Eleven Year Results of Total Hip Arthroplasty in Patients with Secondary Osteoarthritis Due to Slipped Capital Femoral Epiphysis

Background: Total hip arthroplasty (THA) in patients with a history of Slipped Capital Femoral Epiphysis (SCFE), is typically indicated to address the consequent deformity of the proximal femur and/or acetabulum. It can be a challenging procedure for the orthopaedic surgeon. Previous studies have focused on prevention of osteoarthritis post-SCFE. However, there is a paucity of data on the outcomes of total hip arthroplasty in patients with osteoarthritis secondary to SCFE. This study was performed to assess the mid-term results of total hip arthroplasty in this patient cohort. Materials and Methods: All patients with secondary osteoarthritis due to slipped capital femoral epiphysis, treated with total hip arthroplasty between 1987 and 2005, were included in this retrospective study (n=30). Thirty patients (17 male, 13 female) met the inclusion criteria with one patient lost to follow-up and one unrelated death one year before follow up examination, thereby leaving 28 patients (32 hips) eligible for the study with a mean follow-up time period of 11.2 years. The Harris Hip Score (HHS) and MOS 36 short form health survey (SF36) were determined preoperatively and at most recent follow-up for all patients. Complications were also noted for all cases. Results: The mean Harris Hip Score increased significantly from 47 (32-59; SD=8.3) to 92.3 (65-100; SD=8.2) (p<0.0001). The SF-36 health survey showed an improvement of quality-of-life in all sub-scales. Overall, revision surgery was required in six cases (19 %). Aseptic loosening, leading to implant removal, was noted in five cases. A single-stage revision to address infection was performed in one case. The cumulative survival rate at latest follow-up was 81 %. No other complications were encountered during the study. Conclusions: Despite a higher failure rate, compared to total hip arthroplasty in the treatment of primary osteoarthritis, total hip arthroplasty can be considered a feasible option for patients with secondary osteoarthritis of the hip due to slipped capital femoral epiphysis. The current study demonstrates good outcomes in patients treated with a cementless column-preserving prosthesis, which is of particular relevance for this young patient cohort. However, further clinical prospective randomized studies are warranted to provide more definitive evidence.

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Total hip arthroplasty after hip joint gunshot injury

Journal of Orthopaedic Surgery ◽

10.1177/2309499019873113 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901987311 ◽

Cited By ~ 2

Author(s):

Ozhan Pazarci ◽

Seyran Kilinc ◽

Yalkin Camurcu ◽

Okay Bulut

Keyword(s):

Total Hip Arthroplasty ◽

Hip Joint ◽

Hip Arthroplasty ◽

Short Form ◽

Gunshot Injury ◽

Harris Hip Score ◽

Joint Region ◽

Total Hip ◽

The Mean

Background: Gunshot injury of the hip joint was reported to constitute 2–17% of all extremity firearm injuries. However, there are few studies in the literature related to gunshot injuries of the hip joint. The aim of the current study was to present the results of 10 cases treated with arthroplasty following a gunshot injury to the hip joint together with the recommended treatment algorithm. Methods: Patients with a previous medical history of hip joint region gunshot injury who underwent total hip arthroplasty were retrospectively evaluated. Those with incomplete medical records or who were lost to follow-up were excluded. Patients were classified according to the severity of the previous gunshot injury to the hip joint region. Harris hip score (HHS) and Short Form-12 quality of life score were the main outcome measurements. Postoperative complications encountered during follow-up were recorded. Results: The mean age of the patients at the time of surgery was 29.9 years. The mean preoperative HHS was 25.2 points and it was 65.8 at the final follow-up. Patients with bullet fragments in the hip joint, classified as group 1, had better HHS, whereas those with contaminated hip joint with intestinal flora, classified as group 3, had worst HHS. Conclusion: Hip arthroplasty after hip joint gunshot injury is a good treatment choice in young patients to reduce pain and regain functions. However, very high infection rates can be seen in patients with accompanying intestinal injury.

