Hip
You are looking at 1 - 10 of 124 items
Search for other papers by Pierre Laboudie in
Google Scholar
PubMed
Search for other papers by Moussa Hamadouche in
Google Scholar
PubMed
-
The French paradox cementing technique encompasses a canal filling highly polished stem with a thin (<1 mm) cement mantle.
-
The technique has been developed by Pr Marcel Kerboull in the late 1960s after he observed the patterns of debonding of the original Charnley stem.
-
The key point of the technique is based upon removal of the metaphyseal cancellous bone (with hollow reamers or aggressive broaches) especially at the supero-medial region.
-
Only two stems have been validated with this technique: the Charnley–Kerboull (CK) and the Ceraver Osteal stem, both of which are collared.
-
This technique is neither a taper slip (the stem does not subside at long-term follow-up) nor a composite beam (a highly polished stem is used).
-
A 12% shortened stem CK has shown similar results to the standard-length stem, including the absence of stem subsidence.
-
Combined with the Hueter anterior approach, this technique has demonstrated one of the lowest femoral PPF rate in elderly patients in the literature.
Search for other papers by Filippo Casella in
Google Scholar
PubMed
Search for other papers by Gianluca Mazzotta in
Google Scholar
PubMed
Search for other papers by Fabio Favetti in
Google Scholar
PubMed
Search for other papers by Matteo Papalia in
Google Scholar
PubMed
Search for other papers by Gabriele Panegrossi in
Google Scholar
PubMed
Search for other papers by Massimo Spinelli in
Google Scholar
PubMed
Search for other papers by Francesco Falez in
Google Scholar
PubMed
-
Scepticism is still the most common attitude of orthopaedic surgeons toward short stems, despite the excellent survival rate reported in the International Registry, together with an acceptable complication risk.
-
In surgical centres where these types of implants are commonly utilised, they account for a significant percentage of procedures (up to 50% of total hip replacements performed).
-
Potential benefits of bone preservation were evident from the very early phase of introduction. Some complications have been experienced, especially with modular short stems.
-
Some limitations and weak points during the evolution from early designs to modern short stems have been identified.
-
With few exceptions, clinical results and survivorship were very good, despite widened indications (age- and pathology-related), giving an overall retrospective evaluation of our experience with short stems similar to primary hip implants.
-
Failure of short stems is mostly related to the validity of bone preservation in terms of revision strategy.
-
Standard surgical revision was generally performed with two-stage revisions in PJI and stem revision in periprosthetic fracture.
Search for other papers by Christophe Combescure in
Google Scholar
PubMed
Search for other papers by James A Smith in
Google Scholar
PubMed
Search for other papers by Christophe Barea in
Google Scholar
PubMed
Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology,
Search for other papers by Lotje A Hoogervorst in
Google Scholar
PubMed
Search for other papers by Rob Nelissen in
Google Scholar
PubMed
Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology,
Search for other papers by Perla J Marang-van de Mheen in
Google Scholar
PubMed
Division of Orthopaedic Surgery, Geneva University Hospitals,
Search for other papers by Anne Lübbeke in
Google Scholar
PubMed
Search for other papers by the Arthroplasty registry group * in
Google Scholar
PubMed
Purpose
-
The objective was to investigate the consistency in cumulative revision rates (CRRs) for a selection of total hip arthroplasty cups and stems across national/regional hip arthroplasty registries worldwide.
Methods
-
Ten cups and ten stems from total hip systems were randomly selected. Two frequently used implants across registries were added, totalling 11 cups and 11 stems. CRRs and 95% CIs were extracted from the latest annual registry reports using these implants. CRRs were pooled for each cup or stem, and differences between cup-stem combinations and between registries were investigated.
Results
-
CRRs were available for ten cups and eight stems from eight registries, totalling 552,148 cups and 727,447 stems. Follow-up was 1–20 years. The 5-year CRR pooled for all cups was 2.9% (95% CI: 2.3–3.6) and for all stems, 3.0% (95% CI: 2.4–3.8). Homogeneous (consistent) CRRs with respect to both associated implant and country were observed for two cups and three stems. Significant differences in CRR were identified in one cup by associated implant only, in one cup by registry only, and in two cups and four stems for both. Sparse data prevented evaluation of four cups and one stem.
Conclusion
-
Registries’ annual reports provide a large amount of publicly available information on CRRs of specific implants. These CRRs can be synthesised to improve the assessment of implant performance over time. Our CRR analysis represents a promising approach to detect implants with a consistent low- or high-risk pattern across registries.
