Functional outcome of total hip replacement using a short stem implant

Background: Conventional cementless THA is associated with stress shielding of the proximal femur and thigh pain. Short femoral stem can conserve bone, reduce stress shielding in the femur and reduce thigh pain. The present study aims to describe the functional outcomes associated with short stem metaphyseal implant in THA in our department.Methods: This prospective study was conducted in the Department of Orthopaedic Surgery, Indira Gandhi Medical College, Shimla among patients who needed THA for painful disabling hip. Modified Harris hip scores (HHS) were assessed for all patients pre-operatively and at their final follow up.Results: During the study period, a total of 20 patients were included in the study, 20% of them were females. The most common indication for THA was avascular necrosis head of femur with secondary osteomyelitis (n=14), of which 12 cases had excellent Hip Harris Score while two were in good category. Modified Harris hip score was excellent in patients where early partial and full weight bearing was started. Per-operatively, there was only one complication of fracture greater trochanter which was fixed with cerclage wire. In early post-operative period, two cases of superficial infection were noted and one case of varus malposition was present. In late post operative period, there were three cases of varus malposition and one case of deep infection as sinus.Conclusions: Total hip replacement with short anatomical metaphyseal loading stem improved the modified Harris Hip score significantly, with very few complications. Future multicentric studies are needed to evaluate the efficacy of short stem implants over a long follow up period.

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Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study

Journal of International Medical Research ◽

10.1177/03000605211012210 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110122

Author(s):

Wenlu Liu ◽

Huanyi Lin ◽

Xianshang Zeng ◽

Meiji Chen ◽

Weiwei Tang ◽

...

Keyword(s):

Femoral Neck ◽

Clinical Outcomes ◽

Total Hip Replacement ◽

Hip Replacement ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Total Hip ◽

Metal On Metal

Objective To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). Methods Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. Results The mean follow-up was 84.12 (67–100) months for UTR and 84.23 (66–101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). Conclusion In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.

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SHALL IT BE BETTER, AS AN APPROACH FOR THR, POSTERIORLY OR LATERALLY; A CLINICO-FUNCTIONAL AND GAIT ANALYTICAL OUTCOME ANALYSIS, IN A PROSPECTIVE STUDY, IN THE SOUTH-INDIAN POPULATION.

10.36106/7014294 ◽

2021 ◽

pp. 71-75

Author(s):

Arun Kumar C ◽

Ganashree S ◽

Arivoli S ◽

Aswath C A ◽

Rakesh Kumar B ◽

...

Keyword(s):

Prospective Study ◽

Total Hip Replacement ◽

Hip Replacement ◽

Posterior Approach ◽

Lateral Approach ◽

Harris Hip Score ◽

South Indian Population ◽

Total Hip ◽

South Indian

Introduction: Hip resurfacing arthroplasty (HRA) or Total hip replacement (THR), as it is popularly called, attempts to mollify these basic clinical problems, in patients with a hip arthritic problem, which may be of a sequela to age-related degeneration, osteonecrosis, systemic disorder like Rheumatoid arthritis (RA) or Ankylosing spondylosis (AS) or as a result of trauma and or an old infection. The basic pathology, is an unfavourable and abrading hip diarthrodial joint. The endeavour of the study was, to establish the efcacy of the Posterior vs Lateral approach for THA/THR, by studying their outcomes in primary THR. This prospective study was undertaken at Che Materials And Methods: ttinad Hospital and Research Institute (CARE), Kelambakkam, Chengalpattu district, Tamilnadu, In the Department of Orthopaedics from Jan 2017 to Dec 2020 (48 months). The Functional outcome of hip surgery was measured using the Harris Hip Score, Oxford hip score and the WOMAC. Rivermead visual gait analysis (RVGA) method was used post-operatively to assess the gait. The Biomechanical outcomes of Abductor Gait Component, were individually assessed by EMG studies. The Harris Hip Score, The Oxford Hip S Results: core and WOMAC score, when the lateral approach was compared to the posterior approach pre-op and post-op in the 12 months minimum follow-up period, the laterally approached group faired better. The VAS score was equivocal. The comprehensive RVGA assessment also showed marginally better results for the laterally approached group as was the case with the Trendelenburg test score. The EMG studies for the Gluteus Maximus, Medius and the lateral rotators of hip also favoured the outcomes for the laterally approach hips. The supremacy of the Lateral Approach, ove Conclusion: r Posterior Approach, cannot be adjudged in a short-term follow-up study. It is thus opined that the Lateral Approach may be statistically and data wise superior, but the patient satisfaction, which is a major factor, is almost the same in both the approach groups. The follow-up needs to be atleast for a decade for us to be able to come to any meaningful conclusion. With regards to surgery like the Total hip replacement, which have a longevity factor exceeding 10 years, studies have to be followed up for periods in excess of 10 years.