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Ceramic-on-metal bearing in short stem total hip arthroplasty: ions, functional and radiographic evaluation at mid-term follow-up

Hip International ◽

10.1177/1120700020971661 ◽

2020 ◽

Vol 30 (2_suppl) ◽

pp. 52-58

Author(s):

Michela Saracco ◽

Giulio Maccauro ◽

Andrea Urbani ◽

Domenico Ciavardelli ◽

Silvia Persichilli ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Metal Ions ◽

Hip Arthroplasty ◽

Short Form ◽

Hip Osteoarthritis ◽

Short Stem ◽

Harris Hip Score ◽

Radiographic Evaluation ◽

Total Hip

Introduction: The aim of this study is to evaluate clinical, radiographic and laboratory results of ceramic-on-metal (CoM) (hybrid hard bearing) in total hip arthroplasty (THA), associated with a short stem implant. Methods: From a cohort of 37 patients suffering from primary or secondary hip osteoarthritis who underwent THA using CoM bearing, 19 were suitable for this study. All procedures were performed by the same surgeon using a posterior-lateral approach. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12F/M), and radiographically (offset, CD angle, limb length discrepancy, cup inclination and anteversion, subsidence, osseointegration, heterotopic ossification). Blood samples were collected in order to evaluate chromium (Cr) and cobalt (Co) ions level. Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed. Results: At a mean follow-up of 97 (73–125) months all implanted stems were well-positioned and osseointegrated. Clear improvements were observed for clinical scores comparing preoperative and postoperative values. Radiographic evaluation showed a good ability to restore proper articular geometry. Cr ion analysis revealed values below the safety threshold except for 1 case. Serum levels of Co were below the threshold in all patients. There was a statistically significant correlation only between Cr metal ions and length of follow-up. Conclusions: CoM bearing has proven to be reliable and safe at a mean 8-year follow-up for patients in whom the components were correctly implanted. The rise of blood metal ions was minimal and involved neither systemic or local toxicity nor influenced clinical results.

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A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study

Hip International ◽

10.1177/11207000211018440 ◽

2021 ◽

pp. 112070002110184

Author(s):

Andrey A Korytkin ◽

Younes M El Moudni ◽

Yana S Novikova ◽

Kirill A Kovaldov ◽

Ekaterina A Morozova

Keyword(s):

Total Hip Arthroplasty ◽

Gait Analysis ◽

Hip Arthroplasty ◽

Posterior Approach ◽

Gait Velocity ◽

Harris Hip Score ◽

Kinematic Parameters ◽

Gait Patterns ◽

Total Hip

Background: The supercapsular percutaneously-assisted total hip (SuperPATH) approach is a muscle sparing surgical technique for total hip arthroplasty (THA). The literature reports good clinical and functional results of the SuperPATH technique in the short term. We aimed to compare early outcomes and gait analysis of THA using the mini posterior approach (MPA) and supercapsular percutaneously-assisted total hip (SuperPATH) approach. Methods: 44 patients who underwent THA, were randomly allocated to either MPA or SuperPATH. The data were then collected prospectively (preoperatively and postoperatively at 6 weeks). Plain anteroposterior radiographs of the pelvis and instrumental gait analysis were obtained. The visual analogue scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were used to assess functional and clinical outcomes. Results: No significant difference was found in patients’ surgical outcomes. Patients in the SuperPATH group had less pain according to the VAS score at follow-up than the MPA group ( p < 0.01). There was also a significant improvement in HHS and HOOS scores for all patients ( p < 0.001) with the SuperPATH group showing superior changes. The comparison of mean differences in gait velocity between preoperative and 6 weeks postoperative result, revealed improvement in the SuperPATH group over the MPA group ( p = 0.06). Limping was more persistent in the MPA group. Kinematic parameters demonstrated improved hip joint excursion slightly higher in the MPA group. There was no significant improvement in kinetic and kinematic parameters at different walking moments for all patients at 6 weeks compared to preoperative gait patterns. Conclusions: SuperPATH and MPA both show excellent results. This study reveals that the SuperPATH technique was associated with lower postoperative pain levels, and higher physical function and quality of life. Improved functional outcomes allowed earlier postoperative rehabilitation and faster recovery. Specific improvement in gait patterns were identified with nonsignificant differences between the 2 approaches at 6 weeks follow-up.

