John Attenello, Maria I Opanova, Anne R. Wright, M. Saruwatari, Kelvin Naito, Sean Chan, Sean Saito, Samantha N. Andrews, Cass K. Nakasone
Background A single stage bilateral total hip arthroplasty utilizing the direct anterior approach has been reported to have a similar incidence of perioperative complications as unilateral total hip arthroplasty. However, previous studies have included various surgeons with differences in contraindications, protocol, technique and/or experience. Questions/Purposes The purpose of this retrospective review was to compare perioperative outcomes in single-stage bilateral and unilateral total hip arthroplasties via the direct anterior approach performed by a single, fellowship trained, high volume arthroplasty surgeon. Methods A retrospective review was completed on consecutive single-stage bilateral total hip arthroplasties performed between 2009 and 2017 and compared to consecutive unilateral total hip arthroplasties performed between 2014 and 2016. Perioperative data and complications occurring within 90 days were collected for all included patients. Student t-tests were performed to detect differences between bilateral and unilateral surgical variables. Results A total of 349 patients (531 hips) were included, consisting of 182 BTHA patients (364 hips) and 167 unilateral THA patients. Patients undergoing unilateral THA had significantly lower operating time, shorter length of stay, lower estimated blood loss, lower rate of transfusions and higher rate of home discharge compared to BTHA (p<0.001). Complications were present in four unilateral THA patients, three requiring revision, and nine BTHA patients, three requiring revision. Conclusions There was no difference in complications, as well as no perioperative mortalities or systemic complications, within 90 days following surgery between unilateral and bilateral patients. Based on these results, single-stage DAA BTHA is a safe procedure to perform, and did not appear to result in higher rates of complications when compared to patients receiving a DAA unilateral THA.
{"title":"Perioperative Complications Following One-Stage Bilateral and Unilateral Total Hip Arthroplasty via Direct Anterior Approach","authors":"John Attenello, Maria I Opanova, Anne R. Wright, M. Saruwatari, Kelvin Naito, Sean Chan, Sean Saito, Samantha N. Andrews, Cass K. Nakasone","doi":"10.15438/RR.8.2.216","DOIUrl":"https://doi.org/10.15438/RR.8.2.216","url":null,"abstract":"Background A single stage bilateral total hip arthroplasty utilizing the direct anterior approach has been reported to have a similar incidence of perioperative complications as unilateral total hip arthroplasty. However, previous studies have included various surgeons with differences in contraindications, protocol, technique and/or experience. Questions/Purposes The purpose of this retrospective review was to compare perioperative outcomes in single-stage bilateral and unilateral total hip arthroplasties via the direct anterior approach performed by a single, fellowship trained, high volume arthroplasty surgeon. Methods A retrospective review was completed on consecutive single-stage bilateral total hip arthroplasties performed between 2009 and 2017 and compared to consecutive unilateral total hip arthroplasties performed between 2014 and 2016. Perioperative data and complications occurring within 90 days were collected for all included patients. Student t-tests were performed to detect differences between bilateral and unilateral surgical variables. Results A total of 349 patients (531 hips) were included, consisting of 182 BTHA patients (364 hips) and 167 unilateral THA patients. Patients undergoing unilateral THA had significantly lower operating time, shorter length of stay, lower estimated blood loss, lower rate of transfusions and higher rate of home discharge compared to BTHA (p<0.001). Complications were present in four unilateral THA patients, three requiring revision, and nine BTHA patients, three requiring revision. Conclusions There was no difference in complications, as well as no perioperative mortalities or systemic complications, within 90 days following surgery between unilateral and bilateral patients. Based on these results, single-stage DAA BTHA is a safe procedure to perform, and did not appear to result in higher rates of complications when compared to patients receiving a DAA unilateral THA.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46371067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Excellent long term results in total hip arthroplasty (THA are achievable through a variety of surgical techniques. However, the push for cost savings and higher patient expectations has shifted the focus to improving short term outcomes such as length of stay and in-hospital narcotic requirements. While approximately 87% of surgeons worldwide continue to prefer traditional posterolateral (PL) or lateral approaches for arthroplasty,1alternative approaches that spare the iliotibial band have emerged over the last several years in hopes of improved outcomes. This review explores the iliotibial band-sparing approaches, their advantages and disadvantages, and provides an overview of their published results.