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Cemented versus uncemented total hip replacement for femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01980-4 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Shuai Mao ◽

Baomin Chen ◽

Ying Zhu ◽

Liang Qian ◽

Jinluan Lin ◽

...

Keyword(s):

Femoral Neck ◽

Total Hip Replacement ◽

Hip Replacement ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Controlled Study ◽

Total Hip ◽

Uncemented Total Hip Replacement

Abstract Background Cemented or uncemented total hip replacement (CTR or UTR) for femoral neck fractures (AO/OTA type 31B/C) is a relatively common procedure in elderly individuals. The recent literature is limited regarding long-term outcomes following CTR versus UTR in the Asian population. Methods Using our institutional database, we performed long-term outcome analysis on 268 patients with femoral neck fractures (AO/OTA type 31B/C) who had undergone a primary UTR or CTR (CTR: n = 132, mean age, 67.43 ± 6.51 years; UTR: n = 136, mean age, 67.65 ± 6.13 years) during 2007–2014, and these patients were followed until 2019. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary endpoint was the Harris hip score (HHS); the secondary endpoint was the incidence of orthopaedic complications. Results The mean follow-up time was 62.5 months (range, 50.1–76.1 months). At the final follow-up, the HHS was 79.39 ± 16.92 vs 74.18 ± 17.55 (CTR vs UTR, respectively, p = 0.011). Between-group significant differences were observed regarding the incidence of prosthesis revision, prosthesis loosening, and periprosthetic fracture (7.6% [95% CI, 6.4–8.2] for CTR vs 16.9% [95% CI, 14.7–17.3] for UTR, p = 0.020; 9.8% [95% CI, 8.3–10.7] for CTR vs 19.9% [95% CI, 18.2–20.9] for UTR, p = 0.022; 5.3% [95% CI, 4.4–6.7] for CTR vs 13.2% [95% CI, 12.1–13.8] for UTR, p = 0.026, respectively). Conclusion CTR showed superiority to UTR by improving the HHS and decreasing the incidence of orthopaedic complications. Our findings need to be confirmed in a prospective, randomized controlled study to verify whether they can be applicable to a broader population.

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Outcomes of Total Hip Replacement in Limbs Affected by Poliomyelitis

Hip International ◽

10.5301/hipint.5000451 ◽

2016 ◽

Vol 27 (2) ◽

pp. 198-204

Author(s):

Cesare Faldini ◽

Marcello De Fine ◽

Alberto Di Martino ◽

Daniele Fabbri ◽

Raffaele Borghi ◽

...

Keyword(s):

Retrospective Study ◽

Total Hip Replacement ◽

Hip Replacement ◽

Hip Osteoarthritis ◽

Lateral Approach ◽

Harris Hip Score ◽

Total Hip ◽

Hip Replacements ◽

Hip Diseases

Introduction The outcomes of total hip replacement in patients suffering from residual poliomyelitis are poorly covered in the literature. In this retrospective study we posed the question of whether total hip replacement performed for degenerative hip diseases in limbs with residual poliomyelitis could determine satisfactory mid-term clinical and radiographic results, with a reasonable complication rate. Methods A retrospective study was carried out to assess the results of 14 total hip replacements performed on 14 patients with residual poliomyelitis on the involved limb from June 1999 to September 2011. Average age at the time of surgery was 51 years (range 26-66 years). Mean duration of follow-up was 92 months (range 52-156 months). Surgery was performed through a direct lateral approach on all hips. All but one were cementless implants. Results 2 implants failed, 1 due to traumatic acetabular fracture 6 days after surgery, and 1 due to aseptic cup loosening 13 years after surgery. Surgery was uneventful in all patients except 1 (7%), who experienced a transient sensory sciatic nerve palsy. At the latest follow up Harris Hip Score was 83.3 (range 72-91) with a marked improvement when compared to preoperative score (average 52, range 32-78). No dislocations had occurred. Conclusions Total hip replacement can be considered a feasible option for hip osteoarthritis in patients with limbs affected by residual poliomyelitis. Longer follow-up studies are needed to assess the effectiveness of unconstrained total hip replacement in polio patients.

