HIP International最新文献

Background: The anterior femoral cortical window is an attractive alternative to the extended trochanteric osteotomy when removing femoral cement in revision hip arthroplasty. CT-based additive manufacturing technology has now permitted the creation of patient-specific instrumented (PSI) jigs to facilitate this. The jig simplifies creation of the window, potentiating medullary exposure through an optimally-sized window and therefore cement removal. Between 2006 and 2021 this technique was used in 22 cases at a regional hospital in New Zealand (mean age 74; range 44 to 89 years). 16 cases were for aseptic loosening and 6 for infection. We describe the technique and our case series. Bone incorporation for the cortical window was assessed in all cases using CT imaging. Oxford scores were obtained at a minimum of 6 months after revision surgery. Of the 6 septic cases 5 went onto successful stage-2 procedures, the other to a Girdlestone procedure.

Results: The mean rectangular shaped window size was 8 × 1.5 cm and in each case, this provided adequate intramedullary access. On average at minimum 5 months post-surgery, 84% bone incorporation of the cortical window occurred on CT (40-100%). The functional outcome Oxford hip score was 37 (range 22-48) for 10 cases. There were 2 cases with femoral component subsidence which then stabilised.

Conclusions: This technique description and retrospective case series has shown the effectiveness of removing a distal femoral cement mantle in revision hip arthroplasty using an anterior femoral cortical window, recently optimised using a PSI jig. This technique is a straightforward alternative to a trochanteric osteotomy. Reliable bony integration of the cortical window occurred and functional outcomes were comparable with the mean score for revision hip procedures reported in the New Zealand Joint Registry.

Introduction: Prior studies have shown human immunodeficiency virus (HIV) may be a risk factor for early revision following THA, but little data exists looking at long-term implant survivorship. Therefore, the purpose of this study was to compare the 10-year cumulative incidence rate for revision following THA in patients with and without HIV.

Methods: A retrospective cohort analysis of patients with HIV undergoing elective THA was conducted using a national database. Patients were stratified into asymptomatic HIV (AHIV) and acquired immune deficiency syndrome (AIDS) cohorts. These patients were propensity-score matched to a group of elective THA patients without HIV based on age, gender, and Charlson Comorbidity Index (CCI) at a 1:2 ratio. Kaplan-Meier and Cox Proportional Hazards Regression Analyses were used to assess cumulative incidence and risk of revisions within 10-years of the index procedure.

Results: In total, 678 patients were at-risk at the 10-year mark. There were no differences in 10-year risk of revision THA, amongst patients with HIV when compared to matched and unmatched controls (p > 0.05 for all). Patients with HIV did have an increased risk of periprosthetic joint infection (PJI) following THA when compared to the unmatched control (p = 0.001).

Discussion: Surgeons and patients can be reassured of comparable 10-year revision rates in patients with and without HIV. However, as these patients are at increased risk for PJI and PPF, especially those with AIDS, when compared to the general population, surgeons should consider PJI prophylactic modalities in this patient population.

Purpose: The aim of the present study was to assess outcomes of using the push-through total femoral prothesis (PTTF) for revision total hip replacement with extreme bone loss.

Methods: 10 consecutive patients who received PTTF between 2012 and 2018 for revision hip arthroplasty were included in the study. Primary functional outcomes were assessed using Harris Hip Score (HHS), Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) scores. Range of motion, complications, and ambulatory status were also recorded to assess secondary outcomes.

Results: 2 of 10 patients underwent surgery with PTTF for both knee and hip arthroplasty revision. The mean time between index surgery and PTTF was 15 years (3-32 yrs). Acetabular components were revised in 6 of 10 patients during PTTF application. After a mean follow-up of 5.9 years, hip dislocations occurred in 3 patients. All of the dislocated hips were ones with retained conventional non-constrained acetabular bearings. Patient satisfaction was high (MSTS: 67%, HHS: 61.2%, TESS 64.6%) despite high re-operation rate (40%) and minor postoperative problems.

Conclusions: PTTF should be considered for hip and knee arthroplasty revision procedures in patients with an extreme bone defect. Consistent usage of constrained liners should be considered to avoid hip dislocation, which was our main problem following the procedure.

