HIP International

We performed a systematic review to assess whether joint replacement in this very young patient group provides significant functional improvement and whether these procedures are associated with good implant survivorship. The studies included presented the results of 450 THA procedures. All patients showed an improvement in functional score and symptom relief. Unce-mented stems showed good integration with no signs of loosening. Cemented implants showed high rates of loosening. This study shows that THA in the very young patient can provide good functional improvement and relief of symptoms and that the more modern uncemented implant designs used with hard-on-hard bearings can be associated with improved implant survival. Long-term studies are necessary to confirm the superiority and improved survivorship of these newer implants.

During the last 25 years uncemented hip stem revision relying on diaphyseal fixation has shown improving clinical results and stem survival. The purpose of this study was to present the long-term results of hip revision with the SOLUTION stem (DePuy Warsaw Indiana).

Ninety-three consecutive SOLUTION hip stem revisions in 84 patients with a mean age of 69 years (range 33-86 years) were reviewed. Of these, clinical and radiographic follow-up examination by an independent observer was possible in 36 hips/29 patients after mean 14 years (range 10-18 years). Stem re-revision was documented by our own files and by the Danish Hip Arthroplasty Registry.

Stem re-revision had been performed in two hips for aseptic loosening, one due to deep infection and in one patient due to stem fracture. The 18 years cumulative survival, free of re-revision for any reason was calculated as 94.4% (88.9-99.8)% and for aseptic loosening to 97.6% (94.3-100%). Intraoperative complications were frequent with incidence of shaft fractures (14/93) and perforations (9/93) showing a significant learning curve. Mean Harris Hip Score was 85 (range 53-99). Osseointegration was seen in 34/36 stems with two stems fibrous fixated. Stress shielding was significant associated with stem diameters ≥15 mm. Severe preoperative bone deficiency had no negative bearing on stem survival and no significant influence on osseointegration of the stem or on Harris Hip Score.

Resurfacing hip replacement has demonstrated good survival and outcomes for cohorts of younger male patients, but few controlled studies exist. In this study we compared patient reported outcome measures and satisfaction scores at one year following resurfacing hip replacement in 69 male patients with two control groups of equal numbers undergoing cemented total hip replacement: aged-matched patients and disease matched patients. At one year we found no difference in improvement in patient reported outcome measures between patients undergoing resurfacing hip replacement and disease matched patients, whereas patients undergoing resurfacing hip replacement had a statistically significant improvement in Oxford Hip Score compared to the age-matched controls (p<0.047) although this was below the minimally clinically detectable difference. Resurfacing hip replacement and total hip replacement both confer increase in patient reported outcome scores and high patient satisfaction at one year. The results of this study will allow better counselling of patients and help inform treatment decisions.

We evaluated the treatment and outcome of 47 cases of periprosthetic femoral fracture presenting to our unit over a nine-year period. The average follow-up period was 48 months (range 24-114). Surgical treatment involved stem revision in 29 hips, open reduction and internal fixation in 11 hips and conservative treatment in seven hips. The mean HHS at the most recent follow-up was 74 (range 49-91). Twenty-five patients were pain-free (53%), 10 patients had occasional mild pain (21%), eight patients had a limp and pain (17%) and four patients had severe disability (9%). Postoperative radiographs showed complete fracture union in all 47 patients. There were 11 complications: three further periprosthetic fractures, two aseptic loosenings, two dislocations, two aseptic loosenings of the primary prostheses, one stem breakeage, and one intraoperative fracture. Our results suggest cementless revision with tapered fluted stems used without cortical strut grafts are a valid procedure for the treatment of Vancouver B2 and B3 periprosthetic fractures.

We investigated the effects of pelvic rotation and femoral head diameter on the anterior stability of the hip joint after total hip replacement. Computer navigation and cadaveric bone were used to simulate the range of motion after total hip replacement. The hip was put at 0 degrees of flexion and it was gradually externally rotated until the hip dislocated. The degree of external rotation when the hip was dislocated was recorded. The test was repeated with the hip at +10, −10, −20, −30, −40 and −50 degrees of flexion. The acetabular component was positioned with abduction of 45 degrees and anteversion at 20 degrees. There was a significant difference amongst each group of pelvic rotation from 0 to −50 degrees in the degree of external rotation when the hip was dislocated. The degree became insignificant when pelvic rotation was increased from 0 to 10 degrees. From −10 to −50 degree of pelvic rotation, 36mm head had significant better stability compared with 32mm and 28mm femoral heads. The presence of significant pelvic sagittal malrotation can increase the risk of anterior dislocation. A larger femoral head is more stable than smaller heads. When pelvic sagittal malrotation is not present, there is no difference in stability between large and small femoral heads.

