Anthropometric Tomographic Study of the Hip in a Brazilian Regional Population / Estudo antropométrico tomográfico do quadril em uma população regional brasileira

Abstract Objective The present study aimed to determine the average hip anthropometry of a regional Brazilian population using measurements based on computerized axial tomography (CAT). Methods Retrospective, descriptive analysis of hip measurements from 200 abdominal CATs from patients visiting a medical center. The tests were selected at random to determine 30 previously defined anthropometric measurements. The data were statistically analyzed and compared according to gender and age. Results The prevalence of hip dysplasia was 6%. Signs suggesting femoroacetabular impingement were seen in 26% of cases. Patients over 50 years old presented significantly greater measures of horizontal acetabulum sectors, center-edge angle, and acetabular arch, as well as lower extrusion index, cervical-diaphyseal angle and vertical offset. Some measurements were significantly different according to gender: the lateral center-edge angle (µ » 35.5°) and the acetabular arch (µ » 68.7°) were higher in females. Males presented increased extrusion index (µ » 16%), lateral offset (µ » 38.3 mm), depth (µ » 19.5 mm), and neck diameter (µ » 26.4 mm). Conclusion The present study characterized the hip anthropometry of a regional Brazilian population. It also demonstrated significant morphological differences per age group and gender.

Resumo Objetivo Determinar a antropometria média do quadril de uma população regional brasileira através de medidas obtidas pela tomografia axial computadorizada (TAC). Método Análise analítico-descritiva, retrospectiva, de medidas coxofemorais de 200 TACs do abdômen de pacientes atendidos em um centro médico. Foram selecionados aleatoriamente exames que permitissem a aferição de 30 medidas antropométricas previamente definidas. Os dados foram estatisticamente analisados e comparados quanto a sexo e idade. Resultados A prevalência de displasia do quadril foi de 6%. Sinais sugestivos de impacto fêmoro-acetabular foramvistosem26% doscasos.A análise dos resultadosnogrupoacima de 50 anos demonstrou medidas significativamente maiores dos: setores horizontais do acetábulo,doângulocentro-bordaedoarcoacetabular,acompanhadosdemenoríndicede extrusão, ângulo cérvico-diafisário e offset vertical. Algumas medidas foram significativamente diferentes em função do sexo: o ângulo centro-borda lateral (µ» 35.5°) e o arco acetabular(µ» 68.7°)semostraram maioresnosexo feminino.Nogrupomasculino,foram maiores o índice de extrusão (µ» 16%), o offset lateral (µ» 38,3mm), a profundidade (µ» 19,5mm) e o diâmetro do colo (µ» 26,4mm). Conclusão O presente estudo caracterizou a antropometria do quadril de uma população brasileira. Demonstrou ainda diferenças morfológicas significativas do quadril entre diferentes faixas etárias e sexos.

Risk factors for radiological hip involvement in patients with ankylosing spondylitis

SUMMARY OBJECTIVE: Our study aimed to explore the potential risk factors for radiological hip joint involvement in patients with ankylosing spondylitis (AS). METHODS: This cross-sectional convey collected the clinical data, laboratory indicators, and radiographic data of patients with AS. Radiographic hip joint involvement was defined as a Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) score ≥2. Multivariate logistic regression analyses were conducted to explore the potential risk factors for radiological hip involvement in patients with AS. RESULTS: Based on BASRI-hip score, all enrolled 386 patients with AS were classified as patients involving with radiological hip joint involvement (BASRI-hip ≥2; n=203) and those without it (BASRI-hip ≤1; n=183). Mean age of enrolled patients with AS were 36.7±11.9 years, and 320 (82.9%) patients were male. Mean course of disease was 10.7±8.3 years, and 349 (90.4%) patients were with a positive HLAB27. Multivariate analyses indicated that Juvenile onset (onset age ≤16 years) (odds ratio [OR]=4.159, 95% confidence interval [CI], 1.779-9.721, p<0.001), body mass index (BMI) <18.5 kg/m2 (OR=1.986, 95%CI 1.187-3.323, p=0.009), continuous nonsteroidal anti-inflammatory drug (NSAID) use (OR=0.351, 95%CI 0.155-0.794, p=0.012), and bone mass below the expected range for age (Z score ≤-2) (OR=2.791, 95%CI 1.456-5.352, p=0.002) were independently associated with radiological hip joint involvement in patients with AS. CONCLUSIONS: The potential risk factors for radiological hip joint involvement were juvenile onset, lower BMI, and bone mass below the expected range for age. Furthermore, continuous NSAID use was the protective factor for radiological hip joint involvement in these population.