{"title":"Understanding Iliotibial Band-Sparing Total Hip Arthroplasty: Alternatives to Traditional THA Approaches","authors":"R. Nevins, Kevin Sagers","doi":"10.15438/RR.8.2.209","DOIUrl":"https://doi.org/10.15438/RR.8.2.209","url":null,"abstract":"Excellent long term results in total hip arthroplasty (THA are achievable through a variety of surgical techniques. However, the push for cost savings and higher patient expectations has shifted the focus to improving short term outcomes such as length of stay and in-hospital narcotic requirements. While approximately 87% of surgeons worldwide continue to prefer traditional posterolateral (PL) or lateral approaches for arthroplasty,1alternative approaches that spare the iliotibial band have emerged over the last several years in hopes of improved outcomes. This review explores the iliotibial band-sparing approaches, their advantages and disadvantages, and provides an overview of their published results.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43856767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Faizan, Laura Y. Scholl, Jingwei Zhang, M. Ries
Background: Durable fixation has been demonstrated with use of large (jumbo) cementless cups in revision total hip arthroplasty (THA). However, anterior protrusion of the cup rim may impinge on the iliopsoas tendon and cause groin pain. The purpose of this study was to assess the effect of cup position and implant design on iliopsoas impingement.Methods: THA was performed on six cadaver hips using oversized (jumbo) acetabular components, 60 to 66mm. A stainless steel cable was inserted into the psoas tendon sheath to identify the location of the psoas muscle. CT scans were performed on each cadaver and imported in an imaging software. The acetabular shells, cables, and pelvi were segmented to create separate solid models of each. The shortest distance between each shell and cable was measured. To determine the influence of cup inclination and anteversion, the inclination (30°/40°/50°) and anteversion (10°/20°/30°) angles were varied in the virtual model for both a hemispheric and offset head center shell design. Results: The shell to wire distance increased linearly with greater cup anteversion (R2>0.99) while inclination had less effect. The distance was greater for the offset head center cup in comparison to the hemispheric cup. Our results indicate that psoas impingement is related to both cup position and implant geometry. Conclusions: For an oversized jumbo cup, psoas impingement is reduced by greater anteversion while cup inclination has little effect. An offset head center cup with an anterior recess was helpful in reducing psoas impingement in comparison to a conventional hemispherical geometry.
{"title":"Effects of Acetabular Cup Orientation and Implant Design on Psoas Impingement in Total Hip Arthroplasty","authors":"A. Faizan, Laura Y. Scholl, Jingwei Zhang, M. Ries","doi":"10.15438/rr.9.1.220","DOIUrl":"https://doi.org/10.15438/rr.9.1.220","url":null,"abstract":"Background: Durable fixation has been demonstrated with use of large (jumbo) cementless cups in revision total hip arthroplasty (THA). However, anterior protrusion of the cup rim may impinge on the iliopsoas tendon and cause groin pain. The purpose of this study was to assess the effect of cup position and implant design on iliopsoas impingement.Methods: THA was performed on six cadaver hips using oversized (jumbo) acetabular components, 60 to 66mm. A stainless steel cable was inserted into the psoas tendon sheath to identify the location of the psoas muscle. CT scans were performed on each cadaver and imported in an imaging software. The acetabular shells, cables, and pelvi were segmented to create separate solid models of each. The shortest distance between each shell and cable was measured. To determine the influence of cup inclination and anteversion, the inclination (30°/40°/50°) and anteversion (10°/20°/30°) angles were varied in the virtual model for both a hemispheric and offset head center shell design. Results: The shell to wire distance increased linearly with greater cup anteversion (R2>0.99) while inclination had less effect. The distance was greater for the offset head center cup in comparison to the hemispheric cup. Our results indicate that psoas impingement is related to both cup position and implant geometry. Conclusions: For an oversized jumbo cup, psoas impingement is reduced by greater anteversion while cup inclination has little effect. An offset head center cup with an anterior recess was helpful in reducing psoas impingement in comparison to a conventional hemispherical geometry. ","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49342723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David A. Crawford, K. Berend, Joanne B. Adams, A. Lombardi
Background: Periprosthetic joint infections following total hip arthroplasty (THA) can cause significant patient morbidity and carry with them a substantial cost burden to the healthcare system. The purpose of this study was to assess whether the addition of topical vancomycin decreased the incidence of superficial and deep infections after primary total hip arthroplasty? Methods: We performed a retrospective analysis of patients who underwent primary THA with (1070 hips) and without (815 hips) the use of topical vancomycin. Records were reviewed to determine incidence of PJI. Infections were categorized as deep or superficial. Medical comorbidity data was evaluated for known risk factors including diabetes, rheumatoid arthritis, and BMI. Records were further reviewed to determine surgical approach used and bacterial cause of PJI. Results: The overall incidence of infection in the control group was 1.47% (12 hips) and significantly decreased to 0.47% (5 hips) with the addition of topical vancomycin (p=0.022). Deep infections also decreased from 0.86% (7 hips) in the control group to 0.09% (1 hip) in the vancomycin group (p=0.011). There was no difference in BMI or percent of patients with diabetes between groups. In all patients, regardless of vancomycin use, the incidence of infection in the direct lateral approach was higher (2.04%, 9 hips) than the anterior approach (0.055%, 8 hips) (p=0.004). Conclusions: We found a lower incidence of periprosthetic joint infection after THA with the addition of topical vancomycin. We also found a decreased incidence of infection in patients who had surgery through an anterior approach compared with those who had a direct lateral approach.
