Management of Primary AVN with Total Hip Replacement

Introduction: Avascular necrosis (AVN) of femoral head is a dreadful and disabling condition. Total Hip Replacement (THR) is an effective solution. In this study we have analyzed the results of total hip replacement performed in ShSMCH, Dhaka for AVN of femoral head from July 2018 up to June 2020. Patients and Methods: In this prospective study, 19 total hip replacement were done. All patients were diagnosed as primary AVN of Ficat and Arlet Grade III and IV. Out of 19 patients, 15 patients operated with cementless pressfit implants and 4 patients with cemented implants. Results: Among the 19 patients 12 were male (63.15%) and 7 were female (36.85%). Mean age was 35.57 year. Operation done on right hip in 10 patients (52.63%) and on left hip 9 patients (47.37%). All the patients were evaluated pre-operatively and Harris Hip Score was poor ie, average 41.84. Three months post operatively Harris Hip Score improved significantly 47.36% patients value was 90-100 ie, excellent, 31.57% patients value was 80-90 ie, good and 21.05% patients value was 70-80 ie, fair. None documented as poor. In complication, 1 patient (5.26%) developed serous discharge which resolved with antibiotic treatment after culture and sensitivity. Conclusion: THR is the most effective method of removing pains and distress of end stage AVN of hip. J Shaheed Suhrawardy Med Coll 2020; 12(2): 87-89

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Surgical management of avascular necrosis of femoral head in young adults treated with uncemented total hip replacement

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214183 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1166

Author(s):

Vijaya Bhaskar Reddy ◽

N. Brahma Chary ◽

Kacham Nikitha

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Avascular Necrosis ◽

Total Hip Replacement ◽

Hip Arthroplasty ◽

Hip Replacement ◽

Daily Activities ◽

Harris Hip Score ◽

Total Hip ◽

Uncemented Total Hip Replacement

Background: Normal hip joint is subjected to many stresses during daily activities performed by an individual. Since it is one of the major weight bearing joints of the body, its normal function is necessary for daily activities. Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Core decompression, fibular sturt graft can be considered in early stages, total hip arthroplasty in later stages of AVN of femoral head.Methods: This is a retrospective study of 30 patients following uncemented total hip replacement, who were operated between August 2017 and March 2020 at MNR medical college and hospital, Sangareddy. They were followed up for a minimum period of 1 year and evaluated using Harris hip scoring system. Harris hip score is designed specifically for measuring functional outcomes in hip arthroplasty.Results: There was a significant improvement in function as measured with the Harris hip score. The overall preoperative Harris hip score was 43, which remarkably improved to 89 postoperatively. The results observed, showed that all patients had good to excellent results, (Harris hip score ≥0) thus showing a good degree of pain relief, improvement in function and range of motion.Conclusions: Although the use of total hip arthroplasty in young patients will more likely necessitate future revision surgery, the consistent relief of pain and good functional results have made this procedure an attractive treatment choice for the debilitating arthritis resulting from osteonecrosis of the femoral head.

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Primary Total Hip Replacement in a Case of Unilateral Hypo Plastic Proximal Femur – A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i04.2148 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Neetin P Mahajan ◽

Lalkar Laxman Gadod ◽

Ajay S Chandanwale ◽

Prasanna Kumar G S ◽

Mrugank Narvekar ◽

...

Keyword(s):