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Use of telephone interviews to follow up patients after total hip replacement

Journal of Telemedicine and Telecare ◽

10.1258/1357633054068883 ◽

2005 ◽

Vol 11 (4) ◽

pp. 211-214 ◽

Cited By ~ 20

Author(s):

Sanjeev Sharma ◽

Ravi Shah ◽

Kingsley Paul Draviraj ◽

M S Bhamra

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Harris Hip Score ◽

Face To Face ◽

Total Hip ◽

Telephone Interviews ◽

Significant Difference ◽

The Mean ◽

The Individual

We studied the feasibility of telephone interviews to assess hip function in patients who had had a total hip replacement. One hundred patients attending the orthopaedic clinic for follow-up after undergoing total hip replacement were studied. A modified Harris hip score was used. Since range of motion and deformity cannot be assessed by telephone, only pain and function were assessed. The maximum possible score was 100. Patients attending follow-up clinics were contacted by telephone one to two weeks prior to their appointment and a telephone assessment was completed. This was then compared with a face-to-face assessment in the subsequent clinic. The mean hip score obtained with the telephone interview was 85.2 and the mean hip score at face-to-face assessment was 86.1. The mean of the differences between the individual scores was −0.9 (SD 5.5). This difference was not significant ( P=0.11). Only three patients had a clinically significant difference (>20 points) between the two methods. Telephone questionnaires may be a useful adjunct to face-to-face assessment for patient follow-up after total hip replacement.

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Primary hip arthroplasty for the treatment of alkaptonuric hip arthritis: 3- to 24-year follow-ups

Arthroplasty ◽

10.1186/s42836-019-0010-8 ◽

2019 ◽

Vol 1 (1) ◽

Author(s):

Javahir A. Pachore ◽

Vikram Indrajit Shah ◽

Sachin Upadhyay ◽

Kalpesh Shah ◽

Ashish Sheth ◽

...

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Harris Hip Score ◽

Daily Routine ◽

Total Hip ◽

Hip Arthritis ◽

Primary Osteoarthrosis ◽

The Mean ◽

Level Of Significance

Abstract Background The objective of this study is to share our experience in total hip replacement for the treatment of ochronotic hip arthritis, in particular to report how to establish the diagnosis and some tips to limit complications. Method A cohort comprised of 10 patients (12 hips) with alkaptonuric hip arthritis. There were six men and four women with the mean age of 62.80 ± 7.57 years. All patients had a stiff spine, grossly restricted movements of hip joints, and severely limited daily routine activities. Total hip replacement was performed in all patients. The patients were evaluated at 6, 12, and 24 months after surgery, as well as every 4 years thereafter. Harris hip score was used to assess the functional outcome. The level of significance was set at p < 0.05. Results The mean follow-up lasted 16.70 ± 6.82 years (3 to 24 years). At the final available follow-up, nine patients returned to work, ambulate without an orthosis, and achieve complete pain relief. Harris hip score was improved from poor to excellent. One patient died 16 years after surgery due to breast cancer. No complication relating to prosthetic failures was detected. Conclusion Total hip replacement gives long-term satisfactory results in patients with alkaptonuric hip arthritis, resulting in comparable function of the hips in patients who undergo primary osteoarthrosis.

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A new anterolateral surgical approach for total hip replacement

Joints ◽

10.11138/jts/2016.4.3.148 ◽

2016 ◽

Vol 04 (03) ◽

pp. 148-152

Author(s):

