Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses

2018 ◽  
Vol 100-B (12) ◽  
pp. 1640-1646 ◽  
Author(s):  
M. R. Medellin ◽  
T. Fujiwara ◽  
R. Clark ◽  
L. M. Jeys
Keyword(s):  
Minimally Invasive ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Range Of Movement ◽  
Musculoskeletal Tumor Society ◽  
Non Invasive ◽  
Length Discrepancy ◽  
The Mean

AimsThe aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses.Patients and MethodsA total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System.ResultsThe overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295).ConclusionThe survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.

The use of a non-invasive extendable prosthesis at the time of revision arthroplasty

2018 ◽  
Vol 100-B (3) ◽  
pp. 370-377 ◽  
Author(s):  
M. M. Gilg ◽  
C. L. Gaston ◽  
L. Jeys ◽  
A. Abudu ◽  
R. M. Tillman ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Revision Procedure ◽  
Length Discrepancy ◽  
Prosthesis Revision ◽  
The Mean ◽  
Primary Bone Tumours

Aims The use of a noninvasive growing endoprosthesis in the management of primary bone tumours in children is well established. However, the efficacy of such a prosthesis in those requiring a revision procedure has yet to be established. The aim of this series was to present our results using extendable prostheses for the revision of previous endoprostheses. Patients and Methods All patients who had a noninvasive growing endoprosthesis inserted at the time of a revision procedure were identified from our database. A total of 21 patients (seven female patients, 14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were included. The indications for revision were mechanical failure, trauma or infection with a residual leg-length discrepancy. The mean follow-up was 70 months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). Lengthening was performed in all but one patient with a mean lengthening of 51 mm (5 to 140). Results The mean residual leg length discrepancy at final follow-up of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of whom one required amputation to eradicate the infection; the other required two-stage revision. Implant survival according to Henderson criteria was 86% at two years and 72% at five years. When considering revision for any cause (including revision of the growing prosthesis to a non-growing prosthesis), revision-free implant survival was 75% at two years, but reduced to 55% at five years. Conclusion Our experience indicates that revision surgery using a noninvasive growing endoprosthesis is a successful option for improving leg length discrepancy and should be considered in patients with significant leg-length discrepancy requiring a revision procedure. Cite this article: Bone Joint J 2018;100-B:370–7.

scholarly journals Two-stage total hip arthroplasty for primary advanced septic arthritis of the hip in adults: comparison of debridement versus femoral head resection with spacer implantation

2020 ◽  
Author(s):  
Zhenzhong Li ◽  
Congcong Wei ◽  
Xiangke Li ◽  
Mengxuan Yao ◽  
Huijie Li
Keyword(s):  
Total Hip Arthroplasty ◽  
Septic Arthritis ◽  
Pain Score ◽  
Hip Arthroplasty ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Two Stage ◽  
Length Discrepancy ◽  
The Mean

Abstract Background To compare the outcomes of debridement and antibiotic-loaded spacer implantation in primary advanced septic arthritis (SA) of the hip in adults treated with two-stage total hip arthroplasty (THA). Methods In the first stage, 9 patients were treated with debridement and 11 patients were treated with antibiotic-loaded spacer implantation. Then, THA was conducted in all patients in the second stage. Patients were evaluated based on the recurrence of infection, Harris hip score, visual analogue scale (VAS) pain score and leg-length discrepancy. Results No cases of infection, deep vein thrombosis, death, and loosening of hip prosthesis were observed during follow-up. The mean follow-up time was 29.09 ± 10.80 months in the debridement with THA group, and 28.22 ± 14.80 months in the spacer implantation with THA group. Before the THA surgery, the mean leg-length discrepancy was 2.80 ± 2.03 cm in the debridement with THA group, and 0.50 ± 0.23 cm in the spacer implantation with THA group (P < 0.05). In the latest follow-up, The Harris hip scores of patients was 90.33 ± 4.85 in the debridement with THA group and 94.36 ± 2.34 in the spacer implantation with THA group (P < 0.05), respectively. There was no statistical significant difference in VAS pain score of the hip between the two groups (P > 0.05).Conclusions Two-stage THA using antibiotic-loaded spacer implantation is an effective method for the treatment of advanced SA of the hip in adults due to it can control infection and significantly improve functional hip.