{"title":"Decreased Incidence of Periprosthetic Joint Infection in Total Hip Arthroplasty with Use of Topical Vancomycin","authors":"David A. Crawford, K. Berend, Joanne B. Adams, A. Lombardi","doi":"10.15438/rr.8.1.201","DOIUrl":"https://doi.org/10.15438/rr.8.1.201","url":null,"abstract":"Background: Periprosthetic joint infections following total hip arthroplasty (THA) can cause significant patient morbidity and carry with them a substantial cost burden to the healthcare system. The purpose of this study was to assess whether the addition of topical vancomycin decreased the incidence of superficial and deep infections after primary total hip arthroplasty? Methods: We performed a retrospective analysis of patients who underwent primary THA with (1070 hips) and without (815 hips) the use of topical vancomycin. Records were reviewed to determine incidence of PJI. Infections were categorized as deep or superficial. Medical comorbidity data was evaluated for known risk factors including diabetes, rheumatoid arthritis, and BMI. Records were further reviewed to determine surgical approach used and bacterial cause of PJI. Results: The overall incidence of infection in the control group was 1.47% (12 hips) and significantly decreased to 0.47% (5 hips) with the addition of topical vancomycin (p=0.022). Deep infections also decreased from 0.86% (7 hips) in the control group to 0.09% (1 hip) in the vancomycin group (p=0.011). There was no difference in BMI or percent of patients with diabetes between groups. In all patients, regardless of vancomycin use, the incidence of infection in the direct lateral approach was higher (2.04%, 9 hips) than the anterior approach (0.055%, 8 hips) (p=0.004). Conclusions: We found a lower incidence of periprosthetic joint infection after THA with the addition of topical vancomycin. We also found a decreased incidence of infection in patients who had surgery through an anterior approach compared with those who had a direct lateral approach.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45116755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Total Knee replacement is one of the successful operations performed for arthritis of knee joint. Popliteal artery occlusion after total knee arthroplasty occurs at a very low incidence. We here describe the incidence of popliteal artery complications in one of the large volume centre in Asia. Our case had complete occlusion of the popliteal artery at the 1st post-operative day. Our reported case of post-TKR popliteal artery thrombosis was without known risk factors. Reason for concern is because of poor collateral circulation, severe ischemia may give rise to irreversible tissue damage necessitating amputation if we do not recognize early and treat them. We reviewed cases from the literature in terms of incidence, prognosis, treatment, potential risk factors and measures to prevent injury.
