Search for other papers by Thorsten Gehrke in
Google Scholar
PubMed
Search for other papers by Mustafa Citak in
Google Scholar
PubMed
Search for other papers by Mustafa Akkaya in
Google Scholar
PubMed
Patient with severe bone defects and pelvis discontinuity in left hip. Preoperative planning and development of individualized megaimplants Assessment of the acetabulum during revision hip arthroplasty is usually performed with direct
Search for other papers by Claude B. Rieker in
Google Scholar
PubMed
bearings. Conclusions All combinations of bearing surface have advantages and disadvantages. An appraisal of the individual patient’s objectives should be part of the assessment of the best bearing surface. At present, it is possible to make the
Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
Search for other papers by Angelika Ramesh in
Google Scholar
PubMed
Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
Search for other papers by Anna Di Laura in
Google Scholar
PubMed
Search for other papers by Johann Henckel in
Google Scholar
PubMed
Institute of Orthopaedics and Musculoskeletal Science, University College London, United Kingdom
Cleveland Clinic London, United Kingdom
Search for other papers by Alister Hart in
Google Scholar
PubMed
parameters (100 kV and 100 mAs) produced scans with adequate image resolution for surgical planning and outcome assessment while inducing a 90% reduction in radiation exposure. Thus, when adopting a low-dose approach, it does not restrict the surgeon
Search for other papers by J R W Crutsen in
Google Scholar
PubMed
Search for other papers by M C Koper in
Google Scholar
PubMed
Search for other papers by J Jelsma in
Google Scholar
PubMed
Search for other papers by M Heymans in
Google Scholar
PubMed
School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
Search for other papers by I C Heyligers in
Google Scholar
PubMed
Search for other papers by B Grimm in
Google Scholar
PubMed
Search for other papers by N M C Mathijssen in
Google Scholar
PubMed
School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
Search for other papers by M G M Schotanus in
Google Scholar
PubMed
(percentage) or as mean ( s.d. ). Quality assessment The risk of bias (RoB) tool of the Cochrane Handbook for Systematic Reviews of Interventions was used and the Newcastle–Ottawa Scale (NOS) was chosen to assess the quality of the articles ( 20 , 21
Search for other papers by Morten Schultz Larsen in
Google Scholar
PubMed
Search for other papers by Hagen Schmal in
Google Scholar
PubMed
-
Atypical femoral fractures (AFF) are stress or ‘insufficiency’ fractures, often complicated by the use of bisphosphonates or other bone turnover inhibitors. While these drugs are beneficial for the intact osteoporotic bone, they probably prevent a stress fracture from healing which thus progresses to a complete fracture.
-
Key features of atypical femoral fractures, essential for the diagnosis, are: location in the subtrochanteric region and diaphysis; lack of trauma history and comminution; and a transverse or short oblique configuration.
-
The relative risk of patients developing an atypical femoral fracture when taking bisphosphonates is high; however, the absolute risk of these fractures in patients on bisphosphonates is low, ranging from 3.2 to 50 cases per 100,000 person-years.
-
Treatment strategy in patients with AFF involves: radiograph of the contralateral side (computed tomography and magnetic resonance imaging should also be considered); dietary calcium and vitamin D supplementation should be prescribed following assessment; bisphosphonates or other potent antiresorptive agents should be discontinued; prophylactic surgical treatment of incomplete AFF with cephalomedullary nail, unless pain free; cephalomedullary nailing for surgical fixation of complete fractures; avoidance of gaps in the lateral and anterior cortex; avoidance of varus malreduction.
Cite this article: EFORT Open Rev 2018;3:494-500. DOI: 10.1302/2058-5241.3.170070.
Search for other papers by Charles Rivière in
Google Scholar
PubMed
Search for other papers by Stefan Lazic in
Google Scholar
PubMed
Search for other papers by Loïc Villet in
Google Scholar
PubMed
Search for other papers by Yann Wiart in
Google Scholar
PubMed
Search for other papers by Sarah Muirhead Allwood in
Google Scholar
PubMed
Search for other papers by Justin Cobb in
Google Scholar
PubMed
-
Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality.
-
Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined.
-
By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity.
-
The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation.
-
The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy.
-
The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.
Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
Search for other papers by Georgios Tsikandylakis in
Google Scholar
PubMed
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
Search for other papers by Soren Overgaard in
Google Scholar
PubMed
Search for other papers by Luigi Zagra in
Google Scholar
PubMed
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
Search for other papers by Johan Kärrholm in
Google Scholar
PubMed
-
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.
-
Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.
-
Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.
-
Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.
-
The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe.
Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002
Department of Clinical Research, University of Southern Denmark, Odense, Denmark
University College Absalon, Center of Nutrition and Rehabilitation, Department of Physiotherapy, Region Zealand, Denmark
Search for other papers by Anders Falk Brekke in
Google Scholar
PubMed
Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Search for other papers by Søren Overgaard in
Google Scholar
PubMed
Odense Patient data Explorative Network (OPEN), Odense, Denmark
Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
Search for other papers by Asbjørn Hróbjartsson in
Google Scholar
PubMed
Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Search for other papers by Anders Holsgaard-Larsen in
Google Scholar
PubMed
and research assessments. In the clinic, pelvic tilt is measured using inclinometry as the angle between a line connecting the anterior and posterior superior iliac spine (ASIS and PSIS) and in the normal healthy population, the reference value of
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy
Search for other papers by Mattia Loppini in
Google Scholar
PubMed
Search for other papers by Francesco Manlio Gambaro in
Google Scholar
PubMed
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
Search for other papers by Rob G H H Nelissen in
Google Scholar
PubMed
Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy
Search for other papers by Guido Grappiolo in
Google Scholar
PubMed
protocol to manage patients after THA stems from a number of reasons such as the early identification of complications and the assessment of the right timing for a possible revision surgery. The latter aspect ensues due to the fact that prosthetic hip
Search for other papers by Mattia Loppini in
Google Scholar
PubMed
Search for other papers by Guido Grappiolo in
Google Scholar
PubMed
) Classes Description Rationale McTighe et al 11 (2013) • Head stabilized • Resurfacing. Assessment of length and method of achieving primary stability of the stem. • Neck stabilized • Short curved neck-sparing stems, and