Giovanni Grano ◽

Maria Pavlidou ◽

Alberto Todesco ◽

Augusto Palermo ◽

Luigi Molfetta

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Case Series ◽

Hip Dislocation ◽

Harris Hip Score ◽

Anterolateral Approach ◽

X Rays ◽

Level Of Evidence ◽

Total Hip

Purpose: the purpose of the present paper is to present the short-term results of a “detachment-free” (DF) anterolateral approach for primary total hip replacement (THR) performed in a large series of patients. Methods: two hundred patients submitted to primary THR were retrospectively reviewed for the present study. In all cases, the surgery was performed using a minimally invasive DF anterolateral approach, which entails no disconnection of tendons and no muscle damage. The study population consisted of 96 men (48%) and 104 women (52%), with an average age of 69.4 years (range 38-75). Clinical and radiographic follow-up was performed after 12 months. Results: the clinical results, evaluated using the Harris Hip Score, were excellent in 95% of the cases and good in 5%; no cases had fair or poor results. X-rays taken at 3, 6 and 12 months after surgery did not show heterotopic ossification, mobilization of the prosthetic components, or hip dislocation. No infections, deep vein thrombosis, or failure of the gluteal muscles were reported. Conclusions: the DF anterolateral approach for THR proved safe and provided effective results at shortterm follow-up. Level of evidence: Level IV, therapeutic case series.

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Salvage Total Hip Replacement after Failed Internal Fixation of Trochanteric Fracture Femur.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v5i1.163 ◽

2021 ◽

Vol 5 (1) ◽

pp. 751-757

Author(s):

Vilson Ruci ◽

Edvin Selmani ◽

Agron Dogjani

Keyword(s):

Internal Fixation ◽

Total Hip Replacement ◽

Hip Replacement ◽

Femoral Fractures ◽

Harris Hip Score ◽

Salvage Procedure ◽

Bone Stock ◽

Total Hip ◽

The Mean

Background: Total hip replacement (THR) is one treatment option for failed hip fracture fixation. It is considered as a salvage procedure for older patients, patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage. Patients and Methods: Total hip replacement was done for forty patients with failed internal fixation of trochanteric femoral fractures, 28 males and 12 females completed the follow up and six patients were lost. The procedure was carried out through a lateral exposure in all cases. Harris hip score (HHS) was used for clinical evaluation preoperatively, postoperatively. Radiographic evaluation comprising anteroposterior radiographic views of the pelvis and femur and a lateral view of the femur were performed at follow-up visits. Results: The mean time of follow up was 48 months (range from 36-72 months). The mean Harris hip score was improved from a mean of 24 points preoperative to 88 points at final follow up. Pain relief and gait correction were noted at the final follow up. Twenty-eight patients (70%) could freely walk outdoors using a cane or elbow crutch; eight patients (20 %) had a limited walking ability using two axillary crutches, and four patients (10 %) were able to walk indoors only. Conclusion: Total hip arthroplasty is a good salvage procedure after failed internal fixation of trochanteric femoral fractures. Individual selection of the implant depends upon the age of patient, level of activity, the bone stock of proximal femur, and the condition of the acetabulum. To maintain stability, reattachment of the greater trochanter should be done. To avoid intraoperative fractures of osteoporotic bone, dislocation of the hip should be very careful.

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Management and Outcome of Patients With Femoral Head Fractures: Injuries and Associated Prognostic Factors

10.21203/rs.3.rs-141488/v1 ◽

2021 ◽

Author(s):

Sujan Shakya ◽

Jialei Chen ◽

JiaChen Sun ◽

Zhou Xiang

Keyword(s):

Femoral Head ◽

Total Hip Replacement ◽

Hip Replacement ◽

Functional Outcomes ◽

Fixation Method ◽

Harris Hip Score ◽

Femoral Head Fracture ◽

Total Hip ◽

Surgical Methods ◽

Modified Harris Hip Score

Abstract Objective: Femoral head fractures are rare injuries that are often associated with poor functional outcome and complications. Fracture management and surgical methods for these fractures are variable. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications and functional outcomes of femoral head fractures.Methods: We conducted a retrospective review of fifty patients who sustained femoral head fractures from January 2011- December 2018. There were thirty-seven males and thirteen females with median age of 40 years. A surgical approach and fixation method were recorded. Patients were classified according to the Pipkin Classification system. Clinical results were evaluated for patients with two years or greater follow-up using the Modified Harris Hip Score (MHHS). Results: Eight patients (16%) were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, 5 (10%) patients required immediate Total Hip Replacement (THR). Six (12%) developed AVN, four (8%) requiring secondary total hip replacement (THR). Sixteen patients (33%) developed PTA, eight (16%) developed HO and six patients (12 %) had sciatic nerve injury, none requiring operative treatment. Overall functional results, according to modified Harris hip score were excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. Conclusion: Femoral head fracture are a rare injury that are often associated with poor outcome. In this study we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on Pipkin classification. This study, adds to the growing literature on femoral head fractures and provide reference for the clinical treatment to guide patient management.

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