HIP International

Bipolar hip arthroplasty (BHA) in the treatment of Ficat stage III osteonecrosis of the femoral head (ONFH) has theoretical advantages over total hip replacement (THR) in that it preserves the natural acetabulum and uses an implant that allows better stability and larger range of movement. The purpose of this study was to evaluate the clinical and radiological outcomes of BHA with uncemented ingrowth stems in the treatment of ONFH.

Thirty-nine hips in 34 patients (two women and 32 men) with a mean age at the time of surgery of 45.31 years (range 30–66 years) operated between 1998 and 2005 were examined in a retrospective evaluation. Mean follow-up was 9.5 years (range 3–14 years). Patients were evaluated with the Harris hip score (HHS). Kaplan-Meier survivorship was calculated to examine the revision rate. Radiographic analysis included evaluation of bipolar head migration, radiolucent lines around the stem and osteolysis in the acetabulum and the femur.

Evaluation of clinical results revealed an increase in HHS from 28 points preoperatively to 88.6 points at the most recent follow-up. Radiographic evaluation showed bipolar head migration in 3 hips (7.7%). Survival rate of BHA, with revision THR defined as the endpoint, was 92.31% at ten years (CI 95%). All implanted uncemented stems were stable without any radiographic signs of loosening or osteolysis.

The results of the present study show that implantation of BHA with uncemented ingrowth stem in Ficat stage III is still justified.

The aim of this study was to investigate the influence of triple pelvic osteotomy on the internal pelvic dimensions and thus on the potential for normal vaginal delivery.

Data were acquired by processing fixed anatomical specimens of 19 female pelves with maintained sacrotuberous and sacrospinous ligaments after unilateral and bilateral osteotomy, respectively. The specimens were measured and x-ray images and photographs were taken.

The dimensions in the plane of the pelvic inlet and the plane of the greatest pelvic dimension after unilateral osteotomy increased in 51%, remained unchanged in 34% and in 15% of cases they decreased. The most critical locations for the passage of fetus decreased in average from 0.016 cm in distantia interspinalis in the plane of the least pelvic dimension to 0.695 cm in distantia intertuberositas in the plane of the pelvic outlet. After bilateral osteotomy are decreases more significant from 0.226 cm (2.05%) to 1.00 cm (9.51%). Decreases we observed in the monitored dimensions were not so big in comparison to other published studies.

Results of this study confirm our hypothesis that unilateral triple pelvic osteotomy does not significantly narrow the bony birth canal and so it does not impede the ability to deliver per vias naturales in female patients with this surgical procedure in anamnesis. After bilateral triple osteotomy we would rather recommend Caesarean section.

The aim of this study was to evaluate the clinical and radiological results of patients presenting older than eight years and treated with Salter osteotomy for Perthes disease.

Seventeen patients (18 hips) with late presentation of Perthes disease treated with Salter osteotomy. Sixteen males were identified. The average age of patients was 8.8 years (range 8-12). Preoperation radiographs were analysed for lateral pillar staging, centre-periphery (CP) angle, Sharp acetabular index, acetabular depth index, acetabular covering percentage and Cross-over sign. Final follow-up radiograph were classified using modified Stulberg grade.

The average follow-up of the patients was 78 months (range 40-104). During the surgery, seven hips were found to be lateral pillar grade B, three hips grade B/C and 8 hips grade C. In the final examination, 10 hips were evaluated as good (Stulberg 1 or 2), seven as medium (Stulberg 3) and one as bad (Stulberg 4). There was shortening in four patients who were all either Stulberg stage 3 or 4. A meaningful difference was detected between the pre-operation and post-operation radiographic values, regardless of the surgical staging. However, no statistical difference was found between the patients in Stulberg stage 3 or 4 and stage 1 or 2 for radiographic variables.

Salter osteotomy can be used to treat older patients with lateral pillar stage B, B/C and C at presentation.

Joint mechanoreceptors are afferent neural elements involved in pain sensation and tactile sense.

We aimed to detect the free nerve endings (FNE) and other types of mechanoreceptors and to compare their quantities in human hip joint capsule (HJC) and ligamentum capitis femoris (LCF) of babies with developmantal dysplasia of hip (DDH) and intrauterine ex foetuses (control group) to find out whether there is an increase in the amount of mechanoreceptors in hip joint due to the occured anatomical chages.

We took 15 LCF and HJC biopsies from 15 patients undergoing hip surgery for DDH, and 15 HJC and LCFs from intrauterine ex fetuses. Total of 60 specimens were investigated. The mean age of the babies was 10.3 months (6-18 months) at the time of surgery. Full thickness 1 × 1 cm HJC and LCF portions were taken as biopsy specimens. An immunohistochemical technique was performed for neurogenic protein S-100 and examined under light microscopy.

FNEs were detected in all four different tissues (type IVa). Other types of mechanoreceptors (Type I-II and III) were not detected in any of the specimens. The positive rates of FNE staining in the control group were % 2.60 ± 1.24 for the LCF and % 2.67 ± 1.11 for the HJC respectively and FNE staining in the DDH group were found to be % 2.67 ± 1.11 for the LCF and % 2.73 ± 1.16 for the HJC. We did not find a statistically significant difference in number of FNEs between the specimens of the DDH group and the control group (p>0.05), also there was no statistically significant difference in number of FNEs between the HJC and LCF within each group (p>0.05).