Protrusio acetabular en artroplastía total de cadera: diez tácticas para un buen resultado quirúrgico / Total hip arthroplasty in protrusio acetabuli: ten tips to improve surgical outcomes

Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.

Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.

Anatomía articular y parámetros radiográficos de la cadera como factor de riesgo de fractura: una mirada actualizada / Joint Anatomy and Radiographic Parameters of the Hip as Risk Factor for Fracture: An Updated Look

RESUMEN Introducción: Existe un aumento de la evidencia de que la estructura geométrica de la anatomía de la cadera juega un importante papel en la etiología de la fractura. Objetivo: Sistematizar los conocimientos más actuales referentes a las características anatómicas de los parámetros radiográficos de la articulación de la cadera, y su relación con la fractura. Métodos: Se realizó una investigación documental, con los artículos científicos publicados en las bases de datos médicas informáticas como PubMed, Ebsco y SciELo en los últimos 5 años. Resultados: La mayoría de las publicaciones analizan el ángulo cervicodiafisario y el eje de la cadera. Otras medidas analizadas son el eje femoral, la longitud y el ancho del cuello femoral, así como medidas acetabulares. No existe un consenso en la medida del largo del cuello femoral o del eje femoral, a pesar de ser un componente importante de la estructura. El conocimiento de las particularidades de la anatomía y de las características biomecánicas de la cadera permite establecer una base para la comprensión de los factores que afectan esta articulación. Conclusiones: Los estudios que se han realizado sobre las características de los componentes estructurales, demuestran que existe una asociación entre sus dimensiones y la ocurrencia de fractura de cadera, en algunos casos independientes de la densidad mineral ósea(AU)

ABSTRACT Introduction: There is increasing evidence that the geometric structure of the hip anatomy plays an important role in the etiology of the fracture. Objective: To systematize the most current knowledge regarding the anatomical characteristics of the radiographic parameters of the hip joint, and their relationship with the fracture. Methods: A documentary research was carried out, with the scientific articles published, in the last 5 years, in medical computer databases such as PubMed, Ebsco and SciELo. Results: Most of the publications analyze the cervicodiaphyseal angle and the axis of the hip. Other measurements analyzed are the femoral axis, the length and width of the femoral neck, as well as acetabular measurements. There is no consensus on the length of the femoral neck or the femoral shaft, despite being an important component of the structure. Knowledge of the particularities of the anatomy and biomechanical characteristics of the hip allows to establish basis for understanding the factors that affect this joint. Conclusions: The studies that have been carried out on the characteristics of the structural components show that there is association between their dimensions and the occurrence of hip fracture, in some cases independent of bone mineral density(AU)

Medición radiográfica del ángulo acetabular para el diagnóstico temprano de la displasia del desarrollo de la cadera / Radiographic measurement of the acetabular angle for early diagnosis of hip development dysplasia

Resumen: Antecedentes: Para evitar secuelas en la displasia del desarrollo de la cadera el tratamiento debe ser temprano; el ángulo acetabular corresponde a la inclinación del techo del acetábulo. Stanisavljevic indica que para medir adecuadamente el ángulo acetabular se deben colocar las caderas en abducción. Pregunta: ¿cuál es la magnitud de la diferencia de la medición radiográfica del ángulo acetabular entre las proyecciones anteroposterior de pelvis en posición neutra y con abducción de caderas? Métodos: Se tomaron 916 mediciones radiográficas comparando las de posición neutra contra las de abducción de caderas, de pacientes atendidos en consulta externa entre el 1 de Abril de 2010 y el 31 de Marzo de 2013. Resultados: Se realizaron pruebas t para medias de dos muestras emparejadas y se obtuvo una diferencia hipotética de las medias de 0.0000 y el coeficiente de correlación de Pearson para cadera derecha fue 0.74427531 y para la izquierda 0.73779866. Usando una Tabla propuesta de normalidad del ángulo acetabular según edad, se obtuvo el área bajo la curva en una distribución tgl457 = 0.650 con p = 0.516. El índice acetabular en posición neutra y con abducción de caderas es similar con alta significancia estadística, según el análisis de correlación de Pearson. Con base en la curva ROC, el índice acetabular en posición de rana tiene una alta sensibilidad y especificidad. Por tanto, la medición del índice acetabular en posición con abducción de caderas, tiene alta confiabilidad de lograr un diagnóstico correcto.

