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

Aims In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the posterior wall in severe protrusio. Methods This is a descriptive observational study, which describes the surgical technique of the partial resection of the posterior wall during hip arthroplasty in patients with severe acetabular protrusio operated on between January 2007 and February 2017. Results In all, 49 hip arthroplasties were performed. The average age of patients was 60 years, and idiopathic was the most frequent aetiology of protrusio. All patients were treated with femoral head autograft and no intra- or postoperative complications were reported. No patients required revision surgery. Conclusion Partial resection of the posterior wall demonstrated to be a safe surgical technique with 100% survival in a follow-up to ten years in total hip arthroplasty due to severe acetabular protrusio. Cite this article: Bone Joint Open 2020;1-7:431–437.

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Partial resection of the posterior wall for hip dislocation in severe acetabular protrusio

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0058.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 431-437

Author(s):

Hugo A. Rodriguez ◽

Felipe Viña ◽

Meilyn A. Muskus

Keyword(s):

Femoral Head ◽

Surgical Technique ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Posterior Wall ◽

Partial Resection ◽

Hip Arthroplasties ◽

Acetabular Protrusio

Aims In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the posterior wall in severe protrusio. Methods This is a descriptive observational study, which describes the surgical technique of the partial resection of the posterior wall during hip arthroplasty in patients with severe acetabular protrusio operated on between January 2007 and February 2017. Results In all, 49 hip arthroplasties were performed. The average age of patients was 60 years, and idiopathic was the most frequent aetiology of protrusio. All patients were treated with femoral head autograft and no intra- or postoperative complications were reported. No patients required revision surgery. Conclusion Partial resection of the posterior wall demonstrated to be a safe surgical technique with 100% survival in a follow-up to ten years in total hip arthroplasty due to severe acetabular protrusio. Cite this article: Bone Joint Open 2020;1-7:431–437.

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499020957109 ◽

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.

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

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00362-x ◽

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.

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Traumatic Obturator Hip Dislocation with Marginal Femoral Head Fracture in a 15-Year-Old Adolescent: A High-Energy Trauma—A Case Report and a Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2018/7268032 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Yoann Durand ◽

Clémence Bruyère ◽

Marco Saglini ◽

Aurélien Michel-Traverso

Keyword(s):

Femoral Head ◽

Hip Dislocation ◽

High Energy ◽

Hip Pain ◽

X Rays ◽

Hip Function ◽

One Year ◽

High Level ◽

Joint Limitation

We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.

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Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04800-w ◽

2021 ◽

Vol 22 (S2) ◽

Author(s):

Domenico De Mauro ◽

Giuseppe Rovere ◽

Amarildo Smakaj ◽

Silvia Marino ◽

Gianluca Ciolli ◽

...

Keyword(s):

Femoral Head ◽

Internal Fixation ◽

Open Reduction ◽

Case Series ◽

Hip Dislocation ◽

Harris Hip Score ◽

Femoral Head Fracture ◽

Surgical Hip Dislocation ◽

Modified Harris Hip Score

Abstract Background The purpose of the study is to evaluate clinical and radiological outcomes in those patients with femoral head fracture, treated with open reduction and internal fixation through Gibson approach and Ganz flip trochanter osteotomy. The treatment of Pipkin fractures is very challenging, especially for small trauma centers, because of the unusual fracture patterns and high-level surgical skills required. Case presentation Between 2017 and 2020, nine cases of Pipkin fractures came to the Emergency Department at the Trauma Center of our Hospital in Rome. Inclusion criteria were the diagnosis of femoral head fracture, the open reduction and internal fixation as surgical choice and at least 24 months follow-up. Patients older than 65 years and those treated through total hip replacement or combined hip procedure (CHP) were excluded. Thus, five patients were included in our case series. The clinical outcome was evaluated according to Western Ontario and McMaster Universities Arthritis Index, Vail Hip score, modified Harris Hip score and Merle D’Aubignè Postel score. Radiographic assessment was scored according to Epstein-Thompson classification and heterotopic ossification was assessed through Brooker classification. The mean follow-up was 24 months (range 12-24). Average modified Harris Hip score was 92.1 points (range 75.9–100), and the average Vail score was 81.8 (range 55-95). WOMAC score was assessed in three different subscales, pain (A), stiffness (B) and physical condition (C), with the following results: 1.4 A (range 0-7), 1.2 B (range 0-6) and 6.4 C (range 0-22). Merle d’Aubignè Postel score resulted excellent for four patients and good for one patient. According to Epstein-Thompson score of the radiological outcome, four patients showed a good result and one a fair result. No mechanical or infective complications occurred in the five patients. Conclusions Gibson’s approach and surgical hip dislocation through Ganz trochanteric flip osteotomy allow a good exposure of the femoral head and acetabulum, giving us the possibility to perform an anatomical reduction of the fracture. In our case series, satisfactory clinical and radiological short-term results were obtained without significant complications.

