scholarly journals Our Experience with Short Stem Hip Replacement Surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Sumeet Rastogi ◽  
Sanjiv K S Marya
Keyword(s):  
Soft Tissue ◽  
Hip Replacement ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Hip Implant ◽  
Excellent Outcome ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

Context-A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips.Materials and methods-50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009). Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw) with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter.Statiscal analysis used-VAS and Harris hip score formed the basis of evaluationResults-These patients were followed up for a mean period of 49 months (Range 36-72 months). The average incision size was 14.38 cm (10-18 cm) and blood loss was 269 ml (175-450 ml). There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 %) had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41) patients had an excellent outcome at last follow-up.Conclusion-We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit initially followed by bone in-growth and was ideally suited to satisfy the requirements of a conservative hip implant. Unfortunately, due to unknown reasons, the implant has been recently withdrawn from the market by DePuy and is no longer available for use.Key MessageConservative hip stems that preserve bone and soft tissue at the time of surgery, prevent femoral stress shielding by circumferential loading, promote positive bone remodeling and help to make revision surgeries easier are ideally suited as hip implants for young active adults with end stage hip disease requiring hip replacement surgery.

scholarly journals Bone and Joint Tissue Penetration of the Staphylococcus-Selective Antibiotic Afabicin in Patients Undergoing Elective Hip Replacement Surgery

2018 ◽  
Vol 63 (3) ◽  
Author(s):  
Annick Menetrey ◽  
Annick Janin ◽  
John Pullman ◽  
J. Scott Overcash ◽  
Amina Haouala ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Soft Tissue ◽  
Synovial Fluid ◽  
Hip Replacement ◽  
Clinical Development ◽  
Efficacy Data ◽  
Content Type ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Joint Infections

ABSTRACT Afabicin (formerly Debio 1450, AFN-1720) is a prodrug of afabicin desphosphono (Debio 1452, AFN-1252), a novel antibiotic in development which targets the staphylococcal enoyl-acyl carrier protein reductase (FabI) and exhibits selective potent antibacterial activity against staphylococcal species, including methicillin-resistant Staphylococcus aureus. As part of clinical development in bone and joint infections, a distribution study in bone was performed in 17 patients who underwent elective hip replacement surgery. Patients received 3 doses of 240 mg afabicin orally (every 12 h) at various time points before surgery. Afabicin desphosphono concentrations were measured by liquid chromatography-tandem mass spectrometry in plasma, cortical bone, cancellous bone, bone marrow, soft tissue, and synovial fluid collected during surgery at 2, 4, 6, or 12 h after the third afabicin dose. The study showed good penetration of afabicin desphosphono into bone tissues, with mean area under the curve ratios for cortical bone-, cancellous bone-, bone marrow-, soft tissue-, and synovial fluid-to-total plasma concentrations of 0.21, 0.40, 0.32, 0.35, and 0.61, respectively. When accounting for the free fraction in plasma (2%) and synovial fluid (9.4%), the mean ratio was 2.88, which is indicative of excellent penetration and which showed that the afabicin desphosphono concentration was beyond the MIC90 of S. aureus over the complete dosing interval. These findings, along with preclinical efficacy data, clinical efficacy data for skin and soft tissue staphylococcal infection, the availability of both intravenous and oral formulations, and potential advantages over broad-spectrum antibiotics for the treatment of staphylococcal bone or joint infections, support the clinical development of afabicin for bone and joint infections. (This study has been registered at ClinicalTrials.gov under identifier NCT02726438.)

Midterm outcomes of total hip arthroplasty with a modular Birmingham head

2019 ◽  
pp. 112070001987738 ◽  
Author(s):  
Duncan W Cushnie ◽  
Brent A Lanting ◽  
Richard McCalden ◽  
Douglas DR Naudie ◽  
James L Howard
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Tissue Reaction ◽  
Harris Hip Score ◽  
Total Hip ◽  
Tissue Reactions ◽  
Clinical Records

Introduction: Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). Methods: A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. Results: 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls ( p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. Discussion: BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

scholarly journals Risk of Venous Thromboembolic Events in Patients with Osteonecrosis of the Femoral Head Undergoing Primary Hip Arthroplasty

