scholarly journals Anterolateral Approach Might Be Superior to Posterolateral Approach in Controlling Lower Limb Discrepancy for Special Total Hip Arthroplasty Patients

2021 ◽  
Author(s):  
Ao Xiong ◽  
Guoqing Li ◽  
Su Liu ◽  
Chang Xu ◽  
Deli Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lower Limb ◽  
Univariate Analysis ◽  
Hospital Costs ◽  
Developmental Dysplasia ◽  
Posterolateral Approach ◽  
Anterolateral Approach ◽  
Total Hip

Abstract Objectives: Variable approaches for total hip arthroplasty (THA) are promoted but investigations of associations between the approaches and the postoperative lower limb discrepancy (LLD) are limited. We intended to compare the efficacy between the anterolateral approach (ALA) and posterolateral approach (PLA) in controlling of postoperative LLD. Methods: Two retrospective cohorts were established including patients undergone unilateral primary THA. Preoperative and latest follow-up radiographs were compared and evaluated. Two hundred and sixty patients (140 females and 126 males; aged 46.70 ± 13.62 years) were recruited with around 20 months follow-up postoperatively. Results: Univariate analysis identified lower postoperative LLD, lower postoperative acetabular offset and lower hospital costs in the ALA group than in the PLA group (p＜0.01), however, the femoral and global offset and length of stay (LOS) are comparable between (p > 0.05). Multivariable liner regression revealed that PLA, preoperative LLD, developmental dysplasia of the hip and aseptic avascular necrosis are major contributors to the postoperative LLD (p<0.05). Conclusions: This study illustrates that the ALA might be superior to the PLA in controlling the postoperative LLD among some of the THA patients. Both ALA and PLA are comparable in regard to femoral and offset and LOS.

The fate of sagittal alignment in tapered uncemented femoral components in total hip arthroplasty: 889 hips followed for a minimum of 10 years

2020 ◽  
pp. 112070001989598
Author(s):  
Eduardo García-Rey
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Sagittal Alignment ◽  
Posterolateral Approach ◽  
Harris Hip Score ◽  
Anterolateral Approach ◽  
Total Hip ◽  
Group 3

Purpose: Aseptic loosening is rare after primary total hip arthroplasty (THA) with mostly uncemented tapered stems; however, different factors can modify the results. We question whether 3 different current femoral components and/or the surgical technique affect the clinical and radiological outcome after a minimum follow-up of 10 years. Methods: 889 uncemented tapered stems implanted from 1999 to 2007 were evaluated for a minimum follow-up of 10 years. Group 1 (273 hips) shared a conical shape and a porous-coated surface, group 2 (286 hips) a conical splined shape and group 3 (330 hips) a rectangular grit-blasted stem. Groups 1 and 2 were implanted through a posterolateral approach and group 3 using an anterolateral approach. Clinical outcomes and anteroposterior and sagittal radiographic analyses were compared. Results: No thigh pain was reported in unrevised patients. Mean Harris Hip score was lower for patients in group 3 for pain and function at all intervals. 14-year implant survival for aseptic loosening was 98.2% (95% confidence interval [CI] 96.2–100) in group 3. No revision for aseptic loosening was found with the other designs. A stem position outside neutral limits in the sagittal alignment ( p = 0.001, hazard ratio: 6.17, 95% CI, 2.05–18.61) was associated with aseptic loosening in group 3. Conclusions: Most current uncemented straight tapered femoral components can provide adequate bone fixation in primary THA after 10 years. Conical stems inserted through a posterolateral approach are more reliable than rectangular ones inserted through an anterolateral approach.

scholarly journals Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jingyang Sun ◽  
Bohan Zhang ◽  
Lei Geng ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Influencing Factors ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Total Hip

Abstract Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

scholarly journals High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II–III Developmental Dysplasia: Results of Midterm Follow‐up

2020 ◽  
Vol 12 (4) ◽  
pp. 1245-1252 ◽  
Author(s):  
Junmin Shen ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Yinqiao Du ◽  
Tiejian Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Type Ii ◽  
Total Hip

Wear of XLPE Liner against Zirconium Heads in Cementless Total Hip Arthroplasty for Patients under 40 Years of Age

2017 ◽  
Vol 27 (6) ◽  
pp. 532-536 ◽  
Author(s):  
Motoki Sonohata ◽  
Masaru Kitajima ◽  
Shunsuke Kawano ◽  
Masaaki Mawatari
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Wear ◽  
Japanese Orthopaedic Association ◽  
Young Patients ◽  
Stress Shielding ◽  
Developmental Dysplasia ◽  
Total Hip ◽  
The Mean

Introduction Total hip arthroplasty (THA) in the young is challenging. The purpose of this study was to retrospectively determine the clinical, radiographic, and polyethylene wear rate of relatively young patients. Methods We evaluated the outcome of consecutive patients receiving primary THA who were under 40 years of age with a minimum 10-year follow-up. Indications for THA in these patients were osteoarthritis due to developmental dysplasia of the hip joint (9 hips), osteonecrosis of the femoral head (7 hips), juvenile idiopathic arthritis (2 hips), and osteoarthritis due to Perthes disease (1 hip). All THA were performed with a cross-linked ultra-high-molecular-weight polyethylene (XLPE) liner against zirconium heads with cementless implants. Results The average Japanese Orthopaedic Association hip score significantly improved from 42 to 93 points at the latest follow-up. The mean steady wear was 0.015 mm/year (maximum 0.033 mm/year), and the mean creep wear was 0.111 mm (maximum 0.4 mm). Osteolysis was observed around 1 acetabular component and 2 stems. 1 femoral component had subsidence over 5 mm. All of the femoral components achieved fixation with an optimal interface with spot welds at the latest follow-up. Stress shielding was observed in all hips. Conclusions THA using an XLPE liner against zirconium heads appeared to have improved THA longevity. However, the imaging findings in some cases were suggestive of wear debris. A rigorous continual follow-up is required for relatively young patients undergoing THA.