Abstract: Background: In order to avoid sequelae in the development dysplasia of the hip the treatment should be early; The acetabular angle corresponds to the inclination of the roof of the acetabulum. Stanisvljevic indicates that to properly measure the acetabular angle, the hips should be placed in abduction. Question: What is the magnitude of the difference in radiographic measurement of the acetabular angle between the anteroposterior projections of pelvis in neutral position and with abduction of hips? Methods: 916 radiographic measurements were taken by contrasting the neutral position against those of hip abduction, of patients in our clinic attended between April 1, 2010 and March 31, 2013. Results: T tests were performed for means of two matched samples and a hypothetical difference of the mean of 0.0000 was obtained and the Pearson correlation coefficient for right hip was 0.74427531 and for the left 0.73779866. Using a proposed Table of normality of the Acetabular angle according to age, the area was obtained under the curve in a distribution Tgl457 = 0.650 with P = 0.516. The index acetabular in neutral position and with abduction of hips is similar with high statistical significance, according to the analysis of correlation of Pearson. Based on the ROC curve, the acetabular index in frog position has a high sensitivity and specificity. Discussion: Therefore, the measurement of the acetabular index in position with hip abduction, has high reliability to achieve a correct diagnosis.

Utilidad de la artrografía en la decisión terapéutica en niños con displasia del desarrollo de cadera de tres meses a tres años de edad / Usefulness of the arthrogram in the decision therapy in children with developmental dysplasia of the hip from 3 months to 3 years of age

Resumen: Objetivo: Evaluar la utilidad de la artrografía como herramienta en la decisión terapéutica de pacientes con displasia del desarrollo de cadera (DDC). Material y métodos: 19 niños con diagnóstico de DDC habitual de edad entre tres meses y tres años, sin antecedentes quirúrgicos, Tonis II o III y expediente radiográfico completo. Para cada caso se registró la decisión terapéutica radiográfica y artrográfica por tres observadores independientemente, en el análisis estadístico el estándar fue la cirugía realizada necesaria para lograr una reducción concéntrica y cobertura acetabular adecuada. Resultados: 20 casos, 19 pacientes, de los cuales 18 fueron unilateral y uno bilateral. Fueron 17 niñas (89%) y dos niños (11%). Edad promedio: un año tres meses (de cuatro meses a dos años 11 meses), 11 Tonis II (55%) y nueve Tonis III (45%). El coeficiente de correlación intraclase (CCI) en relación con la decisión terapéutica radiográfica fue de 0.8933 y para la artrografía fue de 0.7205. El CCI de la decisión terapéutica radiográfica en relación con el estándar fue de 0.7933 y para la artrográfica fue de 0.6219. Se confirmó que en los 20 casos revisados la utilidad de la artrografía (CCI 0.6219) es menor que la de las radiografías (CCI 0.7933). La utilidad de la artrografía fue mayor en los pacientes con Tonis II con una edad entre nueve meses y dos años.

Abstract: Objective: To evaluate the utility of arthrography as a tool in therapeutic decision in developmental dysplasia of hip (DDH). Material and methods: 19 children with true DDH with age between three months and three years, without previous surgical treatment, with Tonis II or III, and complete X-rays. For each case; therapeutic decision was registered for X-rays and arthrography by three independent observers, we took like standard, surgery in each patient necessary to obtain a concentric reduction and good acetabular coverage. Results: 20 cases, 19 patients. 18 unilateral, 1 bilateral. They were 17 girls (89%) and 2 children (11%). Average Age: 1 year 3 months (4 months to 2 years 11 months). 11 Tonis II (55%) and 9 Tonis III (45%). The intraclass coefficient of correlation (ICC) in relation to the decision therapeutic radiographic was of 0.8933 and for the arthrography of 0.7205. And ICC of the decision therapeutic radiographic in connection with the standard was of 0.7933 and for the arthrography it was of 0.6219. We confirm that in our 20 cases, the utility of the arthrography (ICC 0.6219), is smaller to the X-rays (ICC 0.7933). The utility of the arthrography was bigger in the patients with Tonis II, and an age between nine months and two years.

