip arthroplasty. For patients with type B injury, due to atrophy or partial bone deficiency of the original acetabulum, the surgical procedure for total hip arthroplasty was probably similar to those for patients with developmental dysplasia of the hip. For patients with type C injury, the situation was similar to that of revision surgery. The average Harris hip score postoperatively was 89.94 ± 5.78 points (range: 79–98 points).Conclusions The new classification system could help surgeons estimate potential difficulties during total hip arthroplasty. The prognosis of most patients after total hip arthroplasty is expected to be excellent or good.

Application of surgical navigation to total hip arthroplasty

2007 ◽  
Vol 221 (7) ◽  
pp. 699-712 ◽  
Author(s):  
T M Ecker ◽  
S B Murphy
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Soft Tissues ◽  
Surgical Navigation ◽  
Surgical Techniques ◽  
Leg Length ◽  
Total Hip ◽  
Less Invasive

Instability, impingement, and leg-length discrepancy are among the most common early problems following total hip arthroplasty (THA). Component positioning is the primary factor affecting all three of these issues and, therefore, all three can be potentially addressed using surgical navigation. While the advent of less invasive surgical techniques performed through smaller incisions has been shown to accelerate recovery, these techniques have also been associated with a further increase in the incidence of these three problems. Acetabular component malpositioning has been a particular problem with less invasive surgical techniques. Nonetheless, it is clear that maximal preservation of the soft tissues around the hip joint may accelerate recovery following surgery and confer greater hip joint stability. Accomplishing these goals without compromising component positioning is the single greatest potential advantage to the application of surgical navigation to THA. The present paper describes the general principles of surgical navigation in THA with respect to methods of tracking, methods of registration, the role of image-free and image-based navigation, and methods of measuring leg-length change during surgery. Further, a description is given of the clinical effect of combining surgical navigation with use of the superior capsulotomy technique of performing THA, which aims maximally to preserve the soft tissues surrounding the hip joint, allowing unrestricted progression of motion and weight-bearing following surgery. These methods have led to statistically significant acceleration of recovery, improvement in acetabular component positioning, and reductions in peri-operative surgical complications.

scholarly journals Long-term clinical and radiological outcome in patients with severe Legg-Calvé-Perthes disease after Chiari pelvic osteotomy: a mean of 14 years follow-up

2021 ◽  
pp. 112070002098815
Author(s):  
Dammerer Dietmar ◽  
Braito Matthias ◽  
Peter Ferlic ◽  
Kaufmann Gerhard ◽  
Juana Kosiol ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Pelvic Osteotomy ◽  
Perthes Disease ◽  
Total Hip ◽  
Joint Incongruence ◽  
Chiari Pelvic Osteotomy

Introduction: The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). Methods: A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6–21.3) years. Results: Mean age at surgery was 10.2 (range 8.2–17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65–100) points. An excellent functional outcome (HHS 90–100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. Conclusions: CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about ⅔ of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients.

Biomechanical analysis of transverse acetabular fracture fixation in the elderly via the posterior versus the anterior approach with and without a total hip arthroplasty

2020 ◽  
Vol 234 (9) ◽  
pp. 966-974
Author(s):  
Joel Moktar ◽  
Alan Machin ◽  
Habiba Bougherara ◽  
Emil H Schemitsch ◽  
Radovan Zdero
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Acetabular Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Failure Load ◽  
The Elderly ◽  
Clinical Failure ◽  
Total Hip

This study provides the first biomechanical comparison of the fixation constructs that can be created to treat transverse acetabular fractures when using the “gold-standard” posterior versus the anterior approach with and without a total hip arthroplasty in the elderly. Synthetic hemipelvises partially simulating osteoporosis (n = 24) were osteotomized to create a transverse acetabular fracture and then repaired using plates/screws, lag screws, and total hip arthroplasty acetabular components in one of four ways: posterior approach (n = 6), posterior approach plus a total hip arthroplasty acetabular component (n = 6), anterior approach (n = 6), and anterior approach plus a total hip arthroplasty acetabular component (n = 6). All specimens were biomechanically tested. No differences existed between groups for stiffness (range, 324.6–387.3 N/mm, p = 0.629), clinical failure load at 5 mm of femoral head displacement (range, 1630.1–2203.9 N, p = 0.072), or interfragmentary gapping (range, 0.67–1.33 mm, p = 0.359). Adding a total hip arthroplasty acetabular component increased ultimate mechanical failure load for posterior (2904.4 vs. 3652.3 N, p = 0.005) and anterior (3204.9 vs. 4396.0 N, p = 0.000) approaches. Adding a total hip arthroplasty acetabular component also substantially reduced interfragmentary sliding for posterior (3.08 vs. 0.50 mm, p = 0.002) and anterior (2.17 vs. 0.29 mm, p = 0.024) approaches. Consequently, the anterior approach with a total hip arthroplasty may provide the best biomechanical stability for elderly patients, since this fixation group had the highest mechanical failure load and least interfragmentary sliding, while providing equivalent stiffness, clinical failure load, and gapping compared to other surgical options.

scholarly journals Dynamic hip joint stiffness in individuals with total hip arthroplasty: Relationships between hip impairments and dynamics of the other joints

2011 ◽  
Vol 26 (6) ◽  
pp. 598-604 ◽  
Author(s):  
Hiroshige Tateuchi ◽  
Rui Tsukagoshi ◽  
Yoshihiro Fukumoto ◽  
Shingo Oda ◽  
Noriaki Ichihashi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Joint Stiffness ◽  
The Other ◽  
Total Hip
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