scholarly journals High Hip Center Technique in Total Hip Arthroplasty for Crowe Type II-III Developmental Dysplasia: Results of Midterm Follow-up

2020 ◽  
Author(s):  
Junmin Shen ◽  
Yonggang Zhou ◽  
Jingyang Sun ◽  
Haiyang Ma ◽  
Yinqiao Du ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Total Hip ◽  
Group A ◽  
Group B ◽  
Dysplasia Of The Hip

Abstract Background: High hip center technique is still controversial about the survivorship of prothesis and postoperative complications. We aimed to show the utility of high hip center technique used in patients with Crowe II-III developmental dysplasia of the hip at the midterm follow-up and evaluated the clinical and radiographic results between different heights of hip center.Methods: We retrospectively evaluated 69 patients (85 hips) with Crowe II-III dysplasia who underwent a high hip center cementless total hip arthroplasty at a mean follow up of 8.9 years (range, 6.0-14.1years). The patients were divided into two groups according to the height of hip center, respectively group A (≥22mm and <28mm) and group B (≥28mm). Radiographic, functional and survivorship outcomes were evaluated.Results: There were no statistically significant differences between two groups in horizontal distance, offset, abductor lever arm, leg length discrepancy and cup inclination. At the final follow up, the mean WOMAC and Harris hip score were significantly improved in both groups. Of the 85 hips, 7 hips (8.2%) showed a positive Trendelenburg sign. Besides, 6 patients (8.7%) presented with a limp. No significant differences were shown regarding the Harris hip score, WOMAC score, Trendelenburg sign and limp between two groups. The Kaplan-Meier implants survivorship rates at the final follow-up for all-causes revisions in group A and group B were similar (96.7% [95% confidence interval, 90.5%-100%] and 96.2% [95% confidence interval, 89.0%-100%], respectively).Conclusions: The high hip center technique is a valuable alternative to achieve excellent midterm results for Crowe II-III developmental dysplasia of the hip.

scholarly journals Heterotopic ossification in primary total hip arthroplasty using the posterolateral compared to the direct lateral approach

2021 ◽  
Author(s):  
J. H. J. van Erp ◽  
J. R. A. Massier ◽  
S. Truijen ◽  
J. E. J. Bekkers ◽  
T. E. Snijders ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Rating Scale ◽  
Lateral Approach ◽  
Posterolateral Approach ◽  
Harris Hip Score ◽  
Total Hip ◽  
Direct Lateral Approach

Abstract Purpose Total hip arthroplasty (THA) is a successful procedure. However, in time, heterotopic ossification (HO) can form due to, amongst others, soft tissue damage. This can lead to pain and impairment. This study compares the formations of HO between patients who underwent either THA with the posterolateral approach (PA) or with the direct lateral approach (DLA). Our hypothesis is that patients who underwent THA with a PA form less HO compared to THA patients who underwent DLA. Methods In this prospective cohort study, 296 consecutive patients were included who underwent THA. A total of 127 patients underwent THA with the PA and 169 with the DLA. This was dependent on the surgeon’s preference and experience. More than 95% of patients had primary osteoarthritis as the primary diagnosis. Clinical outcomes were scored using the Numeric Rating Scale (NRS) and Harris Hip Score (HHS), radiological HO were scored using the Brooker classification. Follow-up was performed at 1 and 6 years postoperatively. Results Two hundred and fifty-eight patients (87%) completed the 6-year follow-up. HO formation occurred more in patients who underwent DLA, compared to PA (43(30%) vs. 21(18%), p = 0.024) after 6 years. However, the presence of severe HO (Brooker 3–4) was equal between the DLA and PA (7 vs. 5,p = 0.551). After 6 years the HHS and NRS for patient satisfaction were statistically significant higher after the PA (95.2 and 8.9, respectively) compared to the DLA (91.6 and 8.5, respectively) (p < 0.001 and p = 0.003, respectively). The NRS for load pain was statistically significant lower in the PA group (0.5) compared to the DLA group (1.2) (p = 0.004). The NRS for rest pain was equal: 0.3 in the PA group and 0.5 in the DLA group. Conclusion THA with the PA causes less HO formation than the DLA. Trial registration Registrated as HipVit trial, NL 32832.100.10, R-10.17D/HIPVIT 1. Central Commission Human-Related research (CCMO) Registry.

scholarly journals Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip

2021 ◽  
Author(s):  
Dominik Kaiser ◽  
Emanuel Ried ◽  
Patrick O. Zingg ◽  
Stefan Rahm
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Developmental Dysplasia ◽  
Acetabular Reconstruction ◽  
Secondary Osteoarthritis ◽  
Total Hip

Abstract Background Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. Methods A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. Results 24 patients (29 hips) with a mean age of 43 (18–75) years and a mean follow-up of 35 months (12–137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0–23) and significantly medialized by a mean of 18 mm (6–29). The bone graft was fully integrated after 12 months in all cases. Conclusion Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.

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