Our results suggest that the number of FNEs does not increase in HJC and LCF of DDH patients even though LCF hypertrophy and capsular elongation occurs.

Bisphosphonates may improve implant fixation by inhibition of bone resorption and stimulation of osteoblasts by up regulation of BMP-2. However, there are few clinical studies in this area.

Does treatment with oral bisphosphonates improve implant fixation and bone remodelling around the acetabular component after revision arthroplasty with or without use of morselised allograft?

Fifty-three patients received university pharmacy blinded medication for three months: 5 mg risedronate or placebo one dosage and 1 g calcium carbonate and 800IE cholecalciferol per day. Forty-one patients were operated upon with revision of the cup. The revisions were performed with an uncemented (Trilogy, Zimmer, Warsaw, USA) or a cemented (Ogee, Depuy Int, England) cup. Radiostereometric analysis was obtained within one week after the operation, at three and six months, and after one, two and three years to study cup migration. Bone mineral density was measured postoperatively, at six months, one and two years, using DEXA. The presence and extension of radiolucent lines and graft remodelling were studied on conventional radiography.

The risendronate group revealed less anterior-posterior rotation at 6 months. We found no significant differences in migration at three years, change in bone mineral density, or graft remodelling and radiolucent lines formation between groups.

We could not demonstrate any beneficial effects of oral administration of risedronate on the fixation, bone mineral density or bone remodelling of revision cups using various amount of bone graft.

Although prophylactic tranexamic acid (TXA) is a safe, low-cost option to reduce bleeding in patients undergoing total hip replacement (THR), its optimal dose and duration is unknown. We compared the safety and effectiveness of TXA given as either a single injection or continuous infusion in THR patients, hypothesising that a second TXA dose would not offer any clinical advantages over the single injection.

One hundred and sixty-four patients undergoing unilateral THR were randomised. Exclusion criteria were history of thromboembolic events (TE), epilepsy, thrombophilia, and severe chronic renal failure. Patients received either a single dose of 30 mg/kg TXA on induction of surgery (one shot [OS] group), or a loading dose of 10 mg/kg TXA followed two hours later by a continuous infusion of 2 mg/kg per hour for 20 hours (one day [OD] group). The primary outcome was blood loss (BL) calculated from haematocrit levels. Secondary outcomes were mortality and TE events within 90 days postoperatively.

All patients completed treatment, with none lost to follow-up. Mean BL was 1107 ± 508 ml in Group OS and 1047 ± 442 ml in Group OD (p = 0.43). No patients were transfused prior to Day 10 postoperatively. At final follow-up, no patients had died, and there were no occurrences of major TE.

The 30 mg/kg TXA single shot was as safe as continuous infusion. As it is also less cumbersome, we recommend it as part of routine care in THR patients.

As hip-preservation surgery is performed in a particularly young and active group of patients, the knowledge accrued in the fields of hip arthroplasty and hip fracture care regarding postoperative thromboprophylaxis cannot be extrapolated to this patient population. Recommendations based on the evidence for each particular surgical procedure and population is desirable. For these reasons, the purpose of our study is to describe the rate of clinically relevant venous thromboembolism (VTE) and anticoagulation-related complications observed in patients undergoing hip-preservation surgery through mini-open femoracetabular osteoplasty (FAO) with a formal postoperative thromboprophylaxis protocol of aspirin dosing.

A prospective case series of 407 consecutive FAO procedures in 375 patients of mean age 34.5 ± 11.1 years (range 15–62 years) were followed six weeks postoperatively to document the presence of clinically relevant VTE as well as major bleeding events, as defined by the most recent American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. All patients were given aspirin 325 mg by mouth daily for two to four weeks.

There was one case of distal DVT in a 31-year-old male with no specific risk factors. No cases of pulmonary embolism were observed. There were no major bleeding events or reoperations due to postsurgical haematoma. There were no deaths. The crude incidence of clinically relevant VTE was 1 per 407 procedures (0.25%).

Aspirin is a safe and effective modality to provide thromboprophylaxis in patients undergoing hip-preservation surgery. The rate of VTE that we observed is, thus far, the lowest in comparison to other published series of hip preservation surgery that specifically focused on this complication.

The clinical results of total hip arthroplasty (THA) with a cementless prosthesis have been constantly improving due to progress in the area of stem design and surface finish. Cementless Spotorno stem (CLS stem; Zimmer, Warsaw, USA) is a double-tapered rectangular straight stem. The purpose of this study is to investigate the mean 10 year results of CLS stem and to evaluate the press-fit stability of CLS stem.

One hundred and eighty-six consecutive patients (194 hips) were evaluated at more than five years after THA using CLS stems. The mean follow-up period was 111 months. The radiographic stability of the femoral stem was determined by Engh's criteria. The ascertained period of spot welds was noted by Gruen zones on the femoral side. The presence of stress shielding, and subsidence was also evaluated.

A stable stem with bony on growth was identified in all cases. The mean period of expression of spot welds was 10.8 months in zone 2, 9.9 months in zone 3, 8.5 months in zone 5, and 8.8 months in zone 6. Stress shielding of more than grade 2 was observed in only three hips, which was non-progressive at one year after surgery. Subsidence of more than 2 mm was not observed in any of the hips.

Excellent stability of CLS stem has been maintained without abnormal bone reaction at the proximal femur. CLS stem is considered to achieve not only press-fit stability at trochanteric and subtrochanteric level, but bony fixation by osseointegration within one year after THA.