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Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

Surgical Technology Online ◽

10.52198/21.sti.38.os1336 ◽

2021 ◽

Author(s):

Moritz Sharabianlou ◽

Prerna Arora ◽

Derek Amanatullah

Keyword(s):

Total Hip Arthroplasty ◽

Functional Recovery ◽

Hip Arthroplasty ◽

Case Series ◽

Harris Hip Score ◽

Timed Up And Go ◽

Total Hip ◽

Radiologic Evaluation ◽

Superior Approach

This study aims to establish the midterm safety and performance for the direct superior approach to minimally invasive surgery total hip arthroplasty (MIS-THA). We used a unicentric, single-surgeon, retrospective, consecutive case series analysis of the first 40 patients who received primary unilateral direct superior MIS-THA. Special attention was given to functional recovery by measuring Harris Hip Score (HHS) and timed-up-and-go (TUG) with a mean follow up of 2.2 ± 0.4 years. A radiologic evaluation was performed. HHS and TUG improved significantly at three months and one year (p < 0.001). All components were placed within the Lewinnek safe zone with no change position or signs of loosening at two years. With a minimum of two years of follow up, the direct superior approach appears to be safe without any obvious or consistent postoperative complications—clinically or radiographically—with excellent functional recovery. Additionally, our subgroup analysis supported no late learning curve effect.

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A 10-Year Follow-Up of Two-Incision and Modified Watson-Jones Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head

BioMed Research International ◽

10.1155/2017/8915104 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Shih-Jie Lin ◽

Tsan-Wen Huang ◽

Po-Chun Lin ◽

Feng-Chih Kuo ◽

Kuo-Ti Peng ◽

...

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Large Scale ◽

Operation Time ◽

Harris Hip Score ◽

Total Hip ◽

Radiographic Parameters

Long-term data and information indicating whether minimally invasive surgery (MIS) approaches are safe and effective with total hip arthroplasty (THA) are lacking. Between 2004 and 2006, 75 patients with alcohol-related osteonecrosis of the femoral head (ONFH) who underwent 75 THAs with the two-incision approach were studied. The medical records, radiographic parameters, and functional outcomes were collected prospectively. All data were compared with those for matched patients who underwent a modified Watson-Jones (WJ) approach. THA using the two-incision approach was associated with longer operation time, more blood loss, more lateral femoral cutaneous nerve injury, and more periprosthetic femoral fractures (p<0.05for all four) than the modified WJ approach. The Harris Hip Score (HHS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) increased significantly from the period preoperatively to 6 weeks postoperatively and thereafter up to the last follow-up in both groups. However, there were no significant differences in terms of radiographic parameters and functional outcomes between the two groups throughout the study period. Both the two-incision and the modified WJ approach provided satisfactory results and survival rates at a mean follow-up of 10.8 years. A prospective, randomized, large-scale cohort study is still warranted for evidence-based recommendations.

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Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

Bone & Joint Open ◽

10.1302/2633-1462.212.bjo-2021-0152.r1 ◽

2021 ◽

Vol 2 (12) ◽

pp. 1035-1042

Author(s):

Maciej Okowinski ◽

Mette Holm Hjorth ◽

Sebastian Breddam Mosegaard ◽

Jonathan Hugo Jürgens-Lahnstein ◽

Stig Storgaard Jakobsen ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Femoral Bone ◽

Total Hip ◽

Stem Subsidence ◽

Femur Fractures

Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.

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Study of functional outcome of total hip arthroplasty in a series of cases of hip pathologies done in rural population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163755 ◽

2016 ◽

Vol 2 (4) ◽

pp. 269

Author(s):

Rahul Kadam ◽

Pankaj Bansal ◽

Abhay Chhallani

Keyword(s):

Total Hip Arthroplasty ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Rural Population ◽

