Inguino-Femoral Hernia in Women

PURPOSE: Inguino-femoral hernias in women are less common than that in a man, and we have had limited experience for hernia repair in women. The purpose of this study was to evaluate the characteristics of inguino-femoral hernias in females and to establish the choice of specific treatment for inguino-femoral hernia in females. METHODS: This retrospective study was based on the medical records of 566 patients who underwent 657 cases of herniorrhaphies for treating inguino-femoral hernia in adult females from January 1998 to June 2006. We evaluated the incidence of hernia, the operative technique and the length of the operation, the complications and the postoperative recurrence rate. The operative findings and median time to reoperation for a recurrent hernia were also evaluated. RESULTS: During the 8.5-year period, we performed 2,931 herniorrhaphies in 2,274 patients. Of these, 657 herniorrhaphies were done in females (22.4%). The types of hernia in females were indirect inguinal hernia (67.3%), direct inguinal hernia (10.2%), the pantaloon type (10%) and femoral hernia (14.9%). Femoral hernia was more frequent in females (14.9%) compared to males (3.5%) (P<0.001). The overall rate of reoperation due to incarceration in the females was higher (2.5%) than that in the men (1.1%)(P<0.001). Femoral hernias in females was found at reoperation in 39.7% compared with 17.2% in the males (P<0.001). CONCLUSION: The incidence of inguino-femoral hernia in females was higher than the results of most published studies and the reoperation rate was higher in females. The increased frequency of femoral hernia at reoperation in females suggests avoiding injuries to the posterior wall of the inguinal canal and the need for exploration of the femoral canal at the time of the primary operation.

Cementless Bony lngrowth Total Hip Prosthesis (Anatomical Contact Porous Coated Total Hip Prosthesis) Design using Computed Axial Tomography and Computer Aid Design

The purpose of this study is to design an Anatomical Contact Porous Coated Total Hip Prosthesis(ACP) which can transmit stress to the bone more physiologically and which can also eliminate the shortcomings of the currently available total hip prosthesis as much as possible. In the designing process, we have utilized computed axial tomography(CAT) and computer aid design (CAD). To obtain the shape of the femoral canal nondestructively, computed axial tomography data was obtained from fourteen male and fourteen female cadaver femurs and from twenty male and twenty female patients. To create the medullary canal in the computer, the actual dimension of each CAT-scan image was traced and digitized. For each femur a close-fit prototype of the stem was made with polyester and this was inserted into the corresponding femur in usual surgical manner. To test the accuracy of the fit of the prototype in the canal, an image of the cross-section of the canal with the polyester stem was obtained by CAT-scan in the same way that the original CAT-scan of the canal of the femur was done. We then had our computer display fit ratio between the prototype and the canal. We made sure all of the prototypes fit in the canal anatomically, especially around the defined regions (proximal medial and distal lateral regions). Further improvement was made on the fit of the stem in the canal by optimized computer programming. From studies on the shape and the size of the femoral canals of the sixty-eight femurs, eight sizes of ACP femoral stems were designed for each side. Also, on the basis of the anthropometric measurement of the acetabuli in twenty-eight cadaver hips and in the hips of forty patients with femoral neck fracture, different sizes of ACP hemispheric acetabular components were designed, ranging from 40 and 70 millimeters with 2 millimeter increments.

Cementless Press-Fit and Fibrous or Bony Ingrowth "Asian Total Hip Prosthesis" Design Using Computed Axial Tomography and Computer Aided Design and Computer Aided

The purpose of this study was to design intramedullary femoral stems that will optimally distribute the stresses to the bone. It was postulated that an ideal distribution of stresses would occur if the femoral stem had the same shape as the canal. However, because of the curved nature of the canal it was not possible to insert a canal replica. To make insertion possible, certain areas on the stem must be removed. Cross-section of the femoral canal at 5 and 10mm intervals, were non-destructively obtained by computer assisted tomography and each outline was stored on computer disk. Close-fit stem shapes were generated by computer aided design. These close-fit hip stem designs significantly improved total and priority region stem-canal contact. Further investigation employing both theoretical analysis and laboratory experimentation will examine the strength of these stems and theirs stress distribution to the femur.