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Pigmented villonodular synovitis (PVNS) is a rare disease that can affect any joint, bursa or tendon sheath.
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The hip is less frequently affected than the knee, and hence is less discussed in scientific journals.
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PVNS of the hip mainly occurs in young adults, requiring early diagnosis and adequate treatment to obtain good results.
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There is no consensus on the management of PVNS of the hip in current literature.
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We will discuss the options for surgical intervention in hip PVNS using a literature review of clinical, biological, etiological, histological and radiographic aspects of the disease.
Cite this article: Steinmetz S, Rougemont A-L, Peter R. Pigmented villonodular synovitis of the hip. EFORT Open Rev 2016;1:260-266. DOI: 10.1302/2058-5241.1.000021.
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Dislocation remains a common cause of failure after total hip arthroplasty. The limitations of existing approaches to address instability have led to the development of powerfull options: constrained liners, dual mobility and large heads. These implant-related options have proven to be very efficient, but have raised concerns.
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With constrained liners, restricted range of motion (ROM) is responsible for impingement leading to high likelihood of failure, depending on the design, with various failure modes.
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Improvements of the bearing materials have addressed some of the concerns about increased volumetric wear of conventional polyethylene and offer an option to reduce instability: large diameter heads have the advantage of increased ROM before impingement, increased head-neck ratio, and jump distance. Highly cross-linked polyethylene helps address the risk for increased wear, and also large heads provide improved stability without the risk of mechanical failures observed with constrained liners. However, the increase of the head size remains limited as reducing the thickness of the liner may lead to fractures. In addition, the jump distance decreases as the cup abduction increases.
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The dual mobility concept simultaneously attempts to address head-neck ratio, constraint, and jump distance. Despite the need for longer follow-up, concerns raised about potential increased wear and intra-prosthetic dislocation with first generation implants have been addressed with modern designs.
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With a dramatic increase of the head-neck ratio whilst reducing the risk of mechanical failure or excessive wear, dual mobility THA outperforms large diameter heads and constrained liners at 10 years follow-up. For these reasons, dual mobility continues to gain interest worldwide and is becoming the most popular option to manage instability.
Cite this article: Guyen O. Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA. EFORT Open Rev 2016;1:197-204. DOI: 10.1302/2058-5241.1.000054.
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Navigation in primary total hip arthroplasty has a history of over 20 years. During this process, imageless computer navigation can be particularly helpful in optimally restoring the hip’s biomechanics. This involves the accurate placement of the acetabular component with the determination of the anteversion and abduction, whereby the navigated femur-first technique also allows for a calculation of the combined anteversion. Additional critical parameters such as the reconstruction of the rotation centre, as well as the femoral and acetabular offset, can also be optimally adjusted. Last but not least, an intra-operative evaluation and equalisation of the leg length is possible.
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Nonetheless, the disadvantages of this surgical technique in terms of the high costs in the acquisition and preservation of the necessary devices, as well as the longer operation time, must be taken into account. However, economic aspects are not the only thing preventing widespread use of the navigation technique. Determining the plane of reference (APP) for the optimal orientation of the implants is based on palpation of the bony landmarks – and this is influenced by the thickness of the soft tissue layer. Furthermore, the experience of the surgeon constitutes a variable that influences the accuracy of navigation.
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In summary, hip navigation certainly offers an interesting technique for the optimisation of total hip arthroplasty with reconstruction of proper biomechanics. At the same time, there is currently a lack of high-quality randomised controlled long-term trials that evaluate the clinical advantage for the patients, together with cost utility and survival rates.
Cite this article: Renner L, Janz V, Perka C, Wassilew GI. What do we get from navigation in primary THA? EFORT Open Rev 2016;1:205-210. 10.1302/2058-5241.1.000034.
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Based on the exceptional tribological behaviour and on the relatively low biological activity of ceramic particles, Ceramic-on-Ceramic (CoC) total hip arthroplasty (THA) presents significant advantages
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CoC bearings decrease wear and osteolysis, the cumulative long-term risk of dislocation, muscle atrophy, and head-neck taper corrosion.
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However, there are still concerns regarding the best technique for implantation of ceramic hips to avoid fracture, squeaking, and revision of ceramic hips with fracture of a component.
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We recommend that surgeons weigh the potential advantages and disadvantages of current CoC THA in comparison with other bearing surfaces when considering young very active patients who are candidates for THA.
Cite this article: Hernigou P, Roubineau F, Bouthors C, Flouzat-Lachaniette C-H. What every surgeon should know about Ceramic-on-Ceramic bearings in young patients. EFORT Open Rev 2016;1:107-111. DOI: 10.1302/2058-5241.1.000027.
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One of the most common causes for revision surgery following total hip arthroplasty (THA) is dislocation.
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Dislocation is associated with a considerable amount of suffering and risks for the patient, and extra costs for the health care system.
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Compared with degenerative arthritis, the dislocation rate is doubled for avascular necrosis and multiplied by three times for congenital dislocation, four for fracture, five for nonunion, malunion or a failed hip arthroplasty, and eleven times after surgery for prosthetic instability.
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In analysing instability the cause may be assessed as 1) locally caused within the hip with explanatory radiographic findings, 2) locally caused without explanatory radiographic findings or 3) non-locally caused, i.e. non-compliant patient, neuromuscular or cognitive disorders.
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Revision strategies for instability are typically directed to correct the underlying aetiology, but also to strive for an upsizing of the head and liner.
Cite this article: Ullmark G. The unstable total hip arthroplasty. EFORT Open Rev 2016;1:83-88. DOI: 10.1302/2058-5241.1.000022.
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Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice.
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DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery.
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Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options.
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Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods.
Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65–71. DOI: 10.1302/2058-5241.1.000026.
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Articulating components should minimise the generation of wear particles in order to optimize long-term survival of the prosthesis.
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A good understanding of tribological properties helps the orthopaedic surgeon to choose the most suitable bearing for each individual patient.
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Conventional and highly cross-linked polyethylene articulating either with metal or ceramic, ceramic-on-ceramic and metal-on-metal are the most commonly used bearing combinations.
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All combinations of bearing surface have their advantages and disadvantages. An appraisal of the individual patient’s objectives should be part of the assessment of the best bearing surface.
Cite this article: Rieker CB. Tribology of total hip arthroplasty prostheses: what an orthopaedic surgeon should know. EFORT Open Rev 2016;1:52-57. DOI: 10.1302/2058-5241.1.000004.