{"title":"Popliteal Artery Complications of Total Knee Replacement – Our Experience In Large Volume Centre and Review of Literature","authors":"Nithin Sunku, A. Reddy, S. Muralidhar","doi":"10.15438/RR.8.1.199","DOIUrl":"https://doi.org/10.15438/RR.8.1.199","url":null,"abstract":"Total Knee replacement is one of the successful operations performed for arthritis of knee joint. Popliteal artery occlusion after total knee arthroplasty occurs at a very low incidence. We here describe the incidence of popliteal artery complications in one of the large volume centre in Asia. Our case had complete occlusion of the popliteal artery at the 1st post-operative day. Our reported case of post-TKR popliteal artery thrombosis was without known risk factors. Reason for concern is because of poor collateral circulation, severe ischemia may give rise to irreversible tissue damage necessitating amputation if we do not recognize early and treat them. We reviewed cases from the literature in terms of incidence, prognosis, treatment, potential risk factors and measures to prevent injury.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46292172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kay, W. Kurtz, Gregory Martin, B. Huber, R. Tait, T. Clyburn
Introduction Manipulation under anesthesia (MUA) is a standard treatment for arthrofibrosis after total knee arthroplasty (TKA), with reported rates of 1.5-6%. Customized TKA may have better outcomes by matching individual patient anatomy. However, a previous study reported an unacceptably high rate of MUA for customized TKAs. This study reports the incidence of MUA in a large cohort of second generation customized TKAs. Methods:Data was collected prospectively on 360 2nd generation ConforMIS iTotal cruciate retaining TKAs. MUA was performed for clinically significant arthrofibrosis. Range of motion (ROM) and New Knee Society Scores (KSS) were evaluated at regular intervals for two years. Results: 11/360 (3.05%) knees underwent MUA. ROM overall improved from 115° to 125°, and from 112° to 122° in patients undergoing MUA. KSS objective and functional scores in MUA patients increased from 57 to 98 and 41 to 90, respectively, and in the entire cohort increased from 65 to 96 and 45 to 86 at 2 years (p<0.05). No MUA patients underwent revision surgery. Discussion and Conclusion:Customized TKA with second generation ConforMIS iTotal implants results in a MUA rate consistent with the literature for all designs. Additionally, patients exhibit significant increases in ROM and Knee Society Scores.
{"title":"Manipulation Rate Is Not Increased After Customized Total Knee Arthroplasty","authors":"A. Kay, W. Kurtz, Gregory Martin, B. Huber, R. Tait, T. Clyburn","doi":"10.15438/RR.8.1.210","DOIUrl":"https://doi.org/10.15438/RR.8.1.210","url":null,"abstract":"Introduction Manipulation under anesthesia (MUA) is a standard treatment for arthrofibrosis after total knee arthroplasty (TKA), with reported rates of 1.5-6%. Customized TKA may have better outcomes by matching individual patient anatomy. However, a previous study reported an unacceptably high rate of MUA for customized TKAs. This study reports the incidence of MUA in a large cohort of second generation customized TKAs. Methods:Data was collected prospectively on 360 2nd generation ConforMIS iTotal cruciate retaining TKAs. MUA was performed for clinically significant arthrofibrosis. Range of motion (ROM) and New Knee Society Scores (KSS) were evaluated at regular intervals for two years. Results: 11/360 (3.05%) knees underwent MUA. ROM overall improved from 115° to 125°, and from 112° to 122° in patients undergoing MUA. KSS objective and functional scores in MUA patients increased from 57 to 98 and 41 to 90, respectively, and in the entire cohort increased from 65 to 96 and 45 to 86 at 2 years (p<0.05). No MUA patients underwent revision surgery. Discussion and Conclusion:Customized TKA with second generation ConforMIS iTotal implants results in a MUA rate consistent with the literature for all designs. Additionally, patients exhibit significant increases in ROM and Knee Society Scores. ","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44431683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundIn the event of a complex revision TKA in which there is extensor mechanism involvement and ligamentous instability or insufficiency, non-linked levels of constraint may not be adequate for achieving restoration of patient function. Total knee arthroplasty devices that incorporate a linked level of constraint are successful alternatives to unlinked devices (PS and PS-Constrained) in this clinical context.Case PresentationWe present the case of a 62 year-old male patient that required a non-articulating knee fusion and multiple total knee arthroplasty revisions in conjunction with a ruptured and repaired extensor mechanism, ligamentous instability, bone loss and periprosthetic joint infection. (Revision knee prosthesis that includes a increasing degree of nodularity and physical constraint). The subsequent risk factors associated with the loss of bone and ligamentous insufficiency required performing conversion arthroplasty with a knee prosthesis that includes an increasing degree of modularity and physical constraint not commonly used in revision total knee arthroplasty.DiscussionThe authors report on a patient who underwent multiple operative procedures, we outline the step wise decision making progression that lead to the successful eradication of the PJI and reimplant device strategy based on the confounding factors presented. We assess the use of revision TKA systems that offer extreme degrees of constraint which should be considered in complex revision knee revision procedures.