A comparison study of radiographic and computerized tomographic angles in slipped capital femoral epiphysis / Estudo comparativo dos ângulos radiográficos e tomográficos na epifisiolistese do fêmur proximal

ABSTRACT Objective: To compare proximal femur radiologic angles in patients with slipped capital femoral epiphysis and to analyze whether computerized tomography may modify the treatment. Methods: Cross-sectional study comparing and analyzing the similarity between angles and radiologic classification of interest in slipped capital femoral epiphysis (SCFE) . Results: It was observed that the therapeutic management in slipped capital femoral epiphysis might be modified depending on the classification and radiologic acquisition method adopted. Conclusion: Multiplanar assessment of proximal femoral deformity in patients with slipped capital femoral epiphysis is a viable option, with the potential to modify the disease classification and, consequently, the therapeutic management.

RESUMO Objetivo: Comparar ângulos radiológicos do fêmur proximal em pacientes com escorregamento proximal da cabeça do fêmur (EPCF) e analisar se a avaliação por tomografia computadorizada pode modificar a conduta. Método: Estudo transversal que comparou e analisou a concordância entre ângulos e classificações radiológicas de interesse no escorregamento proximal da cabeça do fêmur (EPCF). Resultado: Observou-se que a conduta terapêutica na EPCF pode ser modificada a depender da classificação adotada e do método de aquisição de imagens radiológicas. Conclusão: A avaliação multiplanar da deformidade do fêmur proximal em pacientes com escorregamento proximal da cabeça do fêmur é uma opção viável e com potencial de modificar a classificação da doença nos pacientes e, por conseguinte, a modalidade terapêutica.

Síndrome femoroacetabular: evidencia de cicatrización del labrum luego de la reparación artroscópica / Femoroacetabular impingement. labral healing after arthroscopic repair

Introducción: el propósito de este trabajo fue evaluar bajo RMN la cicatrización del labrum en pacientes a los cuales se realizó su reparación artroscópica, con por lo menos 1 año de evolución. Materiales y métodos: Entre enero de 2012 y enero de 2015, se realizaron 54 artroscopias de cadera con diagnóstico de síndrome fricción femoroacetabular, de las cuales en 24 se realizó reparación del labrum. Se incluyeron en éste trabajo aquellos pacientes a los cuales se les realizó la reparación y que contaban con un seguimiento mínimo de 1 año. Fueron excluidos pacientes con cirugías previas en la cadera. Los pacientes fueron sometidos a una RMN para evaluar la cicatrización del mismo. Las RMN fueron evaluadas por 1 especialista y 1 fellow, ambos especializados en cirugía artroscópica de cadera y 1 especialista en diagnóstico por imágenes, teniendo en cuenta la variabilidad inter e intraobservador. Resultados: Se interpretó que un 68% presentaban cicatrización del labrum, mientras que en el 15% no se visualiza signos de cicatrización, y en el 17% restante no se pudo evaluar en la resonancia convencional la cicatrización del labrum. Sólo en un 47% de los estudios se logró un 100% de concordancia entre los observadores. Conclusión: La evaluación de la reparación del labrum debe hacerse con precaución, siempre de la mano de un buen examen físico y un buen interrogatorio, y no únicamente con la RMN debido a la variabilidad inter e intraobservador existente y la posibilidad de errores diagnósticos.

Objectives: the purpose of this study was to evaluate MRI images of labral repair after one year, trying to establish MRI images as a reliable tool for the diagnosis of labral healing. Materials and Methods: One hundred and sixty-two patients presenting with femoroacetabular impingement that underwent an arthroscopic surgery were treated between 2012 and 2015. Of these, 124 met the selection criteria and were included in this study. Only patients with 12 months of follow up and labral repair were included. Patients with previous hip surgery were excluded. Coronal, sagittal and axial MRI cuts were evaluated by three independent observers, an arthroscopic hip surgery, a fellow in hip arthroscopic surgery and a musculoskeletal radiologist. Results: On regard of our statistics 68% of the patients had labral healing images, 16% had no healing signals and 16% unsatisfactory images. Just in the 47% the observers had a 100% of agreement. Interobserver variation was: intraobserver agreement was 94% (arthroscopic surgeon), 72% (radiologist), 67% (fellow). Conclusion: The main finding of this study was that a high inter and intraobserver variability was found when analysing the healing status of hip repaired labrums. Assessment of labrum healing after an arthroscopic repair should not only rely on imaging methods and therefore should be concurrently performed with a comprehensive physical examination.

