scholarly journals Excellent Mid-Term Results of a New Polished Tapered Modular Cemented Stem: A Study of 113 Hip Replacements with Minimum 5-Year Follow-Up

2017 ◽  
Vol 27 (5) ◽  
pp. 455-459 ◽  
Author(s):  
Jens Vanbiervliet ◽  
Jan F.A. Somers

Background This prospective cohort study reports the medium-term clinical and radiographic results of 113 hips treated with a hybrid total hip replacement (THR) with a new cemented tapered cobalt-chrome (Co-Cr) stem with a titanium (Ti) modular neck (ProfemurXm®). Method Between October 2008 and December 2010 we performed 115 consecutive hybrid THR with the ProfemurXm® in 105 patients. Results Survivorship of the implant (stem and modular neck) at a mean of 6.5 years (min 5-max 8) was 100% with the endpoint revision for any reason. No implant was at risk for revision or showed signs of loosening. The mean Harris Hip Score was 89/100, mean Oxford Hip Score was 43/48, mean WOMAC was 91/100. No patient had thigh pain, no patient reported squeaking. There were no dislocations in this cohort. No implant showed development of radiolucent lines (RLL), either at the stem-cement or cement-bone interface. No hip showed osteolysis or calcar resorption. The mean femoral subsidence of the stem within the cement mantel was 0.31 mm (range 0-0.6 mm) after 6.5 years. With the use of this modular stem, 93% of hips showed no measurable leg length difference after THR, and leg length could be restored within a 5-mm limit in 99% of hips. Conclusions The mid-term results of this new polished stem were excellent, without adverse effects from the use of modularity.


2019 ◽  
Vol 48 (6) ◽  
pp. 1526-1534
Author(s):  
Sarah L. Chen ◽  
David R. Maldonado ◽  
Cammille C. Go ◽  
Cynthia Kyin ◽  
Ajay C. Lall ◽  
...  

Background: There is a plethora of literature on outcomes after hip arthroscopic surgery in the adult population; however, outcomes in the adolescent population have not been as widely reported. Additionally, as adolescents represent a very active population, it is imperative to understand their athletic activity and return to sport after hip arthroscopic surgery. Purpose: To analyze patient-reported outcomes (PROs) after hip arthroscopic surgery in adolescents (aged 10-19 years) and present a return-to-sport analysis in the athletic adolescent subgroup. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, Embase, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify articles that reported PROs after hip arthroscopic surgery in adolescents. The standardized mean difference was calculated to compare the effect size of hip arthroscopic surgery on various PROs. For the athletic subgroup, a return-to-sport summary was also provided. Results: Ten studies, with 618 adolescent hips and a collective study period of December 2004 to February 2015, were included in this systematic review. Across all studies, the mean age was 15.8 years (range, 11.0-19.9 years), and female patients composed approximately 56.7% of the entire cohort. The mean follow-up was 34.5 months (range, 12-120 months). The modified Harris Hip Score (mHHS) was reported in 9 studies, and at latest follow-up, scores were excellent in 4 studies (range, 90-95) and good in the remaining 5 studies (range, 82.1-89.6). All adolescents also showed significant improvement on the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL), the HOS–Sport-Specific Subscale (HOS-SSS), the physical component of the 12-Item Short Form Health Survey (SF-12P), a visual analog scale for pain (VAS), and both versions of the International Hip Outcome Tool (iHOT-12 and iHOT-33) at latest follow-up ( P < .05). Further, mean improvements reported in all studies surpassed reported values of the minimal clinically important difference and patient acceptable symptomatic state for the mHHS, HOS-ADL, HOS-SSS, and iHOT-33. Finally, the collective return-to-sport rate among athletic adolescents was 84.9%. Conclusion: In the setting of labral tears and femoroacetabular impingement, hip arthroscopic surgery can safely be performed in adolescents and leads to significant functional improvement. Furthermore, athletic adolescents return to sport at high levels after hip arthroscopic surgery.



2021 ◽  
pp. 036354652110469
Author(s):  
Benjamin R. Saks ◽  
Vivian W. Ouyang ◽  
Elijah S. Domb ◽  
Andrew E. Jimenez ◽  
David R. Maldonado ◽  
...  