scholarly journals A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

2018 ◽  
Vol 12 (5) ◽  
pp. 509-514 ◽  
Author(s):  
M. Troy ◽  
B. Shore ◽  
P. Miller ◽  
S. Mahan ◽  
D. Hedequist ◽  
...  
Keyword(s):  
Operative Time ◽  
Surgical Techniques ◽  
Leg Length Discrepancy ◽  
Complication Rates ◽  
Leg Length ◽  
Treatment Groups ◽  
Length Discrepancy ◽  
Baseline Activity ◽  
Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

scholarly journals PAEDIATRIC FEMUR FRACTURE

2018 ◽  
Vol 25 (05) ◽  
pp. 639-642
Author(s):  
Umar Zia Khan ◽  
Mian Amjad Ali ◽  
Faaiz Ali Shah
Keyword(s):  
Surgical Site Infection ◽  
Weight Bearing ◽  
Leg Length Discrepancy ◽  
Site Infection ◽  
Spica Cast ◽  
Leg Length ◽  
Range Of Movement ◽  
Length Discrepancy ◽  
Hip Spica Cast ◽  
Flexible Intramedullary Nails

Objectives: To evaluate the outcome of retrograde flexible intramedullary nailsin treatment of paedriatic diaphyseal fractures in comparison with the traditional treatment ofimmediate hip spica cast. Hypothesis: We hypothesised that in children with femur fracturewho are managed with flexible intramedullary nails have better outcome in comparison tothose managed with immediate hip spica cast. Study Design: Randomized control trail. Place& Duration of Study: Lady Reading Hospital, Peshawar from June 2016 to October 2017.Methods: A group of forty-eight children aged 6-12 were randomly allocated either elasticintramedullary nail or immediate hip spica casting and were followed up to six months. Fracturealignment (coronal and sagittal angulation, leg length discrepancy), time for fracture union,recovery mile stones (time to start weight bearing with aids, independent walking, knee rangeof movement) and the presence of complications including surgical site infection were recordedand compared between two groups. Results: Children treated with elastic intramedullary nailsin comparison with those treated with immediate hip spica had early union (p<0.001), shortertime to start weight bearing with support or independently (p<0.001). Leg Length discrepancy(p<0.001), coronal and sagittal angulation (p<0.001 and p=0.02) was significantly higher in hipspica group. Difference observed between the two groups regarding knee range of movement(p=0.085) and surgical site infection (p=0.076) was not significant. Conclusion: Children aged6-12 years treated with elastic intramedullary nail for femoral diaphyseal fracture had earlierunion, reduced rate of shortening, malunion and allowed earlier rehabilitation.

Leg length discrepancy in patients with Perthes’ disease

2021 ◽  
Vol 103-B (11) ◽  
pp. 1736-1741
Author(s):  
Jaap J. Tolk ◽  
Deborah M. Eastwood ◽  
Aresh Hashemi-Nejad
Keyword(s):  
Skeletal Maturity ◽  
Perthes Disease ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Unaffected Side ◽  
Tibial Length ◽  
Length Discrepancy ◽  
Length Measurements ◽  
The Mean ◽  
Total Leg