Case Report ◽

Femoral Head ◽

Septic Arthritis ◽

Total Hip Replacement ◽

Proximal Femur ◽

Hip Replacement ◽

Weight Bearing ◽

Harris Hip Score ◽

Femoral Canal ◽

Total Hip

Introduction: Primary total hip replacement in hypo plastic proximal femur is difficult due to the presence of a small canal, soft- tissue contracture, fragility of bone, and poor femoral cement mantle when used. Intraoperatively, there could be occurrence of fracture of the femur, inadequate fit, and fill with cement less femoral component. It is found unilaterally in cases of osteonecrosis of femoral head, post- traumatic, and in sequelae of childhood septic arthritis. Case Report: A 45-year- old male patient presented to the OPD with complaints of pain in the left hip and difficulty in walking since for 4 years. The patient had a history of fever and swelling over the left hip in childhood with no treatment taken for the same. X-ray of pelvis with both hips showed deformed femoral head, short neck, narrow femoral canal (Grade 1 Dorr), and arthritic changes in acetabulum. We managed with total hip replacement using Wagner cone stem. Postoperatively, the patient is having good range of motion and having no difficulty in walking and weight- bearing. Functional outcome is good as per Harris hip score. Conclusion: Total hip replacement in hypo plastic femur with arthritis is always a challenging problem. It requires surgical expertise and proper implant selection and pre-operative planning, which prevents intraoperative and post-operative complications. Wagner cone stem is a very good option in managing this type of patients. Keywords: Unilateral hypo plastic proximal femur, childhood septic arthritis, narrow femoral canal (Grade 1 Dorr), total hip replacement, Wagner cone stem.

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Management and Outcome of Patients With Femoral Head Fractures: Injuries and Associated Prognostic Factors

10.21203/rs.3.rs-141488/v1 ◽

2021 ◽

Author(s):

Sujan Shakya ◽

Jialei Chen ◽

JiaChen Sun ◽

Zhou Xiang

Keyword(s):

Femoral Head ◽

Total Hip Replacement ◽

Hip Replacement ◽

Functional Outcomes ◽

Fixation Method ◽

Harris Hip Score ◽

Femoral Head Fracture ◽

Total Hip ◽

Surgical Methods ◽

Modified Harris Hip Score

Abstract Objective: Femoral head fractures are rare injuries that are often associated with poor functional outcome and complications. Fracture management and surgical methods for these fractures are variable. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications and functional outcomes of femoral head fractures.Methods: We conducted a retrospective review of fifty patients who sustained femoral head fractures from January 2011- December 2018. There were thirty-seven males and thirteen females with median age of 40 years. A surgical approach and fixation method were recorded. Patients were classified according to the Pipkin Classification system. Clinical results were evaluated for patients with two years or greater follow-up using the Modified Harris Hip Score (MHHS). Results: Eight patients (16%) were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, 5 (10%) patients required immediate Total Hip Replacement (THR). Six (12%) developed AVN, four (8%) requiring secondary total hip replacement (THR). Sixteen patients (33%) developed PTA, eight (16%) developed HO and six patients (12 %) had sciatic nerve injury, none requiring operative treatment. Overall functional results, according to modified Harris hip score were excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. Conclusion: Femoral head fracture are a rare injury that are often associated with poor outcome. In this study we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on Pipkin classification. This study, adds to the growing literature on femoral head fractures and provide reference for the clinical treatment to guide patient management.

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Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study

Journal of International Medical Research ◽

10.1177/03000605211012210 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110122

Author(s):

Wenlu Liu ◽

Huanyi Lin ◽

Xianshang Zeng ◽

Meiji Chen ◽

Weiwei Tang ◽

...

Keyword(s):

Femoral Neck ◽

Clinical Outcomes ◽

Total Hip Replacement ◽

Hip Replacement ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Total Hip ◽

Metal On Metal

Objective To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). Methods Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. Results The mean follow-up was 84.12 (67–100) months for UTR and 84.23 (66–101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). Conclusion In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.

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Total Hip Replacement after Failed Femoral Head and Neck Excision in Two Dogs and Two Cats

Veterinary Surgery ◽

10.1111/j.1532-950x.2011.00940.x ◽

2012 ◽

Vol 41 (1) ◽

pp. 136-142 ◽

Cited By ~ 12

Author(s):

Noel Fitzpatrick ◽

Laura Pratola ◽

Russell Yeadon ◽

Christos Nikolaou ◽

Michael Hamilton ◽

...