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center,
Search for other papers by Eustathios Kenanidis in
Google Scholar
PubMed
Search for other papers by Eleni Gkoura in
Google Scholar
PubMed
Search for other papers by Eleni Tsamoura in
Google Scholar
PubMed
Search for other papers by Zakareya Gamie in
Google Scholar
PubMed
Search for other papers by Peter Sculco in
Google Scholar
PubMed
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center,
Search for other papers by Eleftherios Tsiridis in
Google Scholar
PubMed
-
The piriformis muscle (PM) is important for posture and preventing falls. It is a key landmark for hip surgery. The PM function is reported to be increasingly important for improving total hip arthroplasty (THA) outcomes and reducing complications. This scoping review aims to map and summarize the literature on the anatomy and function of the PM and the outcomes of clinical studies on THA preserving the PM to improve readers’ understanding and identify areas for further research.
-
A scoping review following the PRISMA guidelines was conducted using PubMed and Scopus from their inception until June 2023. We used the search term ‘piriformis’ or ‘PM’ to include all PM-related studies. Two independent reviewers screened abstracts and full texts to select key aspects of PM anatomy and function and the main clinical THA studies reporting outcomes on PM preservation.
-
Fifty-seven studies published between 1980 and 2023 met our inclusion criteria. During hip surgery, the PM anatomy, including its origin and insertion, muscle belly, and relation to other short hip rotators and the sciatic nerve, can vary greatly, making it difficult to recognize.
-
The current literature on PM-preserving THA and hemiarthroplasty clinical studies is limited. It suggests potential benefits in terms of hip stability, dislocation risk, and functional outcomes compared to no PM preservation in short-term follow-up.
-
Identifying and preserving the PM during hip surgery may be difficult due to its variable anatomy and its relation to surrounding structures. Although the literature supporting PM preservation potentially indicates better outcomes, further high-level research studies are needed.
Search for other papers by Jonas Liebe in
Google Scholar
PubMed
Search for other papers by Michel Schläppi in
Google Scholar
PubMed
Search for other papers by Christoph Meier in
Google Scholar
PubMed
Faculty of Medicine, University of Berne,
Search for other papers by Peter Wahl in
Google Scholar
PubMed
Purpose
-
Total hip arthroplasty (THA) is performed commonly for various end-stage diseases of the hip joint. However, the likelihood of a subsequent contralateral THA (cTHA) after primary unilateral index THA (iTHA) remains insufficiently defined, with reported rates of 13–29.1% after 5 years and 8.7–54% after 10 years of follow-up. This review aims to determine the long-term likelihood over time of cTHA after iTHA.
Methods
-
Systematic review of the literature with meta-analysis, including any clinical study published until July 2022, evaluating or documenting the likelihood over time of cTHA after iTHA, independently of the etiology. Excluded were cTHA within 12 months. A total of 21 studies, including 1,456,071 patients, who subsequently received 249,117 cTHA, were analyzed. Kaplan–Meier analysis was performed, weighting data on sample size, considering death as competing risk.
Results
-
At 5 years after iTHA, likelihood of cTHA was 17.8% (95% confidence interval 12.3–23.3%). At 10 years, this likelihood increased to 22.7% (16.1–29.4%), with a marginal subsequent increase. The likelihood increased slightly considering death as competing risk.
Conclusion
-
Nearly every fourth THA patient will require cTHA within 10 years. The likelihood of cTHA in this review appears to fall within the lower third of previously published ranges. However, most cTHA are required within the first years. Our findings suggest that the likelihood of requiring cTHA within the initial 10 years is approximately twice as high as the likelihood of requiring revision of the iTHA.
INSERM, U1093, CAPS, University of Burgundy, Dijon, France
Search for other papers by Pierre Martz in
Google Scholar
PubMed
Clinique de la Hanche et du Genou – 2 Avenue de Terrefort, Bruges, France
Search for other papers by Jerome Magendie in
Google Scholar
PubMed
Search for other papers by Sonia Ramos-Pascual in
Google Scholar
PubMed
Search for other papers by Ankitha Kumble in
Google Scholar
PubMed
Clinique de la Hanche et du Genou – 2 Avenue de Terrefort, Bruges, France
Search for other papers by Benoît Boutaud in
Google Scholar
PubMed
Clinique de la Hanche et du Genou – 2 Avenue de Terrefort, Bruges, France
Search for other papers by Nicolas Verdier in
Google Scholar
PubMed
Purpose
-
To identify, synthesise, and critically appraise findings of systematic reviews and/or meta-analyses on hip preservation surgeries for borderline and/or frank dysplasia with or without concomitant femoroacetabular impingement (FAI).
