Inverted reamer technique for bone grafting of the acetabulum: technical note

Background Socket fixation with bone grafting for dysplastic hips is technically demanding, and inadequate coverage of the socket may cause poor results in patients with severely dysplastic hips. An accurate technique to form a bone graft to fit into the defect is necessary. We aim to introduce the simple method of bone grafting, “inverted reamer technique” in cemented total hip arthroplasty (cTHA). Methods After acetabular preparation with a normal acetabular reamer, the bone graft was prepared from the resected femoral head with the inverted reamer. The graft can be press-fit into the defect of the acetabulum with good compatibility through this method. Then, the bone graft was fixed with 1–3 screws and the socket was implanted with bone cement. Results The “inverted reamer technique” can easily and automatically create a well-fit graft. This method is simple and technically less demanding; it can be performed by every surgeon, including trainee and inexperienced surgeons. Conclusion This method can improve the outcome of cTHA for dysplastic hips by preserving bone stock and increasing bone coverage of the socket implanted in the anatomic position.

Accuracy of Digital Templating for Non-Cemented Total Hip Arthroplasty: A Large Series by a Single Surgeon

IntroductionPreoperative planning for total hip arthroplasty (THA) is an essential step taken to reduce surgical errors and improve patient outcomes. Previously, templating using acetate radiographs proved accurate and beneficial. However, digital templating of digitally acquired radiographs has become more commonplace. The purpose of this study was to quantify accuracy of digital templating for THA’s performed by a single surgeon over a 4-year period and to determine if accuracy improved over time. Materials and Methods491 patients undergoing primary THA from 2013-2017 performed by a single surgeon were retrospectively analyzed. Digital templating was performed using ORTHOVIEW Orthopaedic Digital Templating for CARESTREAM PACS (© 2019 Carestream Health). Digitally templated acetabular and femoral component sizes were compared to actual implanted sizes to determine template percent accuracy. To investigate changes in accuracy over time, THA cases were divided in half and compared. Chi Square and Fisher’s Exact Tests were used to determine statistically significant differences in percent accuracy over time. Results Overall percent accuracy of acetabular and femoral components was 97.4% and 87.2% respectively. When comparing the first and second half, percent accuracy of acetabular and femoral components was 98.4% versus 97.1% (P =0.58) and 89.4% versus 84.9% (P= 0.14) respectively. ConclusionsThis study represents one of the largest retrospective analyses aimed at determining accuracy of digital templating in THA procedures performed by a single surgeon at a single institution. Percent accuracy was consistently high throughout time and deemed an accurate methodology for preoperative planning of cementless THA.

Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: A randomised controlled trial of 50 patients

Background The primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups. Methods A prospective double-blind randomised control trial was conducted. Fifty patients with an intracapsular hip fracture meeting the inclusion criteria were randomised to either an uncemented (n = 25) or cemented (n = 25) THA. There were no differences (p > 0.45) in age, gender, health status or preinjury hip function between the groups. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. These were assessed at 4, 12 and 72 months after surgery, apart from the TUG which as only assessed as 6 months. Results The study was terminated early due to the significantly (n = 8, p = 0.004) higher rate of intraoperative complications in the uncemented group: three fractures of the proximal femur and five conversions to a cemented acetabular component. There were no significant (p ≥ 0.09) differences in the functional measures (OHS, HSS, EQ5D, TUG and pain) or patient satisfaction between the groups. There was no difference in operative time (p = 0.75) or blood loss (p = 0.66) between the groups. There were two early revisions prior to 3 months post-operatively in the uncemented group and none in the cemented group, but this was not significant (log rank p = 0.16). Conclusion There was a high rate of intraoperative complications, which may be due to poor bone quality in this patient group. There were no ergonomic or functional advantages demonstrated between uncemented and cemented THA. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure.

Uncemented versus cemented total hip arthroplasty for displaced femoral neck fractures in elderly patients with osteoporosis: A retrospective analysis

Objective This study was performed assess the clinical outcomes of elderly patients with osteoporotic femoral neck fractures (FNFs) (AO/OTA: 31B/C) treated by initial uncemented total hip arthroplasty (UTA) or cemented total hip arthroplasty (CTA). Methods This study involved consecutive elderly patients with osteoporotic FNFs (AO/OTA: 31B/C) treated by initial UTA or CTA in our medical centre from 2010 to 2015. The primary outcomes were the Harris hip score (HHS) and the rates of revision, loosening, periprosthetic fracture, and dislocation. Results In total, 224 patients were included in the final analysis (UTA, n = 114; CTA, n = 110). The mean follow-up duration was 60 months (range, 32–68 months). The mean HHS was 75.34 ± 18.82 for UTA and 80.12 ± 17.83 for CTA. Significant dissimilarities were detected in the rates of revision, loosening, and periprosthetic fracture between UTA and CTA (14.0% vs. 5.5%, 20.2% vs. 10.0%, and 12.3% vs. 4.5%, respectively). A significant difference was also detected in the probability of revision between the two groups. Conclusion Elderly patients with osteoporotic FNFs (AO/OTA: 31B/C) treated with CTA show greater improvements in functional outcomes and key orthopaedic complications than those treated with UTA.

Problems in the Revision of Failed Moore Prosthesis

Over the years, Moore prosthesis has been described as a good option in the treatment of femoral neck fracture. Its main disadvantages are about femoral fixation and the acetabular erosion. Because of less cost, it still be used improperly and provide a large number of failures. Improper placement of the Moore prosthesis provide biomechanical disturbances of the arthroplasty. The insufficient of residual femoral neck length or the insufficient of metaphyseal fill are associated with the failure of the Moore arthroplasty. The aim of our study is to report and evaluate intraoperative findings and difficulties while we were convert failed aseptic Moore hemiarthroplasty into cemented total hip arthroplasty.