Keyword(s):

Femoral Head ◽

Head And Neck ◽

Total Hip Replacement ◽

Hip Replacement ◽

Total Hip

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SHALL IT BE BETTER, AS AN APPROACH FOR THR, POSTERIORLY OR LATERALLY; A CLINICO-FUNCTIONAL AND GAIT ANALYTICAL OUTCOME ANALYSIS, IN A PROSPECTIVE STUDY, IN THE SOUTH-INDIAN POPULATION.

10.36106/7014294 ◽

2021 ◽

pp. 71-75

Author(s):

Arun Kumar C ◽

Ganashree S ◽

Arivoli S ◽

Aswath C A ◽

Rakesh Kumar B ◽

...

Keyword(s):

Prospective Study ◽

Total Hip Replacement ◽

Hip Replacement ◽

Posterior Approach ◽

Lateral Approach ◽

Harris Hip Score ◽

South Indian Population ◽

Total Hip ◽

South Indian

Introduction: Hip resurfacing arthroplasty (HRA) or Total hip replacement (THR), as it is popularly called, attempts to mollify these basic clinical problems, in patients with a hip arthritic problem, which may be of a sequela to age-related degeneration, osteonecrosis, systemic disorder like Rheumatoid arthritis (RA) or Ankylosing spondylosis (AS) or as a result of trauma and or an old infection. The basic pathology, is an unfavourable and abrading hip diarthrodial joint. The endeavour of the study was, to establish the efcacy of the Posterior vs Lateral approach for THA/THR, by studying their outcomes in primary THR. This prospective study was undertaken at Che Materials And Methods: ttinad Hospital and Research Institute (CARE), Kelambakkam, Chengalpattu district, Tamilnadu, In the Department of Orthopaedics from Jan 2017 to Dec 2020 (48 months). The Functional outcome of hip surgery was measured using the Harris Hip Score, Oxford hip score and the WOMAC. Rivermead visual gait analysis (RVGA) method was used post-operatively to assess the gait. The Biomechanical outcomes of Abductor Gait Component, were individually assessed by EMG studies. The Harris Hip Score, The Oxford Hip S Results: core and WOMAC score, when the lateral approach was compared to the posterior approach pre-op and post-op in the 12 months minimum follow-up period, the laterally approached group faired better. The VAS score was equivocal. The comprehensive RVGA assessment also showed marginally better results for the laterally approached group as was the case with the Trendelenburg test score. The EMG studies for the Gluteus Maximus, Medius and the lateral rotators of hip also favoured the outcomes for the laterally approach hips. The supremacy of the Lateral Approach, ove Conclusion: r Posterior Approach, cannot be adjudged in a short-term follow-up study. It is thus opined that the Lateral Approach may be statistically and data wise superior, but the patient satisfaction, which is a major factor, is almost the same in both the approach groups. The follow-up needs to be atleast for a decade for us to be able to come to any meaningful conclusion. With regards to surgery like the Total hip replacement, which have a longevity factor exceeding 10 years, studies have to be followed up for periods in excess of 10 years.

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Feasibility study of hybrid or cemented implants for total hip replacement

http://isrctn.com/ ◽

10.1186/isrctn11097021 ◽

2021 ◽

Author(s):

Tony Coffey

Keyword(s):

Total Hip Replacement ◽

Feasibility Study ◽

Hip Replacement ◽

Total Hip ◽

Cemented Implants

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A study to assess functional outcome of cemented and uncemented total hip replacement in a tertiary care center

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193679 ◽

2019 ◽

Vol 5 (5) ◽

pp. 828

Author(s):

Kunal Ajitkumar Shah ◽

Mohan Madhav Desai

Keyword(s):