{"title":"Conversion Knee Arthroplasty Using a Rotating Hinge as a Salvage Prosthesis Following Periprosthetic Joint Infection and Ligamentous Insufficiency: A Case Report","authors":"J. Minter","doi":"10.15438/RR.8.1.208","DOIUrl":"https://doi.org/10.15438/RR.8.1.208","url":null,"abstract":"BackgroundIn the event of a complex revision TKA in which there is extensor mechanism involvement and ligamentous instability or insufficiency, non-linked levels of constraint may not be adequate for achieving restoration of patient function. Total knee arthroplasty devices that incorporate a linked level of constraint are successful alternatives to unlinked devices (PS and PS-Constrained) in this clinical context.Case PresentationWe present the case of a 62 year-old male patient that required a non-articulating knee fusion and multiple total knee arthroplasty revisions in conjunction with a ruptured and repaired extensor mechanism, ligamentous instability, bone loss and periprosthetic joint infection. (Revision knee prosthesis that includes a increasing degree of nodularity and physical constraint). The subsequent risk factors associated with the loss of bone and ligamentous insufficiency required performing conversion arthroplasty with a knee prosthesis that includes an increasing degree of modularity and physical constraint not commonly used in revision total knee arthroplasty.DiscussionThe authors report on a patient who underwent multiple operative procedures, we outline the step wise decision making progression that lead to the successful eradication of the PJI and reimplant device strategy based on the confounding factors presented. We assess the use of revision TKA systems that offer extreme degrees of constraint which should be considered in complex revision knee revision procedures.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44443504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. McPherson, S. Sherif, Madhav Chowdhry, M. Dipane
Background: Primary total hip arthroplasty (THA) is considered one of the most cost effective and functionally beneficial procedures to treat end-stage coxarthrosis worldwide. However, in all regions of the world, there is a small percentage of patients that are plagued by residual anterior hip pain and have limited hip flexion. One explanation for this problem is bone and soft tissue impingement in the anterior hip region. In the native hip, the problem is described as femoral acetabular impingement (FAI). FAI is a form of developmental dysplasia of the hip (DDH). Not infrequently, these dysplastic acetabula are also retroverted. In primary THA, a retroverted boney acetabulum adversely affects prosthetic hip function. Specifically, when the acetabular cup is inserted in an anteverted position and the native acetabulum is retroverted, the proximal femur will still impinge upon the retroverted acetabular bone with flexion and internal rotation. This causes mechanical instability, pain, and prosthetic subluxation. We aptly name this condition prosthetic femoral acetabular impingement (PFAI).Methods: In this study we address PFAI with an anterior acetabular bone wall reduction (AABWR). In a consecutive series of 426 primary THA’s, we prospectively removed all impinging anterior retroverted bone during the THA procedure. All acetabular cups were placed between 25-35 degrees of anteversion. Retroverted acetabular bone extending beyond the acetabular cup was removed along with impinging capsular tissues. All femoral stems were positioned between 15-20 degrees.Results: The study group consisted of 426 THA’s. Three hundred patients (70%) had an AABWR. There were 140 females (47%) and 160 males (53%). The average amount of bone resected in the AABWR group was 1.32 cm (0.3 cm to 3.4 cm). For females, the average bone resection measured 1.1 cm (0.3 to 2.0 cm). For males, the average bone resection measured 1.53 cm (0.3 cm to 3.4 cm). Harris Hip Scores (HHS) at minimum of 1 year follow-up (range 1 to 11.5 years) averaged 91 (64 to 100) for the entire group. In the AABWR group, HHS averaged 92 (71 to 100). Average hip flexion was 110 degrees (100 to 130 degrees). In the non-AABWR group, HHS averaged 87 (71 to 100). Average flexion was 109 degrees (88 to 125 degrees). In the AABWR group, 12 patients (4%) experienced groin pain symptoms. On a scale from 0 to 4, the peak groin pain rating was 1 in 10 of the 12 patients and the remaining 2 rated his/her pain at a 2. As time progressed, 50% of these patients saw their groin pain resolve. In the non-AABWR group, 2 patients (1.6%) experienced groin pain and both patients rated his/her pain at a 1.Discussion: Maximizing hip flexion and function for the active patient undergoing primary THA requires meticulous surgical technique. PFAI may be one reason for unexplained anterior hip pain in the highly active patient that demands higher hip flexion and rotation. Our experience shows that the anterior acetabular rim and p
