ABSTRACT
We compared 47 patients with groin pain following hip resurfacing to a matched control group. Functional scores and plain radiographs were assessed along with measurement of whole blood cobalt and chromium by inductively coupled mass spectrometry. Symptomatic patients underwent ultrasound scan of the affected hip. Mean functional outcomes were poor in those with pain and good in the control group. Groin pain was associated with valgus stem positioning and lower neck:head ratio (relatively narrow neck) (p=0.03, p=0.04 respectively). We classified patients with groin pain into two groups: biological and mechanical. The biological group had soft tissue abnormalities on USS and higher levels of cobalt and chromium (p=0.04, p=0.05 respectively). The mechanical group had normal USS, lower metal ion levels and more retroverted femoral components (p=0.01).
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Femoracetabular Impingement/etiology , Groin , Pain, Postoperative/etiology , Pelvic Pain/etiology , Adult , Aged , Case-Control Studies , Chromium/blood , Cobalt/blood , Female , Femoracetabular Impingement/blood , Femoracetabular Impingement/physiopathology , Follow-Up Studies , Hip Joint/diagnostic imaging , Hip Joint/physiopathology , Hip Joint/surgery , Humans , Male , Mass Spectrometry , Middle Aged , Pain, Postoperative/blood , Pain, Postoperative/physiopathology , Pelvic Pain/blood , Pelvic Pain/physiopathology , Radiography , Range of Motion, ArticularABSTRACT
Femoral neck fracture is an important early complication after hip resurfacing. Our aims were firstly to determine the incidence of fracture in an independent series and secondly, in a case control study, to investigate potential risk factors. Fifteen femoral neck fractures occurred in a series of 842 procedures, representing an incidence of 1.8%. No relationship existed between age, sex, and fracture incidence. Mechanical factors such as notching, femoral neck lengthening, and varus alignment of the femoral component were found to have a similar incidence in both fracture and control groups. The proportion of patients that had at least 1 mechanical risk factor was not different between the 2 groups (fracture group, 50%; control group, 41%). Established avascular necrosis of the femoral head was evident in all retrieved femoral heads (n = 9) of patients who sustained postoperative fracture; in none of these patients was avascular necrosis the initial diagnosis. This study suggests that in our practice, mechanical factors, such as neck notching, neck lengthening, or varus angulations, are not the primary cause of femoral neck fractures.
Subject(s)
Arthroplasty, Replacement, Hip , Femoral Neck Fractures/etiology , Postoperative Complications , Reoperation , Adult , Aged , Biomechanical Phenomena , Case-Control Studies , Female , Femoral Neck Fractures/diagnostic imaging , Femoral Neck Fractures/epidemiology , Femur Head Necrosis/complications , Femur Neck/surgery , Hip Joint/diagnostic imaging , Hip Joint/surgery , Hip Prosthesis/adverse effects , Humans , Incidence , Male , Metals , Middle Aged , Radiography , Retrospective Studies , Risk FactorsABSTRACT
Beals syndrome (congenital contractural arachnodactyl) is a genetic disorder of the connective tissue phenotypically related to Marfan syndrome. It is characterised by dolichostenomelia, arachnodactyly, multiple joint contractures, crumpled ears, hypoplastic muscles and scoliosis. The latter, the most important clinical feature of this rare condition, presents in the infantile and juvenile age group and has a tendency to rapid progression. Bracing often fails to control the scoliosis and surgery is the recommended treatment. We present our experience of two cases managed with the paediatric Isola instrumentation and a non-fusion technique.