Introduction: Bone loss represents a formidable challenge in hip revision surgery. Recent advances in revision implants and the use of new materials have diminished the need for cup-cages in addressing severe acetabular bone loss, which, however, may still be indicated in certain situations. The objectives of this study are to assess survival, functional outcomes, and reasons for the failure of managing severe acetabular bone loss with titanium cages and cemented cup.

Methods: 57 patients treated with an acetabular cage and cemented cup for acetabular revision between January 2014 and July 2018 were retrospectively evaluated. Inclusion criteria comprised cup loosening with bone loss greater than IIB according to Paprosky classification, and a follow-up of at least 60 months.

Results: The average age at the time of surgery was 74.8 years (SD 10.7). The acetabular bone defect according to the Paprosky classification was: type II C in 10 patients (21.7%), type III A in 21 patients (45.7%) and type III B in 15 patients (32.6%). Pelvic discontinuity was present in 35 cases (76.1%). The average follow-up during the final assessment was 78.3 months (SD 14.9). The reoperation rate was 13% (6 patients) and the complications rate was 17.4%. The survivorship of the implant was 87% at final follow-up.At the final follow-up average HHS was 89.4 ± 13.4, average WOMAC 15.7 ± 17.2, average HOOS 81.3 ± 19 and average FJS-12 83.7 ± 17.2. At the final follow-up, 32 patients (80%) showed excellent or good outcomes (HHS >80).

Conclusions: In the presence of severe bone defects, acetabular reconstruction using titanium acetabular cages and cemented UHMWPE cups remains a valid treatment option. Specifically, this acetabular reconstruction system should be favoured for elderly or low-demand patients, with the possibility of using it safely even in patients with pelvic discontinuity.

Introduction: Surgeons allocate an indication(s) for revision surgery on NJR Minimum Data Set forms in the immediate perioperative period, when results from intraoperative histology and microbiology samples are not available. We evaluated to what extent the postoperative diagnostics obtained for patients undergoing metal-on-metal hip arthroplasty (MoMHA) revision surgery align with the indication for revision listed in the NJR.

Methods: NJR data for MoMHA revision patients (2004-2015) at a single centre were linked to hospital records of microbiology and histology testing for prosthetic joint infection (PJI) and adverse reaction to metal debris (ARMD). The Musculoskeletal Infection Society and Mirra classifications were used as "gold standards' to classify PJI and ARMD respectively and to assess the diagnostic accuracy of the clinician selected revision indication recorded on MDS forms.

Results: Of 301 cases, 5.6% (n = 17) and 3.7% (n = 11) were revised for PJI and ARMD respectively. In a further 6.6% (n = 20, PJI) and 15.6% (n = 47, ARMD) the indication for revision selected at the time of surgery did not corroborate with the test results from intraoperative samples. Diagnostic accuracy analysis revealed sensitivity and specificity of indication for surgery at the time of revision for PJI of 35.5% (95% CI, 19.2-54.6) and 97.8% (CI, 54.6-95.2) respectively, and for ARMD of 7.41% (CI, 2.06-17.9) and 97.2% (CI, 94.3-98.9) respectively.

Conclusions: We observed that the results of histology and microbiology analyses of intraoperative samples may provide evidence to support alternative diagnoses in 20% of cases. This indicates a need for a change in the work-up of these cases to allow a more accurate prediction of the indication for revision. Alternatively, if there was evidence of a difference in outcome for patients where the indication may be changed when such data becomes available, the feasibility of a facility to add additional information from samples taken intraoperatively when it becomes available should be explored.

Background: Total hip arthroplasty is one of the most successful and cost-effective interventions for improving quality of life. Dislocation is a well-recognised complication with a significant health and economic burden. The aim of this study was to establish the current management practices for patients presenting with a prosthetic hip dislocation. This was measured through the primary outcome of definitive management, either in the form of revision surgery or the consideration for this through a referral pathway. The secondary outcome measured the number of dislocations per patient resulting in consideration for definitive management.

Methods: Between January and July 2019, 186 patients who sustained a prosthetic hip dislocation were identified from 13 separate institutions. Data were retrospectively collected including patient demographics, co-morbidities, details of the arthroplasty, number of dislocations, and management, both in the acute setting and after discharge.

