Femoral Head-Trunnion Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty  – A Unique Case Report

Background: Gross trunnion failure (GTF) after total hip arthroplasty is a rare complication and has only been reported in a few case series. Some of the associated risk factors have been described in the literature and include larger femoral heads, greater offset, and increased BMI. Despite this, the mechanism behind GTF is poorly understood and early diagnosis and treatment continues to be challenging.Case Presentation: We present the case of complete femoral head and trunnion dissociation in a 63 year-old female nine years after total hip arthroplasty. Unique to this case is the lack of classic patient and implant risk factors for GTF along with the acute onset nearly nine years after implantation. Discussion: This case presentation highlights the fact that the contributing factors and mechanism behind GTF continue to be poorly understood. There is a need for future research to help better understand this phenomenon and to help potentially identify those at risk for GTF.

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Epidemiological Study of Femoral Head Osteonecrosis

Revista de Chimie ◽

10.37358/rc.17.5.5593 ◽

2017 ◽

Vol 68 (5) ◽

pp. 974-976

Author(s):

Alexandru Patrascu ◽

Liliana Savin ◽

Dan Mihailescu ◽

Victor Grigorescu ◽

carmen Grierosu ◽

...

Keyword(s):

Risk Factors ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Young Patients ◽

Head Group ◽

Bipolar Hemiarthroplasty ◽

Aseptic Necrosis ◽

Total Hip ◽

Femoral Head Osteonecrosis

In recent years, there has been an increase in the number of studies on the etiology of femoral head necrosis. We retrospectively reviewed all patients diagnosed with aseptic necrosis of the femoral in the period of 2010-2015. We recorded a total of 230 cases diagnosed with aseptic necrosis of the femoral head, group was composed of 65.7% men and 34.3% women, risk factors identified was 19.13% (post-traumatic), 13.91% (glucocorticoids), 26.52% (alcohol), 3.47% (another cause) and in 36 95% of the cases no risk factors were found. The results of the study based on the type of surgery performed on the basis of stages of disease progression, 8 patients (3.48%) benefited from osteotomy, 28 patients (12.17%) benefited of bipolar hemiarthroplasty prosthesis and 188 patients (81.74%) benefited of total hip arthroplasty. Osteonecrosis of the femoral head is characteristic to young patients between the age of 30-50 years old. Predisposing factors, alcohol and corticosteroid therapy remains an important cause of the disease. Total hip arthroplasty remains the best option for the patients with osteonecrosis of the femoral head.

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Risk Factors Leading to Total Hip Arthroplasty in Patients with Subchondral Insufficiency Fractures of the Femoral Head

Journal of Orthopaedic Surgery ◽

10.1177/230949901001800302 ◽

2010 ◽

Vol 18 (3) ◽

pp. 271-275 ◽

Cited By ~ 12

Author(s):

Keita Miyanishi ◽

Kohei Ishihara ◽

Seiya Jingushi ◽

Takehiko Torisu

Keyword(s):

Risk Factors ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Insufficiency Fractures ◽

Total Hip

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Cementless Total Hip Arthroplasty Using an Autograft of the Femoral Head for Marked Acetabular Dysplasia: Case Series

Journal of Orthopaedic Surgery ◽

10.1177/230949900401200104 ◽

2004 ◽

Vol 12 (1) ◽

pp. 14-18 ◽

Cited By ~ 7

Author(s):

T Yamaguchi ◽

M Naito ◽

I Asayama ◽

K Shiramizu

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Dysplasia ◽

Case Series ◽

Total Hip ◽

Cementless Total Hip Arthroplasty

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Anterior Subluxation after Total Hip Replacement Confirmed by Radiographs: Report of Two Cases

Advances in Orthopedics ◽

10.4061/2011/519254 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4

Author(s):

Conor P. McGrory ◽

Brian J. McGrory

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Total Hip Replacement ◽

Hip Arthroplasty ◽

Hip Replacement ◽

Rare Complication ◽

Unusual Complication ◽

Total Hip ◽

Anterior Subluxation

Demonstrable anterior subluxation of the femoral head after a total hip arthroplasty is a rare complication and is usually transient. Both a case of recurrent subluxation and a case of chronic subluxation are described in this paper, each one presenting with unexpected femoral head eccentricity in the acetabulum on radiograph. We show how this unusual complication can be successfully identified and treated.