Methods
-
A search, following the PRISMA guidelines, was conducted using Medline and Embase on 19/04/2023. Findings extracted from eligible studies were tabulated and synthesised.
Results
-
The search identified 477 references. Nineteen were eligible for data extraction: nine reported on arthroscopy, five reported on periacetabular osteotomy (PAO), one reported on shelf acetabuloplasty, and one reported on Chiari osteotomy, while two compared arthroscopy versus PAO, and one compared PAO versus rotational acetabular osteotomy (RAO) versus eccentric acetabular osteotomy (ERAO). The nomenclature and lateral centre edge angle (LCEA) thresholds to define hip dysplasia varied widely across included studies. All hip preservation surgeries provided good outcomes, with the Harris hip score (HHS) being the most commonly reported clinical score. Using the AMSTAR checklist for risk of bias, no systematic reviews were rated as high quality; ten were rated as moderate quality; six were rated as low quality; and three were rated as critically low quality.
Conclusions
-
Most published systematic reviews on hip preservation surgery are of moderate or low quality, and there is high heterogeneity among them regarding outcomes reported, follow-up periods, and definitions of dysplasia. The authors recommend the following thresholds and nomenclature for dysplasia: LCEA < 20° for frank dysplasia, 20°–25° for borderline dysplasia, and >25° for no dysplasia. Although all hip preservation surgeries can provide good outcomes, it is challenging to conclude which surgery provides the best outcomes and to determine if treatment options are dependent on LCEA.
Search for other papers by Gregor Giebel in
Google Scholar
PubMed
Search for other papers by Sebastian Hardt in
Google Scholar
PubMed
Search for other papers by Carsten Perka in
Google Scholar
PubMed
Search for other papers by Rudolf Ascherl in
Google Scholar
PubMed
-
The indication for femoral stem cementation should be made on a patient-specific basis, taking physical activity, femoral geometry, and bone tissue quality into account. Age alone should not be the sole justification for cementation. The Dorr classification can serve as decision support for whether a cemented fixation should be used. Femoral neck fractures should generally be cemented.
-
Familiarize yourself with the applied stem philosophy. Force-closed stems typically have a polished surface that allows for subsidence, especially in the first 2 years postoperatively. Stems following the shape-closed philosophy have rougher surfaces and do not allow subsidence.
-
There are various types of cement that differ in viscosity and can be categorized accordingly. These cement types go through four temperature-dependent phases: mixing phase, waiting phase, working phase, and curing phase. Rough implants should be implanted quickly, using wetter cement. For a polished stem, the cement should be slightly firmer.
-
To avoid complications like bone cement implantation syndrome, it is essential to adhere to the state-of-the-art retrograde cementation technique, which recommends pulsatile lavage and vacuum mixing of the cement. Additionally, cement restrictors and pressurizers are used.
-
A thorough understanding of cementation techniques is crucial to ensure a favorable outcome with a uniformly thick cement mantle that encompasses the entire stem. Incorrect cementing can lead to the premature failure of the endoprosthesis.
Search for other papers by Arya Nicum in
Google Scholar
PubMed
Department of Mechanical Engineering, University College London, UK
Search for other papers by Harry Hothi in
Google Scholar
PubMed
Search for other papers by Johann Henckel in
Google Scholar
PubMed
Department of Mechanical Engineering, University College London, UK
Search for other papers by Anna di Laura in
Google Scholar
PubMed
Search for other papers by Klaus Schlueter-Brust in
Google Scholar
PubMed
Royal National Orthopaedic Hospital, Stanmore, UK.
Cleveland Clinic London, London, UK
Search for other papers by Alister Hart in
Google Scholar
PubMed
-
Three-dimensional printing is a rapidly growing manufacturing method for orthopaedic implants and it is currently thriving in several other engineering industries. It enables the variation of implant design and the construction of complex structures which can be exploited in orthopaedics and other medical sectors.
-
In this review, we develop the vocabulary to characterise 3D printing in orthopaedics from terms defined by industries employing 3D printing, and by fully examining a 3D-printed off-the-shelf acetabular cup (Fig. 1). This is a commonly used 3D-printed implant in orthopaedics, and it exhibits a range of prominent features brought about by 3D printing.