Harris Hip Score ◽

Controlled Study ◽

Walking Ability ◽

Total Hip ◽

Medical College

Background: The objective of the study was to assess the functional outcome of total hip arthroplasty (THA) done in a series of cases of hip pathologies rural population.Methods: A retrospective randomized controlled study conducted in 50 cases of hip arthritis (38 males and 12 females) treated with uncemented THA for an average follow-up of 2 years at department of orthopedics MGM Medical College, Kamothe, Navi Mumbai. Harris hip scoring system was used for the functional scoring and the postoperative radiographs were assessed by Gruen zones for the femoral component and DeLee and Charnley zones for the acetabular component. All patients were evaluated pre operatively and post operatively 3 months 6 months, 12months, 2years with Harris Hip score.Results: 81% of our patients scored 85 points or better for a rating of excellent by Harris hip score system. 90% patients had little /no pain post operatively, whereas walking ability improved and was unlimited in 80% of the patients post operatively. Harris hip score improved from 40 to 80. 80.5% -excellent, 13.80% -good, 5.7% -fair results. Poor results were not seen in any patient.Conclusions: THR provided excellent pain relief, adequate stability, and remarkable range of motion in severely painful, refractory hip. A significant improvement was seen at two year follow-up.

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Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up

Hip International ◽

10.1177/1120700018781807 ◽

2018 ◽

Vol 29 (2) ◽

pp. 191-197 ◽

Cited By ~ 2

Author(s):

Pascal C Haefeli ◽

Moritz Tannast ◽

Martin Beck ◽

Klaus A Siebenrock ◽

Lorenz Büchler

Keyword(s):

Los Angeles ◽

Total Hip Arthroplasty ◽

Femoroacetabular Impingement ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Harris Hip Score ◽

Control Group ◽

Total Hip ◽

Tönnis Grade

Introduction: The best treatment of acetabular chondral flaps during surgery for femoroacetabular impingement (FAI) is unknown. We asked if subchondral drilling improves clinical and radiographic outcome and if there are factors predicting failure. Methods: We treated 79 patients with symptomatic FAI and acetabular chondral flaps with surgical hip dislocation between January 2000 and December 2007. Exclusion of all patients with previous hip pathology or trauma resulted in 62 patients (80 hips). The chondral flap was slightly debrided in 43 patients/51 hips (control group). In 28 patients/29 hips (study group), additional osseous drilling was performed. 4 patients (5 hips, 6%) were lost to follow-up. Mean follow-up was 9 years (5–13 years). The groups did not differ in demographic data, radiographic parameters or follow-up. Clinical outcome was assessed with the Merle d’Aubigné score, modified Harris Hip Score and University of California Los Angeles activity score and progression of osteoarthritis with the Tönnis grade. Results: No patient underwent conversion to total hip arthroplasty (THA) in the drilling group compared to 7 patients (8 hips, 16%) in the control group ( p = 0.005); in the remaining hips, clinical scores and progression of Tönnis grade did not differ. Increased acetabular coverage, age and body mass index were univariate predictive factors for conversion to THA. No drilling was as an independent predictive factor for conversion to THA (hazard ratio 58.07, p = 0.009). Conclusion: Subchondral drilling under acetabular chondral flaps during surgical treatment of FAI is an effective procedure to reduce the rate of conversion to THA.

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Midterm outcomes of total hip arthroplasty with a modular Birmingham head

Hip International ◽

10.1177/1120700019877389 ◽

2019 ◽

pp. 112070001987738 ◽

Cited By ~ 1

Author(s):

Duncan W Cushnie ◽

Brent A Lanting ◽

Richard McCalden ◽

Douglas DR Naudie ◽

James L Howard

Keyword(s):

Soft Tissue ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Tissue Reaction ◽

Harris Hip Score ◽

Total Hip ◽

Tissue Reactions ◽

Clinical Records

Introduction: Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). Methods: A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. Results: 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls ( p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. Discussion: BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

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A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design

Joints ◽

10.1055/s-0040-1710388 ◽

2020 ◽

Author(s):

Christian Carulli ◽

Giacomo Sani ◽

Fabrizio Matassi ◽

Roberto Civinini ◽

Massimo Innocenti

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Systemic Complications ◽

Total Hip ◽

Metal On Metal ◽

Long Term Follow Up

Abstract Purrpose Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution. Methods Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's t-test. Results The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups. Conclusion Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up. Level of Evidence This is a therapeutic case series, Level 4 study.

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