Functional Outcome ◽

Total Hip Replacement ◽

Hip Replacement ◽

Cost Effective ◽

Harris Hip Score ◽

Total Hip ◽

Vas Score ◽

Group A ◽

The Difference ◽

Group B

Background: Total hip replacement (THR) is the most successful and cost effective treatment with aim of pain relief and functional rehabilitation for hip disorders. As the implant designs of THR have evolved over time, the functional outcome and survivorship has improved. Even after so many advancements, it remains unclear that which implants are better, uncemented or cemented. Hence, we took up this study to analyze which of the uncemented or cemented THR have better functional outcome.Methods: This was a longitudinal study conducted during 2014 to 2018. Hundred cases were randomized into groups of 50 each. All patients with age between 55-80 years in whom THR was indicated were included in the study. Uncemented THR was done in Group A and cemented THR was done in Group B. Patients were followed up at 12 weeks, 6 months, 12 months, and 3 years. At follow-up, functional examination in terms of visual analogue scale (VAS) score and Harris hip score (HHS) was done.Results: The mean age of patients in Group A (uncemented) and Group B (cemented) was 62.5 years and 60 years respectively. We found that the difference of VAS score and HHS between Group A and B was statistically significant at 12 weeks and 6 months. The difference of VAS and HHS scores between Group A and B at 12 months and 3 years was not significant.Conclusions: We conclude that cemented THR has better functional outcome at short term. They are cost effective option at age ≥55-60 years.

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Gait Analysis after Unilateral Total Hip Replacement Surgery

Al-Nahrain Journal for Engineering Sciences ◽

10.29194/njes.21040458 ◽

2018 ◽

Vol 21 (4) ◽

pp. 458-466

Author(s):

Sadiq J. Hamandi ◽

Marwa Azzawi ◽

Waleed Abdulwahed

Keyword(s):

Pain Relief ◽

Gait Analysis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Reaction Force ◽

Harris Hip Score ◽

Gait Dynamics ◽

Total Hip ◽

Normal Ranges ◽

Gait Parameters

Total hip replacement (THR) is an elective surgical procedure with the primary indication being pain relief. The aim of this study is to analyze gait dynamics for patients after they underwent a unilateral THR surgery and compare it with normal parameters. To investigate the gait dynamics a gait analysis was performed on five patients after they underwent a unilateral THR surgery; only two of them were examined before the surgery. The gait analysis was performed using a digital video camera with two force plates. Kinematics data were obtained from 2D trajectories of seven passive markers using SkillSpector software. MATLAB software has been used for inverse dynamics computation. General gait parameters, Harris Hip Score, joints’ angles, forces, moments and powers were obtained during gait cycle. It was found that the average of improvement in Harris Hip Score (for four patients who were examined 1.5, 2.5, 3 and 9 months after surgery) is 61.8 points, which is an indication of pain relief. In the other hand, the general gait parameters were found slightly lower than normal after THR surgery. The average hip reaction force was found to be 2.988 N/BW, which is within normal range. Also, the average of maximum hip extension and maximum hip flexion angles were found to be 25.69 and -13.524 degree respectively, which both are within normal ranges. Furthermore, hip, knee and ankle moments and powers results showed some abnormality. Therefore as a conclusion, patient satisfaction and functional improvement are not related to general gait parameter. And it is not unusual that gait mechanics improvement would not reach normal after months of recovery. Also, the results of gait dynamics which are from the engineer’s perspective are compatible with Harris Hip Score, which is from the physician’s perspective, in quantifying surgical results and subsequent recovery progress.

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Malunion of the Acetabulum Treated by Intra-articular Buttress

Case Reports in Orthopedics ◽

10.1155/2020/8361690 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

D. Saragaglia ◽

J. Gaillot

Keyword(s):

Femoral Head ◽

Total Hip Replacement ◽

Clinical Result ◽

Hip Replacement ◽

Surgical Indications ◽

Total Hip ◽

Original Technique ◽

Head Fragment

Acetabulum malunions are extremely difficult to treat, and for many years, surgical indications have been dominated by total hip replacement. We treated a protruding acetabular malunion, 20 years ago, using an intra-articular buttress, by means of an allograft corresponding to a femoral head fragment which had been cryopreserved. The radiological and clinical result with this extended follow-up is quite remarkable, which has motivated us to present this original technique.

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