Aims Perthes’ disease (PD) often results in femoral head deformity and leg length discrepancy (LLD). Our objective was to analyze femoral morphology in PD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalization on proximal and subtrochanteric femoral lengths. Methods All patients treated for PD in our institution between January 2013 and June 2020 were reviewed retrospectively. Patients with unilateral PD, LLD of ≥ 5 mm, and long-leg standing radiographs at skeletal maturity were included. Total leg length, femoral and tibial length, articulotrochanteric distance (ATD), and subtrochanteric femoral length were compared between PD side and the unaffected side. Furthermore, we compared leg length measurements between patients who did and who did not have a contralateral epiphysiodesis. Results Overall, 79 patients were included, of whom 21 underwent contralateral epiphysiodesis for leg length correction. In the complete cohort, the mean LLD was 1.8 cm (95% confidence interval (CI) 1.5 to 2.0), mean ATD difference was 1.8 cm (95% CI -2.1 to -1.9), and mean subtrochanteric difference was -0.2 cm (95% CI -0.4 to 0.1). In the epiphysiodesis group, the mean LLD before epiphysiodesis was 2.7 cm (95% CI 1.3 to 3.4) and 1.3 cm (95% CI -0.5 to 3.8) at skeletal maturity. In the nonepiphysiodesis group the mean LLD was 2.0 cm (95% CI 0.5 to 5.1; p = 0.016). The subtrochanteric region on the PD side was significantly longer at skeletal maturity in the epiphysiodesis group compared to the nonepiphysiodesis group (-1.0 cm (95% CI -2.4 to 0.6) vs 0.1 cm (95% CI -1.0 to 2.1); p < 0.001). Conclusion This study demonstrates that LLD after PD originates from the proximal segment only. In patients who had contralateral epiphysiodesis to balance leg length, this is achieved by creating a difference in subtrochanteric length. Arthroplasty surgeons need to be aware that shortening of the proximal femur segment in PD patients may be misleading, as the ipsilateral subtrochanteric length in these patients can be longer. Therefore, we strongly advise long-leg standing films for THA planning in PD patients in order to avoid inadvertently lengthening the limb. Cite this article: Bone Joint J 2021;103-B(11):1736–1741.

scholarly journals Z-Plasty for Severe Gluteal Muscle Contracture in Children

2016 ◽  
Vol 24 (3) ◽  
pp. 383-386
Author(s):  
Kun Zha ◽  
Guohui Liu ◽  
Shuhua Yang ◽  
Faqi Cao
Keyword(s):  
Treatment Outcome ◽  
Pelvic Tilt ◽  
Functional Score ◽  
Leg Length ◽  
Gluteal Muscle ◽  
Muscle Contracture ◽  
Length Discrepancy ◽  
Gluteal Muscle Contracture ◽  
The Mean

Purpose To review the records of 363 patients with severe gluteal muscle contracture to determine its mechanism, underlying pathology, and treatment outcome. Methods Records of 136 males and 227 females aged 5 to 18 (mean, 12.2) years who underwent Z-plasty for bilateral (n=347) or unilateral (n=16) severe gluteal muscle contracture were reviewed. Severe gluteal muscle contracture was classified as typical (n=52) or special (n=311). The typical type is associated with symptoms of positive out-toe gait, Ober sign, back-extending test, cross-leg test, squatting with knee side-by-side test, and hip dysfunction. It is further subdivided into mild (n=0), moderate (n=40), or severe (n=12). The special type is associated with additional symptoms of pelvic tilt and leg length discrepancy (<2 cm in 181 hips, 2–4 cm in 82 hips, and >4 cm in 48 hips). 311 hips had pelvic tilt and 47 hips had lumbar compensatory scoliosis. Treatment outcome was assessed at 6 months. Hip functional score was assessed at the final follow-up. Results The mean hospitalisation period was 11 days. After a mean follow-up of 1.5 years, the mean hip functional score improved from 8.03 to 11.69; improvement was higher in children (age 5–13 years) than in adolescents (age 14–18 years) [3.7 vs. 2.9, p<0.001]. At 6 months, outcome was excellent in 280 hips, good in 80, fair in 3 hips, and poor in 0. The 3 hips with fair outcome had persistent slight pelvic tilt and swaying gait. Two of them had preoperative leg length discrepancy >4 cm, and intra-operatively the contracture band severely affected the joint capsule. The third patient did not comply with postoperative exercises. Conclusion Surgical treatment for severe gluteal muscle contracture achieved good outcome.