Results: 149 patients who sustained 200 dislocations were included. The median (interquartile range) interval between primary total hip arthroplasty and first dislocation was 6 (0-13) years. An urgent reduction was achieved either in the emergency department or operating theatre in 3 (1.5%) and 188 (94%) cases, respectively, and 2 (1%) underwent urgent revision. Only 55 patients (36.9%) received definitive management, either in the form of revision surgery or consideration for this. The number of dislocations was the only independent predictor of definitive management (p = 0.001, odds ratio [OR] 1.332; 95% confidence intervals 1.130-1.570).

Conclusions: There is a lack of consensus regarding the definitive management of patients with prosthetic hip dislocation. Our study highlights the need for a standardised pathway for the management of this complication. We aim to expand this study to a national level to propose a data-driven management algorithm for prosthetic hip dislocations.

Background: Whether postoperative posterior pelvic tilt progression is an independent risk factor for cup revision after total hip arthroplasty (THA) with a conventional polyethylene (PE) liner is unclear. This long-term follow-up study assessed the association between posterior pelvic tilt and cup revision after THA using the porous-coated anatomic (PCA) total hip system.

Methods: This retrospective cohort study included 94 patients who underwent THA using the PCA total hip system and participated in postoperative follow-up for a mean of 25 years. The Japanese Orthopaedic Association (JOA) hip score was the clinical outcome, and prosthetic alignment and the change in pelvic tilt were measured as radiological outcomes. Prosthetic survival rates for revision as the endpoint were evaluated, and risk factors for cup revision were identified using a multivariate logistic regression analysis.

Results: The JOA hip score improved significantly (p < 0.001) after THA (before THA: 41 ± 6.3 points; after THA: 86 ± 8.9 points). The postoperative posterior pelvic tilt progressed 3.6 ± 3.2°. Survival rates of the cup and stem at 27 years postoperatively were 60.8% and 87.5%, respectively (p < 0.001). The main reason for revision (81% of all revisions) was aseptic loosening. Postoperative posterior pelvic tilt progression was an independent risk factor for cup revision (odds ratio, 1.53; 95% confidence interval, 1.06-2.20; p = 0.022).

Conclusions: When the PCA total hip system was used, the stem exhibited good longevity during a mean follow-up period of 25 years; however, the cup was vulnerable because of aseptic loosening. Postoperative posterior pelvic tilt progression was an independent risk factor for cup revision.

Introduction: The anatomical Lubinus SPII-stem is commonly used in hemi-arthroplasty for femoral neck fractures (FNF), combined with either the bipolar Variocup, the Unipolar Head (UH) and a newly introduced unipolar Modular Trauma Head (MTH). Similar constructs like the MTH are reported to have risk of corrosion and wear. This is the first publication evaluating the MTH.

Aim: To describe the revision rate of the SPII-stems/heads which were divided into 3 groups (Variocup, UH, MTH). The head types are compared by their rate of revision at 2 years, due to any cause and to dislocation. Revision and mortality rates up to 10 years are reported.

Methods: This observational cohort study based on prospectively registered data from the Swedish Arthroplasty Register included 33,059 patients with hemiarthroplasty 2005-2021 due to FNF. SPII-stems combined with Variocup (n = 7,281), UH (n = 23,980), MTH (n = 1,798) were included. The follow-up ended at 10 years for Variocup and UH, for MTH at 2 years. Kaplan-Meier survival analyses was used, with a 95% confidence interval (CI). Patients were censored at death or at the end of the study (31 December 2021).

Results: The 2-year revision rate regardless of cause was similar between the groups: after Variocup 3.5% (CI, 3.1-4.0), UH 3.1% (CI, 2.9-3.4), MTH 3.5% (CI, 2.6-4.5).At 10 years, the Variocup and UH had similar revision rates; 4.6% (CI, 4.0-5.2) and 5.0% (CI, 4.4-5.6).For revision due to dislocation at 2 years Variocup 2.3% (CI, 1.9-2.7) had an inferior outcome compared to UH 1.5% (CI, 1.3-1.7). The MTH had an intermediate outcome, 1.7% (CI, 1.0-2.3). Variocup had a higher dislocation related revision rate, until the 10th year.The 2-year-mortality was 36% (CI, 35-37) after Variocup, 43% (CI, 42-43) after UH and 44% (CI, 41-47) after MTH.