-
The key features and defects of the porous and dense regions of the implant are clarified and discussed in depth to determine reliable definitions and a common understanding of characteristics of 3D printing between engineers and medical experts in orthopaedics.
-
Despite the extensive list of terminology derived here, it is clear significant gaps exist in the knowledge of this field. Therefore, it is necessary for continued investigations of unused implants, but perhaps more significantly, examining those in vivo and retrieved to understand their long-term impact on patients and the effects of certain features (e.g. surface-adhered particles).
-
Analyses of this kind will establish an understanding of 3D printing in orthopaedics and additionally it will help to update the regulatory approach to this new technology.
Search for other papers by Yingze Su in
Google Scholar
PubMed
Search for other papers by Kangming Chen in
Google Scholar
PubMed
Search for other papers by Jinyan Wu in
Google Scholar
PubMed
Search for other papers by Junfeng Zhu in
Google Scholar
PubMed
Search for other papers by Xiaodong Chen in
Google Scholar
PubMed
-
Femoral version (FV) is more widely adopted with the definition as the angle between the long axis of the femoral neck and the tangent line of the posterior femoral condyles on the axial plane, and the normal range between 5 and 20°.
-
FV can be measured by imaging and functional tests. Cross-sectional CT including both the hip and the knee is the typically used imaging technique, yet variation exists according to the different landmarks used. As MRI investigations are routinely performed preoperatively, and protocols can be easily adopted to include version measurement, they are frequently used as an alternative to CT and offers several advantages.
-
Abnormal FV has adverse effects on the biomechanics and musculoskeletal health of the whole lower limb. It affects the lever arm of muscles and the forces that the hip and patellofemoral joints suffer, and can lead to disorders such as osteoarthritis and impingement.
-
In adult hip preservation surgery for developmental dysplasia of the hip (DDH), abnormal FV is sometimes accompanied by other morphological abnormities of the hip, a more severe DDH, and can help predict postoperative range of motion (ROM), and postoperative impingement.
-
Currently, the most frequently used surgical technique for abnormal FV is femoral derotational osteotomy.
-
Many controversies are left to be solved, including the specific origin of FV, the indication for femoral derotational osteotomy, especially in patients with combined DDH and abnormal FV, and the explicit compensation mechanism of abnormal FV by tibial torsion.
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
Search for other papers by Leonardo Tassinari in
Google Scholar
PubMed
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
Search for other papers by Alberto Di Martino in
Google Scholar
PubMed
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
Search for other papers by Matteo Brunello in
Google Scholar
PubMed
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
Search for other papers by Valentino Rossomando in
Google Scholar
PubMed
Orthopedics-Traumatology and Prosthetic Surgery and Hip and Knee Revision, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Search for other papers by Francesco Traina in
Google Scholar
PubMed
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
Search for other papers by Cesare Faldini in
Google Scholar
PubMed
Purpose
-
Leg length discrepancy (LLD) is a common complication following total hip arthroplasty (THA). The direct anterior approach (DAA) for THA is gaining popularity due to its advantages, but there is limited research on the incidence and size of LLD. This systematic review aims to explore the differences in LLD between DAA and other approaches, as well as the techniques to control LLD in DAA.
Methods
-
A comprehensive literature search was conducted to identify relevant studies comparing THA by DAA with other surgical approaches and investigating methods to control LLD in DAA, following PRISMA guidelines and a priori registration on PROSPERO (CRD42023412644). The quality of the included studies was assessed. Data on preoperative and postoperative LLD and other relevant outcomes were extracted and analyzed descriptively.
Results
-
In total, 29 studies were included in this systematic review. The majority (86%) were classified as level IV evidence. Comparisons between DAA and posterior approach (PA) or anterolateral approach (ALA) showed DAA had lower rates of LLD >10 mm compared to PA and ALA. Different pre- and intra-operative techniques were evaluated, but no consensus on the best method for preventing LLD in DAA was reached.
Conclusion
-
DAA shows comparable or superior results in the prevention of LLD compared to other surgical approaches. Supine patient placement, direct leg measurement, and the use of IF contribute to these outcomes. Intraoperative fluoroscopy with a grid and preoperative planning offers a good option, especially for training purposes, but its role in preventing LLD by experienced DAA surgeons needs further investigation.