Association Between Leg Length Discrepancy and Posterior Tibial Tendon Dysfunction

2014 ◽  
Vol 7 (2) ◽  
pp. 119-126 ◽  
Author(s):  
Jose Antônio Veiga Sanhudo ◽  
Joao Luiz Ellera Gomes
Keyword(s):  
Case Control ◽  
Leg Length Discrepancy ◽  
Control Group ◽  
Case Group ◽  
Posterior Tibial Tendon ◽  
Leg Length ◽  
Control Series ◽  
Posterior Tibial ◽  
Length Discrepancy ◽  
The Mean

Background. Leg length discrepancy (LLD) is associated with a variety of orthopaedic disorders and biomechanical gait changes that involve possible overload of the posterior tibial tendon (PTT). In view of the biomechanical disturbances induced by LLD, an association may exist between LLD and PTT dysfunction (PTTD). Purpose. To compare the frequency and magnitude of LLD between subjects with and without PTTD and ascertain whether associations exist between clinical features and presence of dysfunction. Study Design. Case–control study. Methods. A total of 118 patients with a diagnosis of PTTD were seen between January 2009 and September 2012 and compared with 118 gender-matched and race-matched volunteers. The frequency of LLD, the mean absolute LLD, and the mean relative LLD were measured by conventional (radiographic) or computed tomography scanography and compared between cases and controls. Results. The prevalence of LLD and mean absolute and relative LLD values were significantly greater in the case group (94.9%, 5.64 mm and 7.36%, respectively) than in the control group (79.7%, 3.28 mm and 4.18%, respectively) (P < .001). Conclusion. The findings of this study demonstrate a relationship between LLD and PTTD. In light of the major biomechanical changes it induces, LLD may be a predisposing factor for development of PTTD. Level of Evidence: Prognostic, Level III: Case–control series, retrospective

scholarly journals Guided Growth in Leg Length Discrepancy in Beckwith-Wiedemann Syndrome: A Consecutive Case Series

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1152
Author(s):  
Maurizio De Pellegrin ◽  
Lorenzo Brogioni ◽  
Guy Laskow ◽  
Graziano Barera ◽  
Roberta Pajno ◽  
...  
Keyword(s):  
Genetic Disorder ◽  
Case Series ◽  
Invasive Procedure ◽  
Leg Length Discrepancy ◽  
Vascular Lesions ◽  
Abdominal Wall Defects ◽  
Leg Length ◽  
Guided Growth ◽  
Length Discrepancy

Beckwith-Wiedemann Syndrome (BWS) is a rare genetic disorder characterized by overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycemia, predisposition to embryonal tumor, lateralized overgrowth, and leg length discrepancy (LLD), which can affect normal posture and gait. Aim of this study was to evaluate the effects of guided growth (temporary epiphysiodesis technique) as LLD management in BWS patients. Between 2007 and 2021, 22 BWS patients (15 F, 7 M) with a mean age of 7.9 years (2.9–14.4) and a mean LLD at first surgery of 3.65 cm (2–10), underwent temporary proximal tibial (PTE) and distal femur epiphysiodesis (DFE). In 18 patients the first surgical procedure was PTE, in one, DFE, and in 3 cases, PTE and DFE at the same time, respectively. Eleven patients reached equality of leg length after a mean follow-up of 7.7 years (3.7–13.0) and mean age of 13.3 years (12.7–27.5); 10 patients underwent 3 surgical procedures, one 7 procedures. Fifteen patients had no complications. No severe complications, infection, articular stiffness, or neuro-vascular lesions occurred in remaining patients; complications included secondary varus or valgus axial deviation in a total of 6 patients, and two screw breakages in two patients. Guided growth as a minimally invasive procedure seems efficient for LLD treatment with low complication rate in BWS patients.

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