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Fatal Fat Embolism following Femoral Head Resection in Total Hip Arthroplasty

Hip International ◽

10.1177/112070000801800412 ◽

2008 ◽

Vol 18 (4) ◽

pp. 332-334 ◽

Cited By ~ 4

Author(s):

N.M. Walker ◽

T. Bateson ◽

P. Reavley ◽

D. Prakash

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Rare Complication ◽

Femoral Shaft ◽

Fat Embolism ◽

Total Hip ◽

Intramedullary Reaming ◽

Embolism Syndrome ◽

Primary Total Hip Arthroplasty

We report a rare complication during primary total hip arthroplasty. A fatal fat pulmonary embolism immediately followed removal of the femoral head, prior to further preparation of the acetabulum or femoral shaft. Fat embolism syndrome is a well-known complication during total joint arthroplasty, usually attributed to preparation of the femoral shaft, particularly intramedullary reaming and insertion of the prosthesis. These risk factors have previously been identified in the literature. We believe that this case highlights the need for further research to establish the intramedullary pressures during the processes of dislocation and resection of the femoral neck and the attendant risk.

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Preoperative Risk Factors for Dissatisfaction After Total Hip Arthroplasty Among Patients With Osteonecrosis of the Femoral Head

10.21203/rs.3.rs-103521/v1 ◽

2020 ◽

Author(s):

Genta Takemoto ◽

Taisuke Seki ◽

Yusuke Osawa ◽

Yasuhiko takegami ◽

Taiki Kusano ◽

...

Keyword(s):

Risk Factors ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Short Form ◽

Japanese Orthopaedic Association ◽

Evaluation Questionnaire ◽

Total Hip ◽

Preoperative Risk Factors ◽

Hip Disease

Abstract Background: The objective of this study was to investigate the preoperative risk factors for dissatisfaction after total hip arthroplasty for osteonecrosis of the femoral head.Methods: A total of 71 patients (91 hips) with osteonecrosis of the femoral head who underwent total hip arthroplasty surgery in our hospital were included. The degree of satisfaction was evaluated using a visual analogue scale one year after the total hip arthroplasty. The patients were divided into two groups: the satisfied group (S group; visual analogue scale score > 20 mm) and the dissatisfied group (D group; visual analogue scale score < 20 mm). The results of the preoperative quality-of-life self-assessments, including the Short Form-36 and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, were compared between the satisfied and dissatisfied groups. Multivariate analysis was performed to examine the independent preoperative risk factors.Results: There were 49 patients (64 hips) and 22 patients (27 hips) in the S and D groups, respectively. Patient age was significantly higher in the D group, and the movement and mental scores obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and the Mental Component Summary scores of the Short Form-36 were significantly lower. However, there were no between-group differences in the pain score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and the Physical Component Summary and Role/Social Component Summary scores of the Short Form-36. Multivariate analysis showed that age and mental score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire were independent risk factors.Conclusions: Preoperative age and mental score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire strongly affected satisfaction levels observed one year after total hip arthroplasty in patients with osteonecrosis of the femoral head.

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Risk Factors for the Development of Nerve Palsy Following Primary Total Hip Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001812010164 ◽

2018 ◽

Vol 12 (1) ◽

pp. 164-172 ◽

Cited By ~ 3

Author(s):

Shunsuke Kawano ◽

Motoki Sonohata ◽

Masaru Kitajima ◽

Masaaki Mawatari

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Body Weight ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Body Mass ◽

Hip Arthroplasty ◽

Nerve Palsy ◽

Hip Dislocation ◽

Total Hip

Background:Nerve palsy following total hip arthroplasty (THA) is a complication that worsens the functional prognosis. The present study analyzed the risk factors of nerve palsy following THA.Methods:The subjects of this study included 6,123 cases in which primary THA was performed under spinal anesthesia with cementless implants used in the posterolateral approach.Results:Fourteen cases (0.22%) developed nerve palsy following THA, all of which involved palsy of the entire peroneal nerve region. The diagnoses included osteoarthritis due to subluxation (n=6), complete hip dislocation (n=3), osteonecrosis of the femoral head (n=2), primary osteoarthritis (n=1), osteoarthritis due to trauma (n=1), and multiple osteochondromatosis (n=1). Recovery from nerve palsy was confirmed in 10 cases; the longest recovery period was three years. A univariate analysis revealed significant differences in the osteoarthritis due to subluxation, osteonecrosis of the femoral head, complete hip dislocation, body weight and body mass index. However, none of the factors remained significant in multivariate analysis. Peroneal (ischiadic) nerve palsy following THA occurred in patients with osteonecrosis of the femoral head, complete hip dislocation, low body weight and a low body mass index. However, there were no cases of nerve palsy after the introduction of THA combined with shortening osteotomy of the femur for complete hip dislocation. patients.Conclusion:It is necessary to pay attention to direct pressure in cases of lower body weight and lower BMI because compression of the sciatic nerve during surgery and compression of the fibular head are considered to be risk factors.

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A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0041-1728760 ◽

2021 ◽

Author(s):

Andrew G. Yun ◽

Marilena Qutami ◽

Kory B. Dylan Pasko

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Radiation Exposure ◽

Hip Arthroplasty ◽

Fluoroscopy Time ◽

Lesser Trochanter ◽

Total Hip ◽

Preoperative Templating ◽

The Mean ◽

Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

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