2019 ◽  
Vol 8 (12) ◽  
pp. 2158
Author(s):  
Pei-Hsun Sung ◽  
Yao-Hsu Yang ◽  
Hsin-Ju Chiang ◽  
John Y. Chiang ◽  
Hon-Kan Yip ◽  
...  
Keyword(s):  
Femoral Head ◽  
Hip Arthroplasty ◽  
Hip Replacement ◽  
Thromboembolic Events ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Post Surgery ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Previous data have shown patients with osteonecrosis of the femoral head (ONFH) have increased lifelong risk of unprovoked venous thromboembolic events (VTE) as compared with the general population, according to sharing common pathological mechanism of endothelial dysfunction. However, whether the risk of VTE increases in those ONFH patients undergoing major hip replacement surgery remains unclear. This is a retrospective nationwide Asian population-based study. From 1997 to 2013, a total of 12,232 ONFH patients receiving partial or total hip replacement for the first time and revision surgeries were retrospectively selected from Taiwan Health Insurance surgical files. By 1:1 matching on age, sex, surgical types, and socioeconomic status, 12,232 subjects without ONFH undergoing similar hip surgery were selected as non-ONFH group. The incidence and risk of post-surgery VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), were compared between the ONFH and non-ONFH groups. Results showed that 53.8% of ONFH patients were male and the median age was 61.9 years old. During the mean follow-up period of 6.4 years, the incidences of VTE (1.4% vs. 1.2%), DVT (1.1% vs. 0.9%), and PE (0.4% vs. 0.4%) were slightly but insignificantly higher in the ONFH than in the non-ONFH group undergoing the same types of major hip replacement surgery (all p-values > 0.250). Concordantly, we found no evidence that the risk of VTE was increased in the ONFH patients as compared with the non-ONFH counterparts (adjusted HR 1.14; 95% CI 0.91–1.42; p = 0.262). There were also no increased risks for DVT and PE in the ONFH subgroups stratified by comorbidities, drug exposure to pain-killer or steroid, and follow-up duration after surgery, either. In conclusion, hip arthroplasty in Asian patients with ONFH is associated with similar rates of VTE as compared to patients with non-ONFH diagnoses.

Total hip arthroplasty in skeletal dysplasia

2003 ◽  
Vol 13 (3) ◽  
pp. 177-183 ◽  
Author(s):  
S.I.M. Umarji ◽  
M.B. Lee ◽  
M.F. Gargan ◽  
N.M.A. Portinaro ◽  
I.D. Learmonth
Keyword(s):  
Revision Surgery ◽  
Juvenile Chronic Arthritis ◽  
Chronic Arthritis ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Hip Prostheses ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
The Mean

This study presents the results of 38 hip prostheses in 24 people of short stature (under 152 cm). A retrospective clinical and radiological study recording the diagnosis, age at reconstruction, height, weight, type of prostheses, length of follow-up, radiological appearances and patient satisfaction was performed. Harris hip scores were used to assess activities of daily living (1). All patients were under 152cm and their diagnoses included achondroplasia, spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, developmental dysplasia of the hip and juvenile chronic arthritis. The mean height of these patients was 135 cm (range: 109cm to 150cm). The mean age was 38 years (range: 19 to 75 years) with mean follow-up 67 months (range: 12 to 406 months). Only one patient, who is now aged 69 years (though 65 years at revision surgery), has required revision surgery to date. The results were excellent for 33 hips (Harris hip score between 80–100), good in three (Harris hip score between 70–80), satisfactory in one (score 60–70) and poor for one (Harris hip score <50). The mean Harris hip score to date is 89. Hip replacement surgery is difficult in this challenging group of patients but can nonetheless yield gratifying results in over 90% of cases.

scholarly journals Self-reported outcomes of patients undergoing total hip replacement surgery assessed by the WOMAC questionnaire

2011 ◽  
Vol 9 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Michele Ferreira de Souza Di Nubila ◽  
Carolina Gomes Matarazzo ◽  
Andrea Diniz Lopes-Albers ◽  
Fátima Cristina Martorano Gobbi
Keyword(s):  
Hip Fracture ◽  
Hospital Discharge ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Hip Osteoarthritis ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Womac Questionnaire ◽  
Baseline Values