Osteochondroma Arising from Anterior Inferior Iliac Spine as a Cause of Snapping Hip

Snapping hip syndrome is a relatively common problem that can be easily managed with conservative treatment. This syndrome can be divided into external, internal and intra-articular types. Internal snapping hip syndrome is the rarest amongst these and its etiology is not well understood. We report a unique case of osteochondroma arising from the anterior inferior iliac spine (AIIS), which caused the internal snapping hip syndrome with hip pain and restriction of activity. This rare case of snapping hip syndrome from the AIIS was treated surgically and the symptoms completely disappeared after excision of the tumor.

The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner

BACKGROUND: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. METHODS: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. RESULTS: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. CONCLUSIONS: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.

Predictive factors of radiographic progression in ankylosing spondylitis

BACKGROUND/AIMS: The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. METHODS: In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. RESULTS: Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. CONCLUSIONS: These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine.

validity of preoperative templating in cementless total hip arthroplasty: a pilot study

Preoperative templating plays an important role in orthopaedic surgery for achieving a successful outcome in THA. This includes not only selecting the type and size of implant, but also deciding on the alignment, position, and orientation of these implants, relying on anatomically defined landmarks. The first goal of this study was to evaluate the validity of preoperative templating technique in terms of determining the final implant size and position. The second goal was to investigate the interobserver and Intraobserver reliability of template readings on conventional radiographs. In Aljumhorei hospital, Mosul city a case series; pilot study has been carried for twenty-eight patients had preoperative templating for total hip arthroplasty between 21/10/2009 to 16/5/2012 was carried by the operating surgeon. Preoperative templating by same two orthopedic surgeons carried for 12 patients from the total. Preoperative templating for Seventeen patientsout of the total were studied with the same operating surgeon after 2 years of experiences. 29% compatibility for shell between preoperative templating with intraoperative for the operator, P_ 0.023. While for stem 39%P_ 0.257. Second surgeon 58% compatibility with P_0.564, Stem differences represent 33% [P_ 0.248]. Differences with two years experiences for the operating surgeon indicate 35% compatibility both for shell and the stem with non-significant differences. Preoperative templating appeared to be more accurate for femoral stem measurements than the acetabular templating in determining the accurate sizes. Two years experienced added no more in templating measurements. There were significant differences for interobserver measurements.

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

BACKGROUND: This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. METHODS: We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. RESULTS: The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. CONCLUSIONS: The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.

Cotyloplasty in Cementless Total Hip Arthroplasty for an Insufficient Acetabulum

BACKGROUND: Cotyloplasty is a technique that involves making a perforation of the medial wall of a shallow acetabulum and then inserting an acetabular cup with the medial aspect of its dome beyond the Kohler line. The purpose of this study was to evaluate the results of cementless total hip arthroplasty (THA) using cotyloplasty with focusing on the amount of medial cup protrusion. METHODS: Sixteen hips with insufficient acetabulum in sixteen patients were treated by cementless THA using cotyloplasty. The average patient age was 47 years. The diagnoses included dysplastic hip (12) and infection sequelae (4). All the patients were followed up for at least 2 years. Clinically, the Harris hip scores were assessed and radiologically, the amount of cup protrusion, the hip center movement and cup fixation were evaluated. RESULTS: The average Harris hip score improved from 57 to 94 postoperatively. The average proportion of cup surface beyond the Kohler line was 44.1% and the hip centers were medialized by an average of 23 mm. Stable fixation of the acetabular cup was achieved in all the cases except one. In this one case, migration of the cup was detected 2 weeks postoperatively and a reoperation was performed. CONCLUSIONS: Using cotyloplasty, good coverage of the acetabular cup was obtained without a block bone graft, and the hip joint centers were medialized. However, the safety margin for the amount of protrusion should be established.