Leg length inequality following total hip replacement remains common. In an effort to reduce this occurrence, surgeons undertake pre-operative measurements, templating and use various forms of intraoperative measurements, including computer navigation. This study aims to delineate which measurement technique is most appropriate for measuring leg length inequality from a pelvic radiograph. Three observers took a total of 9600 measurements from 100 pelvic radiographs.  Four lines were constructed on each of the radiographs, bisecting the acetabular teardrops, ischial spines, inferior sacroiliac joint and inferior obturator foramen. Measurements were taken from these lines to the most prominent medial point on the lesser trochanter and to the tip of the greater trochanter. The effect of pelvic positioning was also assessed using radiographs of a synthetic pelvis and femur. Intra-observer and inter-observer variability were calculated. Measuring from the inferior aspect of the ischial tuberosities to the most prominent medial point on the lesser trochanter appears to be the best method for measuring LLD however large error margin still exist, even when corrected for magnification errors.

Femoroacetabular impingement (FAI) is an increasingly recognised cause of hip symptoms in the young active adult and can lead to labral tears and chondral damage. FAI can be treated with open surgery or arthroscopically: aiming to stabilise labral tears and remove bony impingement. We report the results of a single surgeon series of arthroscopic labral debridement and cam resection in 118 consecutive cases during a two-year period, with a minimum follow-up of one year. Quantitative assessment was undertaken using the Non-Arthritic Hip Score (NAHS) calculated preoperatively and at two, four and 12 months postoperatively. Mean NAHS in all patient groups at two and four months, and at one year showed improvement (p<0.05). These results compare favourably with previous patients treated with open osteochondroplasty by the same surgeon, as well as with the published results from other larger centres. The faster improvement and the shorter hospital stay and lower morbidity make arthroscopic surgery for FAI a favourable option, and a feasible treatment modality in the non-specialist setting.

A retrospective study was performed in patients with ankylosing spondylitis (AS) from south China, to investigate the efficacy and safety of infliximab after total hip arthroplasty (THA). Thirty-two AS patients were divided into two groups. The treatmen group recieved infliximab at four weeks after unilateral THA (11 patients) and were compare to a control group (21 patients). Patients in the control group were treated with traditional medications. Clinical assessment, laboratory examinations, and x-rays were performed pre- and postoperatively. The BASDAI score decreased more in the infliximab group at six and 12 months after THA, as did the CRP and ESR. The contralateral hips without arthroplasty of patients in the infliximab group improved significantly compared to the control group, in terms of Harris score (HHS), range of motion (ROM) and VAS. However, the hips with an arthroplasty in the control group had a better prognosis than those without arthroplasty of the infliximab group. Hips with arthroplasty in the infliximab group achieved better improvement of HHS than hips without arthroplasty in the control group, but not for ROM and pain relief. No radiological evidence of prosthesetic loosening was found in either group. There was no significant difference of the incidence of adverse events between the two groups. Compared with THA, AS patients using infliximab only would not obtain as good an outcome. Infliximab was shown to be safe and could be effective to improve hip function and systemic symptoms.

The aim of the study was to assess the value of D-dimer as an event predicitor for deep vein thrombosis (DVT) in patients given low molecular weight heparin (LMWH) after total hip arthroplasty (THA). Plasma D-dimer levels were obtained preoperatively and at days 1, 3, and 7 postoperatively in 83 consecutive patients undergoing THA treated with nadroparin prophylaxis plus intermittent pneumatic compression. Unilateral ascending venography was performed at postoperative day 7 or 8. There was a significant difference between the D-dimer levels in the DVT group (28 patients) and non-DVT group (55 patients) on each day (P<0.01). ROC analysis showed the AUC on postoperative days 1, 3 and 7 was 0.706, 0.712 and 0.772 respectively.

The D-dimer concentration on postoperative day 1, day 3 or day 7 is of moderate predicting value of DVT in patients undergoing THA, treated with nadroparin prophylaxis plus intermittent pneumatic compression.

The psychosocial impact of hip disease on the young adult has not been elucidated. This study aimed to identify the functional and psychosocial characteristics of a cohort of young patients (age less than 40 years) presenting to our tertiary care complex hip clinic. A postal questionnaire comprising of a Visual Analogue Scale (VAS) for Pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale (HADS) was posted to 63 patients. Forty-nine (n = 49) patients (79%) responded to the questionnaire. Mean age was 20 years (range 16-38) with a gender ratio of 2:1 (female: male). More than half of our patients had moderate to severe pain based on the VAS and at least moderate disability on the ODI. HADS showed that 32% and 49% of patients were classified as having borderline to abnormal levels of depression and anxiety respectively. Multiple regression showed ODI scores to be a significant predictor of anxiety and depression. Comparison with asymptomatic controls shows that these patients have significantly worse ODI and HADS scores compared to normal population. This study quantifies the degree of functional and psychosocial compromise present in young patients with hip problems.