RESUMEN
Objective: To investigate the influence of body mass index [BMI] and hip anatomy on direct anterior approach [DAA] total hip replacement
Subjects and Methods: The study is a retrospective analysis of 124 cases of DAA total hip replacement from 2009 to 2012. The BMI, the ratio of the greater trochanter [GT] and anterior superior iliac spine [ASIS] bilaterally [GT/ASIS], and the vertical distance between the ASIS and GT [AGVD] were obtained from medical records. All cases were categorized into three groups [43, 49, and 32 cases in each group, respectively] based on BMI [BMI <18.5, BMI 18.5-25, and BMI >25] or divided into two groups based on GT/ASIS [ 1.17] or AGVD [ 86 mm]. Operating time, intraoperative bleeding, and surgical complications were compared between different groups
Results: A longer average operating time, more intraoperative bleeding, and a higher rate of complications were observed in the group with the highest BMI. The complications included a case of intraoperative femur fracture, a wound hematoma, and a lateral femoral cutaneous nerve injury. The group with higher GT/ASIS had a shorter average operating time, less bleeding, and a lower complication rate than the group with lower GT/ASIS. Moreover, the group with higher AGVD showed a shorter average operating time, less bleeding, and a lower complication rate compared with the group with lower AGVD
Conclusion: Our study suggests that lower BMI and larger GT/ASIS and AGVD are associated with a shorter operating time, less bleeding, and a lower complication rate in DAA total hip replacement. These findings are valuable for clinicians to make the appropriate choice of surgery types for different individuals
RESUMEN
To investigate whether or not reconstruction of the medial cortex in subtrochanteric fracture can reduce the risks of internal fixation failure, fracture malunion, and nonunion. Between 2005 and 2008, 46 patients with subtrochanteric fracture were treated with intramedullary nailing and followed up. The average age was 42 years. According to the Seinsheimer classification, 26 patients were type IIIA, 7 were type IIIB, 11 were type IV and 2 were type V. Medial cortex alignment was achieved under traction in 40 cases. In 5 cases, the medial fractures were too far away and we used minimally invasive open reduction with wire or titanium cable cerclage. In 1 case of type IIIA subtrochanteric fracture, the displaced medial fracture was not reconstructed and was fixed with a long Gamma nail. We reviewed all patients' radiographs before and after treatment to evaluate bone healing. The 46 patients were followed up for an average of 24.3 months. Bone union was achieved within an average of 18.7 weeks in 45 cases. One case, a type IIIA fracture nonunion with displaced medial fracture, was not reconstructed. Instead, we used a free fibular transplantation on the medial side and fracture union was achieved 6 months after revision surgery. In reconstructing the medial cortex in subtrochanteric fracture treatment, continuity and integrity are important. They can reduce the failure of internal fixation and the incidence of nonunion
RESUMEN
[Objective]To discuss the outcome of acetabular protrusion after total hip arthroplasty. [Method]Fifteen patients(M=7,F=9) having painful acetabular protrusion received total hip arthroplasty with reinforcement of the acetabulum with bone grafts(autogenous or allogeneous bone).The results were reported at 1~4 years(mean,3 years) of follow-up.Of the 15 cases,5 were mild protrusion and 10 were moderate protrusion.The Harris hip-rating and radiographs were taken pre-and postoperatively. [Result]The average Harris hip-rating was improved from 45 points(range,39~60 points) preoperatively to 85 points(range,70~100 points) postoperatively.The average preoperative protrusion of the femoral head medial to the Kohler line was 8.8 mm(6~18 mm).The average postoperative placement of the prosthetic femoral head was 10 mm(6~13 mm) lateral to the Kohler line.None acetabulum prothesis failure or bone grafts absorption was seen.The grafts were well incorporated on radiograms in all patients one year after operation by radiographs. [Conclusion]Good results can be obtained in hips with acetabular protrusion after reconstructed with autogeneous or allogeneous bone grafting and total hip arthroplasty.