Seven-year Results of a Tapered, Titanium, Hydroxyapatite-Coated Cementless Femoral Stem in Primary Total Hip Arthroplasty

BACKGROUND: Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. METHODS: Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency. RESULTS: Eighty-six hips (78 patients) were available for review at follow-up of greater than 7 years. In 11 of the 86 cases, acetabular failure required revision of the acetabular component, but the femoral stem survived and it was available for long-term evaluation. The radiographs were obtained at 7-year follow-up for another 20 hips, but the patients would not come in for the 7-year clinical evaluation. Therefore, a phone interview was conducted to assess any change in the functional status at a minimum of 7 years. CONCLUSIONS: The mechanical fixation of a tapered, titanium, HA-coated femoral implant was excellent in this study. This femoral design provided reliable osseointegration that was durable at a mean of 7 years follow-up.

Are Portable Imaging Intraoperative Radiographs Helpful for Assessing Adequate Acetabular Cup Positioning in Total Hip Arthroplasty?

Despite advances in surgical techniques and instrumentation, current intra-operative estimations of acetabular version in total hip arthroplasty are of limited accuracy. In the present study, two experienced orthopedic surgeons compared intra-operatively measured (using portable imaging) anteversions and vertical inclinations of acetabular components with those measured using standardized radiographs post-operatively in 40 patients. Of the all vertical inclinations measured from intra-operative radiographs, 72.5% (n=29) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees of those determined using post-operative radiographs, and for anteversion, 52.5% (n=21) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees. Post-operative radiographs demonstrated that 90.0% (n=36) of vertical inclinations and anteversions were within the adequate zone. Obviously, our method has its limitations, but the authors conclude that the method described in this article better allows surgeons to verify acetabular version intra-operatively. In particular, the described method is suitable in cases with a deformed acetabular anatomy and difficult revision surgery.

Cemented and cementless total Hip replacement. critical analysis and comparison of clinical and radiological results of 182 cases operated in Al Razi Hospital, Kuwait

In this study we present the results of a series of cemented Exeter and cementless Zweymuller implants. Subject and Methods: Eighty-seven cemented and 95 cementless hip replacements for different hip pathologies were followed for an average period of 36 months for cementless and 60 months for cemented cases. Clinical results were calculated using the Merle d'Aubigne score. The orientation of the prosthetic components and the fixation of the cup and stem were analyzed. The clinical and radiological results were compared using statistical methods. In the average period of 36 months in cementless and 60 months in cemented hip replacements the clinical results improved significantly when compared with the preoperative score [p < 0.05]. Sixty-seven cemented acetabular cups [77.1%] were in the desired position [30-50°] and 20 cemented cups [22.9%] were outside this range. Seventy-six cups [80%] were in the desired degree of abduction and 19 [20%] were outside this range. All cups except 1 were anteverted or neutral. Of the femoral stems, 173 were in the neutral position, 5 in the valgus and 4 in the varus position. Cemented cups were more commonly loose and cemented and cementless stems did equally well. No significant differences in rate of complications were found. Cementless acetabular implants had better clinical results and a lower loosening rate at 3 years of follow-up compared to cemented implants at 5 years of follow-up. The cemented femoral implants were equally stable compared to the cementless ones

Joint involvement in asymptomatic Egyptian patients with HCV infection; ultrasonographic study

This case control diagnostic ultrasonographic study was undertaken to detect the presence of early articular and peri-articular involvement in Egyptian patients infected with hepatitis C virus [HCV] without any articular manifestation. The knee, hip and shoulder were evaluated clinically and by ultrasonography in a cohort of fifty patients with HCV without any current or previous articular manifestations in comparison with twenty healthy controls who were negative for HCV and HBV infections. Ultrasonographic alterations were detected in 96% of the HCV patients with highly significant difference in comparison to controls [p < 0.000]. Slight inflammatory changes were found in all the joints examined more than the moderate or severe changes. The knee and shoulder joints were involved in 74% of the HCV patients for each and the hip in 68%. There were higher prevalence and highly significant differences as regard the knee synovial thickening and effusion, hip effusion, trochanteric bursitis, supraspinatus tendon fluid collection and acromioclavicular joint effusion in comparison to the control group. Our study demonstrated the presence of joint changes in near all the asymptomatic patients with HCV with the prevalence of slight inflammatory alterations that can be explained by the presence of sub-clinical synovitis as well as the presence of significant changes in some of peri-articular structures. In countries like Egypt, the HCV is an endemic disease, so it is thus recommended that patients with rheumatic symptoms should be tested for the HCV infection and conversely that sign and symptoms of articular involvement should be evaluated in HCV patients