ABSTRACT Objective: To assess pain, stiffness and physical function outcomes among patients undergoing total hip replacement using the Western Ontario and McMaster Universities Osteoarthritis Index. Methods: From January 2009 to July 2010, 64 male and female patients were assessed using the WOMAC questionnaire at baseline, hospital discharge, 3-month follow-up, and 6-month follow-up; one group of patients with primary hip osteoarthritis (n = 42) and another group with hip fracture (n = 22). Results: Changes in the total scores of the osteoarthritis group were statistically significant comparing baseline, hospital discharge, 3-month and 6-month assessments, demonstrating continued improvement over time up to 6-month follow-up. The total scores of the hip fracture group demonstrated a worsening from baseline to discharge, followed by improvement. The differences were statistically significant between baseline and discharge, as well as between discharge and the 6-month assessment. No statistically significant differences were found between baseline values and the 3-month assessment or baseline values and the 6-month assessment, demonstrating that the patients returned to their baseline health status after 3 months and maintained this status up to 6-month follow-up. Conclusion: The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire detected changes in outcome following hip replacement surgery among patients with primary diagnoses of hip osteoarthritis and hip fracture, with differences in the pattern of changes between the two groups.

scholarly journals Trans-osseous intraoperative limb length measurement in hip replacement surgery

2020 ◽  
Vol 6 (6) ◽  
pp. 1258
Author(s):  
Anoop Pilar ◽  
Srivatsa Nagaraj Rao ◽  
Madan Mohan Muniswamy ◽  
Sandesh G Manohar ◽  
Rajkumar S. Amaravathi
Keyword(s):  
Hip Replacement ◽  
Intraoperative Imaging ◽  
Weight Bearing ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Harris Hip Score ◽  
Posterior View ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Length Discrepancy

<p><strong>Background:</strong> Discrepancy of the limb length following total hip replacement is one of common complication. To reduce the occurrence, various modalities are used like pre-operative templating, navigation assisted measurements and intraoperative methods. This study was done using trans-osseous method of measurement using hip gauge which provides a faster, simpler assessment of limb length.</p><p><strong>M</strong><strong>ethods: </strong>A prospective study of 25 patients who underwent uncemented hip arthroplasty was taken in the study and the LLD was measured before and after the surgical procedure. Patient were re-assessed for limb length discrepancy after 6 months with functional Harris hip score and radiological analysis on weight bearing standard X-ray antero-posterior view of the pelvis with bilateral hip joint.<strong></strong></p><p><strong>R</strong><strong>esults: </strong>The results showed significant improvement in limb length discrepancy, and analysis of postoperative radiographs found the mean length difference of 2.44 mm and average Harris hip score was 95.5. No device related complications were reported, and none of them complained of the discomfort related to limb-length discrepancy after surgery. <strong></strong></p><p><strong>C</strong><strong>onclusions: </strong>Trans-osseous fixed method using hip gauge provides a faster, reproducible and simpler method for the assessment of Limb length and aids with offset placement, acetabular anteversion for precise cup placement. This is a reliable method as it can be used both in the primary and revision hip surgery and most importantly doesn’t require any additional intraoperative imaging.<strong></strong></p>

scholarly journals Functional outcome of total hip replacement using a short stem implant

2019 ◽  
Vol 5 (3) ◽  
pp. 449
Author(s):  
Rajiv Kapila ◽  
Mukand Lal ◽  
Preeti Takkar Kapila
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Stress Shielding ◽  
Thigh Pain ◽  
Short Stem ◽  
Harris Hip Score ◽  
Total Hip ◽  
Post Operative Period ◽  
Modified Harris Hip Score

<p class="abstract"><strong>Background:</strong> Conventional cementless THA is associated with stress shielding of the proximal femur and thigh pain. Short femoral stem can conserve bone, reduce stress shielding in the femur and reduce thigh pain. The present study aims to describe the functional outcomes associated with short stem metaphyseal implant in THA in our department.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the Department of Orthopaedic Surgery, Indira Gandhi Medical College, Shimla among patients who needed THA for painful disabling hip. Modified Harris hip scores (HHS) were assessed for all patients pre-operatively and at their final follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the study period, a total of 20 patients were included in the study, 20% of them were females. The most common indication for THA was avascular necrosis head of femur with secondary osteomyelitis (n=14), of which 12 cases had excellent Hip Harris Score while two were in good category. Modified Harris hip score was excellent in patients where early partial and full weight bearing was started. Per-operatively, there was only one complication of fracture greater trochanter which was fixed with cerclage wire. In early post-operative period, two cases of superficial infection were noted and one case of varus malposition was present. In late post operative period, there were three cases of varus malposition and one case of deep infection as sinus.</p><p class="abstract"><strong>Conclusions:</strong> Total hip replacement with short anatomical metaphyseal loading stem improved the modified Harris Hip score significantly, with very few complications. Future multicentric studies are needed to evaluate the efficacy of short stem implants over a long follow up period.</p>

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