Background: Access to quality health care and treatment outcomes can be affected by patients’ socioeconomic status (SES). Purpose: To evaluate the effect of patient SES on patient-reported outcome measures (PROMs) after arthroscopic hip surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic, radiographic, and intraoperative data were prospectively collected and retrospectively reviewed on all patients who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear between February 2008 and September 2017 at one institution. Patients were divided into 4 cohorts based on the Social Deprivation Index (SDI) of their zip code. SDI is a composite measure that quantifies the level of disadvantage in certain geographical areas. Patients had a minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool—12, and visual analog scale (VAS) for both pain and satisfaction. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for the mHHS, NAHS, and VAS pain score. Rates of secondary surgery were also recorded. Results: A total of 680 hips (616 patients) were included. The mean follow-up time for the entire cohort was 30.25 months. Division of the cohort into quartiles based on the SDI national averages yielded 254 hips (37.4%) in group 1, 184 (27.1%) in group 2, 148 (21.8%) in group 3, and 94 (13.8%) in group 4. Group 1 contained the most affluent patients. There were significantly more men in group 4 than in group 2, and the mean body mass index was greater in group 4 than in groups 1 and 2. There were no differences in preoperative radiographic measurements, intraoperative findings, or rates of concomitant procedures performed. All preoperative and postoperative PROMs were similar between the groups, as well as in the rates of achieving the MCID or PASS. No differences in the rate of secondary surgeries were reported. Conclusion: Regardless of SES, patients were able to achieve significant improvements in several PROMs after hip arthroscopy for FAIS and labral tear at the minimum 2-year follow-up. Additionally, patients from all SES groups achieved clinically meaningful improvement at similar rates.



2021 ◽  
Author(s):  
Zhe-Yu Huang ◽  
Jing Ling ◽  
Zhi-Min Zeng ◽  
Zheng-Lin Di ◽  
Jun-Hui Zhang ◽  
...  

Abstract Background Performing total hip arthroplasty (THA) in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging. Subtrochanteric shortening osteotomy is typically required for placing the acetabular component within the anatomic hip center. However, the outcomes of subtrochanteric osteotomy using cemented components are not widely reported. This study aimed to evaluate the outcomes of cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH.Methods We retrospectively evaluated data of patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018. Patients who underwent surgery at the hip joint were excluded. Data regarding pre- and postoperative clinical and radiological parameters were collected and reviewed.Results Among 14 patients included (14 hips), the mean age was 60.4 (range, 47–73) years. The mean Harris hip score improved from 40.7 to 87.7. The mean limb length discrepancy reduced from 52 mm to 12.7 mm. No neurologic deficits were noted. The mean osteotomy union time was 10.6 months. Delayed union and postoperative dislocation were observed in one and two patients, respectively. Cement leakage into the osteotomy gap was observed in one patient. No revisions were required. No signs of loosening or migration were observed. Conclusions Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective for the treatment of patients with Crowe IV DDH. The cemented femoral component showed promising mid-term follow up results. However, cement leakage affects bone healing. Osteotomy and cementing should be performed meticulously.Trial Registration: Retrospectively registered



2019 ◽  
Vol 47 (9) ◽  
pp. 2029-2037 ◽  
Author(s):  
Hirotaka Nakashima ◽  
Manabu Tsukamoto ◽  
Yasuo Ohnishi ◽  
Hajime Utsunomiya ◽  
Shiho Kanezaki ◽  
...  

Background:The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established.Purpose:To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI.Study Design:Case-control study; Level of evidence, 3.Methods:Patients were included who underwent primary hip arthroscopic treatment for FAI between March 2009 and March 2014. Patients were excluded who had <2-year follow-up, underwent bilateral surgery, or had a history of surgery, osteoarthritis (Tönnis grade 2 or 3), and other diagnoses, including lateral center-edge angle <25° diagnosed as developmental hip dysplasia. Patients were divided into 2 groups according to their labral condition: reconstruction and refixation. Unsalvageable labral tear was defined as any irreparable labral tear, including severe degenerative tear, frayed labrum, labral ossification, flattened labrum, and failed prior repair during surgery. Univariate and multivariate analyses identified risk factors for segmental labral reconstruction. Patient-reported outcome scores and postoperative revision rates were also assessed.Results:Twenty-five hips (18 male, 7 female) and 126 hips (65 male, 61 female) were included in the reconstruction and refixation groups, respectively. The mean ± SD ages were 52.6 ± 15.0 and 36.5 ± 16.1 years in the reconstruction and refixation groups, respectively. In the reconstruction group, the mean modified Harris Hip Score significantly improved from 67.3 ± 14.9 preoperatively to 95.0 ± 8.1 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 63.0 ± 18.3 preoperatively to 89.5 ± 10.1 at final follow-up ( P < .001). In the refixation group, the mean modified Harris Hip Score significantly improved from 69.2 ± 18.6 preoperatively to 93.0 ± 11.2 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 60.7 ± 18.8 preoperatively to 88.6 ± 15.0 at final follow-up ( P < .001). No significant difference was noted in patient-reported outcome scores and revision hip arthroscopy rates. The rate of conversion of total hip arthroplasty was higher in the reconstruction group than in the refixation group. Risk factors for unsalvageable labral tear were age ≥45 years (odds ratio [OR], 8.83; P < .007), body mass index ≥23.1 kg/m2(OR, 13.05; P < .001), and vertical center anterior angle ≥36° (OR, 19.03; P < .001). Furthermore, in this study, unsalvageable labral tears were present in cases with at least 2 of the 3 risk factors.Conclusion:Age ≥45 years, body mass index ≥23.1 kg/m2, and vertical center anterior angle ≥36° are risk factors for unsalvageable labral tear at initial hip arthroscopic surgery for patients with FAI.