Conclusions: The hemi-heads have comparable revision rates within 2 and 10 years. The new MTH performs similar to the standard UH. The bipolar Variocup is associated with more revisions due to dislocation.

Purpose: To assess clinical and radiographic outcomes of anterior acetabular wall reconstruction and cup revision in patients with anterior acetabular wall defects and associated iliopsoas tendinopathy (IPT) following total hip arthroplasty (THA).

Methods: 7 patients with IPT (defined as groin pain that increased with active hip flexion) and pre-revision computed tomography (CT) scans showing anterior acetabular wall defects and cup-iliopsoas impingement were included. During cup revision, an autologous biconvex iliac crest graft was harvested and placed over the anterior acetabular wall defect before press-fitting a revision cup. Cup inclination and anteversion, axial and sagittal cup overhang, and iliopsoas muscle strength (0-5) were evaluated pre- and post-revision. Forgotten joint score (FJS; 0-100), Oxford hip score (OHS; 0-48), hip pain (0-10), satisfaction (0-10), graft osseointegration and resorption were evaluated post-revision.

Results: Pre-revision cup inclination was 43.7 ± 9.4°, anteversion was 30.4 ± 10.5°, axial overhang was 6.6 ± 7.9 mm, and sagittal overhang was 14.2 ± 4.8 mm. Immediate post-revision cup anteversion was 33.0 ± 7.9°, inclination was 45.3 ± 5.1°, while there was no axial or sagittal overhang. At 60.3 ± 5.6 (52-70) months follow-up, 6 of 7 patients were available for assessment (1 patient had died). Iliopsoas muscle strength increased from 3.9 ± 0.7 to 4.6 ± 0.9, FJS was 77.5 ± 32.8, OHS was 40.3 ± 12.8, hip pain on VAS was 0.2 ± 0.4 at rest and 2.3 ± 2.6 during activities. Patient satisfaction with surgery was 8.3 ± 2.3, but 1 patient was dissatisfied and reported persistent hip pain. Last follow-up CT scans were available for 4 of 7 patients, with 3 showing osseointegrated grafts and no graft resorption.

Conclusions: Anterior acetabular wall reconstruction and cup revision resulted in satisfactory clinical outcomes at a minimum follow-up of 4 years in 5 of 7 cases. Most patients fully recovered their iliopsoas muscle strength, had minimal to no pain, excellent FJS, and an osseointegrated acetabular wall graft.

Background: Impaction bone grafting (IBG) has been shown to be effective and reliable for contained or medial large acetabular defects, but large segmental rim defects may need alternative options for reconstruction. We hypothesised that IBG combined with lateral trabecular augments in large segmental acetabular bone defects can provide comparable results to IBG combined with conventional metallic meshes.

Methods: In a series of 382 acetabular revisions using IBG 30 hips with a lateral trabecular augment (case group) were matched for age, gender and bone defect with 54 controls (with a lateral mesh). The mean follow-up was 5 years. All hips had a Paprosky 3A or 3B bone defect. Clinical outcome, radiological results and re-revisions rate were analysed in each over time. A Kaplan-Meier analysis was used to determine the survival of the cup, with radiological failure and re-revision as the endpoints.

Results: 5 (16.7%) hips in the case group and 9 (16.7%) in the control group were re-revised. The 10-year survival for reoperation for any reason was 80.8% (95% CI, 69.7-92.0) and 93.3% (95% CI, 84.0-100) respectively. At latest follow-up the mean Harris Hip Score was 85.3 in the case group and 82.9 in the control group (p = 0.4). In the case group, 7 (23%) hips showed acetabular radiological migration, 3 requiring further revision surgery. In the control group, 12 (22%) hips showed acetabular radiological migration, with 6 needing re-revision. Acetabular radiological migration was more frequent in hips with a greater radiological horizontal distance (p = 0.01).

Conclusions: IBG combined with lateral trabecular augments in large segmental acetabular bone defects was comparable to IBG combined with a lateral mesh. Improvements in surgical reconstruction could decrease the radiological migration rates of the acetabular component.