背景:在世界范围内，原发性全髋关节置换术(THA)被认为是治疗终末期关节关节病最具成本效益和功能效益的方法之一。然而，在世界上所有地区，有一小部分患者受到残留髋关节前疼痛的困扰，髋关节屈曲有限。对这个问题的一种解释是髋前部的骨和软组织撞击。在原髋关节，问题被描述为股髋臼撞击(FAI)。FAI是髋关节发育不良(DDH)的一种形式。通常情况下，这些发育不良的髋臼也会后移。在原发性全髋关节置换术中，髋臼后移对假髋关节功能有不利影响。具体来说，当髋臼杯插入前倾位置，原髋臼向后时，股骨近端仍会以屈曲和内旋的方式撞击向后的髋臼骨。这会导致机械不稳定、疼痛和假体半脱位。我们将这种情况恰当地命名为假股骨髋臼撞击(PFAI)。方法:在本研究中，我们通过髋臼前骨壁复位(AABWR)治疗PFAI。在连续的426例原发性全髋关节置换术中，我们前瞻性地在全髋关节置换术中切除了所有撞击性前退骨。所有髋臼杯放置在前倾25-35度之间。延伸到髋臼杯以外的向后髋臼骨连同撞击的囊组织一起被切除。所有股骨柄定位在15-20度之间。结果:研究组共纳入426例THA。300例患者(70%)有AABWR。其中女性140例(47%)，男性160例(53%)。AABWR组平均骨切除量为1.32 cm (0.3 cm ~ 3.4 cm)。对于女性，平均骨切除量为1.1厘米(0.3至2.0厘米)。对于男性，平均骨切除量为1.53厘米(0.3厘米至3.4厘米)。Harris髋关节评分(HHS)在至少1年的随访(1 - 11.5年)中，整个组平均为91(64 - 100)。在AABWR组，HHS平均为92(71 - 100)。髋部平均屈曲度为110度(100 ~ 130度)。在非aabwr组，HHS平均为87(71 - 100)。平均屈曲度为109度(88至125度)。在AABWR组中，12名患者(4%)出现腹股沟疼痛症状。在从0到4的评分范围内，12名患者的腹股沟疼痛峰值评分为1 / 10，其余2名患者的疼痛评分为2。随着时间的推移，50%的患者腹股沟疼痛得到缓解。在非aabwr组中，2例患者(1.6%)经历腹股沟疼痛，两例患者均将其疼痛评分为1分。讨论:对于接受原发性全髋关节置换术的活动患者，最大化髋关节屈曲和功能需要细致的手术技术。PFAI可能是高活动度患者发生不明原因的髋前部疼痛的原因之一，这些患者需要更高的髋关节屈曲和旋转。我们的经验表明，髋臼前缘和部分前柱可以在初级THA时切除，而不会影响THA手术。AABWR现在是我们主要THA技术的一个组成部分。
{"title":"Correction of Femoral Acetabular Impingement at the Time of Primary THA","authors":"E. McPherson, S. Sherif, Madhav Chowdhry, M. Dipane","doi":"10.15438/rr.8.1.206","DOIUrl":"https://doi.org/10.15438/rr.8.1.206","url":null,"abstract":"Background: Primary total hip arthroplasty (THA) is considered one of the most cost effective and functionally beneficial procedures to treat end-stage coxarthrosis worldwide. However, in all regions of the world, there is a small percentage of patients that are plagued by residual anterior hip pain and have limited hip flexion. One explanation for this problem is bone and soft tissue impingement in the anterior hip region. In the native hip, the problem is described as femoral acetabular impingement (FAI). FAI is a form of developmental dysplasia of the hip (DDH). Not infrequently, these dysplastic acetabula are also retroverted. In primary THA, a retroverted boney acetabulum adversely affects prosthetic hip function. Specifically, when the acetabular cup is inserted in an anteverted position and the native acetabulum is retroverted, the proximal femur will still impinge upon the retroverted acetabular bone with flexion and internal rotation. This causes mechanical instability, pain, and prosthetic subluxation. We aptly name this condition prosthetic femoral acetabular impingement (PFAI).Methods: In this study we address PFAI with an anterior acetabular bone wall reduction (AABWR). In a consecutive series of 426 primary THA’s, we prospectively removed all impinging anterior retroverted bone during the THA procedure. All acetabular cups were placed between 25-35 degrees of anteversion. Retroverted acetabular bone extending beyond the acetabular cup was removed along with impinging capsular tissues. All femoral stems were positioned between 15-20 degrees.Results: The study group consisted of 426 THA’s. Three hundred patients (70%) had an AABWR. There were 140 females (47%) and 160 males (53%). The average amount of bone resected in the AABWR group was 1.32 cm (0.3 cm to 3.4 cm). For females, the average bone resection measured 1.1 cm (0.3 to 2.0 cm). For males, the average bone resection measured 1.53 cm (0.3 cm to 3.4 cm). Harris Hip Scores (HHS) at minimum of 1 year follow-up (range 1 to 11.5 years) averaged 91 (64 to 100) for the entire group. In the AABWR group, HHS averaged 92 (71 to 100). Average hip flexion was 110 degrees (100 to 130 degrees). In the non-AABWR group, HHS averaged 87 (71 to 100). Average flexion was 109 degrees (88 to 125 degrees). In the AABWR group, 12 patients (4%) experienced groin pain symptoms. On a scale from 0 to 4, the peak groin pain rating was 1 in 10 of the 12 patients and the remaining 2 rated his/her pain at a 2. As time progressed, 50% of these patients saw their groin pain resolve. In the non-AABWR group, 2 patients (1.6%) experienced groin pain and both patients rated his/her pain at a 1.Discussion: Maximizing hip flexion and function for the active patient undergoing primary THA requires meticulous surgical technique. PFAI may be