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Delayed diagnosis of traumatic posterior hip dislocation in a 6-year-old girl with 6 years follow up: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20174526 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3511

Author(s):

Paa Kwesi Baidoo ◽

Boniface Adegah

Keyword(s):

Case Report ◽

Femoral Head ◽

Avascular Necrosis ◽

Delayed Diagnosis ◽

Hip Dislocation ◽

Traumatic Hip Dislocation ◽

Left Posterior ◽

Posterior Hip Dislocation

Though uncommon, cases of traumatic hip dislocation have been reported in children worldwide. Averagely, it is recommended that the acceptable duration for reduction after such dislocations is about 6 hours. Even with that there is about 5% documented chance of developing avascular necrosis of the head of the femur. The incidence of avascular necrosis increases with delayed relocation of the femoral head. We report a case involving a 6-year-old girl with a 2-week delayed diagnosis of a left posterior hip dislocation that was reduced and followed up for 6 years.

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Results of primary THA using 36 mm femoral heads on first-generation highly cross-linked polyethylene in patients less than 60 years of age: Minimum 10-year follow-ups

Journal of Orthopaedic Surgery ◽

10.1177/2309499019896448 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949901989644

Author(s):

Myung-Rae Cho ◽

Chung-Mu Jun ◽

Kyung-Tae Kim ◽

Suk Kyun Song ◽

Won-Kee Choi

Keyword(s):

Wear Rate ◽

First Generation ◽

Femoral Stem ◽

Long Term Results ◽

Harris Hip Score ◽

Acetabular Cup ◽

Wear Rates ◽

Femoral Heads ◽

The Mean

Purpose: Long-term results of total hip arthroplasty (THA) using highly cross-linked polyethylene (HXLPE) and metal femoral head with more than 10 years of follow-up have already been reported. However, most studies included results with a head size of 28 mm that could affect wear rates. The aim of this study was to evaluate the results of 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age with a minimum follow-up of 10 years. Methods: Retrospective analysis included 54 cases from 47 patients. The mean age at the time of surgery was 47.22 years and the mean follow-up period was 131.04 months. Porous-coated cementless acetabular cups (Trilolgy®; Zimmer Inc., Warsaw, Indiana, USA) and HXLPE acetabular liners (Longevity®; Zimmer Inc.) were used for all cases. Acetabular cup abduction angles, anteversion angles, and wear rates of liner were measured using polyWare pro 3D distal version 5.10. Results: The average modified Harris hip score at the final follow-up was 88.48 (range 80–96). Average Merle d’Aubigne and Postel score was 15.57 (range 14–18). There was no acetabular cup or femoral stem failing due to aseptic loosening. The average steady-state wear rate determined using radiographs taken at 1 year postoperatively and at the latest follow-up was 0.053 ± 0.025 mm/year. There were no statistically significant differences in liner wear rate with respect to age, variety of the femoral stem, or liner thickness. Conclusion: Results of THA with 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age were satisfactory.

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Traumatic Hip Dislocation with Associated Femoral Head Fracture

Case Reports in Orthopedics ◽

10.1155/2015/865786 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

H. Dortaj ◽

A. Emamifar

Keyword(s):

Femoral Head ◽

Full Range ◽

Hip Dislocation ◽

High Energy ◽

Femoral Head Fracture ◽

Hip Instability ◽

The Right ◽

Dislocation Of The Hip ◽

Critical Injury

Dislocation of the hip is a critical injury that results from high-energy trauma. This paper describes a case of posterior dislocation of the right hip in a 35-year-old woman with associated ipsilateral femoral head fracture. Initial treatment included reduction of the right hip through posterior approach and fixation of the femoral head fracture with three absorbable screws. After 15-month follow-up, a full range of motion has been achieved and there are no signs of avascular necrosis, hip instability, or limping. The authors describe their method of surgery.

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Medium-term outcome and classification of traumatic anterior hip dislocations

Hip International ◽

10.1177/1120700020918868 ◽

2020 ◽

pp. 112070002091886

Author(s):

Lee S Yaari ◽

Assaf Kadar ◽

Shai Shemesh ◽

Barak Haviv ◽

Michael P Leslie

Keyword(s):

Femoral Head ◽

Range Of Motion ◽

Clinical Outcomes ◽

Weight Bearing ◽

Hip Dislocation ◽

Anterior Dislocation ◽

Harris Hip Score ◽

Surgical Data ◽

Anterior Hip Dislocation

Introduction: Traumatic anterior hip dislocations are subdivided to obturator (inferior) and pubic (superior) dislocations by Epstein’s descriptive classification. This rare injury is thought to have favourable clinical outcomes. The incidence of associated femoral head and acetabular injuries has been low in past case series. We sought to revisit this injury and classification in the era of advanced imaging and contemporary surgical techniques. Materials and methods: A retrospective study of 15 patients treated for anterior hip dislocation was performed. Medical records were reviewed for demographic and surgical data. Imaging studies were revisited to determine direction of dislocation and associated fractures. Patients were assessed for pain, hip function using the modified Harris Hip Score (mHHS), hip range of motion and radiographic changes. Mean follow-up time was 3 years. Results: Anterior dislocation occurred in an obturator (inferior), pubic (superior) or central direction. 9 patients had concomitant femoral head impaction and 7 patients suffered from acetabular fractures. 8 patients with an anterior hip dislocation underwent surgical treatment. This therapy, along with early range of motion and weight bearing, produced favourable clinical outcomes with 9 patients reporting no pain and an average mHHS of 83.8. 6 patients had heterotopic ossification at latest follow-up. Conclusions: Traumatic anterior hip dislocation is commonly associated with femoral head impaction and acetabular injuries which should be addressed operatively when appropriate to produce favourable results. In this paper, we propose a revision to the commonly used descriptive classification system.

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