2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 73-77
Author(s):  
Loris Perticarini ◽  
Mario Mosconi ◽  
Marta Medetti ◽  
Laura Caliogna ◽  
Francesco M Benazzo

Background: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36’) in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. Aim: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. Methods: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17–94; standard deviation [SD] 21.9) years. Results: The mean body mass index of the patients was 24.6 (17–34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8–40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35–58) preoperatively to 87 (range 75–94). Leg length discrepancy was found in 10% of cases but never >1 cm. Conclusions: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.



2007 ◽  
Vol 15 (2) ◽  
pp. 163-166 ◽  
Author(s):  
SH Zaki ◽  
S Sadiq ◽  
B Purbach ◽  
BM Wroblewski

Purpose. To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. Methods. 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. Results. Patients were followed up for a mean of 14 (range, 8–18) years. The mean Harris hip score improved from 29 (range, 5–40) to 78 (range, 56–88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6–14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. Conclusion. Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.



2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093507
Author(s):  
David R. Maldonado ◽  
Sarah L. Chen ◽  
Jeffery W. Chen ◽  
Jacob Shapira ◽  
Philip J. Rosinksy ◽  
...  

Background: Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration. Purpose: To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers’ compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported. Results: A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found ( P < .001 for all). A significant decrease was shown for VAS scores ( P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients. Conclusion: In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option.



Author(s):  
Junfeng Zhu ◽  
Kangming Chen ◽  
Jianping Peng ◽  
Yang Li ◽  
Chao Shen ◽  
...  

Abstract In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.



2018 ◽  
Vol 28 (6) ◽  
pp. 649-656 ◽  
Author(s):  
Benjamin G Domb ◽  
Danil Rybalko ◽  
Brian Mu ◽  
Jody Litrenta ◽  
Austin W Chen ◽  
...  

Introduction: There is a paucity in the literature regarding mid-term results of microfracture in hip arthroscopy. We aim to assess 5-year outcomes of patients who underwent acetabular microfracture for full-thickness chondral lesions as a part of hip arthroscopy. Methods: Between August 2008 and September 2011, data were prospectively gathered for patients undergoing acetabular microfracture during hip arthroscopy with minimum 5-year follow-up. All patients were assessed pre- and postoperatively, with modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS). International Hip Outcome Tool (iHOT-12) and satisfaction were collected postoperatively. Exclusion criteria included previous hip conditions, or preoperative Tönnis grade ≥2. Results: Fifty three hips were eligible for this study. Of these, 43 (81.1%) hips in 42 patients had follow-up. The study group had a male majority (65.1%) and an average age of 44.4 ± 9.5 years. There was statistically significant improvement in all patient-reported outcomes (PROs) and VAS at follow-up. Patient satisfaction was 7.6 ± 2.6. A comparison of 2-year to minimum 5-year follow-up results identified no statistically significant deterioration in PROs, VAS, and patient satisfaction. Survivorship was 72.1% with 12 patients converted to total hip arthroplasty (THA). 4 patients (10.8%) underwent secondary arthroscopy. Conclusions: In the mid-term, microfracture as a part of hip arthroscopy demonstrated favourable outcomes and 72% survivorship. Careful patient selection is warranted to limit the risk of conversion to THA.



2019 ◽  
Vol 6 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Ran Atzmon ◽  
Zachary T Sharfman ◽  
Barak Haviv ◽  
Michal Frankl ◽  
Gilad Rotem ◽  
...  

Abstract Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon’s preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, P = 0.898; post-operative HOS: 85.4 and 87.2, P = 0.718; pre-operative MHHS: 63.2 and 58.4, P = 0.223; post-operative MHHS: 85.7 and 88.7, P = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; P = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear.



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