one reason for unexplained anterior hip pain in the highly active patient that demands higher hip flexion and rotation. Our experience shows that the anterior acetabular rim and p","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48074483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Search engine optimization is becoming increasingly important for medical publishing professionals. They know the value of writing papers and articles that help expand the knowledge of their specific area of expertise. They also know that in today’s online environment their publications need to be found in relevant web searches to be cited by fellow researchers. But if authors ignore the basics of keyword research and search engine optimization they run the risk of their research being lost in a vast sea of search results. What good is all that work if it never reaches the intended audience? The purpose of this commentary is to provide submitting authors basic yet important suggestions to help optimize their articles for online publishing with Reconstructive Review.
{"title":"Search Engine Optimization for Medical Publishing","authors":"D. Faroo","doi":"10.15438/rr.7.4.198","DOIUrl":"https://doi.org/10.15438/rr.7.4.198","url":null,"abstract":"Search engine optimization is becoming increasingly important for medical publishing professionals. They know the value of writing papers and articles that help expand the knowledge of their specific area of expertise. They also know that in today’s online environment their publications need to be found in relevant web searches to be cited by fellow researchers. But if authors ignore the basics of keyword research and search engine optimization they run the risk of their research being lost in a vast sea of search results. What good is all that work if it never reaches the intended audience? The purpose of this commentary is to provide submitting authors basic yet important suggestions to help optimize their articles for online publishing with Reconstructive Review.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43900580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background : Gross trunnion failure (GTF) after total hip arthroplasty is a rare complication and has only been reported in a few case series. Some of the associated risk factors have been described in the literature and include larger femoral heads, greater offset, and increased BMI. Despite this, the mechanism behind GTF is poorly understood and early diagnosis and treatment continues to be challenging. Case Presentation : We present the case of complete femoral head and trunnion dissociation in a 63 year-old female nine years after total hip arthroplasty. Unique to this case is the lack of classic patient and implant risk factors for GTF along with the acute onset nearly nine years after implantation. Discussion : This case presentation highlights the fact that the contributing factors and mechanism behind GTF continue to be poorly understood. There is a need for future research to help better understand this phenomenon and to help potentially identify those at risk for GTF.
{"title":"Femoral Head-Trunnion Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty – A Unique Case Report","authors":"Nick N Patel, George N Guild, Greg A. Erens","doi":"10.15438/RR.7.4.196","DOIUrl":"https://doi.org/10.15438/RR.7.4.196","url":null,"abstract":"Background : Gross trunnion failure (GTF) after total hip arthroplasty is a rare complication and has only been reported in a few case series. Some of the associated risk factors have been described in the literature and include larger femoral heads, greater offset, and increased BMI. Despite this, the mechanism behind GTF is poorly understood and early diagnosis and treatment continues to be challenging. Case Presentation : We present the case of complete femoral head and trunnion dissociation in a 63 year-old female nine years after total hip arthroplasty. Unique to this case is the lack of classic patient and implant risk factors for GTF along with the acute onset nearly nine years after implantation. Discussion : This case presentation highlights the fact that the contributing factors and mechanism behind GTF continue to be poorly understood. There is a need for future research to help better understand this phenomenon and to help potentially identify those at risk for GTF.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46986842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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